|The impact of age and nulligravidity on natural fertility in an older reproductive age cohort.
Anne Steiner, MD, MPH, David Pritchard, MS, Joseph Stanford, MD, MSPH, Amy Herring, ScD
OBJECTIVE: To examine the effect of age and nulligravidity on natural fertility.
METHODS: A prospective, time-to-pregnancy cohort study of 30-44 year old women with no known history of infertility was conducted. Women (N=500), who had been trying to conceive for 3 months or less, completed a questionnaire at enrollment. They were followed without intervention until a positive pregnancy test or until censoring at 6 months of attempt. Time-to-pregnancy and fecundability ratios were determined using discrete Cox proportional hazard models.
RESULTS: The probability of conceiving by 6 cycles of attempt was greatest among women age 30-31 years of age (79%, 95% Confidence Interval (CI) 0.72, 0.84%, N=191) and lowest among women who were 40-43 years of age (42%, 95% CI 0.15, 0.60%, N=25). The impact of age differed by history of prior pregnancy. Women, who had previously conceived and were 38-43 years of age had 0.63 times the odds of conceiving in a given cycle compared to their younger counterparts. However, nulligravid women ages 38-43 had only 0.13 times the odds of conceiving in a given cycle compared to their younger counterparts (FR 0.13, 95% CI 0.02, 0.92). A prior pregnancy was a stronger predictor of fecundability among the older women (FR 6.42) than among the younger women (FR 1.31, 95% CI 1.03, 1.66).
CONCLUSIONS: Natural fertility declines with age. The impact of aging is greatest among nulligravid women; however, this could be attributable to the movement of women out of the nulligravid group upon achieving a pregnancy, selecting out the more fertile and leaving the less fertile in the remaining nulligravid group.
Date: June 2013
|Cervical mucus monitoring in women trying to conceive.
Emily Evans-Hoeker, MD, Mamie McLean, MD, Anne Steiner, MD, MPH
BACKGROUND AND SIGNIFICANCE: Cervical mucus monitoring has been promoted as a mechanism by which women may determine their fertile window. However, to date, studies analyzing the efficacy of cervical mucus monitoring have all included formal instruction on cervical mucus monitoring and therefore may not be generalizable to women outside of study conditions.
OBJECTIVE(S): To characterize cervical mucus monitoring in the general, non-infertile population and determine the extent to which such monitoring decreases time-to-pregnancy.
MATERIALS AND METHOD(S): This study is a secondary analysis of a prospective cohort study of women, 30-44 years old, with no history of infertility, who had been trying to conceive for less than 3 months. Participants completed a baseline survey, providing demographic and medical history data. While attempting to conceive, women completed a daily diary for up to 3 months in which they recorded vaginal bleeding, intercourse, method and result of ovulation monitoring (temperature, ovulation predictor kit, cervical mucus) and pregnancy test results. Women were followed without intervention until pregnancy or 6 months. Student’s t-test, ANOVA, fisher’s exact were used for bivariate analyses. Cox regression analysis was used to compare fecundability between groups. A fecundability ratio (FR) less than 1 suggests a lower probability of pregnancy per cycle compared to the reference group.
RESULT(S): A total of 339 women were enrolled between April 2008 and December 2010 with daily diary data available for 657 cycles. Of all subjects, 41.6% recorded cervical mucus scores while trying to conceive; however, of those, only 18.5% (7.7% of all subjects) monitored cervical mucus on a consistent basis (> 66% of days in a given menstrual cycle). Compared to women who did not monitor cervical mucus, women who performed consistent cervical mucus monitoring were younger (31.9 ± 2.1 years vs 33.5 ± 3.2years, P=0.01), more likely to be nulligravid (62% vs 40%, P=0.04) and more likely to report a history of cervicitis (12% vs 5%, P=0.14). Cervical mucus monitors were also more likely to use additional ovulation predictors such as kits (33% vs 18%, P=0.04) and temperatures (12% vs 5%, p<0.001). However, consistent cervical mucus monitoring did not improve fecundability (FR0.95, 95% CI: 0.563-1.60), after adjusting for age, previous pregnancies and history of cervicitis.
CONCLUSION(S): Consistent cervical mucus monitoring is uncommon among women attempting to conceive. Monitoring is more common in younger, nulligravid women, who use additional methods to monitor ovulation. Cervical mucus monitoring without formal instruction does not appear to improve fecundability in the first 6 months of attempt.
Date: April 2012
Journal: Fertility and Sterility
|Serum markers of ovarian aging are associated with natural fertility.
Anne Steiner, MD, MPH, Steven Hoberman, MS, Frank Stanczyk, PhD, Donna Baird, PhD, MPH
OBJECTIVE: Measures of ovarian aging are used as tests of fertility. We sought to generate estimates of the associations between early follicular phase follicle stimulating hormone (FSH), antimullerian hormone (AMH), inhibin B, and estradiol (E2) and fecundability in the general population.
DESIGN: Prospective time-to-pregnancy study.
MATERIALS AND METHODS: Women, 30-44 years old, with no history of infertility, who were trying to conceive for less than 3 months, provided early follicular phase serum (N=99). They were followed until pregnancy or for 6 months. While trying to conceive, women conducted standardized pregnancy testing and kept a diary recording bleeding and intercourse. Serum was analyzed for E2, FSH, AMH, and inhibin B. To adjust for patterns of intercourse, diary data were used to calculate day-specific probabilities of conception.
RESULTS: Sixty-four percent of women had conceived after 6 months of follow up. After adjusting for age, low AMH and high FSH were respectively associated with a 62% and 56% lower odds of conceiving given an act of intercourse on a fertile day. Inhibin B and E2 showed no significant association with day-specific probabilities of conception.
CONCLUSION: Early follicular phase, serum FSH and AMH appear to be associated with natural fertility in the general population. Further studies are needed to determine their ability to predict infertility.
Date: October 2010
Presented at the Annual Meeting of the American Society for Reproductive Medicine in San Diego, California, October 2012.
Journal: Fertility and Sterility