• 【过去对持久性有机氯污染物生物标志物男性和女性血清浓度的估计及其对生育力估计的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.envres.2005.10.005 复制DOI
    作者列表:Axmon A,Rignell-Hydbom A
    BACKGROUND & AIMS: :Persistent organochlorine pollutants (POPs) have been suggested to have negative effects on a number of hormonal systems. Several studies performed retrospectively have reported a possible association between POP exposure and fertility, measured as time to pregnancy (TTP). However, these studies lack biomarkers of exposure at the time when the women tried to conceive. It has previously been found that past female serum concentrations of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) can be estimated using a complex decay model, assuming that the biological half-life is 5 years, the yearly environmental reduction of the compound has been 3% since 1976, and the reduction of body burden due to lactation is 20% for periods up to 6 months and 30% for periods exceeding 6 months. In the present study, it is established that the model is valid also for estimations of past male serum concentrations of CB-153. Furthermore, the complex decay model was found to be useful also for estimating past serum concentrations of 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE), assuming that the biological half-life of the compound is 8 years, the yearly reduction between 1971 and 1981 was 20% and after that 9%, and the reduction of body burden due to lactation is the same as that for CB-153. However, even though the estimated past serum concentrations of CB-153 and p,p'-DDE were found to be better proxy measures of actual past concentrations than current serum concentrations, there was little change in the rank order of the population investigated. Thus, the effect estimate for TTP was similar for both proxy measures when using categorized measures of exposure.
    背景与目标: :持久性有机氯污染物(POPs)已被建议对许多激素系统具有负面影响。回顾性进行的几项研究报告了POP暴露与生育能力之间的可能关联,以怀孕时间(TTP)衡量。但是,这些研究在妇女试图受孕时缺乏暴露的生物标志物。以前已经发现,假设生物学半衰期为5,可以使用复杂的衰变模型估算过去女性2,2',4,4',5,5'-六氯联苯(CB-153)的血清浓度。自1976年以来,该化合物的年度环境减少量为3%,并且由于哺乳而导致的身体负担在6个月以内减少了20%,在6个月以内减少了30%。在本研究中,已确定该模型对于过去男性CB-153血清浓度的估计也是有效的。此外,假设生物学半衰期为零,发现复杂的衰变模型也可用于估算1,1-二氯-2,2-双(对氯苯基)-乙烯(p,p'-DDE)的过去血清浓度。 -化合物的寿命为8年,1971年至1981年之间的年减少量为20%,此后为9%,并且由于泌乳导致的身体负担减少与CB-153相同。但是,尽管发现估计的过去CB-153和p,p'-DDE过去的血清浓度比当前的过去血清浓度更好地替代了过去的实际浓度,但所调查人群的排名几乎没有变化。因此,当使用分类的暴露量度时,两种替代量度的TTP效果估计都相似。
  • 【最小的子宫内膜异位症和降低的生育能力:通过捐赠计划进行人工授精的前瞻性证据。】 复制标题 收藏 收藏
    DOI:10.1016/s0015-0282(16)49474-4 复制DOI
    作者列表:Jansen RP
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【北美先入为主的队列中糖类饮料的摄入量和可生育性。】 复制标题 收藏 收藏
    DOI:10.1097/EDE.0000000000000812 复制DOI
    作者列表:Hatch EE,Wesselink AK,Hahn KA,Michiel JJ,Mikkelsen EM,Sorensen HT,Rothman KJ,Wise LA
    BACKGROUND & AIMS: BACKGROUND:Dietary factors, including sugar-sweetened beverages, may have adverse effects on fertility. Sugar-sweetened beverages were associated with poor semen quality in cross-sectional studies, and female soda intake has been associated with lower fecundability in some studies. METHODS:We evaluated the association of female and male sugar-sweetened beverage intake with fecundability among 3,828 women planning pregnancy and 1,045 of their male partners in a North American prospective cohort study. We followed participants until pregnancy or for up to 12 menstrual cycles. Eligible women were aged 21-45 (male partners ≥21), attempting conception for ≤6 cycles, and not using fertility treatments. Participants completed a comprehensive baseline questionnaire, including questions on sugar-sweetened beverage consumption during the previous 4 weeks. We estimated time-to-pregnancy from follow-up questionnaires completed every 2 months by the female partner. We calculated adjusted fecundability ratios (FR) and 95% confidence intervals (CIs) according to intake of sugar- sweetened beverages using proportional probabilities regression. RESULTS:Both female and male intakes of sugar-sweetened beverages were associated with reduced fecundability (FR = 0.81; 95% CI = 0.70, 0.94 and 0.78; 95% CI = 0.63, 0.95 for ≥7 sugar-sweetened beverages per week compared with none, for females and males, respectively). Fecundability was further reduced among those who drank ≥7 servings per week of sugar-sweetened sodas (FR = 0.75, 95% CI = 0.59, 0.95 for females and 0.67, 95% CI = 0.51, 0.89 for males). CONCLUSIONS:Sugar-sweetened beverages, particularly sodas and energy drinks, were associated with lower fecundability, but diet soda and fruit juice had little association.
    背景与目标: 背景:饮食因素,包括含糖饮料,可能会对生育产生不利影响。在横断面研究中,含糖饮料与精液质量差有关,在某些研究中,女性汽水的摄入与生育力降低有关。
    方法:在一项北美前瞻性队列研究中,我们评估了3828名计划怀孕的女性和1045名男性伴侣的女性和男性含糖饮料摄入量与生育能力的相关性。我们一直跟踪参与者,直到怀孕或最多12个月经周期。符合条件的女性年龄在21-45岁之间(男性伴侣≥21),尝试怀孕≤6个周期,并且不使用生育治疗。参加者完成了一项全面的基线调查表,其中包括有关前4周内含糖饮料消费的问题。我们根据女性伴侣每2个月完成一次的随访问卷估计了怀孕时间。我们使用比例概率回归,根据含糖甜味饮料的摄入量,计算了调整后的生育能力比(FR)和95%置信区间(CIs)。
    结果:女性和男性摄入含糖饮料的生育能力均降低(FR = 0.81; 95%CI = 0.70、0.94和0.78;每周≥7种含糖饮料的95%CI = 0.63,0.95)无,分别针对女性和男性)。每周饮用≥7份加糖苏打水的人的生育力进一步降低(女性FR = 0.75,95%CI = 0.59,0.95,男性0.67,95%CI = 0.51,0.89)。
    结论:含糖饮料,特别是苏打水和能量饮料,其生育力较低,但低糖苏打水和果汁几乎没有相关性。
  • 【孕前孕妇脂蛋白水平与生育能力的关系。】 复制标题 收藏 收藏
    DOI:10.1093/humrep/dex052 复制DOI
    作者列表:Pugh SJ,Schisterman EF,Browne RW,Lynch AM,Mumford SL,Perkins NJ,Silver R,Sjaarda L,Stanford JB,Wactawski-Wende J,Wilcox B,Grantz KL
    BACKGROUND & AIMS: STUDY QUESTION:Are maternal preconception lipid levels associated with fecundability? SUMMARY ANSWER:Fecundability was reduced for all abnormal female lipid levels including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total triglyceride levels. WHAT IS KNOWN ALREADY:Subfecundity affects 7-15% of the population and lipid disorders are hypothesized to play a role since cholesterol acts as a substrate for the synthesis of steroid hormones. Evidence illustrating this relationship at the mechanistic level is mounting but few studies in humans have explored the role of preconception lipids in fecundity. STUDY DESIGN, SIZE, DURATION:A secondary analysis of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial (2007-2011), a block-randomized, double-blind, placebo-controlled trial. PARTICIPANTS/MATERIALS, SETTING, METHODS:A total of 1228 women, with 1-2 prior pregnancy losses and without a diagnosis of infertility, attempting pregnancy for up to six menstrual cycles were recruited from clinical sites in Utah, New York, PA and Colorado. Time to pregnancy was the number of menstrual cycles to pregnancy as determined by positive hCG test or ultrasound. Individual preconception lipoproteins were measured at baseline, prior to treatment randomization and dichotomized based on clinically accepted cut-points as total cholesterol ≥200 mg/dl, LDL-C ≥130 mg/dl, HDL-C <50 mg/dl and triglycerides ≥150 mg/dl. MAIN RESULTS AND THE ROLE OF CHANCE:There were 148 (12.3%) women with elevated total cholesterol, 94 (7.9%) with elevated LDL-C, 280 (23.2%) with elevated triglycerides and 606 (50.7%) with low HDL-C. The fecundability odds ratio (FOR) was reduced for all abnormal lipids before and after confounder adjustment, indicating reduced fecundability. Total cholesterol ≥200 mg/dl was associated with 24% (FOR: 0.76, 95% CI: 0.59, 0.97) and 29% (FOR: 0.71, 95% CI: 0.55, 0.93) reduced fecundability for hCG-detected and ultrasound-confirmed pregnancy, respectively, compared with total cholesterol <200 mg/dl. There was a 19-36% decrease in the probability of conception per cycle for women with abnormal lipoprotein levels, though additional adjustment for central adiposity and BMI attenuated observed associations. LIMITATIONS, REASONS FOR CAUTION:Although the FOR is a measure of couple fecundability, we had only measures of female lipid levels and can therefore not confirm the findings from a previous study indicating the independent role of male lipids in fecundity. The attenuated estimates and decreased precision after adjustment for central adiposity and obesity indicate the complexity of potential causal lipid pathways, suggesting other factors related to obesity besides dyslipidemia likely contribute to reduced fecundability. WIDER IMPLICATIONS OF THE FINDINGS:Our results are consistent with one other study relating preconception lipid concentrations to fecundity and expand these findings by adding critically important information about individual lipoproteins. As lipid levels are modifiable they may offer an inexpensive target to improve female fecundability. STUDY FUNDING AND COMPETING INTEREST(S):This study was funded by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have declared that no conflicts of interest exist. TRIAL REGISTRATION NUMBER:#NCT00467363.
    背景与目标: 研究问题:孕产妇的孕前血脂水平是否与生育能力有关?
    总结答案:所有异常女性脂质水平,包括总胆固醇,低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C)和总甘油三酸酯水平的可育性均降低。
    已经知道的是:亚生育力影响了7-15%的人口,并且由于胆固醇是类固醇激素合成的底物,脂质障碍被认为发挥了作用。在机械水平上说明这种关系的证据越来越多,但是在人类中很少有研究探讨先孕脂质在生殖力中的作用。
    研究设计,大小,时间:阿司匹林在妊娠和生殖中的作用的二次分析(EAGeR)试验(2007-2011年),该试验是一项区块随机,双盲,安慰剂对照试验。
    参与者/材料,背景,方法:从犹他州,纽约州,宾夕法尼亚州和科罗拉多州的临床地点招募了总共1228名女性,这些女性有1-2例先兆流产且没有诊断出不育症,并尝试了长达六个月经的尝试怀孕。 。怀孕时间是通过hCG测试阳性或超声确定的怀孕月经周期数。在治疗随机化之前,在基线时测量各个受孕前的脂蛋白,并根据临床可接受的切分标准将其二分为二,因为总胆固醇≥200 mg / dl,LDL-C≥130mg / dl,HDL-C <50 mg / dl和甘油三酯≥ 150毫克/分升。
    主要结果和机会:总胆固醇升高的女性有148位(12.3%),低密度脂蛋白胆固醇升高的女性有94位(7.9%),甘油三酸酯升高的女性有280位(23.2%),高密度脂蛋白低的女性606位(50.7%)。 C。混杂因素调整前后,所有异常脂质的生育能力比值比(FOR)均降低,表明生育力降低。总胆固醇≥200mg / dl与24%(FOR:0.76,95%CI:0.59,0.97)和29%(FOR:0.71,95%CI:0.55,0.93)降低了hCG检测和超声检查的生育能力。确认怀孕的总胆固醇分别低于200 mg / dl。脂蛋白水平异常的女性,每个周期受孕的可能性降低了19-36%,尽管对中央肥胖和BMI的进一步调整减弱了观察到的关联。
    局限性,注意事项的原因:尽管FOR是衡量夫妇生育能力的指标,但我们仅能测量雌性脂质水平,因此无法证实以前的研究结果表明雄性脂质在生育力中的独立作用。对中心性肥胖和肥胖症进行调整后,估计值的降低和准确性下降表明潜在的因果性脂质途径的复杂性,表明除血脂异常外,与肥胖症相关的其他因素也可能导致生育能力降低。
    研究结果的进一步暗示:我们的结果与另一项有关将先孕期血脂浓度与生育力相关的研究一致,并通过添加有关单个脂蛋白的至关重要的信息扩大了这些发现。由于脂质水平是可调节的,因此它们可以提供廉价的靶标来提高女性的受精能力。
    研究资助和竞争兴趣:这项研究由Eunice Kennedy Shriver国家儿童健康与人类发展研究所的内部研究计划资助。作者宣称没有利益冲突。
    试用注册号:#NCT00467363。
  • 【丹麦怀孕计划者的主动和被动吸烟与生育能力。】 复制标题 收藏 收藏
    DOI:10.1016/j.fertnstert.2014.03.018 复制DOI
    作者列表:Radin RG,Hatch EE,Rothman KJ,Mikkelsen EM,Sørensen HT,Riis AH,Wise LA
    BACKGROUND & AIMS: OBJECTIVE:To investigate the extent to which fecundability is associated with active smoking, time since smoking cessation, and passive smoking. DESIGN:Prospective cohort study. SETTING:Denmark, 2007-2011. PATIENT(S):A total of 3,773 female pregnancy planners aged 18-40 years. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Self-reported pregnancy. Fecundability ratios (FRs) and 95% confidence intervals (CIs) were estimated using a proportional probabilities model that adjusted for menstrual cycle at risk and potential confounders. RESULT(S):Among current smokers, smoking duration of ≥10 years was associated with reduced fecundability compared with never smokers (FR, 0.85, 95% CI 0.72-1.00). Former smokers who had smoked ≥10 pack-years had reduced fecundability regardless of when they quit smoking (1-1.9 years FR, 0.83, 95% CI 0.54-1.27; ≥2 years FR, 0.73, 95% CI 0.53-1.02). Among never smokers, the FRs were 1.04 (95% CI 0.89-1.21) for passive smoking in early life and 0.92 (95% CI 0.82-1.03) for passive smoking in adulthood. CONCLUSION(S):Among Danish pregnancy planners, cumulative exposure to active cigarette smoking was associated with delayed conception among current and former smokers. Time since smoking cessation and passive smoking were not appreciably associated with fecundability.
    背景与目标: 目的:探讨生育能力与主动吸烟,戒烟时间和被动吸烟相关的程度。
    设计:前瞻性队列研究。
    地点:丹麦,2007-2011年。
    患者:共有3,773位18-40岁的女性怀孕计划者。
    干预措施:无。
    主要观察指标:自我报告的妊娠。使用比例概率模型估算可受孕率(FRs)和95%置信区间(CIs),该模型针对处于危险和潜在混杂因素的月经周期进行了调整。
    结果:在目前的吸烟者中,与不吸烟者相比,吸烟时间≥10年与生育能力降低相关(FR,0.85,95%CI 0.72-1.00)。抽烟≥10包年的前吸烟者,无论何时戒烟,生育力都会降低(1-1.9岁FR,0.83,95%CI 0.54-1.27;≥2岁FR,0.73,95%CI 0.53-1.02)。在从不吸烟的人群中,早年被动吸烟的FRs为1.04(95%CI 0.89-1.21),成年后被动吸烟的FRs为0.92(95%CI 0.82-1.03)。
    结论:在丹麦的怀孕计划者中,活跃吸烟者的累积暴露与现吸烟者和前吸烟者的受孕延迟有关。自戒烟和被动吸烟以来的时间与生育能力无关。
  • 【一项北美孕前队列研究中的体重指数,体育活动和生育能力。】 复制标题 收藏 收藏
    DOI:10.1016/j.fertnstert.2016.04.011 复制DOI
    作者列表:McKinnon CJ,Hatch EE,Rothman KJ,Mikkelsen EM,Wesselink AK,Hahn KA,Wise LA
    BACKGROUND & AIMS: OBJECTIVE:To evaluate the association between adiposity, physical activity (PA), and fecundability. DESIGN:Prospective cohort study. SETTING:Not applicable. PATIENT(S):A total of 2,062 female pregnancy planners from the United States and Canada who were enrolled during the preconception period. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Self-reported pregnancy. Fecundability ratios (FRs) and 95% confidence intervals (CIs) were estimated using proportional probabilities models that adjusted for potential confounders. RESULT(S):Relative to body mass index (BMI) 18.5-24 kg/m(2), FRs for BMI <18.5, 25-29, 30-34, 35-39, 40-44, and ≥45 kg/m(2) were 1.05 (95% CI 0.76-1.46), 1.01 (95% CI 0.89-1.15), 0.98 (95% CI 0.82-1.18), 0.78 (95% CI 0.60-1.02), 0.61 (95% CI 0.42-0.88), and 0.42 (95% CI 0.23-0.76), respectively. Reduced fecundability was observed among women with the largest waist-to-hip ratios (≥0.85 vs. <0.75; FR = 0.87, 95% CI 0.74-1.01) and waist circumferences (≥36 vs. <26 inches [≥90 vs. <66 cm]; FR = 0.80, 95% CI 0.59-1.01). Tendency to gain weight in the chest/shoulders (FR = 0.63, 95% CI 0.36-1.08) and waist/stomach (FR = 0.90, 95% CI 0.79-1.02), relative to hips/thighs, was associated with lower fecundability. Moderate PA was associated with increased fecundability (≥5 vs. <1 h/wk; FR = 1.26, 95% CI 0.96-1.65), but there was no dose-response relation. Among overweight/obese women (BMI ≥25 kg/m(2)), fecundability was 27% higher for vigorous PA of ≥5 versus <1 h/wk (95% CI 1.02-1.57). CONCLUSION(S):Various measures of overall and central adiposity were associated with decreased fertility among pregnancy planners. Vigorous PA was associated with improved fertility among overweight and obese women only; moderate PA was associated with improved fertility among all women.
    背景与目标: 目的:评估肥胖,体力活动(PA)和生育能力之间的关联。
    设计:前瞻性队列研究。
    设置:不适用。
    患者:在孕前期共招募了2,062位来自美国和加拿大的女性怀孕计划人员。
    干预措施:无。
    主要观察指标:自我报告的妊娠。使用针对潜在混杂因素进行调整的比例概率模型估算可可行性比(FRs)和95%置信区间(CIs)。
    结果(S):相对于体重指数(BMI)18.5-24 kg / m(2),BMI的FRs <18.5、25-29、30-34、35-39、40-44和≥45kg / m(2)分别为1.05(95%CI 0.76-1.46),1.01(95%CI 0.89-1.15),0.98(95%CI 0.82-1.18),0.78(95%CI 0.60-1.02),0.61(95%CI 0.61-1.02),0.61(95%CI 0.60-1.02),0.61(95%CI 0.42-0.88)和0.42(95%CI 0.23-0.76)。在腰臀比最大的女性(≥0.85vs. <0.75; FR = 0.87,95%CI 0.74-1.01)和腰围(≥36vs. <26英寸[≥90vs.]的女性中,生育力降低。 <66厘米]; FR = 0.80,95%CI 0.59-1.01)。相对于臀部/大腿,胸部/肩膀(FR = 0.63,95%CI 0.36-1.08)和腰部/胃(FR = 0.90,95%CI 0.79-1.02)增重的趋势与较低的生育能力相关。中度PA与生育力增加相关(≥5vs. <1 h / wk; FR = 1.26,95%CI 0.96-1.65),但没有剂量反应关系。在超重/肥胖女性(BMI≥25 kg / m(2))中,≥5的剧烈PA的生育能力比<1 h / wk高(27%CI 1.02-1.57)。
    结论:各种总体和中央肥胖测量指标与计划生育者生育力下降有关。剧烈的PA仅与超重和肥胖妇女的生育能力有关;中度PA与所有妇女的生育能力提高有关。
  • 【尝试怀孕时使用大麻:一项前瞻性队列研究,评估与可生育性,活产和流产的关系。】 复制标题 收藏 收藏
    DOI:10.1093/humrep/deaa355 复制DOI
    作者列表:Mumford SL,Flannagan KS,Radoc JG,Sjaarda LA,Zolton JR,Metz TD,Plowden TC,Perkins NJ,DeVilbiss EA,Andriessen VC,A C PS,Kim K,Yisahak SF,Freeman JR,Alkhalaf Z,Silver RM,Schisterman EF
    BACKGROUND & AIMS: STUDY QUESTION:Is cannabis use assessed via urinary metabolites and self-report during preconception associated with fecundability, live birth and pregnancy loss?

    SUMMARY ANSWER:Preconception cannabis use was associated with reduced fecundability among women with a history of pregnancy loss attempting pregnancy despite an increased frequency of intercourse.

    WHAT IS KNOWN ALREADY:Cannabis use continues to rise despite limited evidence of safety during critical windows of pregnancy establishment. While existing studies suggest that self-reported cannabis use is not associated with fecundability, self-report may not be reliable.

    STUDY DESIGN, SIZE, DURATION:A prospective cohort study was carried out including 1228 women followed for up to six cycles while attempting pregnancy (2006 to 2012), and throughout pregnancy if they conceived.

    PARTICIPANTS/MATERIALS, SETTING, METHODS:Women aged 18-40 years with a history of pregnancy loss (n = 1228) were recruited from four clinical centers. Women self-reported preconception cannabis use at baseline and urinary tetrahydrocannabinol metabolites were measured throughout preconception and early pregnancy (up to four times during the study: at baseline, after 6 months of follow-up or at the beginning of the conception cycle, and weeks 4 and 8 of pregnancy). Time to hCG-detected pregnancy, and incidence of live birth and pregnancy loss were prospectively assessed. Fecundability odds ratios (FOR) and 95% CI were estimated using discrete time Cox proportional hazards models, and risk ratios (RRs) and 95% CI using log-binomial regression adjusting for age, race, BMI, education level, baseline urine cotinine, alcohol use and antidepressant use.

    MAIN RESULTS AND THE ROLE OF CHANCE:Preconception cannabis use was 5% (62/1228), based on combined urinary metabolite measurements and self-report, and 1.3% (11/789) used cannabis during the first 8 weeks of gestation based on urinary metabolites only. Women with preconception cannabis use had reduced fecundability (FOR 0.59; 95% CI 0.38, 0.92). Preconception cannabis use was also associated with increased frequency of intercourse per cycle (9.4 ± 7 versus 7.5 ± 7 days; P = 0.02) and higher LH (percentage change 64%, 95% CI 3, 161) and higher LH:FSH ratio (percentage change 39%, 95% CI 7, 81). There were also suggestive, though imprecise, associations with anovulation (RR 1.92, 95% CI 0.88, 4.18), and live birth (42% (19/45) cannabis users versus 55% (578/1043) nonusers; RR 0.80, 95% CI 0.57, 1.12). No associations were observed between preconception cannabis use and pregnancy loss (RR 0.81, 95% CI 0.46, 1.42). Similar results were observed after additional adjustment for parity, income, employment status and stress. We were unable to estimate associations between cannabis use during early pregnancy and pregnancy loss due to limited sample size.

    LIMITATIONS, REASONS FOR CAUTION:Owing to the relatively few cannabis users in our study, we had limited ability to make conclusions regarding live birth and pregnancy loss, and were unable to account for male partner use. While results were similar after excluding smokers, alcohol use and any drug use in the past year, some residual confounding may persist due to these potential co-exposures.

    WIDER IMPLICATIONS OF THE FINDINGS:These findings highlight potential risks on fecundability among women attempting pregnancy with a history of pregnancy loss and the need for expanded evidence regarding the reproductive health effects of cannabis use in the current climate of increasing legalization.

    STUDY FUNDING/COMPETING INTEREST(S):This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland (Contract numbers: HHSN267200603423, HHSN267200603424, HHSN267200603426, HHSN275201300023I). Jeannie G. Radoc has been funded by the National Institutes of Health Medical Research Scholars Program, a public-private partnership supported jointly by the National Institutes of Health and generous contributions to the Foundation for the National Institutes of Health from the Doris Duke Charitable Foundation (DDCF Grant # 2014194), Genentech, Elsevier, and other private donors. The authors report no conflict of interest in this work and have nothing to disclose.

    TRIAL REGISTRATION NUMBER:Clinicaltrials.gov NCT00467363.

    背景与目标: 研究问题:受孕前是否通过尿液代谢产物和自我报告评估了大麻的使用与生育力,活产和妊娠损失相关?

    摘要性答复:受孕前尽管性交频率增加,但大麻的使用与尝试流产的孕妇之间的性交能力下降有关,尽管性交频率增加。

    已经知道的事情:尽管证据有限,大麻的使用仍在继续增加建立关键窗口期间的安全性。尽管现有研究表明,自我报告的大麻使用与生育能力无关,但自我报告可能并不可靠。

    研究设计,大小,持续时间:进行了一项前瞻性队列研究

    参与者/材料,设置,方法:18岁的女性包括1228名妇女在尝试怀孕期间(2006年至2012年)以及整个怀孕期间进行了多达六个周期的随访。

    参与者/材料,设置,方法从四个临床中心招募有-40年怀孕史的孕妇(n = 1228)。在孕前和怀孕初期对女性自我报告的孕前使用大麻和尿中四氢大麻酚代谢物进行了测量(研究期间最多进行了四次:基线,随访6个月后或受孕周期开始以及数周内)怀孕的4和8)。前瞻性评估了hCG检测到的怀孕时间,活产和流产的发生率。使用离散时间Cox比例风险模型估算可赔率比(FOR)和95%CI,使用对数二项回归对年龄,种族,BMI,教育水平,基线尿可替宁进行校正,以风险比(RRs)和95%CI进行估算,酒精使用和抗抑郁药的使用。

    主要结果和发生的作用:根据尿液代谢产物的综合测量和自我报告,孕前使用大麻的比例为5%(62/1228),在怀孕的前8周内仅靠尿液代谢物使用了1.3%(11/789)的大麻。怀孕前使用大麻的妇女生育能力降低(FOR 0.59; 95%CI 0.38,0.92)。怀孕前使用大麻还与每个周期的性交频率增加(9.4±±7比7.5±±7天; P = 0.02)和较高的LH(百分比变化64%,95%CI 3、161)和较高的LH:FSH比(百分比变化39%,95%CI 7、81)。尽管不精确,但也提示与无排卵的关联(RR 1.92,95%CI 0.88,4.18)和活产(42%(19/45)大麻使用者与55%(578/1043)的非使用者; RR 0.80、95 %CI 0.57,1.12)。怀孕前使用大麻与流产之间没有关联(RR 0.81,95%CI 0.46,1.42)。在对平价,收入,就业状况和压力进行进一步调整后,观察到相似的结果。由于样本量有限,我们无法估计早孕期间使用大麻与流产之间的关联。

    局限性,需要谨慎的原因:由于本研究中的大麻使用者相对较少,我们对活产和妊娠丢失的结论能力有限,并且无法说明男性伴侣的使用情况。在排除吸烟者,酒精和任何药物使用后的一年中,结果相似,但由于这些潜在的共同暴露,一些残留的混杂现象可能会持续存在。

    发现的广泛含义 :这些发现凸显了在有怀孕史的孕妇中,尝试怀孕的妇女具有潜在的生育能力风险,并且在当前日益合法化的环境中,有必要扩大使用大麻对生殖健康的证据。

    研究资助/竞争兴趣:这项工作得到了美国马里兰州贝塞斯达国立卫生研究院国家儿童健康和人类发展研究所的尤妮丝·肯尼迪·史瑞弗国家内部研究计划的支持(合同编号:HHSN267200603423,HHSN267200603424 ,HHSN267200603426,HHSN275201300023I)。珍妮·拉多克(Jeannie G. Radoc)由国立卫生研究院医学研究学者计划(National Institutes of Health Medical Research Scholars Program)资助,该计划是由国立卫生研究院共同支持的公私合作伙伴关系,并由多丽丝·杜克慈善基金会(Doris Duke Charitable Foundation)向国立卫生研究院基金会慷慨捐款( DDCF Grant#2014194),Genentech,Elsevier和其他私人捐助者。作者报告在这项工作中没有利益冲突,也没有什么可披露的。

    试验注册号:Clinicaltrials.gov NCT00467363。

  • 【职业性溶剂暴露对男性生殖激素浓度和生育力的影响。】 复制标题 收藏 收藏
    DOI:10.1002/ajim.20100 复制DOI
    作者列表:Luderer U,Bushley A,Stover BD,Bremner WJ,Faustman EM,Takaro TK,Checkoway H,Brodkin CA
    BACKGROUND & AIMS: BACKGROUND:Little is known about the effects of organic solvents on male reproductive health. To assess fertility and reproductive endocrine function in solvent-exposed men, we investigated time-to-pregnancy using a retrospective cohort design and cross-sectionally measured reproductive hormone concentrations in painters and millwrights compared to a reference group of carpenters. METHODS:Detailed occupational, exposure, medical, and time-to-pregnancy histories were obtained by telephone interview. Plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone concentrations were determined by immunoassay. Exposure indices, which summarized working life exposure to total solvents, chlorinated solvents, aromatic solvents, and thinners, degreasers, varnishes, and adhesives as a category were calculated from exposure histories. RESULTS:FSH concentrations increased significantly with increasing exposure indices for all solvents and for chlorinated solvents. There were no significant associations of solvent exposure indices with LH or testosterone levels. LH, FSH, and testosterone concentrations also did not differ by job title. Using Cox regression, time-to-pregnancy was non-significantly longer in the painters and millwrights than the carpenters. There was no significant association between time-to-pregnancy and any of the solvent exposure indices; however, it should be noted that some of the pregnancies occurred more than 20 years previously, potentially reducing the reliability of the retrospectively collected pregnancy and exposure data. CONCLUSIONS:The significant associations between FSH levels and solvent exposure indices suggest the potential for adverse effects of solvent exposures on reproductive function in men.
    背景与目标: 背景:关于有机溶剂对男性生殖健康的影响知之甚少。为了评估暴露于溶剂的男性的生育力和生殖内分泌功能,我们使用回顾性队列研究调查了怀孕时间,并与参考木匠组比较,横断面测量了画家和女权人的生殖激素浓度。
    方法:通过电话采访获得详细的职业,接触,医疗和怀孕时间的历史记录。通过免疫测定法测定血浆黄体生成激素(LH),促卵泡激素(FSH)和睾丸激素的浓度。暴露指数是根据暴露历史计算得出的,该指数总结了总溶剂,氯化溶剂,芳族溶剂以及稀释剂,脱脂剂,清漆和粘合剂的使用寿命。
    结果:对于所有溶剂和氯化溶剂,FSH浓度均随着暴露指数的增加而显着增加。溶剂暴露指数与LH或睾丸激素水平无显着相关性。 LH,FSH和睾丸激素的浓度在职称上也没有差异。使用Cox回归,与木匠相比,画家和牧师的怀孕时间没有明显延长。怀孕时间与任何溶剂暴露指数之间均无显着相关性。但是,应该指出的是,有些怀孕发生在20多年前,可能降低了回顾性收集的怀孕和暴露数据的可靠性。
    结论:FSH水平与溶剂暴露指数之间的显着相关性表明,溶剂暴露对男性生殖功能可能产生不利影响。
  • 【宫颈上皮内瘤变和可生育性治疗的前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.ajog.2019.12.017 复制DOI
    作者列表:Wise LA,Willis SK,Perkins RB,Wesselink AK,Klann A,Crowe HM,Hahn KA,Mikkelsen EM,Hatch EE
    BACKGROUND & AIMS: BACKGROUND:Treatments for cervical intraepithelial neoplasia remove precancerous cells from the cervix by excising or ablating the transformation zone. Most studies show no association between cervical intraepithelial neoplasia treatments and fertility outcomes. However, only 2 studies have examined time to pregnancy, both using retrospective study designs, with 1 study showing no association and the other showing a 2-fold increased risk of infertility (time to pregnancy >12 months) following excisional or ablative treatment. OBJECTIVE:We examined the association between cervical intraepithelial neoplasia treatments and fecundability. MATERIALS AND METHODS:We analyzed data from Pregnancy Study Online (PRESTO), a prospective cohort study of North American pregnancy planners enrolled during 2013-2019. At baseline, women reported whether they ever had an abnormal Papanicolaou test result, the number of abnormal Papanicolaou test results, and their age at first abnormal Papanicolaou test result. They also reported whether they underwent diagnostic (colposcopy) or treatment (excisional or ablative) procedures, and their age at each procedure. We restricted analyses to 8017 women with 6 or fewer cycles of attempt time at enrollment who reported receiving a Papanicolaou test in the previous 3 years. We estimated fecundability ratios and 95% confidence intervals using proportional probabilities models adjusted for sociodemographics, healthcare use, smoking, number of sexual partners, history of sexually transmitted infections, and human papillomavirus vaccination. RESULTS:A history of abnormal Papanicolaou test results showed little association with fecundability (fecundability ratio, 1.00; 95% confidence interval, 0.95-1.06). Likewise, receipt of colposcopy or treatment procedures, and time since treatment were not materially associated with fecundability. Results were similar when stratified by age and smoking status. CONCLUSION:We observed no appreciable association of self-reported history of abnormal Papanicolaou test results, colposcopy, treatments for cervical intraepithelial neoplasia, or recency of treatment with fecundability. These results agree with the majority of previous studies in indicating little effect of cervical intraepithelial neoplasia treatments on future fertility.
    背景与目标: 背景:宫颈上皮内瘤变的治疗方法是切除或消融转化区,从子宫颈中去除癌前细胞。大多数研究表明宫颈上皮内瘤变治疗与生育结局之间没有关联。但是,只有两项研究使用回顾性研究设计检查了妊娠时间,其中一项研究显示无关联,而另一项研究显示,经切除或消融治疗后不孕风险增加(妊娠时间> 12个月)增加了2倍。
    目的:我们研究了宫颈上皮内瘤变治疗与生育能力之间的关系。
    材料与方法:我们分析了Pregnancy Study Online(PRESTO)的数据,PRESTO是一项针对2013-2019年间参与的北美妊娠计划者的前瞻性队列研究。基线时,妇女报告是否曾经有异常的帕帕尼古拉测试结果,异常的帕帕尼古拉测试结果数量以及首次出现帕潘尼古拉测试结果异常时的年龄。他们还报告了他们是否接受了诊断(阴道镜检查)或治疗(切除或消融)手术,以及他们每次手术的年龄。我们将分析仅限于8017名入选尝试时间少于或等于6个周期的女性,她们报告在过去3年中接受了Papanicolaou测试。我们使用比例概率模型(根据社会人口统计学,医疗保健用途,吸烟,性伴侣的数量,性传播感染的历史记录和人乳头瘤病毒疫苗接种情况)调整了比例概率模型,从而估算了可育度比率和95%的置信区间。
    结果:Papanicolaou测试结果异常的历史表明与生育力关系不大(生育率1.00; 95%置信区间0.95-1.06)。同样,接受阴道镜检查或治疗程序以及治疗后的时间与生育力也没有实质联系。按年龄和吸烟状况分层,结果相似。
    结论:我们没有观察到自我报告的异常Papanicolaou检查结果,阴道镜检查,宫颈上皮内瘤变的治疗或近期可生育性的病史相关性。这些结果与大多数以前的研究相吻合,表明宫颈上皮内瘤变治疗对未来生育力影响很小。
  • 【在意大利塞维索的母女中,二恶英暴露与生育能力和不育性有关。】 复制标题 收藏 收藏
    DOI:10.1093/humrep/deaa324 复制DOI
    作者列表:Eskenazi B,Ames J,Rauch S,Signorini S,Brambilla P,Mocarelli P,Siracusa C,Holland N,Warner M
    BACKGROUND & AIMS: STUDY QUESTION:Is there an association between 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure and fecundability and infertility among Seveso women and their daughters?

    SUMMARY ANSWER:TCDD exposure is associated with a decrease in fecundability and increased risk of infertility in women, as well as their daughters.

    WHAT IS KNOWN ALREADY:In animal studies, maternal exposure to TCDD is associated with decreased fertility in offspring. Effects of TCDD are mediated by activation of the aryl hydrocarbon receptor (AHR) pathway.

    STUDY DESIGN, SIZE, DURATION:The Seveso Women's Health Study (SWHS) has followed 981 women exposed to TCDD in a 1976 accident since 1996. In 2014, we initiated the Seveso Second Generation Study to follow-up their children.

    PARTICIPANTS/MATERIALS, SETTING, METHODS:We obtained information on pregnancy history including time of trying to conceive from SWHS women and their daughters who were 18 years or older. We considered TCDD exposure as initial 1976 serum TCDD concentration and estimated TCDD at pregnancy. We examined relationships of TCDD exposure with time to pregnancy (TTP, the monthly probability of conception within the first 12 months of trying) and infertility (≥12 months of trying to conceive). We also assessed contributions of polymorphisms in the AHR pathway via genetic risk score.

    MAIN RESULTS AND THE ROLE OF CHANCE:Among SWHS women (n = 446), median TTP was 3 months and 18% reported taking ≥12 months to conceive. Initial 1976 TCDD (log10) was associated with longer TTP (adjusted fecundability odds ratio = 0.82; 95% CI 0.68-0.98) and increased risk of infertility (adjusted relative risk = 1.35; 95% CI 1.01-1.79). TCDD at pregnancy yielded similar associations. Among SWHS daughters (n = 66), median TTP was 2 months and 11% reported taking ≥12 months to conceive. Daughters showed similar, but non-significant, associations with maternal TCDD exposure.

    LIMITATIONS, REASONS FOR CAUTION:A limitation of this study is time to pregnancy was reported retrospectively, although previous studies have found women are able to recall time to conception with a high degree of accuracy many years after the fact. The number of SWHS daughters who had a live birth was small and we were unable to examine fecundability of SWHS sons.

    WIDER IMPLICATIONS OF THE FINDINGS:Consistent with previous findings in animal studies, our study found that TCDD exposure may be associated with decreased fertility in Seveso mothers and potentially in their daughters exposed in utero. There may be susceptible genetic subgroups. The literature has largely considered the genetics of the AHR pathway in the context of male fertility but not female fertility, despite strong biological plausibility. These findings should be replicated in larger populations and of different ancestry. Future studies in Seveso should examine the sons and the grandchildren of exposed mothers given the animal literature suggesting potential heritable epigenetic effects.

    STUDY FUNDING/COMPETING INTEREST(S):This study was supported by grant numbers F06 TW02075-01 from the National Institutes of Health, R01 ES07171 and 2P30-ESO01896-17 from the National Institute of Environmental Health Sciences, R82471 from the U.S. Environmental Protection Agency and #2896 from Regione Lombardia and Fondazione Lombardia Ambiente, Milan, Italy. J.A. was supported by F31ES026488 from the National Institutes of Health. The authors declare they have no actual or potential competing financial interests.

    TRIAL REGISTRATION NUMBER:N/A.

    背景与目标: 研究问题:Seveso妇女及其女儿的2,3,7,8-四氯二苯并-对-二恶英(TCDD)暴露与生育能力和不育之间是否存在关联?

    < strong>摘要答案:TCDD暴露与女性及其女儿的生育能力下降和不孕风险增加有关。

    已经知道的信息:在动物研究中,母体接触TCDD与后代生育力下降有关。 TCDD的作用是由芳烃受体(AHR)途径的激活介导的。

    研究设计,大小,持续时间:Seveso妇女健康研究(SWHS)跟踪了981名妇女暴露自1996年以来,在1976年的一次事故中导致TCDD死亡。2014年,我们发起了Seveso第二代研究,以随访他们的孩子。

    参与者/材料,设置,方法:我们获得了信息怀孕史,包括尝试从SWHS怀孕的妇女及其18岁或18岁以上女儿的时间。我们将TCDD暴露作为1976年初始血清TCDD浓度,并在怀孕时估计TCDD。我们研究了TCDD暴露与怀孕时间(TTP,尝试的前12个月内每月受孕的概率)和不孕症(≥12个月的受孕)之间的关系。我们还通过遗传风险评分评估了AHR途径中多态性的贡献。

    主要结果和机会的作用:在SWHS女性(n = 446)中,TTP中位数为3个月。 18%的人报告怀孕时间≥12个月。 1976年最初的TCDD(log10)与更长的TTP(调整的受孕几率= 0.82; 95%CI 0.68-0.98)和不孕风险增加(调整的相对风险= 1.35; 95%CI 1.01-1.79)相关。怀孕时的TCDD产生了相似的关联。在SWHS女儿中(n = 66),中位TTP为2个月,而11%的人报告怀孕时间≥12个月。女儿表现出与孕妇TCDD暴露相似但不显着的关联。

    局限性,谨慎的原因:尽管先前的研究回顾性地报道了这项研究的局限性,但该研究是怀孕时间。事实证明,事实已经很多年了,女性能够以很高的精确度回想起受孕的时间。有活产的SWHS女儿数量很少,我们无法检查SWHS儿子的生育能力。

    发现的广泛意义:与先前在动物研究中的发现一致,我们的研究发现,在塞维索(Seveso)母亲中以及在子宫内暴露的女儿中,TCDD暴露可能与生育能力下降有关。可能存在易感的遗传亚群。尽管生物学上的可信度很高,但文献在很大程度上考虑了男性生殖力而非女性生殖力的AHR途径的遗传学。这些发现应在更大的人群和不同的血统中重复使用。鉴于动物文献表明潜在的遗传后生效应,Seveso的未来研究应检查裸露母亲的儿子和孙子。

    研究资金/竞争兴趣:该研究得到了支持由美国国立卫生研究院(National Institutes of Institute)授予的F06 TW02075-01,美国国家环境卫生科学研究所(NIH)的R01 ES07171和2P30-ESO01896-17,美国环境保护局的R82471和来自米兰的Regione Lombardia和Fondazione Lombardia Ambiente的#2896 , 意大利。 J.A.由美国国立卫生研究院的F31ES026488支持。作者声明他们没有实际或潜在的竞争性财务利益。

    试验注册号:不适用。

  • 【传统摩洛哥人口(阿米兹米兹,马拉喀什)的生理成熟度,生殖方式和女性生育能力。】 复制标题 收藏 收藏
    DOI:10.1002/ajhb.1310050308 复制DOI
    作者列表:Varea C,Bernis C,Elizondo S
    BACKGROUND & AIMS: :The interaction between age at menarche, adolescent motherhood, and subfecundity were evaluated in 496 Moroccan women 25-54 years of age from the province of Marrakech. Since this population is characterized by later sexual maturation and early marriage, significantly increased subfecundity, measured by the waiting time to first live birth and the incidence of fetal loss, was expected. Menstrual age was defined as the difference between age at marriage and age at menarche. Social access to reproduction was conditioned by age at menarche: early maturers married at a younger age, while late maturers had a significantly shorter menstrual age despite the fact that married at a significantly older age. Although there was a tendency for late maturers to have longer waiting times and more fetal loss, there were no significant differences for either variable according to menarcheal age. Women with a shorter menstrual age became pregnant within the first year after marriage significantly less frequently than women with a greater menstrual age, but did not experience a greater occurrence of fetal loss during their reproductive life. The results indirectly support the hypothesis that the regularity of ovarian function is similar among populations independent of the timing of menarche. © 1993 Wiley-Liss, Inc.
    背景与目标: :对来自马拉喀什省的496名25-54岁的摩洛哥妇女进行了初潮年龄,青春期母亲年龄和生育力不足之间的相互作用的评估。由于该人群的特征是性成熟和早婚较晚,因此,以首次活产的等待时间和胎儿流失的发生率来衡量,次生育能力将显着增加。月经年龄定义为结婚年龄与初潮年龄之间的差。社会获得生殖的机会取决于初潮的年龄:早熟的人较年轻结婚,而晚熟的人尽管明显结婚,但月经年龄却短得多。尽管晚期成熟者倾向于等待更长的时间和更多的胎儿流失,但根据初潮年龄,这两个变量都没有显着差异。月经较短的妇女在结婚后的第一年内怀孕的频率明显低于月经较大的妇女,但是在生育过程中没有发生更多的胎儿流失。结果间接支持以下假设:卵巢功能的规律性在各个人群中相似,而与初潮的时机无关。 ©1993 Wiley-Liss,Inc.
  • 【具有自然观念的女性的抗苗勒氏激素水平和生育能力。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejogrb.2017.08.015 复制DOI
    作者列表:Hvidman HW,Bang AK,Priskorn L,Scheike T,Birch Petersen K,Nordkap L,Loft A,Pinborg A,Tabor A,Jørgensen N,Nyboe Andersen A
    BACKGROUND & AIMS: OBJECTIVES:To investigate the association between anti-Müllerian hormone (AMH), a well-established marker of the ovarian reserve, and time-to-pregnancy (TTP) in natural conceptions, and to assess changes in serum-AMH in early pregnancy. STUDY DESIGN:A cross sectional study comprising 279 women aged 21-42 years with a natural conception recruited during 2012-2014. AMH was measured in gestational week 10-19. AMH z-scores (z-AMH) adjusted for gestational week at blood sampling were categorised in the 1st, 2nd-4th (reference), and 5th quintile. Data were analysed by discrete-time survival-analysis and results presented as odds ratios (OR), 95% confidence interval (CI); OR <1 indicating a longer TTP and OR >1 indicating a shorter TTP. RESULTS:The median AMH-level was 23.0 (range:<3.0;144.0)pmol/l, and serum-AMH decreased by 7.5% (95% CI:-12.0%;-2.8%) per gestational week. Mean±SD female age was 30.9±3.6years. The median TTP was 2 (range: 1-32) months. After adjustment for possible confounders including total sperm count, TTP was unrelated to female age (aOR:1.0, 95% CI:0.9;1.0) and continuous z-AMH (aOR:0.8, 95% CI:0.7;1.0), but women in the low z-AMH group had a shorter TTP than the reference group (aOR:1.7, 95% CI:1.1;2.7). TTP was prolonged in preconception oral contraceptive (OC) users (aOR:0.7, 95% CI:0.5;1.0, p=0.04). Compared with women having used OC <2 years, TTP was significantly longer in women having used OC for 2-12 years (aOR:0.5, 95% CI:0.2;1.0, p=0.048) and >12 years (aOR:0.4, 95% CI:0.2;0.9, p=0.022) after age-adjustment. CONCLUSIONS:TTP was unrelated with z-AMH when modelled as a continuous covariate. Unexpectedly, TTP was shorter in the low z-AMH group. Natural conception was observed in women with a wide range of AMH-levels including women with undetectable serum-AMH. A continuous decrease in serum-AMH was observed during first and second trimester. Preconception OC-use was identified as an independent predictor of a prolonged TTP, and the duration of OC-use appeared to influence the delay in conception. Although this is presently one of the largest studies investigating the association between AMH and fecundability in fertile women, the study has some limitation including a relatively low participation rate and a risk of selection bias in addition to AMH assessment in pregnancy and a retrospective collection of TTP and OC-use associated with a risk of recall bias. These limitations may explain the unexpected finding of a shorter TTP in the low z-AMH group.
    背景与目标: 目的:研究公认的卵巢储备标志物抗苗勒氏激素(AMH)与自然受孕时间(TTP)之间的关联,并评估早孕期血清AMH的变化。
    研究设计:一项横断面研究,由279名年龄在21-42岁之间的女性组成,他们在2012-2014年期间招募了一个自然受孕的女性。在孕10-19周测量AMH。在采血时调整孕周的AMH z得分(z-AMH)分为第一,第二,第四(参考)和第五个五分位数。数据通过离散时间生存分析进行分析,结果以比值比(OR),95%置信区间(CI)表示; OR <1表示较长的TTP,OR> 1表示较短的TTP。
    结果:孕周平均AMH水平为23.0(范围:<3.0; 144.0)pmol / l,血清AMH下降了7.5%(95%CI:-12.0%;-2.8%)。女性的平均±SD年龄为30.9±3.6岁。 TTP的中位数为2(范围:1-32)个月。在对可能的混杂因素(包括精子总数)进行调整后,TTP与女性年龄(aOR:1.0,95%CI:0.9; 1.0)和持续性z-AMH(aOR:0.8,95%CI:0.7; 1.0)无关,但是女性低z-AMH组中的TTP比参考组短(aOR:1.7,95%CI:1.1; 2.7)。孕前口服避孕药(OC)使用者的TTP延长(aOR:0.7,95%CI:0.5; 1.0,p = 0.04)。与使用OC <2年的女性相比,使用OC 2至12年的女性(aOR:0.5,95%CI:0.2; 1.0,p = 0.048)和> 12岁(aOR:0.4, 95%CI:0.2; 0.9,p = 0.022)。
    结论:当以连续协变量建模时,TTP与z-AMH不相关。出乎意料的是,低z-AMH组的TTP较短。在具有广泛AMH水平的女性中观察到自然受孕,包括血清AMH不可检测的女性。在孕早期和孕中期观察到血清AMH持续下降。避孕前使用OC被确定为TTP延长的独立预测因素,并且OC使用的持续时间似乎会影响受孕的延迟。尽管这是目前调查AMH与可育妇女生育力之间关系的最大研究之一,但该研究存在一些局限性,包括相对较低的参与率和除妊娠期AMH评估和TTP回顾性收集外还有选择偏见的风险。 OC使用会带来召回偏见风险。这些局限性可能解释了在低z-AMH组中意外发现更短的TTP的原因。
  • 【2孕前队列研究中的饮食脂肪摄入量和生育能力。】 复制标题 收藏 收藏
    DOI:10.1093/aje/kwx204 复制DOI
    作者列表:Wise LA,Wesselink AK,Tucker KL,Saklani S,Mikkelsen EM,Cueto H,Riis AH,Trolle E,McKinnon CJ,Hahn KA,Rothman KJ,Sørensen HT,Hatch EE
    BACKGROUND & AIMS: :The association between dietary fat and fertility is not well studied. We evaluated intakes of total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, trans fatty acids (TFA), ω-3 fatty acids, and ω-6 fatty acids in relation to fecundability in Danish and North American preconception cohort studies. Women who were attempting to become pregnant completed a validated food frequency questionnaire at baseline. Pregnancy status was updated bimonthly for 12 months or until pregnancy. Fecundability ratios (FR) and 95% confidence intervals were estimated using multivariable proportional probabilities regression. Intakes of total fat and saturated, monounsaturated, polyunsaturated, and ω-6 fatty acids were not appreciably associated with fecundability. TFA intake was associated with reduced fecundability in North American women (for the fourth quartile vs. the first, FR = 0.86, 95% confidence interval (CI): 0.71, 1.04) but not Danish women (for the fourth quartile vs. the first, FR = 1.04, 95% CI: 0.86, 1.25), though intake among Danish women was low. In North America, ω-3 fatty acid intake was associated with higher fecundability, but there was no dose-response relationship (among persons who did not use fish oil supplements: for the fourth quartile vs. the first, FR = 1.40, 95% CI: 1.13, 1.73); no association was found in Danish women, among whom low intake was rare. In the present study, high TFA intake and low ω-3 fatty acid intake were associated with reduced fecundity.
    背景与目标: :饮食脂肪与生育能力之间的关联尚未得到很好的研究。在丹麦和北美先验队列研究中,我们评估了总脂肪,饱和脂肪酸,单不饱和脂肪酸,多不饱和脂肪酸,反式脂肪酸(TFA),ω-3脂肪酸和ω-6脂肪酸的摄入量与生育能力的关系。 。试图怀孕的妇女在基线时完成了经过验证的食物频率问卷调查。怀孕状态每两个月更新一次,持续12个月或直到怀孕。使用多变量比例概率回归估计可可行性比(FR)和95%置信区间。总脂肪和饱和,单不饱和,多不饱和和ω-6脂肪酸的摄入量与生育力没有显着相关。在北美女性中,TFA摄入与生育能力降低相关(第四个四分位数与第一个四分位数,FR = 0.86,95%置信区间(CI):0.71、1.04),但丹麦女性则没有(第四个四分位数与第一个四分位数)。 ,FR = 1.04,95%CI:0.86,1.25),尽管丹麦女性的摄入量较低。在北美,ω-3脂肪酸的摄入与较高的生育力相关,但没有剂量反应关系(在未使用鱼油补充剂的人群中:第四个四分位数与第一个四分位数的人相比,FR = 1.40,95% CI:1.13、1.73);在丹麦妇女中没有发现关联,其中低摄入量很少见。在本研究中,高TFA摄入量和低ω-3脂肪酸摄入量与生育力降低相关。
  • 【针对人乳头瘤病毒的疫苗接种对可生育性的影响。】 复制标题 收藏 收藏
    DOI:10.1111/ppe.12408 复制DOI
    作者列表:McInerney KA,Hatch EE,Wesselink AK,Mikkelsen EM,Rothman KJ,Perkins RB,Wise LA
    BACKGROUND & AIMS: BACKGROUND:The human papillomavirus (HPV) vaccine was developed to prevent infection with strains of HPV that cause cervical cancer. While HPV infection has been associated with reduced semen quality and lower pregnancy rates in some studies, no studies have examined the relationship between HPV vaccination and fecundability. We hypothesize that HPV prevention via vaccination will protect fecundity. METHODS:We analysed data from Pregnancy Study Online (PRESTO), a preconception cohort of North American pregnancy planners. Between 2013 and 2017, we followed 3483 female pregnancy planners and 1022 of their male partners for 12 months or until reported pregnancy, whichever came first. At baseline, participants reported whether they had been vaccinated against HPV and their age at vaccination. We estimated fecundability ratios (FR) and 95% confidence intervals (CI) using proportional probabilities models adjusted for sociodemographics, smoking, and abnormal Pap test before HPV vaccination (females only). RESULTS:HPV vaccination was more prevalent among females (33.9%) than males (5.2%). There was little overall association between female vaccination (FR 0.98, 95% CI 0.90, 1.08) or male vaccination (FR 1.07, 95% CI 0.79, 1.46) and fecundability. Among females with a history of sexually transmitted infections or pelvic inflammatory disease (i.e. a group at high risk of exposure to HPV infection), those vaccinated against HPV had higher fecundability than those not vaccinated (FR 1.35, 95% CI 0.99, 1.86). CONCLUSION:Although HPV vaccination had little effect on fecundability overall, HPV vaccination was positively associated with fecundability among women with a history of sexually transmitted infections.
    背景与目标: 背景:人类乳头瘤病毒(HPV)疫苗是为了防止感染导致宫颈癌的HPV株而开发的。尽管在某些研究中,HPV感染与精液质量下降和妊娠率降低有关,但尚无研究检查HPV疫苗接种与生育能力之间的关系。我们假设通过疫苗预防HPV可以保护生殖力。
    方法:我们分析了来自北美怀孕计划制定者的孕前研究在线妊娠研究(PRESTO)的数据。在2013年至2017年之间,我们追踪了3483位女性怀孕计划者和1022位男性伴侣,为期12个月或直到报告怀孕为止,以先到者为准。基线时,参与者报告他们是否已经接种过HPV疫苗和接种年龄。我们使用比例概率模型(针对女性人口统计学,吸烟和HPV疫苗接种前的子宫颈抹片检查异常)调整了比例概率模型,从而估计了生育力比率(FR)和95%置信区间(CI)(仅限女性)。
    结果:HPV疫苗接种在女性(33.9%)中比男性(5.2%)更普遍。女性疫苗接种(FR 0.98,95%CI 0.90,1.08)或男性疫苗接种(FR 1.07,95%CI 0.79,1.46)与生育能力之间的关联很少。在有性传播感染或盆腔炎病史的女性中(即高暴露于HPV感染的人群),接种过HPV的女性比未接种过的女性具有更高的生育能力(FR 1.35,95%CI 0.99,1.86)。
    结论:尽管HPV疫苗接种总体上对生育能力影响不大,但在有性传播感染史的女性中,HPV疫苗接种与生育能力呈正相关。
  • 【在妊娠建立的各个关键窗口中,尿液中的血清素选择性再摄取抑制剂:可生育性和妊娠流失的前瞻性队列研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.fertnstert.2020.06.037 复制DOI
    作者列表:Sjaarda LA,Radoc JG,Flannagan KS,Mumford SL,Kim K,Perkins NJ,Silver RM,Schisterman EF
    BACKGROUND & AIMS: OBJECTIVE:To prospectively investigate the association of selective serotonin reuptake inhibitor (SSRI) exposure through critical windows of pregnancy establishment with fecundability and pregnancy loss. DESIGN:Prospective cohort study using longitudinal urine measurements of common SSRIs while women are actively trying to conceive. SETTING:Four clinical sites. PATIENT(S):A total of 1,228 women without uncontrolled depression/anxiety, attempting natural conception while participating in a randomized trial of preconception-initiated low-dose aspirin. INTERVENTIONS(S):Not applicable. MAIN OUTCOME MEASURE(S):Urinary SSRIs (fluoxetine, sertraline, escitalopram/citalopram) were measured while trying to conceive and, for women who became pregnant, at weeks 0, 4, and 8 of pregnancy. Fecundability odds ratios and incidence of pregnancy loss and live birth were estimated. RESULT(S):A total of 172 women (14%) were exposed to SSRIs while trying to conceive. SSRI exposure was associated with 24% reduced fecundability, and accordingly, a nonsignificant 9% lower live birth incidence, with significantly lower live birth in fluoxetine-exposed women. SSRI exposure was not associated with subsequent pregnancy loss, whether exposure was before conception or at 0, 4, or 8 weeks of gestation, although estimates varied by specific SSRI drug. CONCLUSION(S):Women using SSRIs may have more difficulty becoming pregnant, and although SSRI exposure overall was not associated with pregnancy loss, fluoxetine deserves caution and future study. CLINICAL TRIAL REGISTRATION NUMBER:NCT00467363.
    背景与目标: 目的:前瞻性研究通过妊娠建立的关键窗口选择性血清素再摄取抑制剂(SSRI)暴露与生育能力和妊娠流失的关系。
    设计:在女性积极尝试受孕的同时,对普通SSRIs进行纵向尿液测量的前瞻性队列研究。
    地点:四个临床站点。
    患者:共有1,228名没有失控的抑郁/焦虑症的妇女,在参加先孕前低剂量阿司匹林的随机试验时尝试自然受孕。
    干预措施:不适用。
    主要观察指标:在尝试怀孕时测量了尿液SSRI(氟西汀,舍曲林,依他普仑/西他普仑),对于怀孕的妇女,在怀孕的第0、4和8周进行了测量。估计可生育性比值比以及流产和流产的发生率。
    结果:共有172名妇女(14%)在尝试受孕时接触了SSRI。 SSRI暴露会降低24%的生育能力,因此,氟西汀暴露的妇女的活产降低了9%,但无统计学意义。尽管估计值因特定的SSRI药物而异,但无论是在怀孕前还是在妊娠0、4或8周时,SSRI暴露都与随后的流产无关。
    结论:使用SSRIs的妇女怀孕的困难可能更大,尽管SSRIs的总体暴露与流产无关,但氟西汀值得谨慎和今后的研究。
    临床试验注册号:NCT00467363。

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