Objective To provide female age-related estimates of fecundity and incidence of infertility by history of prior pregnancy among women 30–44 years of age. Design Prospective, time-to-pregnancy cohort ...study. Setting Not applicable. Patient(s) Women, between 30 and 44 years of age, attempting to conceive for ≤3 months, and no known history of infertility, polycystic ovarian syndrome (PCOS), or endometriosis. Intervention(s) Not applicable. Main Outcome Measure(s) Fecundability and incidence of infertility. Result(s) Compared to women aged 30–31 years, fecundability was reduced by 14% in women 34–35 years of age (fecundability ratio FR 0.86, 95% confidence interval CI 0.68–1.08), 19% in women 36–37 years of age (FR 0.81, 95% CI 0.60–1.08, 30% in women 38–39 years of age (FR 0.70, 95% CI 0.48–1.01), 53% in women 40–41 years of age (FR 0.47, 95% CI 0.28–0.78), and 59% in women 42–44 years of age (FR 0.39, 95% CI 0.16–0.93). Fecundability did not differ between women aged 30–31 years and 32–33 years. In general, fecundability and cumulative probability of pregnancy was lower for women who had never had a prior pregnancy. Conclusion(s) Women experience a significant reduction in fecundity and increase in the probability of infertility in their late thirties. At any age >30 years, women who have never conceived have a lower probability of achieving a pregnancy. Clinical Trial Registration Number NCT01028365.
Sleep characteristics and fecundity Steiner, Anne Z.
Fertility and sterility,
February 2023, 2023-02-00, 20230201, Letnik:
119, Številka:
2
Journal Article
ABSTRACT
STUDY QUESTION
Are serum omega-3 and omega-6 essential fatty acid concentrations associated with the probability of conceiving?
SUMMARY ANSWER
There is no strong association between serum ...concentrations of omega-3 and omega-6 fatty acids and the probability of conceiving naturally.
WHAT IS KNOWN ALREADY
Omega-3 and omega-6 fatty acid serum concentrations have been shown to play an important role in reproduction in animal models, while conflicting results have been reported in human studies of infertile women. It is unknown to what extent omega fatty acid serum concentrations impact natural fertility.
STUDY DESIGN, SIZE, DURATION
A nested, case–control study was conducted consisting of 200 participants fertile: conceived within 3 cycles of attempt (n = 50), subfertile: conceived within 4 and 12 cycles of attempt (n = 100) and infertile: did not conceive within 12 cycles of attempt (n = 50) randomly selected from the Time to Conceive cohort, a prospective time-to-pregnancy study (2008 to 2015).
PARTICIPANTS/MATERIALS, SETTING, METHODS
In the Time to Conceive study, women aged 30–44 years who were trying to conceive for <3 months and had no history of infertility were recruited and followed until the end of their pregnancy or ~1 year of pregnancy attempt. For this study, serum collected early in the woman’s pregnancy attempt was analysed for anti-Müllerian hormone (AMH) and omega-3 and omega-6 fatty acid concentrations by liquid chromatography-mass spectrometry. The primary outcome was a positive home pregnancy test. The secondary outcomes were miscarriage and serum AMH level. A discrete-time Cox proportional hazards model was used to estimate the fecundability ratio. The odds ratios for miscarriage were calculated using logistic regression. The association between serum omega fatty acid concentrations and AMH level (natural log transformed) was analysed using Pearson’s Correlation.
MAIN RESULTS AND THE ROLE OF CHANCE
A total of 200 women provided 1321 cycles for analysis.
Mean omega-3, omega-6 and omega-6:omega-3 ratios did not significantly differ between the fertile, subfertile and infertile groups. There were no associations (all fecundability ratios ~1.0) between pregnancy and individual omega-3 fatty acid concentrations, including alpha-linolenic acid, eicosapentaenoic acid and docosahexaenoic acid, or omega-6 fatty acids, including linoleic acid (LA), dihommo-gamma linolenic acid and arachidonic acid. There was no significant association between any individual omega fatty acid serum concentration and the age-adjusted odds of miscarriage. No association was found between any serum omega fatty acid concentration and AMH.
LIMITATIONS, REASONS FOR CAUTION
This study is limited by the sample size. Omega-3 and omega-6 fatty acid concentrations were derived from serum provided at a single timepoint in the first cycle of enrollment. Serum concentrations may therefore not be representative of all critical timepoints in the menstrual cycle or throughout their attempts to conceive. Additionally, women enrolled in this study were 30 years of age and older, and therefore the findings may not apply to younger women.
WIDER IMPLICATIONS OF THE FINDINGS
These data would suggest that omega-3 and omega-6 serum levels are not associated with natural fertility or risk of miscarriage. However, due to the above-mentioned limitations, future investigation is still needed to determine whether omega-3 fatty acid supplementation may benefit women planning to conceive naturally.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Division of Reproductive Endocrinology and Infertility at the University of North Carolina at Chapel Hill, by the NIH/NICHD (R21 HD060229-01 and R01 HD067683-01) and, in part, by the Intramural Research Program of the National Institute of Environmental Health Sciences (Z01ES103333). Dr. Jukic received vitamin D supplements for a research study from Theralogix, Inc. The authors have no other conflicts of interest to disclose.
TRIAL REGISTRATION NUMBER
N/A
To determine the association between antimüllerian hormone (AMH), a measure of ovarian reserve, and miscarriage among naturally conceived pregnancies.
Prospective cohort study.
Not applicable.
Women ...(n = 533), between 30 and 44 years of age with no known history of infertility, polycystic ovarian syndrome, or endometriosis who conceived naturally.
None.
Miscarriage, defined as an intrauterine pregnancy loss before 20 weeks’ gestation.
After adjusting for maternal age, race, history of recurrent miscarriage, and obesity, risk of miscarriage decreased as AMH increased (risk ratio per unit increase in natural log of AMH = 0.83; 95% confidence interval CI, 0.73, 0.94). Women with severely diminished ovarian reserve (AMH ≤ 0.4 ng/mL) miscarried at over twice the rate of women with an AMH ≥ 1 ng/mL (hazard ratio, 2.3; 95% CI, 1.3, 4.3).
AMH levels are inversely associated with the risk of miscarriage. Women with severely diminished ovarian reserve are at an increased risk of miscarriage.
IMPORTANCE: Despite lack of evidence of their utility, biomarkers of ovarian reserve are being promoted as potential markers of reproductive potential. OBJECTIVE: To determine the associations ...between biomarkers of ovarian reserve and reproductive potential among women of late reproductive age. DESIGN, SETTING, AND PARTICIPANTS: Prospective time-to-pregnancy cohort study (2008 to date of last follow-up in March 2016) of women (N = 981) aged 30 to 44 years without a history of infertility who had been trying to conceive for 3 months or less, recruited from the community in the Raleigh-Durham, North Carolina, area. EXPOSURES: Early-follicular-phase serum level of antimüllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B and urinary level of FSH. MAIN OUTCOMES AND MEASURES: The primary outcomes were the cumulative probability of conception by 6 and 12 cycles of attempt and relative fecundability (probability of conception in a given menstrual cycle). Conception was defined as a positive pregnancy test result. RESULTS: A total of 750 women (mean age, 33.3 SD, 3.2 years; 77% white; 36% overweight or obese) provided a blood and urine sample and were included in the analysis. After adjusting for age, body mass index, race, current smoking status, and recent hormonal contraceptive use, women with low AMH values (<0.7 ng/mL n = 84) did not have a significantly different predicted probability of conceiving by 6 cycles of attempt (65%; 95% CI, 50%-75%) compared with women (n = 579) with normal values (62%; 95% CI, 57%-66%) or by 12 cycles of attempt (84% 95% CI, 70%-91% vs 75% 95% CI, 70%-79%, respectively). Women with high serum FSH values (>10 mIU/mL n = 83) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (63%; 95% CI, 50%-73%) compared with women (n = 654) with normal values (62%; 95% CI, 57%-66%) or after 12 cycles of attempt (82% 95% CI, 70%-89% vs 75% 95% CI, 70%-78%, respectively). Women with high urinary FSH values (>11.5 mIU/mg creatinine n = 69) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (61%; 95% CI, 46%-74%) compared with women (n = 660) with normal values (62%; 95% CI, 58%-66%) or after 12 cycles of attempt (70% 95% CI, 54%-80% vs 76% 95% CI, 72%-80%, respectively). Inhibin B levels (n = 737) were not associated with the probability of conceiving in a given cycle (hazard ratio per 1-pg/mL increase, 0.999; 95% CI, 0.997-1.001). CONCLUSIONS AND RELEVANCE: Among women aged 30 to 44 years without a history of infertility who had been trying to conceive for 3 months or less, biomarkers indicating diminished ovarian reserve compared with normal ovarian reserve were not associated with reduced fertility. These findings do not support the use of urinary or blood follicle-stimulating hormone tests or antimüllerian hormone levels to assess natural fertility for women with these characteristics.
Psychosocial aspects of fertility, infertility, and assisted reproductive technology (ART) can significantly impact patients' sense of self-identity and personal agency, mental well-being, sexual and ...marital relationships, reproductive efficiency, compliance with treatment, and pregnancy outcomes. Research is needed to understand how stress, anxiety, depression, mood disorders, and psychotropic medications impact fertility and infertility treatment. The psychosocial implications of ART on our society include a shift toward older maternal age at conception, the complexities of third-party reproduction, and consideration for the psychological and socioeconomic barriers to receiving care. Clinicians must understand, screen for, and identify couples struggling with the psychological and social aspects of fertility and ART.
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