The impact of lifestyle risk factors on female infertility

AI Tools for Assessing Human Fertility Using Risk Factors: A State-of-the-Art Review

Infertility has massively disrupted social and marital life, resulting in stressful emotional well-being. Early diagnosis is the utmost need for faster adaption to respond to these changes, which makes possible via AI tools. Our main objective is to comprehend the role of AI in fertility detection since we have primarily worked to find biomarkers and related risk factors associated with infertility. This paper aims to vividly analyse the role of AI as an effective method in screening, predicting for infertility and related risk factors. Three scientific repositories: PubMed, Web of Science, and Scopus, are used to gather relevant articles via technical terms: (human infertility OR human fertility) AND risk factors AND (machine learning OR artificial intelligence OR intelligent system). In this way, we systematically reviewed 42 articles and performed a meta-analysis. The significant findings and recommendations are discussed. These include the rising importance of data augmentation, feature extraction, explainability, and the need to revisit the meaning of an effective system for fertility analysis. Additionally, the paper outlines various mitigation actions that can be employed to tackle infertility and its related risk factors. These insights contribute to a better understanding of the role of AI in fertility analysis and the potential for improving reproductive health outcomes.

High prevalence of reduced fertility and use of assisted reproductive technology in a German cohort of patients with peripartum cardiomyopathy

BACKGROUND

Over the past decades the use of assisted reproduction technology (ART) increased worldwide. ARTs are associated with an elevated risk for cardiovascular complications. However, a potential relation between subfertility/ARTs and the heart disease peripartum cardiomyopathy (PPCM) has not been systematically analyzed yet.

METHODS

A retrospective cohort study was carried out, including n = 111 PPCM patients from the German PPCM registry. Data from PPCM patients were compared to those from postpartum women in the German general population.

RESULTS

The prevalence of reported subfertility was high among PPCM patients (30%; 33/111). Most of the subfertile PPCM patients (55%; 18/33) obtained vitro fertilizations (IVF) or intracytoplasmic sperm injections (ICSI). PPCM patients were older (p < 0.0001), the percentage of born infants conceived by IVF/ICSI was higher (p < 0.0001) with a higher multiple birth (p < 0.0001), C-section (p < 0.0001) and preeclampsia rate (p < 0.0001), compared to postpartum women. The cardiac outcome was comparable between subfertile and fertile PPCM patients. Whole exome sequencing in a subset of n = 15 subfertile PPCM patients revealed that 33% (5/15) carried pathogenic or likely pathogenic gene variants associated with cardiomyopathies and/or cancer predisposition syndrome.

CONCLUSIONS

Subfertility occurred frequently among PPCM patients and was associated with increased age, hormonal disorders, higher twin pregnancy rate and high prevalence of pathogenic gene variants suggesting a causal relationship between subfertility and PPCM. Although this study found no evidence that the ART treatment per se increases the risk for PPCM or the risk for an adverse outcome, women with subfertility should be closely monitored for signs of peripartum heart failure.

Health Related Behaviors and Life Satisfaction in Patients Undergoing Infertility Treatment

The aim of the study was to evaluate the level of life satisfaction and health behaviors presented by patients with diagnosed infertility. This cross-sectional study included 456 patients (235 women and 221 men) from infertile couples in southeastern Poland from June 2019 to February 2020. Participants completed a questionnaire on sociodemographic characteristics, the Health Behaviors Inventory (HBI), and the Satisfaction with Life Scale (SWLS). The average score of severity of health behaviors for the study group was 82.96 points. Satisfaction with life at a higher level was declared by 57.6% of respondents, at an average level was declared by 31.4%, and at a lower level was declared by 11%. The SWLS score for the entire study group was 24.11 points (6.82 points on the sten scale). Respondents who achieved a higher rate of life satisfaction also had a higher level of severity of health behaviors (p < 0.0001). There were no significant differences between male and female SWLS scores, although the women had significantly higher rates of severity of health behaviors than men. The level of health behavior is positively related to life satisfaction in infertile patients. Medical personnel should conduct health education on a healthy lifestyle that promotes the improvement of reproductive health.

Maternal fluoride exposure, fertility and birth outcomes: The MIREC cohort

OBJECTIVE

Fluoride exposure >1.5 mg/L from water has been associated with adverse pregnancy and birth outcomes. Little is known, however, about the effect of fluoride at levels consistent with water fluoridation (i.e., 0.7 mg/L) on pregnancy and birth outcomes. We examined the relationship between maternal fluoride exposure, fertility, and birth outcomes in a Canadian pregnancy cohort living in areas where municipal drinking water fluoride concentrations ranged from 0.04 to 0.87 mg/L.

METHODS

Using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) study, we estimated fluoride exposure during pregnancy using three different metrics: (1) maternal urinary fluoride concentrations standardized for specific gravity (MUF_SG) and averaged across all three trimesters (N = 1566), (2) water fluoride concentration (N = 1370), and (3) fluoride intake based on self-reported consumption of water, coffee, and tea, adjusted for body weight (N = 1192). Data on fertility, birth weight, gestational age, preterm birth, and small-for-gestational age (SGA) were assessed. We used multiple linear regression to examine associations between fluoride exposure, birth weight and gestational age, and logistic regression to examine associations with fertility, preterm birth, and SGA, adjusted for relevant covariates.

RESULTS

Median (IQR) MUF_SG was 0.50 (0.33-0.76) mg/L, median water fluoride was 0.52 (0.17-0.64) mg/L, and median fluoride intake was 0.008 (0.003-0.013) mg/kg/day. MUF_SG, water fluoride concentrations, and fluoride intake were not significantly associated with fertility, birth weight, gestational age, preterm birth, or SGA. Fetal sex did not modify any of the associations.

CONCLUSION

Fluoride exposure during pregnancy was not associated with fertility or birth outcomes in this Canadian cohort.

High-sensitivity C-reactive protein is not independently associated with self-reported infertility in National Health and Nutrition Examination Survey 2015–2018 data

Objective

To study the association between high-sensitivity C-reactive protein (hs-CRP) and infertility among reproductive-age women while controlling for obesity and other metabolic markers. Previous studies found a link between infertility and cardiovascular diseases (CVDs). C-reactive protein is a sensitive marker of CVDs, and its levels are affected by obesity.

Design/Setting

We conducted a cross-sectional study using national data from 2015 through 2018.

Patients

A total of 940 women aged 20–45 years who self-reported infertility, had hs-CRP values measured, and did not have CRP >10 mg/L, asthma, arthritis, bronchitis, thyroid disease, bilateral oophorectomy, hysterectomy, and who were not breastfeeding or pregnant, premenarchal at the time of study or had menarche after the age of 20.

Interventions

N/A.

Main outcome measure(s)

Infertility status (ever reporting inability to conceive with 12 months of trying to become pregnant).

Results

In comparison to noninfertile women, self-reported infertile women had higher mean of hs-CRP (3.11 mg/L vs. 2.40 mg/L) and higher percentage of moderate/high hs-CRP values (77.0% vs 58.8%). However, after adjusting for metabolic markers, there was a nonsignificant association between moderate/high hs-CRP and self-reported infertility in the multivariable logistic regression analysis. Odds ratio estimates of the association between hs-CRP and infertility increased over 40% after removing obesity measures and/or high-density lipoprotein from regression models.

Conclusion

There was no association between hs-CRP and self-reported infertility after controlling for obesity measures and other risk factors for CVDs in a sample of U.S. women aged 20–45 years.

Obesity in Infertile Women, a Cross-Sectional Study of the United States Using NSFG 2011-2019

Reproductive health can be affected by obesity through various mechanisms. Obesity-associated inflammatory markers and altered hormones can have direct and indirect impacts on female reproductive health. However, little is known about obesity prevalence and trend among infertile women and obesity association with infertility in reproductive-age women of the U.S. In a cross-sectional study, we sought to conduct a secondary analysis of National Survey of Family Growth (NSFG) data from 2011 to 2019. A total of 6,035 infertile and non-pregnant fecund women aged 20-44 years were included in a nationally representative sample of the U.S. The weighted prevalence of obesity (BMI ≥ 30) among infertile women was 41.63% for the period 2011-2019. Obese women had 62% higher odds of infertility (95% CI 1.24, 2.17) compared to non-obese women of reproductive age (20-44 years). However, there was no specific trend of obesity among infertile and non-pregnant fecund women aged 20-44 years in the U.S. from 2011 to 2019. Given the negative impact of obesity on female reproductive health and in light of our results, it is important to counsel obese infertile reproductive-age women of the U.S. about behavioral changes that include weight management. Future longitudinal studies are needed to evaluate the risk of infertility among obese women.

Influence of social determinants on fertility: a critical review

PURPOSE OF REVIEW

Intrinsic factors, such as age, weight and lifestyle habits, together with extrinsic factors, such as socioeconomic level, must be considered when it comes to reproductive healthcare. Over the last few years, studies that attempt to respond to the participation and interaction of these factors in subfertility have been published; however, some questions remain unanswered.

RECENT FINDINGS

Although there are little modifiable factors for women, it is possible to influence other factors, such as behavioural or cultural factors in order to minimize fertility problems; however, they are often highly influenced by each other.

SUMMARY

Advanced age, obesity, sedentary lifestyle, alcohol, tobacco and other compounds, have a clearly negative effect and may extend time-to-pregnancy, although the responsible mechanisms and the magnitude of the detriment that they produce in the reproductive health are yet to be studied. Economic context and new environmental factors are a current challenge for reproductive health too.

The utility of self-rated health in population surveys: the role of bodyweight

Background

Self-rated health (SRH) is one of the most commonly used summary measures of overall health and well-being available to population scientists due to its ease of administration in large-scale surveys and to its efficacy in predicting mortality. This paper assesses the extent to which SRH is affected by its placement before or after questions about bodyweight on a survey, and whether differences in placement on the questionnaire affects SRH’s predictive validity.

Methods

I assessed the validity of SRH in predicting the risk of mortality by comparing outcomes of sample members who were asked to rate their health before reporting on their bodyweight (the control group) and sample members who were asked to rate their health after reporting on their bodyweight (the treatment group). Both the control and treatment group were randomly assigned via an experiment administered as a module in a nationally representative sample of adults in the USA in 2019 (N = 2523).

Results

The odds of reporting a more favorable appraisal of health are 30% lower for sample members who were in the treatment group when compared with the control group. Additionally, the SRH of treatment group members is significantly associated with their risk of mortality, while the SRH of control group members is not.

Conclusion

The findings from this study suggest that for researchers to maximize the utility of SRH, closer attention needs to be paid to the context of the survey within which it asked. SRH is highly sensitive to the questions that precede it, and this sensitivity may in turn mischaracterize the true health of the population that the survey is intending to measure.

Association of income and education with fecundability in a North American preconception cohort

PURPOSE

The purpose of this study is to evaluate socioeconomic determinants of fecundability.

METHODS

Among 8654 female pregnancy planners from Pregnancy Study Online, a North American prospective cohort study (2013-2019), we examined associations between socioeconomic status and fecundability (the per-cycle probability of conception). Information on income and education was collected via baseline questionnaires. Bimonthly follow-up questionnaires were used to ascertain pregnancy status. We estimated fecundability ratios (FRs) and 95% confidence intervals (CIs) using proportional probabilities regression, controlling for potential confounders.

RESULTS

Relative to an annual household income of greater than or equal to $150,000, adjusted FRs were 0.91 (95% CI: 0.83-1.01) for less than $50,000, 0.99 (95% CI: 0.92-1.07) for $50,000-$99,000, and 1.09 (95% CI: 1.01-1.18) for $100,000-$149,000. FRs for less than 12, 13-15, and 16 years of education, relative to greater than or equal to 17 years, were 0.90 (95% CI: 0.76-1.08), 0.84 (95% CI: 0.78-0.91), and 0.89 (95% CI: 0.84-0.95), respectively. Slightly stronger associations for income and education were seen among older women.

CONCLUSIONS

Lower levels of education and income were associated with modestly reduced fecundability. These results demonstrate the presence of socioeconomic disparities in fecundability.

Suboptimal endometrial-embryonal synchronization is a risk factor for ectopic pregnancy in assisted reproduction techniques

RESEARCH QUESTION

What are the main risk factors associated with ectopic pregnancy and what is the true incidence of ectopic pregnancies in an IVF programme?

DESIGN

Retrospective single-centre study of 12,429 blastocyst transfers (8182 fresh and 4247 frozen embryo transfers) conducted between January 2010 and December 2017. IVF outcome was analysed, and ectopic pregnancy risk evaluated according to patient's characteristics and assisted reproductive technology treatment factors.

RESULTS

Of 5061 patients reporting a positive pregnancy test, 43 were diagnosed with ectopic pregnancy (0.85%). Neither female age (36.7 versus 35.8 years), body mass index, quality of transfer nor stimulation protocol affected the ectopic pregnancy rate, but history of previous ectopic pregnancy (OR 3.26; P = 0.0080), tubal surgery, or both (OR 6.20; P < 0.0001) did. The incidence of ectopic pregnancy was increased in women with uterine malformations (OR 3.85; P = 0.0052), uterine pathologies (OR 5.35; P = 0.0001), uterine surgeries (OR 2.29; P = 0.0154) or sub-optimal endometrial build-up (OR 4.46 to 5.31; P < 0.0001). Transfer of slow-developing blastocysts (expressed by expansion) significantly increased the risk of ectopic pregnancy (OR 2.59; P = 0.0102).

CONCLUSIONS

Unfavourable uterine environment, including uterine pathologies, uterine or tubal surgery and suboptimal endometrial build-up were related to ectopic pregnancy. Low expansion grade of blastocysts was identified as an additional putative risk factor for ectopic pregnancy, indicating the importance of proper embryonal-maternal synchronization. The overall ectopic pregnancy rate after blastocyst transfer was low, comparable with reported ectopic pregnancy rates in spontaneous conceptions. Proper evaluation of tubal and uterine pathologies, optimizing endometrial preparation and the transfer of expanded blastocysts in a frozen embryo transfer cycle, might be beneficial.

Risk factors of tubal infertility in a tertiary hospital in a low-resource setting: a case-control study

BACKGROUND

Infertility is the inability to sustain a pregnancy in a woman with regular (2-3 times per week) unprotected sexual intercourse for a period of 1 year. This is a major public health problem that remains under-recognised in Cameroon and most countries in sub-Saharan Africa. This study aimed at identifying the risk factors associated with tubal infertility in a tertiary hospital in Douala, Cameroon.

METHODS

We conducted a case-control study at the Obstetrics, Gynaecology and Radiology Departments of the Douala Referral Hospital from October 1, 2016, to July 30, 2017. We recruited 77 women with tubal infertility diagnosed using hysterosalpingography and 154 unmatched pregnant women served as controls. Data on socio-demographic, reproductive and sexual health, and radiologic assessments were collected using a pretested questionnaire. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 24.0. Logistic regression models were fitted to identify demographic, reproductive health factors, surgical, medical and toxicological factors associated with tubal infertility. The adjusted odds ratios (AOR) and their 95% confidence interval were interpreted. Statistical significance set at p < 0.05.

RESULTS

Sixty-one per cent of respondents had secondary infertility. Following multivariate logistic regression analysis, respondents who were housewives (AOR 10.7; 95% CI: 1.68-8.41, p = 0.012), self-employed (AOR 17.1; 95% CI: 2.52-115.8, p = 0.004), with a history of Chlamydia trachomatis infection (AOR 17.1; 95% CI: 3.4-85.5, p = 0.001), with Mycoplasma infection (AOR 5.1; 95% CI: 1.19-22.02, p = 0.03), with ovarian cyst (AOR 20.5; 95% CI: 2.5-168.7, p = 0.005), with uterine fibroid (AOR 62.4; 95% CI: 4.8-803.2, p = 0.002), have undergone pelvic surgery (AOR 2.3; 95% CI: 1.0-5.5, p = 0.05), have undergone other surgeries (AOR 49.8; 95% CI: 6.2-400, p = 0.000), diabetic patients (AOR 10.5; 95% CI 1.0-113.4, p = 0.05) and those with chronic pelvic pain (AOR 7.3; 95% CI: 3.2-17.1, p = 0.000) were significantly associated with tubal infertility while the young aged from 15 to 25 (AOR 0.07; 95% CI: 0.01-0.67, 0.021), those in monogamous marriages (AOR 0.05; 95% CI: 0.003-1.02, p = 0.05), as well as those with a history of barrier contraceptive methods (condom) (AOR 0.17; 95% CI: 0.03-1.1, p = 0.06) were less likely to have tubal infertility.

CONCLUSION

The following factors were independently associated with tubal infertility: being a housewife, self-employed, history of Chlamydia trachomatis, Mycoplasma infection, and uterine fibroid. Furthermore, a history of pelvic surgery and other surgeries, diabetes mellitus, and chronic pelvic pain were also associated with tubal infertility. Young age, persons in monogamous marriages and users of barrier methods of contraception (condom) were less likely to have tubal infertility. Identification of these factors will be a target of intervention to avoid tubal infertility.

A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age

More women postpone childbearing nowadays while female fertility begins to decline with advancing age. Furthermore, with the rolling out of the two-child policy, there is a huge demand for a second child for Chinese aged women. There are various assisted reproductive technology (ART) strategies applied for age-related infertility without solid evidence. On behalf of the Society of Reproductive Medicine, Chinese Medical Association, we would like to develop a Chinese guideline of ART strategies for age-related infertility. This guideline was produced following the recommendations for standard guidelines described in the 2012 WHO Handbook for guideline development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. A protocol was formulated and a Guideline Development Group was formed with specialists of reproductive medicine, methodologists from Chinese GRADE working group, and patient representative. Questions regarding the ART strategies for aged infertility were formulated and 8 most important ones were chosen to be structured in PICO format (Population, Intervention, Comparison, Outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria and be categorized as high, moderate, low, or very low. Twenty-five recommendations were formulated among members of the Guidelines Development Group (Delphi method) basing on the overall quality of the evidence, in addition to the balance between benefits and harms, values and preferences, and resource implications. The final recommendations were agreed on by consensus during face-to-face meetings. This is the first Chinese practice guideline in reproductive medicine developed following the standard and scientific method.

PREVALENCE AND RISK FACTORS OF INFERTILITY IN TURKEY: EVIDENCE FROM DEMOGRAPHIC AND HEALTH SURVEYS, 1993-2013

The inability to have children affects couples worldwide and causes emotional and psychological distress in both men and women. Turkey is a country that lays particular emphasis on the issue of infertility, especially after experiencing a dramatic fertility decline over the last two decades. This study aimed to understand the changes in the prevalence of infertility in Turkey using three different approaches: the DHS Approach, the Constructed Approach and the Current Duration Approach. Furthermore, the factors contributing to elevated risks of infertility as derived from the Constructed Approach were investigated using four different logistic regression models. The data came from the 1993, 1998, 2003, 2008 and 2013 Demographic and Health Surveys conducted by the Hacettepe University Institute of Population Studies. The findings of the Constructed and Current Duration Approaches suggested that the prevalence of infertility decreased markedly from 1993 to 2013 in Turkey. This decline was the result of improvements in maternal health care services in Turkey, as well as an increase in the use of Assisted Reproductive Technology (ART), from 1.9% in 2008 to 4.1% in 2013. The results of the final logistic regression model suggested that the risk of infertility was significantly higher among women aged between 35 and 49 (p<0.01), uneducated women (p<0.01), women whose age at first marriage was over 30 (p<0.01), women defined as overweight (p<0.05) and women whose age at menarche was less than 12 years (p<0.05). This is the first nationwide study to examine the prevalence of infertility and its socio-demographic risk factors in Turkey, a developing country; previous studies have established these risk factors mainly in developed countries.

Developmental influences on fertility decisions by women: an evolutionary perspective

Developmental environments are crucial for shaping our life course. Elements of the early social and biological environments have been consistently associated with reproduction in humans. To date, a strong focus has been on the relationship between early stress, earlier menarche and first child birth in women. These associations, found predominately in high-income countries, have been usefully interpreted within life-history theory frameworks. Fertility, on the other hand--a missing link between an individual's early environment, reproductive strategy and fitness--has received little attention. Here, we synthesize this literature by examining the associations between early adversity, age at menarche and fertility and fecundity in women. We examine the evidence that potential mechanisms such as birth weight, childhood body composition, risky health behaviours and developmental influences on attractiveness link the early environment and fecundity and fertility. The evidence that menarche is associated with fertility and fecundity is good. Currently, owing to the small number of correlational studies and mixed methodologies, the evidence that early adversity predicts fecundity and fertility is not conclusive. This area of research is in its infancy; studies examining early adversity and adult fertility decisions that can also examine likely biological, social and psychological pathways present opportunities for future fertility research.

Preliminary study of blood methylmercury effects on reproductive hormones and relevant factors among infertile and pregnant women in Taiwan

Methylmercury (MeHg) is the most poisonous mercury species and an endocrine-disrupting chemical that could cause reproductive and developmental harm effects in animals. In this study, we recruited 310 infertile women and 57 pregnant women and investigated their blood MeHg levels. The distribution of blood reproductive hormone, selenium and zinc levels, and the difference of relevant factors by the reference level of blood MeHg (5.8 μg/L) of infertile women were further examined. Results showed that greater percentages of sashimi consumption, frequencies of Chinese herbal medicine use, alcohol consumption, and lack of physical activity were observed in infertile women than those for pregnant women. Blood MeHg concentration was significantly greater in infertile than that in pregnant women. Significant concentration differences for FSH and LH by the dichotomized reference level of blood MeHg (5.8 μg/L) in infertile women were not observed, which may stem from that these reproductive hormones in participated infertile women were mostly in the normal reference range. Consumption of fish and sashimi represented the major source of MeHg exposure in infertile women. MeHg levels were elevated in infertile women, and consistent with fish consumption frequency. Compared to the referent level of blood MeHg levels <5.8 μg/L, the elevated blood MeHg levels (⩾5.8 μg/L) in infertile women were 3.35 and 4.42 folds risk in categorized frequencies of fish consumption 1-2 meals per week and more than 3 meals per week, respectively. The obtained results provide evidences and help updating the advisory of fish consumption and improving women's reproductive health.

Childhood social hardships and fertility: a prospective cohort study

PURPOSE

To examine the effect of lifetime social hardships on fertility.

METHODS

Using the British National Child Development Study, a longitudinal cohort study, the impact of exposure to childhood hardships on becoming pregnant, reported infertility, and time-to-pregnancy was investigated. In total, 6477 women reported on whether they had become pregnant by 41 years, and 5198 women had data on at least one pregnancy. Factor analysis was used to identify six types of childhood hardships (as reported by parent, child, social worker, or teacher); retrospective report of child abuse was also examined. Logistic regression and discrete failure-time analysis was used to adjust for potential confounders.

RESULTS

Never-married women were more likely to have become pregnant at some point if they had experienced more childhood hardships. Retrospectively, reported child abuse was associated with an increased likelihood of having been told that one was unable to have children. Among ever-married women, childhood hardships were associated with reduced fecundability, but the association was weakened by adjustment for adult social class.

CONCLUSIONS

The relationship between childhood adversity and adult fertility is complex. Future research should investigate pathways between characteristics of adversities and fertility.

Socioeconomic variations in female fertility impairment: a study in a cohort of Portuguese mothers

OBJECTIVES

This study aimed to assess the association of socioeconomic conditions with female fertility impairment among women who delivered a live birth.

DESIGN

Cross-sectional analysis.

SETTING

Population-based birth cohort (Generation XXI) assembled in 2005/2006 from five public maternity units in Porto Metropolitan Region, Northern Portugal.

PARTICIPANTS

7472 women aged 18 or more with spontaneous conception and no male diagnosis of infertility were recruited and interviewed immediately after birth with structured questionnaires.

EXPOSURES OF INTEREST

Maternal education, occupation and income were recorded as proxy indicators of social conditions.

OUTCOME

Impaired female fertility, defined as women who had unsuccessfully tried to conceive for over a year.

DATA ANALYSIS

Multivariate logistic regression models were fitted to estimate the association between each socioeconomic indicator and impaired female fertility, stratified by previous pregnancy experience and adjusted for age, pregnancy planning and behavioural characteristics.

RESULTS

Among primigravidae, 7.7% (95% CI 6.8% to 8.6%) presented impaired fertility and the prevalence was 9.6% (95% CI 8.7% to 10.6%) in multigravidae. In crude analysis, we found women with impaired fertility to be older, less educated, more likely to have planned the current pregnancy and to be overweight/obese; they had similar levels of income or occupation. In multivariate models, a significant independent association between educational level and female fertility impairment remained among primigravidae (OR (95% CI) vs ≤6 schooling years: 7-9: 0.85 (0.54 to 1.34); 10-12: 0.34 (0.21 to 0.54); >12: 0.24 (0.14 to 0.40), ptrend<0.001) but not in multigravidae.

CONCLUSIONS

This study shows that education might be important in understanding female fertility impairment, particularly among first-time pregnant women. It also points out that the association is not totally explained by other sociodemographic and lifestyle characteristics that have been previously found to be important to disclose this relation.

Lifestyle factors and reproductive health: taking control of your fertility

Approximately 10 to 15% of couples are impacted by infertility. Recently, the pivotal role that lifestyle factors play in the development of infertility has generated a considerable amount of interest. Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall health and well-being, including fertility. Many lifestyle factors such as the age at which to start a family, nutrition, weight, exercise, psychological stress, environmental and occupational exposures, and others can have substantial effects on fertility; lifestyle factors such as cigarette smoking, illicit drug use, and alcohol and caffeine consumption can negatively influence fertility while others such as preventative care may be beneficial. The present literature review encompasses multiple lifestyle factors and places infertility in context for the couple by focusing on both males and females; it aims to identify the roles that lifestyle factors play in determining reproductive status. The growing interest and amount of research in this field have made it evident that lifestyle factors have a significant impact on fertility.

Physical activity and body mass index among women who have experienced infertility

INTRODUCTION

The experience of infertility is a common medical condition in the developing countries. The aim of this retrospective epidemiologic study was to determine fertility status and parity in Babol, Iran and then identify physical activity and body mass index (BMI) among women who have experienced infertility.

MATERIAL AND METHODS

A total of 1,081 women aged 20-45 years were selected using cluster sampling. The current physical activity was measured using the original International Physical Activity Questionnaire short form. Lifestyle factors were compared between those who had experienced infertility (n = 168) and the rest of the women. A face-to-face household interview was conducted using a specially designed interview questionnaire.

RESULTS

After adjusting for suspected confounding factors, women with infertility experience had a 4.8-fold increased risk of obesity (OR = 2.02, CI = 0.70, 5.84) and almost a 3.8-fold increased risk of being overweight (OR = 2.11, CI = 0.72, 6.17) compared to women without infertility. No significant differences were found in Met-minutes of sedentary activity, intensity of walking, moderate, vigorous, and total physical activity, self-reported dietary intake, exercise, and level of physical activity between women with and without experience of infertility.

CONCLUSIONS

Since both obesity and infertility are increasing public health issues in Iranian women, more attention should be paid to lifestyle behaviors, especially gaining weight in women who have experienced infertility.

The influence of endocrine disruptors in a selected population of infertile women

Several studies report that endocrine disrupting chemicals (EDC) able to interfere with endocrine homeostasis may affect women's reproductive health. We analyzed EDC serum levels and nuclear receptors (NRs) expression in order to have an indication of the internal dose of biologically active compounds and a measurement of indicators of their effects, as a result of the repeated uptake from environmental source. The percentage of patients with detectable bisphenol A (BPA) concentrations was significantly higher in the infertile patients compared with fertile subjects. No significant difference was found between the groups with regard to perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), mono-ethylhexyl phthalate (MEHP) and di-(2-ethylhexyl) phthalate (DEHP) concentrations. Among infertile women, the mean expression of estrogen receptor alpha (ERα) and beta (Erβ), androgen receptor (AR) and pregnane X receptor (PXR) was significantly higher than fertile patients. The mean expression of aryl hydrocarbon receptor (AhR) and peroxisome proliferator-activated receptor gamma (PPARγ) did not show significant differences between two groups. Patients with endometriosis had higher levels of PPARγ than all women with other causes of infertility. This study led further support to EDC exposure as a risk factor for women's fertility.

Estimating the prevalence of infertility in Canada

BACKGROUND

Over the past 10 years, there has been a significant increase in the use of assisted reproductive technologies in Canada, however, little is known about the overall prevalence of infertility in the population. The purpose of the present study was to estimate the prevalence of current infertility in Canada according to three definitions of the risk of conception.

METHODS

Data from the infertility component of the 2009-2010 Canadian Community Health Survey were analyzed for married and common-law couples with a female partner aged 18-44. The three definitions of the risk of conception were derived sequentially starting with birth control use in the previous 12 months, adding reported sexual intercourse in the previous 12 months, then pregnancy intent. Prevalence and odds ratios of current infertility were estimated by selected characteristics.

RESULTS

Estimates of the prevalence of current infertility ranged from 11.5% (95% CI 10.2, 12.9) to 15.7% (95% CI 14.2, 17.4). Each estimate represented an increase in current infertility prevalence in Canada when compared with previous national estimates. Couples with lower parity (0 or 1 child) had significantly higher odds of experiencing current infertility when the female partner was aged 35-44 years versus 18-34 years. Lower odds of experiencing current infertility were observed for multiparous couples regardless of age group of the female partner, when compared with nulliparous couples.

CONCLUSIONS

The present study suggests that the prevalence of current infertility has increased since the last time it was measured in Canada, and is associated with the age of the female partner and parity.

Helping patients through the pain of infertility

While males and combined couple factors play a large part in infertility cases, women often carry the physical, social, and emotional burden of these diagnoses. Nurse practitioners are in a prime position to assess women at risk for infertility, initiate an investigation to identify potential etiologies, refer women to specialized centers, and provide them with ongoing care and support through this difficult period in their lives.

Hair and urine testing to assess drugs of abuse consumption in couples undergoing assisted reproductive technology (ART)

For the first time in Europe hair and urine testing have been applied to assess drugs of abuse consumption in couples undergoing assisted reproductive technology and the eventual association of toxic habits with other lifestyle, health status and sociodemographic factors was also investigated. Couples attending five assisted reproduction centers in Rome were invited to join the study. When they presented at the Centre for the visit, they were asked to answer a structured questionnaire concerning sociodemographic characteristics and lifestyle habits, and at the same time to provide hair and urine samples. Hair and urine testing for drugs of abuse, urinary profile of principal endogenous steroids involved in fertility process (testosterone, epitestosterone, androsterone, etiocholanolone and dehydroepiandrosterone) and of alcohol and tobacco smoke biomarkers were performed with validated methodologies. Of the 594 enrolled individuals (297 couples), 352 (164 couples and 24 single individuals from the couple) completed the questionnaire and gave both hair and urine samples, apart from 3 bald men, who only gave urine samples. Urine testing showed an overall 4.8% (17 individuals) positivity to drugs of abuse: 4.2% to cannabinoids, 1.4% to cocaine and 0.85% to both drugs. Results of 4cm segment hair samples testing matched those from urine samples. Thus, taking together, results of urine and hair testing confirmed repeated use of cannabis, cocaine and both drugs in 3.7, 0.85 and 0.57% examined individuals, respectively. Drug consumers were in a statistically higher percentage active smokers and alcohol drinkers, less prone to physical activity and with a trend towards higher weight than non consumers. Finally, repeated drug consumption was associated with significant lower concentration of urinary testosterone in males and of urinary dehydroepiandrosterone in females. The findings of the present study confirm the suitability of urine testing to disclose recent drugs of abuse consumption and of hair analysis to verify repeated consumption. Association between different toxic habits and sedentary lifestyle is also substantiated by the obtained results in our cohort of couples attending assisted reproduction centers.

Effect of smoking and ABO blood groups on maternal age at child bearing and on birth weight

OBJECTIVE

The negative effects of cigarette smoking on human reproduction and on birth weight are well documented. On the other hand ABO system, encoding for glycosyltransferases, contributes to biosynthesis of antigens and oligosaccharide structures involved in blastocyst adhesion and intrauterine selection. In this paper we have searched for possible interaction between ABO system and smoking concerning their effects on maternal age at child bearing and on birth weight.

STUDY DESIGN

We have studied 395 consecutive healthy puerperae from the White Caucasian population of Rome. ABO blood group was determined by standard laboratory methods. Three-way contingency table analysis was performed according to Sokal and Rohlf and Chi square test of independence by SPSS programs.

RESULTS

The proportion of smokers is higher in A phenotype than in other ABO types among young puerperae (≤ 24 years) while it is lower in A phenotype than in other types among older women. The negative effects of smoke on birth weight is much more evident in women with A blood group than in women carrying other ABO phenotypes. The interaction between smoking and ABO blood groups concerning their effects on birth weight is influenced by gender of newborn and by maternal age.

CONCLUSION

ABO blood groups and smoking could have a joint influence on maternal age at child bearing and on birth weight.

Factors related to knowledge and perception of women about smoking: a cross sectional study from a developing country

Background

Smoking rates among women are currently low, but they are the fastest growing segment of cigarette smoking population in developing countries. We aimed to assess the knowledge and perceptions towards smoking and to identify the factors related with level of knowledge and perceptions among adult women in urban slums.

Methods

This was a cross sectional study conducted on 250 adult (≥18 years of age) women attending primary care clinics in three slums of Karachi, Pakistan. A pre-tested and structured, interviewer administered questionnaire was used for data collection. Factors associated with level of understanding about smoking were analyzed with chi-square test.

Results

Most of the women knew that smoking has adverse effects on women and children's health but the knowledge of specific health effects was limited. About one third of the women knew that active smoking can cause lung disease, but only a small percentage (7%) knew that it could lead to heart disease. None of the women were aware that smoking contributes to infertility and osteoporosis. A small proportion of women were aware that smoking can lead to low birth weight (7%), congenital anomalies (5%) and less than 1% of women knew that it contributes to pregnancy loss, still birth and preterm delivery. The understanding of passive smoking affecting children's lung was low (20%) and a similar proportion voiced concern about the bad influence of maternal smoking on children. Educated women had better knowledge of health effects of smoking. Education was associated with having better knowledge about effects on women health in general (p = 0.02) and specific effects like lung (p = 0.03) and reproductive health effects (p < 0.001). Education was also associated with knowledge regarding effects on fetus (p < 0.001) and children (p < 0.005). Although most of the women disliked being around smokers, more than one third thought that smoking decreases boredom (39%), tension (38%) and also helps to relax (40%). A large proportion (48%) of women had the misconception that smoking helps to reduce weight.

Conclusions

This study reveals that women are aware of the general ill effects of smoking but fail to identify smoking to be associated with female maladies particularly those who were illiterate and had lower levels of education. Understanding and attitudes needs to be improved by increasing health awareness and education of women in these urban communities with special emphasis on the effects of smoking on women's health.

Factors associated with subfertility among women attending an antenatal clinic in Hull

OBJECTIVES

To identify lifestyle factors associated with subfertility (time to pregnancy >12 months) among women attending an antenatal clinic, and to determine whether this changed from 2001 to 2007.

METHODS

Waiting-room surveys administered in 2001 and 2007.

RESULTS

There were significant changes in lifestyle factors between 2001 and 2007, including such factors as previous contraceptive use and obesity, smoking, alcohol and caffeine intake of both partners. All changes were in the direction favourable to health and fertility. However, despite these health improvements, there was no overall decrease in the prevalence of subfertility in the antenatal population. Mathematical modelling showed that even if the entire population had improved their lifestyle this would have made little difference to the proportion of subfertile couples.

CONCLUSIONS

A modest improvement in lifestyle over a period of 6 years in couples trying to conceive a pregnancy did not lead to any reduction in the incidence of subfertility and even substantial changes would not have made a significant difference.

Smoking in pregnancy and lactation: a review of risks and cessation strategies

BACKGROUND

Despite documented evidence of harm to fetus and infant, a substantial number of women continue to smoke during pregnancy and lactation.

OBJECTIVE

To examine the literature regarding smoking during pregnancy and breastfeeding to ascertain adverse effects as well as the efficacy of interventions to enable women to stop smoking in the perinatal period.

STUDY DESIGN

A comprehensive literature search was undertaken to identify all published studies reporting on smoking in pregnancy and lactation. MEDLINE, EMBASE, PUBMED, and Web of Science databases were searched for studies published in English from 1966 to 2008 that reported on smoking in pregnancy and breastfeeding, with information on adverse effects and on all forms of smoking cessation, including behavioral interventions, nicotine replacement therapy, and pharmacotherapy such as antidepressants.

RESULTS

There is evidence that smoking in pregnancy and lactation may cause many adverse affects in the perinatal period, childhood, and up to adulthood. These adverse effects include infertility, ectopic pregnancy, spontaneous abortion, placenta insufficiency, low birth weight, fetal growth restriction, preterm delivery, orofacial clefts, SIDS, craniosynostosis, clubfoot, childhood respiratory disease, attention deficit disorder, and some childhood cancers. A number of strategies have been developed to assist pregnant women in quitting smoking, including both behavioral interventions and pharmacological therapies, such as nicotine replacement and antidepressant therapy.

CONCLUSIONS

Behavioral interventions report only modest success rates. Nicotine replacement therapy and antidepressants appear to be safe to use in pregnancy, but do not achieve a substantially higher success rate for quitting.