Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive

Park, Jihye; Stanford, Joseph B.; Porucznik, Christina A.; Christensen, Kylie; Schliep, Karen C.

doi:10.1016/j.psyneuen.2019.104446

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…Association Between Neighborhood Disadvantage and Decreased Fertility poorer in vitro fertilization outcomes 18 and reduced fecundability among couples attempting spontaneous conception. 19,20 Similar results have also been found for salivary α-amylase, a biomarker of stress levels, and fecundability. 21,22 To our knowledge, no studies of disadvantaged neighborhood environment have directly examined fertility-related outcomes in the US.…”

Section: Jama Network Open | Environmental Healthsupporting

confidence: 73%

Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US

et al. 2022

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IMPORTANCE Decades of inequitable policies in the US have yielded disparities in neighborhood quality, and some studies show that living in a socioeconomically disadvantaged neighborhood is associated with worse health outcomes, including reproductive health outcomes. However, no US studies to date have directly examined the association between residence in disadvantaged neighborhoods and fertility. OBJECTIVETo examine the association between residence in disadvantaged neighborhoods and fecundability, a sensitive marker of fertility with many health implications. DESIGN, SETTING, AND PARTICIPANTSThis prospective preconception cohort study used the Pregnancy Study Online, for which baseline data were collected from June 19, 2013, through April 12, 2019. The study included 6356 participants who identified as female, were 21 to 45 years of age, were attempting conception without fertility treatment, and provided a valid residential address in the contiguous US at enrollment. EXPOSURES A standardized area deprivation index (ADI) derived at the census block group level applied to each residential address.MAIN OUTCOMES AND MEASURES Fecundability, the per-cycle probability of conception, via questionnaires that were completed every 8 weeks for 12 months, until conception or a censoring event. Proportional probabilities models were used to estimate fecundability ratios and 95% CIs for associations between ADI and fecundability. Restricted cubic splines were also implemented to examine nonlinearity. Models were adjusted for demographic characteristics and factors associated with fertility. The study's a priori hypothesis was that higher levels of neighborhood disadvantage would be associated with decreased fecundability. RESULTS Among 6356 participants, 3725 pregnancies were observed for 27 427 menstrual cycles of follow-up. The mean (SD) baseline age was 30.0 (4.1) years, and most participants were non-Hispanic White (5297 [83.3%]) and nulliparous (4179 [65.7%]). Comparing the top and bottom deciles of disadvantaged neighborhood status, adjusted fecundability ratios were 0.79 (95% CI, 0.66-0.96) for national-level ADI rankings and 0.77 (95% CI, 0.65-0.92) for within-state ADI rankings. Restricted cubic splines showed some evidence of nonlinearity in the association.Associations were slightly stronger among participants with lower annual incomes (<$50 000). CONCLUSIONS AND RELEVANCEIn this cohort study, residence in a socioeconomically disadvantaged neighborhood was associated with moderately decreased fecundability. If confirmed (continued) Key Points Question Is living in a disadvantaged neighborhood associated with decreased fertility? Findings In this cohort study of 6356 women attempting to conceive without the use of fertility treatment, the probability of conception was reduced 21% to 23% per menstrual cycle when comparing the highest with the lowest deciles of disadvantaged neighborhoods. When disadvantaged neighborhood status was categorized within each state (as opposed to nationally), the results were slightly ...

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Section: Jama Network Open | Environmental Healthsupporting

confidence: 73%

Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US

et al. 2022

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“…A potential confounding factor would be acute illness or stressful events that might reduce the events of intercourse during a cycle to zero, and also might disturb or alter cycle characteristics. Only one of the cohorts (TTP) had information noted systematically for daily stress and stressful events; in a prior analysis of that cohort, higher stress did not cause reduced fecundability, but the impact on cycle characteristics was not specifically studied ( Park et al , 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of menstrual cycles with or without intercourse in women with no known subfertility

Najmabadi

Schliep

Simonsen

et al. 2022

Human Reproduction Open

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STUDY QUESTION Does sexual intercourse enhance the cycle fecundability in women without known subfertility? SUMMARY ANSWER Sexual intercourse (regardless of timing during the cycle) was associated with cycle characteristics suggesting higher fecundability, including longer luteal phase, less premenstrual spotting, and more than two days of cervical fluid with estrogen-stimulated qualities. WHAT IS KNOWN ALREADY Human females are spontaneous ovulators, experiencing a luteinizing hormone surge and ovulation cyclically, independent of copulation. Natural conception requires intercourse to occur during the fertile window of a woman’s menstrual cycle, i.e., the 6-days interval ending on the day of ovulation. However, most women with normal fecundity do not ovulate on day 14, thus the timing of the hypothetical fertile window varies within and between women. This variability is influenced by age and parity and other known or unknown elements. While the impact of sexual intercourse around the time of implantation on the probability of achieving a pregnancy has been discussed by some researchers, there are limited data regarding how sexual intercourse may influence ovulation occurrence and menstrual cycle characteristics in humans. STUDY DESIGN, SIZE, DURATION This study is a pooled analysis of three cohorts of women, enrolled at Creighton Model FertilityCare centres in the USA and Canada: “Creighton Model MultiCenter Fecundability Study” (CMFS: retrospective cohort, 1990–1996), “Time to Pregnancy in Normal Fertility” (TTP: randomized trial, 2003–2006), and “Creighton Model Effectiveness, Intentions, and Behaviors Assessment” (CEIBA: prospective cohort, 2009–2013). We evaluated cycle phase lengths, bleeding and cervical mucus patterns and estimated the fertile window in 2,564 cycles of 530 women, followed for up to one year. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were US or Canadian women aged 18–40 and not pregnant, who were heterosexually active, without known subfertility and not taking exogenous hormones. Most of the women were intending to avoid pregnancy at the start of follow-up. Women recorded daily vaginal bleeding, mucus discharge and sexual intercourse using a standardized protocol and recording system for up to one year, yielding 2,564 cycles available for analysis. The peak day of mucus discharge (generally the last day of cervical fluid with estrogen-stimulated qualities of being clear, stretchy or slippery) was used to identify the estimated day of ovulation, which we considered the last day of the follicular phase in ovulatory cycles. We used linear mixed models to assess continuous cycle parameters including cycle, menses and cycle phase lengths, and generalized linear models using Poisson regression with robust variance to assess dichotomous outcomes such as ovulatory function, short luteal phases, and presence or absence of follicular or luteal bleeding. Cycles were stratified by the presence or absence of any sexual intercourse, while adjusting for women’s parity, age, recent oral contraceptive use and breast feeding. MAIN RESULTS AND THE ROLE OF CHANCE Most women were <30 years of age (75.5%) (median 27, interquartile range 24–29), non-Hispanic White (88.1%), with high socioeconomic indicators, and nulliparous (70.9%). Cycles with no sexual intercourse compared to cycles with at least one day of sexual intercourse were shorter (29.1 days (95% confidence interval 27.6, 30.7) versus 30.1 days (95% confidence interval 28.7, 31.4)), had shorter luteal phases (10.8 days (95% confidence interval 10.2, 11.5) versus 11.4 days (95% confidence interval 10.9, 12.0)), had a higher probability of luteal phase deficiency (<10 days) (adjusted probability ratio 1.31 (95% confidence interval 1.00, 1.71)), had a higher probability of two days of premenstrual spotting (adjusted probability ratio 2.15 (95% confidence interval 1.09, 4.24)), and a higher probability of having two or fewer days of peak-type (estrogenic) cervical fluid (adjusted probability ratio 1.49 (95% confidence interval 1.03, 2.15)). LIMITATIONS, REASONS FOR CAUTION Our study participants were geographically dispersed but relatively homogeneous in regard to race, ethnicity, income and educational levels, and all had male partners, which may limit the generalizability of the findings. We cannot exclude the possibility of undetected subfertility or related gynaecologic disorders among some of the women, such as undetected endometriosis or polycystic ovary syndrome, which would impact the generalizability of our findings. Acute illness or stressful events might have reduced the likelihood of any intercourse during a cycle, while also altering cycle characteristics. Some cycles in the no intercourse group may have actually had undocumented intercourse or other sexual activity, but this would bias our results towards the null. The Creighton Model FertilityCare System (CrM) discourages use of barrier methods, so we believe that most instances of intercourse involved exposure to semen; however, condoms may have been used in some cycles. Our dataset lacks any information about the occurrence of female orgasm, precluding our ability to evaluate the independent or combined impact of female orgasm on cycle characteristics. WIDER IMPLICATIONS OF THE FINDINGS Sexual activity may change reproductive hormonal patterns, and/or levels of reproductive hormones may influence the likelihood of sexual activity. Future work may help with understanding the extent to which exposure to seminal fluid, and/or female orgasm and/or timing of intercourse could impact menstrual cycle function. In theory, large data sets from women using menstrual and fertility tracking apps could be informative if women can be appropriately incentivized to record intercourse completely. It is also of interest to understand how cycle characteristics may differ in women with gynecological problems or subfertility. STUDY FUNDING/COMPETING INTEREST(S) Funding for the research on the three cohorts analyzed in this study was provided by the Robert Wood Johnson Foundation (Creighton Model MultiCenter Fecundability Study), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Time to Pregnancy in Normal Fertility), and the Office of Family Planning, Office of Population Affairs, Health and Human Services (Creighton Model Effectiveness, Intentions, and Behaviors Assessment). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A

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“…It is important to note that the process of progressively experimenting with multiple methods to discover the effective method elicited self-doubt and stress for the women in our pilot study. A review of the literature revealed that (1) daily perceived stress was not adversely associated with time to pregnancy among women with proven fertility (Park et al 2019), and (2) that there is no difference in levels of stress between women using digital ovulation tests to time intercourse compared with women who were trying to conceive without any additional aids (Tiplady et al 2013). Furthermore, the use of fertility tracking provided benefits to participants, such as an increased understanding of the menstrual cycle as well as reassurance and confidence in focusing conception attempts on the correct time in the cycle (Tiplady et al 2013).…”

Section: Discussionmentioning

confidence: 99%

A Pilot Qualitative Case Study of Women's Experiences with Fertility Awareness-Based Methods

Capotosto

2022

Linacre Q

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This pilot qualitative case study was able to elicit rich data enabling a description of how women went through the journey of achieving pregnancy using fertility awareness-based methods. Findings underscore that women preferred using natural ways to detect ovulation and would recommend other women to do so, but with healthcare providers’ guidance. The findings of this case study can serve as a starting point to provide a framework to understand women's experiences of enduring trial and error with multiple fertility awareness-based methods before discovering their effective method. Findings emphasize the importance for healthcare providers to guide women in using fertility awareness-based methods.

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Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive

Cited by 9 publications

References 29 publications

Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US

Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US

Characteristics of menstrual cycles with or without intercourse in women with no known subfertility

A Pilot Qualitative Case Study of Women's Experiences with Fertility Awareness-Based Methods

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