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Diet and Lifestyle in the Prevention of Ovulatory Disorder Infertility

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Abstract

To evaluate the relation of a dietary pattern and other lifestyle practices to risk of ovulatory disorder infertility. We followed a cohort of 17,544 women without a history of infertility for 8 years as they tried to become pregnant or became pregnant. A dietary score based on factors previously related to lower ovulatory disorder infertility (higher consumption of monounsaturated rather than trans fats, vegetable rather than animal protein sources, low glycemic carbohydrates, high fat dairy, multivitamins, and iron from plants and supplements) and other lifestyle information was prospectively related to the incidence of infertility. Increasing adherence to a "fertility diet" pattern was associated with a lower risk of ovulatory disorder infertility. The multivariable-adjusted relative risk of ovulatory disorder infertility comparing women in the highest with women in the lowest quintile of the "fertility diet" pattern score was 0.34 (95% confidence interval 0.23-0.48; P for trend<.001). This inverse relation was similar in subgroups defined by women's age, parity, and body weight. A combination of five or more low-risk lifestyle factors, including diet, weight control, and physical activity was associated with a 69% lower risk of ovulatory disorder infertility and an estimated population attributable risk of 66% (95% confidence interval 29-86%). Following a "fertility diet" pattern may favorably influence fertility in otherwise healthy women. Further, the majority of infertility cases due to ovulation disorders may be preventable through modifications of diet and lifestyle. II.

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... Approximately 15% of women worldwide experience either primary or secondary infertility (Direkvand-Moghadam, Sayehmiri, & Delpisheh, 2014). Prevalence of ovulation problems in these couples is 18-30% (Chavarro et al., 2007b). PCOS is the most frequent endocrine disorder and the primary cause of anovulatory infertility that affects 8-13% of women in reproductive age (Bozdag, Mumusoglu, Zengin, Karabulut, & Yildiz, 2016;March et al., 2010). ...
... There is strong evidence that a healthy dietary pattern and lifestyle practices focused on specific micronutrients, increased physical activity and weight control can improve insulin sensitivity and help prevent ovulatory disorders (Chavarro et al., 2007a;Chavarro, Rich-Edwards, Rosner, & Willett, 2006;Chavarro, Rich-Edwards, Rosner, & Willett, 2008). The fertility diet score was defined according to the US Nurses' Health Study based on the study of Chavarro, Rich-Edwards, Rosner and Willett (2007b). The researchers in that study found that there is an association between risk of ovulatory dysfunction and dietary factors such as macronutrients, dairy, caffeine and alcohol (Chavarro, Rich-Edwards, Rosner & Willett, 2007b). ...
... The fertility diet score was defined according to the US Nurses' Health Study based on the study of Chavarro, Rich-Edwards, Rosner and Willett (2007b). The researchers in that study found that there is an association between risk of ovulatory dysfunction and dietary factors such as macronutrients, dairy, caffeine and alcohol (Chavarro, Rich-Edwards, Rosner & Willett, 2007b). ...
Article
We performed this case-control study with 303 polycystic ovarian syndrome (PCOS) patients and 588 age-matched controls to evaluate the relation between fertility diet score and odds of PCOS. In a fully adjusted model, the top tertile of fertility diet score compared to the bottom was associated with 22% [95%CI 0.71–0.93] lower odds of PCOS (P trend = 0.012). Ratio of monounsaturated to trans fat and vegetable protein was associated with a lower odd of PCOS. Animal protein intake and glycemic load were associated with a higher odd of PCOS. Based on our results, increasing the quality of the diet according to fertility diet score can reduce the odds of PCOS.
... Replacing animal proteins with plant proteins was also advantageous. Other important factors are low glycaemic diet, high intake of fat-rich dairy products, and provision of the right amount of vitamins and nonhaem iron in the form of plants and dietary supplements [3][4][5]. ...
... Chavarro et al. demonstrated a positive correlation between the consumption of high glycaemic index (GI) products and ovulatory infertility in the prepregnancy period in nulliparous women (i.e. women who give birth for the first time) and a negative correlation in the case of low-GI products [3]. According to the results of the study, in terms of high-GI products, female students consumed sweets and confectionery more often than male students who ate white flour products and other refined flour products more frequently. ...
... The type of protein ingested also had a significant impact on the pathogenesis of fertility disorders. It has been demonstrated that replacing 5% of animal protein energy with plant protein energy reduces the risk of ovulatory infertility by half [3,29]. Sources of plant protein include legumes, which were less often eaten by male students. ...
... Page 2 of 9 Eskew et al. Reproductive Biology and Endocrinology (2022) 20:33 Background Studies have shown that dietary patterns are associated with endometriosis, ovulatory infertility and fecundability [1][2][3][4][5]. Additionally, emerging evidence suggests that modifiable lifestyle factors, including adherence to certain dietary patterns and avoidance of environmental toxins, are associated with improved reproductive outcomes, including clinical pregnancy, spontaneous miscarriage and live birth rates, in women undergoing in vitro fertilization (IVF) [6,7]. ...
... Additionally, emerging evidence suggests that modifiable lifestyle factors, including adherence to certain dietary patterns and avoidance of environmental toxins, are associated with improved reproductive outcomes, including clinical pregnancy, spontaneous miscarriage and live birth rates, in women undergoing in vitro fertilization (IVF) [6,7]. The Fertility Diet (FD) was first described in 2007 from the Nurses' Health Study II [5]. This diet, which is characterized by lower intake of trans fat and higher intake of monounsaturated fatty acids, plant-based protein, and high-fat dairy, has been shown to associated with the lowest risk of ovulatory infertility. ...
... Adherence to predefined dietary patterns and the common dietary patterns in our cohort were calculated from each participant's daily food consumption. For the FD and PFD, points were assigned to food groups most associated with fertility, as described in Chavarro et al. and Gaskins et al., respectively [5,6]. For the PFD, pesticide residue burden was determined by pesticide residual based scoring which did not account for intake of organic produce [28]. ...
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Background Growing evidence suggests that adherence to certain dietary patterns is associated with improved fecundity and reproductive outcomes in the general population and infertile couples assisted reproductive treatments. The objective of this study was to assess if dietary patterns are associated with ovarian reserve in reproductive age women without a history of infertility. Methods This was a cross-sectional study of 185 women in the Lifestyle and Ovarian Reserve (LORe) cohort. Women aged 18–44 without a history of infertility were recruited from the local community at an academic medical center. Subjects completed validated food frequency and physical activity questionnaires to assess patterns over the year prior to presentation. Dietary patterns including a Western (including meat, refined carbohydrates, high-calorie drinks), prudent (including fruits, vegetables, olive oil and nuts), fertility (lower intake of trans fat with higher intake of monounsaturated fatty acids, increased intake of plant based protein, high-fat dairy, lower glycemic load carbohydrates and supplemental iron) and profertility diet (PFD) (characterize by whole grains, soy and seafood, low pesticide residue produce, supplemental folic acid, B12 and vitamin D) were identified through principal component analysis. Main outcome measures were serum antimullerian hormone concentration (AMH) (ng/mL) and antral follicle count (AFC) obtained by transvaginal ultrasound. Results After stratifying by BMI, adjusting for age, smoking and physical activity, dietary patterns were not associated with ovarian reserve in normal weight women. Increased adherence to a profertility diet in overweight and obese women (BMI ≥ 25 kg/m ² ) was associated with a significantly higher AMH. Women in the third and fourth quartiles of PFD adherence had a mean AMH concentration of 1.45 ng/mL (95%CI 0.33–2.56, p = 0.01) and 1.67 ng/mL (95%CI 0.60–2.74, p = 0.003) higher than women in the lowest quartile respectively. The highest adherence to PFD was also associated with a higher AFC in women with a BMI ≥ 25 kg/m ² (β = 7.8, 95%CI 0.003–15.34, p < 0.05). Other common dietary patterns were not significantly associated with ovarian reserve. Conclusions Increased adherence to a profertility diet is associated with improved markers of ovarian reserve in overweight and obese women. These findings provide novel insight on potential modifiable lifestyle factors associated with ovarian reserve.
... It is known that environmental factors influencing the reproductive functions of women include improper diet, ab-Revised manuscript accepted for publication September 12, 2018 normal physical activity, and excessive body mass [4][5][6][7][8][9][10][11][12][13][14][15][16][17]; the objective of this study was to analyse the literature in this filed. ...
... Additionally, replacing animal proteins with plant proteins is also advantageous. Other important factors are low glycemic load and index of the diet, as well as intake of fat-rich dairy products, the supply of the right amount of vitamins, and non-haem iron from both plant sources and dietary supplements [4][5][6]. ...
... The harmful effect of isomers of trans-and saturated fatty acids in the context of fertility is probably related to the adverse effects of these compounds on the activity of the peroxisome proliferator -activated receptor γ (PPAR-γ) and the effect on the expression of genes related to insulin sensitivity of adipose tissue cells. High TFAs intake have been shown to increase the risk of insulin resistance, type 2 diabetes and markers of inflammation [4,5,20] The results of NHS II have also shown a decrease in the risk of ovulatory infertility in women consuming fat-rich dairy products. This dependence is probably related to the presence of estrogens (which are involved in the regulation of the menstrual cycle) synthesized in the bodies of dairy cows, as well as of trans-palmitoleic acid. ...
... Research investigating nutritional intake and fertility has flourished over the last two decades, indicating a healthier diet during the preconception period is associated with overall improved fertility outcomes [15][16][17]. Healthier dietary patterns characterised by high consumption of beans, wholegrains, vegetables and fruits [18], greater adherence to a Mediterranean diet [19,20], higher consumption of fruits and lower intakes of fast foods [21], and lower intake of sugar sweetened beverages [22] were associated with shorter time to pregnancy, higher fecundability, higher rates of clinical pregnancy and live birth, and a reduced risk of ovulatory disorder infertility. Interestingly, the study by Chavarro et al. found that the association between the "fertility diet" score and ovulatory infertility was not modified by age, parity, or BMI, with diet composition having a greater apparent impact on fertility than BMI [18]. ...
... Healthier dietary patterns characterised by high consumption of beans, wholegrains, vegetables and fruits [18], greater adherence to a Mediterranean diet [19,20], higher consumption of fruits and lower intakes of fast foods [21], and lower intake of sugar sweetened beverages [22] were associated with shorter time to pregnancy, higher fecundability, higher rates of clinical pregnancy and live birth, and a reduced risk of ovulatory disorder infertility. Interestingly, the study by Chavarro et al. found that the association between the "fertility diet" score and ovulatory infertility was not modified by age, parity, or BMI, with diet composition having a greater apparent impact on fertility than BMI [18]. The study by Karayiannis et al. found that in non-obese women aged <35 years, a 5-point increase in the MedDietScore was associated with~2.7 times higher likelihood of achieving clinical pregnancy and live birth, but not among women ≥35 years [19]. ...
Article
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Background: Increasing age is a strong risk factor for infertility, and there is accumulating evidence of the importance of a healthier diet for fertility. Whether a healthier diet modifies the association between increasing age and infertility has not been investigated. This study aimed to (i) examine if better diet quality could help reduce age-related infertility; and (ii) assess whether changes in diet quality over time are associated with fertility problems. Methods: Data were from Surveys 3 and 5 of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health. Cross-sectional analysis with multivariable generalized linear models were used to examine the association between age and fertility status, adjusted for various confounders. Multiplicative and additive effect modification by diet quality was assessed, with additive effect modification evaluated with the relative risk for interaction (RERI). Results: In total, 3387 women were included from Survey 3 (age range 24-31 years) and 5614 women from Survey 5 (age range 30-38 years); 588 (17.4%) and 1321 (23.4%) self-reported to have fertility problems in the respective surveys. In Survey 3, compared to younger women with a good-quality diet, older women with a poor-quality diet had a 43% increased risk for fertility problems, with risk increasing after further adjustment for BMI (RR: 1.59; 95% CI: 1.07, 2.37) and PCOS (RR: 1.74; 95% CI: 1.15, 2.62). In Survey 5 in younger women (<33.9 years), there was no association between diet quality and risk for infertility problems. The RERI (across different adjusted models) was between -0.08 (-0.70, 0.55) to -0.39 (-1.40, 0.62) in survey 3 and 0.07 (-0.17, 0.31) to 0.08 (-0.17, 0.32) in Survey 5. Conclusions: There is little evidence to suggest effect modification on the effect of age and fertility problems with diet quality.
... Regarding the high trans fatty acids (TFA) content, there are conflicting studies. Chavarro and colleagues, in the previously described study, conducted in the USA from 1991 to 1995, showed that even a 2% increase in TFAs is responsible for an increased rate of infertility for ovulatory disorders [8]. However, Mumford and colleagues, in the Byocicle study, conducted in the USA from 2005 to 2007, found no association between the amount of TFAs and anovulatory disorders [9]. ...
... The Chavarro study found that protein consumption also affects fertility. In particular, it has shown that animal proteins negatively impact ovulation as they facilitate the release of insulin and IGF1 [2,8]. This is not the case with plant proteins, which increase the fertility rate in women >32 years, which has not yet been identified [6]. ...
Article
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Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, the prevalence of which ranges from 8 to 13%. It is characterized by metabolic, reproductive, and psychological alterations. PCOS prevalence is related to body mass index (BMI). Women with BMI < 25 kg/m2 have a prevalence of 4.3%, whereas women with BMI >30 kg/m2 have a prevalence of 14%. Moreover, women with PCOS have a risk of type 2 diabetes mellitus (T2DM) two-fold higher than controls, independently of BMI. Both PCOS and T2DM are also consequences of lower serum sex-hormone-binding globulin (SHBG) levels, which is currently considered a biomarker of metabolic disorders, in particular T2DM. Aim: To evaluate the effect of the very-low-calorie ketogenic diet (VLCKD) on markers suggested to be predictive of metabolic and ovulatory dysfunction. These comprehend SHBG, anti-Mullerian hormone (AMH), and progesterone levels on day 21 of the menstrual cycle in a cohort of obese non-diabetic women with PCOS and regular menses. Methods: Twenty-five patients (mean age 25.4 ± 3.44 years) with obesity and PCOS underwent VLCKD for 12 weeks. Each of them underwent measurements of anthropometric parameters (body weight, height, and waist circumference) and blood testing to evaluate serum levels of SHBG, AMH, and progesterone before and after 12 weeks of VLCKD. Results: At enrollment, all patients had high BMI, WC, and AMH, whereas SHBG and progesterone levels were low. After VLCKD, the patients showed a significant reduction in BMI, WC, and HOMA index. In particular, 76% of patients (19/25) switched from obesity to overweight, and the HOMA index normalized, reaching values lower than 2.5 in 96% (24/25) of patients. In addition, serum AMH levels significantly decreased, and progesterone and SHBG significantly increased after VLCKD. Conclusion: This is the first study documenting the effects of VLCKD on ovarian reserve and luteal function in women with PCOS. VLCKD could be used to improve metabolic and ovulatory dysfunction in women with PCOS. Further studies are needed to understand the reasons for the AMH reduction.
... It appears that intense physical activity may affect ovarian function and thus impair a woman's fertility. However, a previous study on ovulatory infertility found that a woman's risk of ovulatory infertility decreased with an increase of physical activity (14). Because previous studies have shown that moderate intensity physical activity has little effect on menstrual characteristics, and the health benefits of appropriate physical activity are well-known, some scientists believe that a certain level of physical activity will have a positive impact on fertility, but beyond a certain threshold, this may have a detrimental impact (15). ...
... will have a negative impact on female fertility. However, a study in a large cohort of American women found that increased levels of vigorous activity were associated with a reduced relative risk of ovulatory infertility (37); the same conclusion was reached in another study investigating lifestyle and ovulatory infertility (14). However, these two articles focused on ovulatory infertility. ...
Article
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Objective Subfertility is a common problem for couples in modern society. Many studies have confirmed that lifestyle factors can affect fertility although there are conflicting conclusions relating to the effects of physical activity and sleep duration on fertility. In this study, we aimed to summarize and analyze the available evidence. Methods PubMed, Web of Science, Cochrane, and Embase databases (as of October 14, 2022) were systematically searched for eligible prospective cohort studies. Data were extracted and effect values were combined. We also performed methodological quality and bias risk assessments for all the included studies. Results A total of 10 eligible articles were included in our analysis; seven investigated the relationship between physical activity and fertility, and three investigated the effect of sleep duration on fertility. Compared with the lowest level of physical activity, high intensity physical activity (the highest levels of physical activity) was negatively correlated with fertility [odds ratio (OR) = 0.84; 95% confidence interval (CI): 0.70, 1.00, I ² = 64%]. However, we did not find an association between moderate intensity physical activity and fertility (OR = 1.09; 95% CI: 0.98, 1.22, I ² = 60%). We observed an inverse association between limited sleep duration (≤ 7 h) and fertility (OR = 0.92; 95% CI: 0.84, 1.00, I ² = 0%) compared with 8 h of sleep. The relationship between long sleep duration (≥9 h) and fertility was not statistically significant (OR = 0.85; 95% CI: 0.60, 1.21, I ² = 83%). According to the Newcastle-Ottawa Scale score, the overall quality of the research articles included was ranked as medium to high (6–9). Through GRADE system, the quality of evidence for the impact of high intensity physical activity and limited sleep duration on fertility was moderate, while the quality of evidence for the impact of moderate intensity physical activity and long sleep duration on fertility was low. Conclusion The current evidence shows that high intensity physical activity and limited sleep time are negatively related to fertility. But there was great heterogeneity among studies, and the quality of research evidence was low to median. Thus, further high-quality research is needed to confirm this conclusion. PROSPERO registration number CRD42022298137.
... These factors can be nonmodifiable such as age (25)(26)(27), irregular menstrual cycles (28)(29)(30)(31), and some genetic factors (32)(33)(34). Then there are several modifiable lifestyle factors that can affect fertility including diet (35)(36)(37), caffeine (38)(39)(40), alcohol consumption (29)(30)(31), body mass index (41)(42)(43), exercise (41,43,44), sexually transmitted infections (45,46), and stress and psychological state (47,48). Some of these important risk factors and causes, along with their biological mechanisms are outlined below. ...
... Proper diet, healthy exercise and weight loss management have been shown in studies to help treat PCOS, increase fecundability and increase odds of natural conception by facilitating spontaneous ovulation (49). However, a bad "fertility" diet from one study included higher intake of trans fats and animal protein, lower intake of high-fiber, plant-based iron and multivitamin use showed to increase the risk of anovulatory infertility (35,36). While vigorous exercise can improve fertility among overweight and obese women, women with normal BMI that exercise vigorously everyday including cycling, running and swimming have increased odds of anovulatory infertility (43,60). ...
Thesis
Tobacco smoke exposures and fertility-related outcomes among females seeking fertility care, and the interaction with N-Acetyltransferase 2 (NAT2)..
... Indeed, in females, reproduction and metabolism are tightly connected and reciprocally regulated (Fontana and Torre, 2016). Body weight, body composition, physical activity, and diet are all factors that can influence female fertility (Chavarro et al., 2007). Overweight or underweight women have the same risk of infertility and ovulatory disorders (Chavarro et al., 2007). ...
... Body weight, body composition, physical activity, and diet are all factors that can influence female fertility (Chavarro et al., 2007). Overweight or underweight women have the same risk of infertility and ovulatory disorders (Chavarro et al., 2007). More specifically, lipid metabolism is essential for ovarian function and supports oocyte quality (Dunning et al., 2014). ...
Article
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Bisphenol A (BPA), an endocrine disruptor, has been replaced by structural analogues including bisphenol S (BPS). BPA and BPS exhibited similar effects regarding reproductive functions. Moreover, metabolic status and lipid metabolism are related to female fertility and could worsen BPS effects. The objective was to determine BPS in vivo effects on folliculogenesis and embryo production after chronic exposure through diet, and the influence of metabolic status in adult ewes. Sixty primiparous 2.5 year-old ewes, undergoing a restricted or well fed diet, were exposed to BPS (0, 4 or 50 µg/kg/day) for at least three months. After hormonal oestrus synchronisation and ovarian stimulation, ewes were subjected to ovum pick-up (OPU) procedures to collect immature oocytes, that underwent in vitro maturation, fertilisation and embryo production. Body weight, body condition score and plasma glucose were higher in well-fed compared to restricted ewes, while plasma NEFA was lower during the 4–5 months after the beginning of the diets. Plasma progesterone levels increased on day 5 before OPU session in well-fed compared to restricted ewes. No effect of BPS dose was observed on follicle population, plasma AMH levels and embryo production numbers and rates. However, a significant diet x BPS dose interaction was reported for cleaved embryos, > 4-cell embryos, blastocyst and early blastocyst numbers, and plasma triiodothyronine levels. Our study showed that a contrasted diet did not affect follicle population nor embryo production in adult ewes but could affect the quality and progesterone secretion of the corpus luteum. Chronic low BPS exposure had no effect on follicular population and oocyte competence. Nevertheless, the significant diet x dose interactions observed on embryo production suggest that BPS effect is modulated by metabolic status. Further studies are required to assess the risk of BPS exposure for public reproductive health.
... Powszechnie wiadomo, że stan odżywienia i zdrowie kobiety ma wpływ na jej organizm przez całe jej życie, warunkując u dziewczynek w okresie dojrzewania właściwy wzrost, rozwój i prawidłowość procesów rozrodczych w wieku dorosłym. Najnowsze wyniki badań wskazują, że sposób żywienia oraz inne składowe stylu życia mają udział w procesie zapłodnienia oraz mogą stanowić czynnik ryzyka wystąpienia niepłodności (Chavarro i wsp., 2007). Do żywieniowych czynników wpływających na płodność zalicza się odpowiedni poziom spożycia witamin A, E i C, witamin z grupy B oraz składników mineralnych, takich jak m.in. ...
... • odpowiednie spożycie jednonienasyconych kwasów tłuszczowych, pochodzących ze źródeł roślinnych, takich jak oliwa z oliwek i olej rzepakowy oraz miękkie margaryny z nich wytwarzane; • unikanie izomerów trans kwasów tłuszczowych obecnych zazwyczaj w dużej ilości w takich produktach, jak: twarde margaryny, przemysłowo wytwarzane ciasta i ciasteczka, batoniki, czekolady, żywność typu fast-food, frytki, chipsy i zupy w proszku. Wysoki poziom ich w diecie wiąże się z większym ryzykiem niepłodności spowodowanej zaburzeniami owulacji, co wynika prawdopodobnie z przyczyniania się tych kwasów do zwiększenia oporności na insulinę, a także do nasilenia procesu zapalnego; • zwiększenie udziału w diecie białka roślinnego; • wybieranie produktów o niskim indeksie glikemicznym (Chavarro i wsp., 2007;Szostak-Węgierek, 2011). Kolejnym ważnym aspektem w kontekście płodności kobiet jest ich masa ciała. ...
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W tej monografii Czytelnik znajdzie 12 prac z trzech obszarów zdrowia kobiet. Pierwszym obszarem będzie problematyka zdrowia w kontekście biomedycznym. Autorzy prezentują wybrane choroby i zagrożenia dla zdrowia kobiet w ujęciu epidemiologicznym i klinicznym, wskazując na specyfikę diagnozy i leczenia chorób kobiecych. Drugi nurt naukowych rozważań odbywa się w odniesieniu do społecznych ról kobiet. Przyjmowane przez kobiety role opiekuńcze: matki, córki, pielęgniarki oznaczają duży wysiłek i generują lęki, napięcie i poczucie odpowiedzialności za zdrowie innych. Ten stres społeczny odciska piętno na zdrowiu subiektywnym i obiektywnym. Trzecim obszarem jest budowanie zdrowia w kontekście kultury współczesnej, kształtowanie wizerunku ciała kobiet, influencerów i followersów, uwypuklając przy tym możliwości „naprawcze” nowoczesnych mediów.
... It is wellknown that nutrition can play an important role in altering fertility-related outcomes in both men and women. In a large prospective cohort of 17,544 women in Nurses' Health Study (NHS)-II, after controlling for certain confounders [age, body mass index (BMI), alcohol intake, coffee intake, smoking, and oral contraceptive use], women with the highest intake of a fertility diet [comprised of full-fat dairy foods, iron (Fe), monounsaturated fats, and plant protein] during the preconception period, were found to have a 66% lower risk of infertility related to ovulatory disorders and a 27% lower risk of infertility due to other causes compared to women with the lowest intake of this type of diet (Chavarro et al., 2007). While there is growing evidence that nutrition may be associated with reproductive outcomes in both sex, there is still no official guidelines for reproductive-aged couples (Rossi et al., 2016). ...
... Similarly, high intake of dairy products in healthy young men has been related to lower concentrations of TT, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) which affect fertility (Nassan et al., 2018). In the NHS-II study, a prospective cohort of United States nurses, there was no relation between total dairy intake and risk of ovulatory infertility; however, anovulatory infertility was inversely associated with highfat and positively associated with low-fat dairy intake (Chavarro et al., 2007). In a more recent study "biocycle study", anovulation was more common among women with higher intake of yogurt and cream (Kim et al., 2017). ...
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Infertility is defined as the inability to conceive after 12 months of unprotected intercourse or six months for women aged 35 years or older. The physical, emotional, psychological, and financial statuses of infertile couples are tremendously affected especially after undergoing diagnostic and/or curative treatments. Human fertility is influenced by multiple factors including female or male, and modifiable or non-modifiable factors. There is growing evidence that nutri-tion may play an important role in adjusting fertility-related outcomes in both men and women. The objective of our study was to summarize the latest data on nutritional factors (specific food groups, nutrients, and nutritional supplements) that have an impact on female or male sexual and reproductive function. PubMed and Google Scholar platforms were used to collect appropriate articles for the review using several combinations of keywords (infertility, diet, dietary supplements, antioxidants, and beverages). Adherence to a healthy dietary pattern favoring fish, poultry, whole grains, fruits, vegetables, and healthy fats, was related to better fertility in both genders. Despite the multifactorial etiology of sexual infertility, nutrition may affect the sexual/reproductive function in both women and men.
... Hormonlu gıda tüketimi ovulasyonu baskıladığı için infertilite oluşma riskini arttırır. [6,7] Obez kadınlarda doğurganlık normal kilodaki kadınlara oranla daha azdır. [6,8] Aşırı egzersiz yapmak ise fertiliteyi olumsuz yönde etkilemektedir. ...
... [6,8] Aşırı egzersiz yapmak ise fertiliteyi olumsuz yönde etkilemektedir. [6][7][8][9][10] Kadınlarda alkol tüketimi östrojen ve progesteron düzeyini olumsuz yönde etkiler. Alkol tüketmek anovulasyona neden olur. ...
... Studies have shown a strong correlation between dietary patterns and nutrient intake and reproductive outcomes for women (Astrup et al., 2008;Nalavade et al., 2016). An inadequate intake of protein, carbohydrates, dairy foods, iron, fatty acids and multivitamins is related to ovulation disorder, which is a cause of infertility (Chavarro et al., 2007). Certain diets may increase the risk of infertility in women. ...
... Other studies have posited similar findings. It has been reported that the consumption of plant-based diets like vegetables and fruit enhances the chances of natural conception and reduces time to pregnancy (Chavarro et al., 2007;Nalavade et al., 2016;Grieger et al., 2018). A study investigating the association between the consumption of dairy products and fertility concluded that the daily consumption of milk lowers the risk of infertility among women (Greenlee et al., 2003). ...
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This study assessed the rate of primary infertility and its associated factors among 402,807 currently married women aged 20–49 years in India using National Family Health Survey-4 data collected in 2015–2016. Dietary patterns and selected morbidities were included as independent variables, and socioeconomic variables were considered as covariates. Bivariate and multivariate analyses were done to estimate the prevalence of primary infertility and assess its association with the selected variables, respectively. The rate of primary infertility among currently married women in India in 2015–16 was 1.9% and this was significantly associated with younger age (<35 years), higher age at marriage (≥18 years), urban residence, higher secondary or above education and poverty. The consumption of dairy products (OR = 0.79, CI = 0.73–0.86), dark green leafy vegetables (OR = 0.57, CI = 0.39–0.81) and fruit (OR = 0.88, CI = 0.77–1.01) significantly reduced the odds of primary infertility. Daily consumption of fish and aerated drinks was related to 1.06–1.21 times higher odds of primary infertility. Overweight/obesity, high blood pressure and high blood glucose levels were associated with 1.08–1.21 times elevated odds of primary infertility. Thyroid disorder (OR = 1.38, CI = 1.21–1.60), heart disease (OR = 1.17, CI = 1.16–1.19) and severe anaemia (OR = 1.24, CI = 1.00–1.53) were associated with an increased likelihood of primary infertility among women (OR 1.17–1.39, CI 1.00–1.60). The findings provide compelling evidence that primary infertility among women is related to dietary patterns and morbidities. Interventions and programmes targeting the promotion of healthy diets and lifestyles could be beneficial in addressing the issue of primary infertility among women.
... A major part of infertility can be prevented by changing one's diet and lifestyle (Chavarro et al., 2007a(Chavarro et al., , 2007bSacha et al., 2018). In a cohort study of fertile women (n ¼ 17,544), a combination of lifestyle interventions, including diet and weight management and a physically active lifestyle, was associated with a 69.0% ...
... In a cohort study of fertile women (n ¼ 17,544), a combination of lifestyle interventions, including diet and weight management and a physically active lifestyle, was associated with a 69.0% lower risk of ovulation infertility (Chavarro et al., 2007a). In addition, ovulatory infertility cases may reduce with positive lifestyle changes, including weight control, physical activity, and diet intervention (Chavarro et al., 2007b). ...
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Obesity in both women and men is regarded as one of the many factors that may contribute to impaired reproductive health. Obesity can be accompanied by several neuroendocrine and ovar-ian dysfunctions, including chronic oligo/anovulation, menstrual irregularities, subfertility, and the increased risk of pregnancy in women. Insulin resistance, elevated triglyceride and fatty acid levels, and the secretion of adipocytokines caused by the excessive accumulation of adipose tissue associated with obesity adversely affect reproductive functions. Alterations in sperm quality and motility and hormone levels related to a rise in body mass index (BMI) may predispose men to infertility. The mechanisms of action of obesity on male infertility include endocrinop-athy, erectile dysfunction, epididymitis, increased leptin and adipocytes, increased aromatase, inflammatory cytokines secreted by fat tissue, and sperm DNA fragmentation. This study reports that an increased BMI may lead to low semen quality, poor sperm motility, and reduced fertilization rates in men as well as anovulation, pregnancy loss, diminished pregnancy, and low live birth rates in women. Having optimal weight with balanced nutrition enables one to maintain a continuity of reproductive health throughout the entire life cycle, which is extremely important in terms of having a healthy embryo, including pre-foetal life, in the continuity of pregnancy and having a live birth. ARTICLE HISTORY
... Prior studies have reported associations of dietary scoring systems, including the "fertility diet" (6) and Mediterranean-style dietary patterns (7), with infertility and clinical pregnancy rates among couples receiving infertility treatment. Three of 4 studies found that greater adherence to the Mediterranean diet was associated with an increased probability of clinical pregnancy (8)(9)(10)(11). ...
... Three of 4 studies conducted in couples undergoing infertility treatment found that greater adherence to the Mediterranean diet was associated with greater probability of clinical pregnancy (8)(9)(10)(11). Investigators from the Nurses' Health Study II (NHS II), a large prospective cohort in the United States, derived the "fertility diet," a dietary pattern used to predict the risk of ovulatory infertility (6). In the NHS II, women with the greatest adherence to the fertility diet had lower risk of ovulatory infertility. ...
Article
Background Diet is increasingly recognized as an important determinant of human fertility, with most research focused on specific nutrients or food groups. However, there has been limited assessment of the effect of dietary patterns on fertility. Objectives We evaluated the association between 4 dietary patterns [the alternative Mediterranean Diet (aMed), the Healthy Eating Index-2010 (HEI-2010), the Danish Dietary Guidelines (DDGI), and the Dietary Inflammatory Index (DII)] and fecundability in 2 preconception cohorts of couples trying to conceive: SF (SnartForaeldre.dk) in Denmark and PRESTO (Pregnancy Study Online) in North America. Methods Participants completed a baseline questionnaire on sociodemographic, anthropometric, and lifestyle factors and, 10 d later, a validated cohort-specific FFQ. We used data from these respective FFQs to calculate adherence to each dietary pattern. Participants completed bimonthly follow-up questionnaires for ≤12 mo or until pregnancy, whichever came first. We restricted analyses to 3429 SF and 5803 PRESTO participants attempting pregnancy for ≤6 cycles at enrollment. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs, adjusting for potential confounders. Results Greater DII, indicative of a less anti-inflammatory diet (i.e., poorer diet quality), was associated with reduced fecundability in both SF and PRESTO (DII ≥ −1.5 compared with < −3.3: FR: 0.83; 95% CI: 0.71, 0.97 and FR: 0.82; 95% CI: 0.73, 0.93, respectively). In PRESTO, greater adherence to the aMed or to the HEI-2010 was associated with greater fecundability. In SF, there was no appreciable association between the aMed and fecundability, whereas greater adherence to the DDGI was associated with greater fecundability. Conclusions In prospective preconception cohort studies from Denmark and North America, higher-quality diets, including diets lower in inflammatory effects, were associated with greater fecundability.
... Obesity and infertility are in growing prevalence in the world, being considered as concerning public health conditions [1][2][3][4]. Also, the weight excess has a well-known negative impact on female fertility, mainly related to ovulation disorders [5]. ...
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Background The aim of this study was to evaluate the influence of the body mass index (BMI) on laboratory, clinical outcomes and treatment costs of assisted reproduction, as there are still controversial and inconclusive studies on this subject. Methods This research was retrospective cohort study, including women undergoing assisted reproduction in a Reproductive Medicine Center between 2013 and 2020. The participants were divided into groups according to BMI (kg/m ² ): Group 1 < 25; Group 2, 25–29.9 and Group 3, ≥ 30. A total of 1753 in vitro fertilization (IVF) fresh embryo transfer (ET) cycles were included for assisted reproduction outcomes analysis and 1869 IVF-ET plus frozen embryo transfer (FET) for cumulative pregnancy analysis. Results As higher the BMI, higher was the proportion of canceled IVF cycles (G1 (6.9%) vs. G2 (7.8%) vs. G3 (10.4%), p = 0.002) and gonadotropin’s total dose (IU) and treatment costs (G1 (1685 ± 595, U$ 683,02) vs. G2 (1779 ± 610, U$ 721,13) vs. G3 (1805 ± 563, U$ 764,09), p = 0.001). A greater number of mature oocytes was observed in G1 and G2 (6 [6.4–7.0] vs. 6 [5.6–6.6] vs. 4 [4.6–6.7], p = 0.011), which was not found in oocyte maturity rate ( p = 0.877). A significant linear tendency ( p = 0.042) was found in cumulative pregnancy rates, pointing to worse clinical outcomes in overweight and obese patients. Conclusion These findings highlight the importance of considering the higher treatment costs for these patients, beyond all the well-known risks regarding weight excess, fertility, and pregnancy, before starting IVF treatments.
... A recent study on women suffering from anovulatory infertility reports an inverse correlation with adherence to the FD, body weight control, and physical activity [15]. ...
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Background The importance of nutrition in reproductive health is widely acknowledged with special emphasis given to periconceptional maternal diet and its implications on embryo-fetal development, pregnancy complications, and the health of the offspring. Methods Following the PRISMA guidelines, we searched for literature in PubMed, CINAHL, and WoS to gather newer information on how diet composition influences the concepts from the very early stages of pregnancy and how maternal health may be affected as well. Fifty-six studies published up to June 2020 met the inclusion criteria. Results With its proportioned and diversified macronutrient composition, the Mediterranean Diet prevents congenital anomalies, preterm birth, hypertensive disorders, and gestational diabetes. Similar dietary patterns rich in vegetables, nuts, fish, and cereals increase the likelihood of conception and have a protective action, mediated by their antioxidant properties, against orofacial clefts, congenital heart and limb defects in the progeny. Conversely, the pro-inflammatory features of western diets, rich in processed foods and low in fruit content, diminish fertility, increase miscarriage rates, and enhance the risk of neural tube defects regardless of folate supplementation. Conclusions It may be concluded that within the multiple dietary options, some of them are soundly associated with beneficial effects for the mother and the newborn. • Implications for practice • An appropriate counseling must be offered to the woman of fertile age to make her aware of how periconceptional nutrition may help fulfill her reproductive expectations.
... For example, the TMD was specifically created to investigate the relationship of the Mediterranean dietary pattern with the overall mortality in a Greek population (37). Although there are already some described dietary patterns specifically created to evaluate outcomes of assisted reproduction, in this study we only considered eight of the most-used generally healthy dietary pattern scores (67,68). The principal strength of the present study is its prospective design as it relates to ART outcomes. ...
Article
Objective To investigate whether men's adherence to dietary patterns promoted for the prevention of cardiovascular disease is associated with semen parameters and couples’ assisted reproductive technology (ART) outcomes. Design Prospective cohort study. Setting Fertility center at an academic medical center. Patient(s) A total of 245 men and their female partners who underwent 438 ART cycles between 2007 and 2020. Intervention(s) Male pretreatment dietary intake was assessed with a 131-item food frequency questionnaire from which we calculated eight a priori defined scores: Trichopoulou Mediterranean, Alternate Mediterranean, Panagiotakos Mediterranean, Healthy Eating Index, Alternative Healthy Eating Index, American Heart Association, Dietary Approaches to Stop Hypertension, and Plant-based. Main Outcome Measure(s) The primary outcome was live births per treatment cycle. The secondary outcomes were fertilization, implantation, and clinical pregnancy and seminogram parameters. Result(s) There was an inverse association between greater adherence by men to the Panagiotakos Mediterranean diet and the American Heart Association dietary pattern and lower fertilization rate. However, there were no significant associations between men’s adherence to any of the analyzed dietary patterns and the probabilities of implantation, clinical pregnancy, or live birth in multivariable-adjusted models. No significant differences in any of the semen parameters were found between participants of the lowest quartile and those of the highest quartile of the eight dietary patterns. Conclusion(s) These findings suggest that men’s adherence to several a priori defined dietary scores with documented cardiovascular benefits is not related to major outcomes of infertility treatment with ART or semen quality.
... Several elements can have an impact on the overall state of reproductive health and these can be addressed by a change of dietary or lifestyle habits or by the inclusion of supplements. This has spurred the advent of a plethora of physical training routines combined with fertility diets that can lower the risk of ovulatory infertility [233] and increases the rates of sustained pregnancies [234]. ...
Article
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Humans’ health is the result of a complex and balanced interplay between genetic factors, environmental stimuli, lifestyle habits, and the microbiota composition. The knowledge about their single contributions, as well as the complex network linking each to the others, is pivotal to understand the mechanisms underlying the onset of many diseases and can provide key information for their prevention, diagnosis and therapy. This applies also to reproduction. Reproduction, involving almost 10% of our genetic code, is one of the most critical human’s functions and is a key element to assess the well-being of a population. The last decades revealed a progressive decline of reproductive outcomes worldwide. As a consequence, there is a growing interest in unveiling the role of the different factors involved in human reproduction and great efforts have been carried out to improve its outcomes. As for many other diseases, it is now clear that the interplay between the underlying genetics, our commensal microbiome, the lifestyle habits and the environment we live in can either exacerbate the outcome or mitigate the adverse effects. Here, we aim to analyze how each of these factors contribute to reproduction highlighting their individual contribution and providing supporting evidence of how to modify their impact and overall contribution to a healthy reproductive status.
... Specifically, "healthy" diets are associated with better fertility and higher live birth rate in assisted reproductive technology studies [4]. The majority of infertility cases caused by ovulation-related disorders may be preventable or improved by modifications in diet and lifestyle [5]. Long-chain Omega-3 fatty acids are one of the "healthy" dietary components that appear to improve female fertility [4,6]. ...
Article
Background: Female infertility is a health issue for both humans and animals and despite developments in medical interventions, there are still some conditions that cannot be treated successfully. It is important to explore other potential therapies or remedies that could improve reproductive health. Choline is an over-the-counter supplement and essential nutrient that has many health benefits. It has been suggested to be beneficial in various aspects of fertility, including fetal development and endocrine disorders like polycystic ovarian syndrome (PCOS). However, choline's impact on ovarian function has not been explored. Methods: To study the effects of choline on ovarian development, 36 female Yorkshire × Landrace pigs were fed the following four supplemented diets between 90 and 186 days of age: (1) Control (corn and soybean meal-based diet that met estimated nutrient requirements, n = 9); (2) Choline (additional 500 mg choline per 1 kg of control diet, n = 8); (3) Omega-3 (additional 5556 mg Omega-3 per 1 kg control diet by introducing fish oil); (4) Choline + Omega-3 (500 mg choline + 5556 mg Omega-3 per 1 kg control diet). Pigs fed the choline-supplemented diet were compared to the control group and those fed diets supplemented with Omega-3 as fertility-promoting agent. Results: It was found that the number of corpus luteum per ovary in the Choline (16.25 ± 2.88), Omega-3 (10.78 ± 1.71) and Choline + Omega-3 (14.89 ± 2.97) groups were all higher in comparison to that of the control group (5.56 ± 1.72, p < 0.05). The percentage of antral follicles in the Choline + Omega-3 group were higher compared to the control group (p < 0.05). To elucidate the potential molecular mechanism of choline on these improved ovarian phenotypes, the expression of a group of genes that are involved in ovarian development, including cytochrome P450 family 11 subfamily A member 1 (CYP11A1), follicle stimulating hormone receptor (FHSR) and luteinizing hormone receptor (LHR), was analyzed using RT-qPCR. The expression of both LHR and CYP11A1 was significantly upregulated in the choline-supplemented group (p < 0.05), while there are no differences in FSHR expression among all the groups. Additionally, the expression of miR-21, -378, -574, previously found to be important in ovarian function, were examined. Our data showed that miR-574 was upregulated in the Choline group while miR-378 was upregulated in the Choline + Omega-3 group in comparison to the control group (p < 0.05). Further, serum metabolite analysis showed that 1-(5Z, 8Z, 11Z, 14Z, 17Z-eicosapentaenoyl)-sn-glycero-3-phosphocholine, a form of phosphatidylcholine metabolite, was significantly increased in all the treatment groups (p < 0.05), while testosterone was significantly increased in both Omega-3 and Choline + Omega-3 groups (p < 0.05) and tended to be reduced in the choline-supplemented group (p = 0.08) compared to the control group. Conclusions: Our study demonstrated choline's influence on ovarian function in vivo, and offered insights into the mechanisms behind its positive effect on ovarian development phenotype.
... Bhattacharya (17) stated that any level of progesterone more than 3 ng/mL confirms ovulation. Results from the Nurse's Health Study indicate reduced risk of ovulatory infertility in women doing vigorous exercise for at least 30 min daily (55). Also, a report of a cohort study indicated a 7% relative risk reduction for ovulatory infertility for each additional hour of vigorous exercise per week in normalweight women (56). ...
Article
There is a traditional believe that if premenopausal women engage in prolonged physical exercise, they are likely to have infertility. This study assessed the effect of prolonged moderate – vigorous exercise on ovarian reserve and ovulatory status in premenopausal students of Nnamdi Azikiwe University, Nnewi Campus. The objectives were to determine the effect of moderate – vigorous intensity exercise on Anti-Mullerian hormone (AMH), day 3 Follicle stimulating hormone (FSH), Luteinizing Hormone (LH), day 3 Estrogen, day 21 Estrogen, and day 21 Progesterone levels in premenopausal women. This was a prospective comparative study involving 80 participants aged between 19 and 25 years, randomly selected and assigned to exercise group and control group. The exercise group comprised 40 participants who engaged in moderate – vigorous intensity exercise using elliptical bike for 30 minutes, five days a week for 3 months; however, 30 individuals completed the exercise. The control group comprised of 40 individuals that did not do exercise but 30 individuals completed the study. Blood (8ml) was collected from each of the participants at baseline, 1 month, 2 months, and 3 months. AMH, FSH, LH, Estrogen and Progesterone levels were analyzed using enzyme- linked Immunosorbent assay (ELISA) method. Results were regarded as significant at p˂ 0.05. In the exercise group, the serum level of day 3 FSH, LH, Estrogen were significantly lower from 7.27±0.77 mIU/ml, 7.00±0.77 mIU/ml, 36.33±5.13 pg/ml respectively at baseline to 5.62±0.48 mIU/ml, 5.36±0.80 mIU/ml, 21.36±4.34 pg/ml respectively after 3 months of exercise while there was significantly higher levels of AMH and day 21 progesterone after 3 months of exercise compared with the baseline and respective control (p<0.05). Prolonged Moderate-to-vigorous exercise may enhance fertility and well-being of premenopausal women. Key words: Anti-Mullerian hormone (AMH), day 3 Follicle stimulating hormone (FSH), Luteinizing Hormone (LH), day 3 Estrogen, day 21 Estrogen, day 21 Progesterone, moderate – vigorous exercise, ovarian reserve, ovulatory status, premenopausal women.
... When marine invertebrates and copepods, which are a link between primary producers and higher trophic levels, are fed on mixed diatom and dinoflagellates diets, they undergo reproductive failures in terms of oocyte maturation, sperm motility, fertilization, embryo development, malformed hatching, and larval survival [174][175][176][177][178]. Otherwise, a recent example of growth-promoting effects of fucoidan dietary supplementation has been highlighted in aquatic organisms, livestock, and humans [179]. A nutritious/well-balanced diet and maintenance of a healthy weight have been shown to lower the risk of infertility in males and females [180,181]. Weight loss and improved insulin sensitivity in obese women may induce metabolic improvement, significant ovulation resumption, and reduce perinatal risks, and, interestingly, the combination with bariatric surgery has been suggested to enhance these potential benefits [182]. ...
Article
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Reproductive health is progressively declining due to multiples endogenous and exogenous factors, such as environmental contaminants, diet and behavior. Accumulated evidences confirm that fertility and reproductive function have been adversely affected by exposure to chemical contaminants released in the environment. Today, the impact of diet and behavior on reproductive processes is also receiving special attention from the scientific community. Indeed, a close relationship between diet and fertility has been proven. Furthermore, a combination of unhealthy behavior, such as exposure to hazardous compounds and stress factors, poses living organisms at higher risk of reprotoxic effects. In particular, it has been described that poor life behaviors are associated with reduced male and female fertility due to decreased gamete quality and function. Most of the erroneous behaviors are, furthermore, a source of oxidative stress that, leading to epigenetic alterations, results in an impaired reproductive fitness. This review reports the detrimental impact of the most common environmental chemical stressors, diet, and behavior on reproductive functionality and success. Although clear evidences are still scarce, reassuring data are provided that a healthy diet and reverting unhealthy lifestyles may be of help to recover physiological reproductive conditions.
... Nutrition is also one of the factors that should be supported. Nutritional habits were also evaluated under the category of high-risk behaviors, because nutritional disorders, being overweight or too weak, can cause infertility, as well as negatively affecting the treatment process (Chavarro et al., 2007). The importance of nutrition in both prevention and treatment of infertility in female and male individuals has been emphasized, especially in recent years, drawing attention to balanced nutrition (González-Rodríguez et al., 2018). ...
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The cultural competence model is an ethnographic model created to improve the cultural understanding of people’s status in the context of health, health promotion and illness. This study aimed to use the Purnell Model for Cultural Competence for determining the cultural care needs of couples undergoing infertility treatment. This study with a qualitative design was conducted at a private in vitro fertilization center in eastern Turkey. The sample of the study consisted of 10 infertile couples with unexplained infertility problems (n = 20). The 12 cultural domains were used as a basis in determining the cultural care needs of the infertile couples, and these domains formed the themes. Data were collected using the method of interpretative phenomenological analysis. The emotions defined in the “spirituality” theme were “seeing it as destiny or seeing it as a test to be passed in terms of religion” and “visiting holy tombs, applying to faith healers and making vows.” The first three emotions that came to the fore in the “pregnancy and childbearing” theme were “feelings of deficiency/illness/stigmatization,” “deterioration in body image” and “unsatisfactory inability to feel love for own child.” In the “healthcare practitioners” theme, it was determined that compliance with treatment was partially sufficient, but the religious-cultural influence was high.
... L'hypertrophie des adipocytes dans le cas de l'obésité induit un niveau de sécrétion d'hormones stéroïdiennes plus élevé que la norme, ce qui affecte la Source: graphique reproduit de (Wise et al., 2010) a Ajusté sur l'âge, le tour de hanche, la régularité du cycle, l'âge du partenaire, l'IMC du partenaire, la pratique d'activité physique, le statut de consommation de tabac, la longueur du cycle, le statut de consommation d'alcool et la fréquence des rapports sexuels b nullipare ou multipare Des études évoquent une association entre l'alimentation et la fonction reproductive par exemple en lien avec la survenue de la puberté (De La Rochebrochard, 2000), ou en lien avec l'infertilité d'origine ovulatoire. Le régime alimentaire méditerranéen semble diminuer le risque d'infertilité, à contrario une alimentation trop riche en protéine et pauvre en nutriments semble augmenter le risque d'infertilité (Chavarro et al., 2008(Chavarro et al., , 2007Rossi et al., 2016;Silvestris et al., 2019). ...
Thesis
Plus de 50 millions de couples souffrent d’infertilité dans le monde. Dans les pays développés, la progression de l’infertilité est due principalement au report de l’âge à la parentalité. La prise en charge de l’infertilité se décompose en deux grandes étapes : les traitements d’induction de l’ovulation et les techniques d’assistance médicale à la procréation (AMP), qui sont respectivement les traitements de première et de seconde intention. Les traitements d’AMP sont relativement bien connus alors que les inductions de l’ovulation restent peu explorées du fait de l’absence de sources de données pour les étudier. L’objectif est d’étudier les traitements de l’infertilité en considérant à la fois les traitements d’induction de l’ovulation et les traitements d’AMP. Pour cela, nous avons utilisé les données de l’assurance maladie française qui sont aujourd’hui accessibles à la recherche, notamment via l’échantillon généraliste des bénéficiaires (EGB) et le Datamart de Consommation Inter-Régime (DCIR). Notre objectif se décline en trois axes. Axe 1 : En France un couple 1 sur 4 ne parvient pas à obtenir une grossesse après 12 mois d’essai. Mais quelle est la proportion de femmes traitées pour infertilité ? Le recours global aux traitements de l’infertilité est méconnu en France et dans le monde. Nous avons mesuré le recours annuel aux traitements de l’infertilité. Chaque année, entre 2008 et 2017, 1,25% des femmes de 20-49 ans ont été traitées pour infertilité en France.Derrière un taux très stable sur la décennie, se cache une augmentation de 24% du recours chez les femmes de 34 ans et plus. Axe 2 : Les coûts des traitements de l’infertilité sont pris en charge à 100 % par l’assurance maladie en France. Cependant, la littérature internationale suggère l’existence possible d’un non-accès à l’AMP, même en cas de couverture des coûts. Dans notre étude, nous avons mis en évidence que 70% des femmes en échec d’induction de l’ovulation n’accédaient pas à la FIV. Le désavantage social, la défavorisation de la zone de résidence, les âges jeunes et les âges avancés augmentent le risque de non-accès à la FIV. Axe 3 : Le dernier axe aborde l’abandon précoce des traitements d’infertilité (durant le premier trimestre suivant l’initiation de l’induction de l’ovulation). Le taux d’abandon précoce de l’induction de l’ovulation a été estimé à 30%. Une analyse stratifiée sur le type d’inducteur et de prescripteur a mis en évidence qu’une bonne prise en charge ou suivi diminuent les risques d’abandon tandis que l’âge avancé augmente ce risque. Par ailleurs, il existe une forte interaction entre le type d’inducteur et de prescripteur et la prise charge. La question des inégalités sociales est souvent un angle mort de la prise en charge de l’infertilité qu’il apparaît essentiel d’investiguer dans de nouvelles recherches.
... There is an upward trend in the incidence of idiopathic infertility that may be associated with an unhealthy diet. Moreover, lifestyle may affect the ovarian function, and unhealthy dietary patterns influence the occurrence of anovulatory infertility [7]. Human fertility depends on nutrition; however, both malnourishment and over-nourishment impair fertility. ...
Article
Long-term hypercaloric diets may adversely affect the development of ovarian follicles. We investigated the effects of high sugar (HS), high fat low sugar (HFLS), and high fat normal sugar (HFNS) diets on the ovarian follicle development in mice fed with these diets as compared to those fed with normal diet (control) for 180 days. Body weight, gonadal fat, glucose, lipid, insulin, estrous cycle, sex hormones and ovarian tissues were examined, and metabolism-related protein expression in the ovaries was evaluated by immunoblotting. The mice fed with hypercaloric diets showed hyperinsulinemia and hyperlipidemia, and exhibited heavier body and gonadal fat weights, longer estrous cycles, and fewer preantral and antral follicles than mice fed with normal diet. The sex hormone levels in the blood were similar to those in controls, except for significantly elevated estradiol levels in the HS diet group. The AMPKα phosphorylation was reduced, while AKT phosphorylation and caspase-3 levels were increased in the ovarian tissues of mice in all three hypercaloric diet groups than those in control. Taken together, the results suggest hyperinsulinemia and hyperlipidemia as possible mechanisms that impair the development of ovarian follicles in response to long-term exposure to unhealthy hypercaloric diets. Graphical Abstract Fullsize Image
... erefore, a healthy lifestyle is essential for adjusting endocrine metabolism. In addition, Chavarro et al. [57] showed that following a nutritional diet plan benefits female fertility. erefore, most cases of female infertility caused by ovulatory dysfunction can be prevented by changing diet and lifestyle. ...
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A higher incidence of female infertility has been reported with an unexpectedly early appearance in recent years. The female infertility treatment and application of assisted reproductive technology have recently gained immense interest from scientists. Many studies have discussed the beneficial effects of acupuncture on female infertility. With advancements in science and medical technology, acupuncture-related research has increased in investigating its effectiveness in treating female infertility. This review focuses on a compilation of research in recent years on acupuncture for female infertility treatment and the exploration of the underlying mechanism. For this purpose, literature was searched using various search engines like PubMed, Web of Science, and Google Scholar. The search was refined by only focusing on recent studies on acupuncture effectiveness and mechanism in female infertility and evaluating pregnancy outcomes.
... A key modifiable risk factor is preconception diet, which has been the focus of a range of studies to date. Substantial evidence suggests that modifying preconception dietary patterns to conform with Food-based Dietary Guidelines (FBDG) is beneficial to fertility outcomes [8,9]. These dietary guidelines recommend reducing discretionary foods (typically advocating limiting intake of free sugars and foods high in saturated fats) while increasing intake of core foods typically high in unsaturated fats and components such as whole grains, vegetables, and fish [9]. ...
Article
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Infertility is a global health concern affecting 48 million couples and 186 million individuals worldwide. Infertility creates a significant economic and social burden for couples who wish to conceive and has been associated with suboptimal lifestyle factors, including poor diet and physical inactivity. Modifying preconception nutrition to better adhere with Food-Based Dietary Guidelines (FBDGs) is a non-invasive and potentially effective means for improving fertility outcomes. While several dietary patterns have been associated with fertility outcomes, the mechanistic links between diet and infertility remain unclear. A key mechanism outlined in the literature relates to the adverse effects of inflammation on fertility, potentially contributing to irregular menstrual cyclicity, implantation failure, and other negative reproductive sequelae. Therefore, dietary interventions which act to reduce inflammation may improve fertility outcomes. This review consistently shows that adherence to anti-inflammatory diets such as the Mediterranean diet (specifically, increased intake of monounsaturated and n-3 polyunsaturated fatty acids, flavonoids, and reduced intake of red and processed meat) improves fertility, assisted reproductive technology (ART) success, and sperm quality in men. Therefore, integration of anti-inflammatory dietary patterns as low-risk adjunctive fertility treatments may improve fertility partially or fully and reduce the need for prolonged or intensive pharmacological or surgical interventions.
... Data show that regular moderate physical activity positively influences ovarian reserve and assisted reproductive treatment (ART) outcomes in overweight and obese women [15][16][17][18]. A few studies also suggested that moderate physical activity improves ovarian reserve in normal weight, reproductive age women [19,20]. ...
Article
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Background This study investigated whether high physical activity affects ovarian reserve in normo-ovulatory, reproductive-age women. Methods This prospective, observational study compared 31 professional female athletes, with 31 women who did not engage in physical activity. It was conducted 2017–2020 in a tertiary medical center. Normo-ovulatory, professional athletes, ages 20–35 years were recruited from The Wingate Institute—the Israeli National Institute for Sport Excellence. They had high International Physical Activity Questionnaire (IPAQ) scores. Non-physically active women, matched by age and body mass index, were recruited from hospital staff. Women were evaluated for ovarian reserve markers on day 2–5 of the menstrual cycle, including follicular stimulating hormone, antral follicle count, anti-Mullerian hormone and Inhibin B. Results The average age of the high physical activity group was 29.9 ± 4.2 years and the nonactive group 31.6 ± 4.2 years (p = 0.062). Body mass index of both groups were similar (22.5 ± 5.0 vs. 21.4 ± 2.5, respectively; p = 0.1). No differences were observed with respect to follicle stimulating hormone (p = 0.12) and anti-Mullerian hormone (p = 0.16). A trend towards higher total antral follicle count in the high physical activity group vs. the non-active group (34.5 ± 12.9 vs. 28.1 ± 15.2, p = 0.08) and lower Inhibin B (68.1 ± 36.8 vs. 89.4 ± 46.1, p = 0.05). Menarche age correlated with anti-Mullerian hormone (r = 0.387, p = 0.003), as did total antral follicle count (r = 0.368, p = 0.004). IPAQ scores and basal follicle stimulating hormone levels were negatively correlated (r = − 0.292, p = 0.005). Conclusions Athletic, normo-ovulatory women have ovarian reserves that are at least as good as those of the general population. As this is the first study examining this issue, it could cautiously reassure women engaged in high physical activity regarding ovarian reserve.
... Europe has the lowest rates, with 1.6 children per woman, compared to 2.5 children per woman globally 1 . An issue with ovulation cannot be diagnosed in more than 70% of couples, prompting researchers to look for possible modifiable risk factors 2,3 . In developed countries, particularly Europe, Australia, and North America, a rising number of women put off having children for a variety of reasons, including higher education, job aspirations, or financial concerns-often unaware that fertility falls with age and that assisted reproductive treatments are less effective in older women 1,4 . ...
Article
Introduction: Over the last few decades, fertility has declined globally to unprecedented low levels. Objective: Main goal was to determine whether the micronutrient supplements have any impact on female fertility. Method: This prospective observational study was conducted at the Department of Gynae and Obs, Dhaka Medical College Hospital, Dhaka, Bangladesh. Total 142 patients were enrolled in the study, during July 2019 to June 2020. Analysis of different variables were done according to standard statistical tool Spss and calculations were done using scientific calculators & using MS-excel program in computer. The present study was conducted after receiving approval from the Medical and Health Research Ethics Committee (MHREC). Result: For vitamins C and E, mean nutritional intake surpassed the estimated average requirement (EAR). There were no variations in antioxidant consumption across the groups. In multivariable models, women with a body mass index (BMI) of R25 kg/m2 had shorter TTP when they took vitamin B6 from dietary supplements. Vitamin C from dietary supplements was also linked to a shorter TTP among women with a BMI of less than 25 kg/m2. Conclusion: Women with a BMI of 25 kg/m2 had a shorter TTP when their vitamin C intake increased, while women with a BMIR of 25 kg/m2 had a shorter TTP when their vitamin B6 intake increased.
... intercourse, is a growing worldwide public health condition, affecting one in four couples in developing countries [3,4] overweight and obesity are well-known risk factors for female infertility and one of the most important preventable risk factors for negative perinatal outcomes [5,6]. However, the effect of excess weight on assisted reproduction is still controversial and inconclusive [7]. ...
Article
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Background In spontaneous pregnancies, maternal weight and gestational diabetes are independent risk factors for macrosomia and large-for-gestational-age newborns. Furthermore, maternal body mass index (BMI) of ≥25 kg/m ² is associated with worse neonatal vitality, classified as an Apgar score of < 7 at the fifth minute of life. However, few studies have evaluated the influence of BMI on perinatal outcomes in pregnancies resulting from assisted reproduction. Therefore, this study aimed to analyze whether the perinatal outcomes of assisted reproduction are influenced by BMI. Methods This was a retrospective cohort study performed at a reproductive medicine center. Patients undergoing assisted reproduction (2013–2020) were divided into three groups according to their BMI (kg/m ² ): group 1, < 25; group 2, 25–29.9, and group 3, ≥30. In total, 1753 in vitro fertilization embryo transfer cycles were analyzed. Data were expressed as mean ± standard deviation or frequency (%). The analysis of variance and chi-square test were performed for comparison. To determine the participants and number of cycles for these analyses, generalized estimating equations were used, considering p < 0.05. Results In groups 1, 2, and 3, the rates of live birth were 33.5, 32.3, and 29.9% ( p = 0.668); preeclampsia were 2.9, 6.1, and 6.3% ( p = 0.268); small-for-gestational-age newborns were 23, 23.2, and 21.7% ( p = 0.965); macrosomia were 1.9, 0.9, and 2.7% ( p = 0.708); Apgar score > 7 at the fifth minute were 97.6, 98.2, and 100% ( p = 0.616); and preterm birth were 29.6, 30.1, and 35.1% ( p = 0.970), respectively. Conclusions In conclusion, although the three groups had similar perinatal outcomes in this study, the study population was too small for conclusive results. The higher the BMI, the lower the chances of clinically relevant LBR and the higher the chances of premature labor and preeclampsia.
... They described the optimal "fertility diet" to resemble very closely the Mediterranean dietary pattern. Such a diet, characterized by a high vegetarian to animal protein ratio, full-fat dairy products, decreased glycemic load, vitamins, and increased monounsaturated fatty acids (MUFA) to trans saturated fats ratio, was associated with a 66% reduction in ovulatory disorders and a 27% decrease in infertility risks (32). The same group of authors also showed that consumption of fruits and vegetables with high pesticide residues was associated with low rates of clinical pregnancy and live births after ART treatment (125). ...
Article
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Female infertility is a major public health concern and a global challenge. It is a disorder of the reproductive system, defined as the inability to achieve a clinical pregnancy. Nutrition and other environmental factors are found to impact reproductive health in women as well as the outcome of assisted reproductive technologies (ART). Dietary factors, such as polyunsaturated fatty acids (PUFA), fiber as well as the intake of Mediterranean diet appear to exert beneficial effects on female reproductive outcomes. The exact mechanisms associating diet to female fertility are yet to be identified, although genomic, epigenomic, and microbial pathways may be implicated. This review aims to summarize the current knowledge on the impact of dietary components on female reproduction and ART outcomes, and to discuss the relevant interplay of diet with genome, epigenome and microbial composition.
... 30 Another study using NHSII data that adjusted for BMI found that women with the highest levels of physical activity were less likely to experience ovulatory infertility than those with low levels of physical activity. 31 Another recent study of physical activity and pregnancy time found that higher levels of physical exercise were linked to a shorter pregnant time. [32] Obesity is caused and maintained by a combination of poor dietary choices and a lack of physical activity, 30 and therefore physical activity may be a key component in improving reproductive function in obese people. ...
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Obesity, a serious health problem, is a widespread affliction among women of reproductive age. Obesity and overweight refer to an abnormal and excessive fat deposition that has a negative impact on the body's health. Obesity causes a slew of issues, including social, psychological, demographic, and health issues. It has been associated to elevated health risks like diabetes, hypertension, coronary heart disease, and osteoarthritis, as well as numerous cancers like endometrial, breast, and colon cancers. Hyperandrogenemia is caused by insulin resistance and hyperinsulinemia in obese women. The levels of sex hormone-binding globulin (SHBG) are lower, but leptin levels are higher. Impaired ovulatory function and, as a result, reproductive health could be explained by these changes. Obese women have a reduced probability of giving birth to a healthy infant due to lower implantation and pregnancy rates, greater miscarriage rates, and increased maternal and fetal problems throughout pregnancy. In these people, losing weight has a positive impact on their reproductive outcomes. Keywords: Obesity, Hyperandrogenemia, Sex hormone-binding globulin (SHBG).
... Infertility is a public health priority estimated to affect around one in six couples worldwide. Underlying medical conditions and lifestyle factors, such as smoking, diet, and exercise, have been found to be causing or contributing factors (Chavarro et al., 2007;Wise et al., 2012;Radin et al., 2014;Heger et al., 2018;Aoun et al., 2021). Increasingly, studies have shown association between exposure to environmental contaminants and infertility, and among them is a particular class of chemicals that causes disturbances of the endocrine system, namely the endocrine disrupting chemicals (EDCs). ...
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Endocrine disrupting chemicals (EDCs) can interfere with normal hormonal action and regulation. Exposure of women to EDCs has been associated with adverse reproductive health outcomes. The assays currently used to identify EDCs that elicit female reproductive toxicity lack screening tests that address effects on the maturation of oocytes, a process that enables them to be fertilized and develop into embryos. Here, a screening method employing the bovine model of in vitro oocyte maturation and embryo production is described. Endpoints explored address important events in oocyte maturation and developmental competence acquisition. To test the method, the effects of the known human EDC diethylstilbestrol (DES; an estrogen receptor agonist) were evaluated in a range of concentrations (10–9 M, 10–7 M, 10–5 M). Bovine oocytes were exposed to DES during in vitro maturation (IVM) or embryos were exposed during in vitro embryo culture (IVC). The endpoints evaluated included nuclear maturation, mitochondrial redistribution, cumulus cell expansion, apoptosis, and steroidogenesis. DES-exposed oocytes were fertilized to record embryo cleavage and blastocyst rates to uncover effects on developmental competence. Similarly, the development of embryos exposed to DES during IVC was monitored to assess the impact on early embryo development. Exposure to 10–9 M or 10–7 M DES did not affect the endpoints addressing oocyte maturation or embryo development. However, there were considerable detrimental effects observed in oocytes exposed to 10–5 M DES. Specifically, compared to vehicle-treated oocytes, there was a statistically significant reduction in nuclear maturation (3% vs 84%), cumulus expansion (2.8-fold vs 3.6-fold) and blastocyst rate (3% vs 32%). Additionally, progesterone and pregnenolone concentrations measured in IVM culture media were increased. The screening method described here shows that bovine oocytes were sensitive to the action of this particular chemical (i.e., DES), albeit at high concentrations. In principle, this method provides a valuable tool to assess the oocyte maturation process and early embryo development that can be used for reproductive toxicity screening and possibly EDC identification. Further studies should include EDCs with different mechanisms of action and additional endpoints to further demonstrate the applicability of the bovine oocyte model for chemical risk assessment purposes and EDC identification.
... In Greece, the Mediterranean diet has been associated with a higher probability of live birth [17] and in the Netherlands, greater adherence to the Dutch dietary recommendations has been associated with higher odds of sustained pregnancy in women undergoing fertility treatment [16]. Three cohort studies have investigated dietary patterns specifically targeting pregnancy, namely the Fertility Diet [18], the Alternative Healthy Eating Index for Pregnancy (AHEI-P) [19], and the pro-fertility diet [15]. Neither the Fertility Diet nor the AHEI-P were associated meaningfully with SAB among couples conceiving spontaneously [13,14]. ...
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Purpose Evidence on the influence of modifiable risk factors on spontaneous abortion (SAB) is scarce. We investigated associations for adherence to national dietary guidelines and a healthy Nordic diet with first-trimester (≤ 12 weeks’ gestation) SAB in a Danish cohort of couples trying to conceive. Methods Participants completed a questionnaire on sociodemographics, lifestyle and reproductive history and a validated food frequency questionnaire (FFQ). We ascertained pregnancies from follow-up questionnaires and restricted analyses to 3,043 women who became pregnant. We assessed adherence to the Danish Dietary Guidelines Index (DDGI, range of 0–6, from low to high), covering intake of fruit, vegetables, fish, red and processed meat, whole grains, saturated fat and added sugar. The Healthy Nordic Food Index (HNFI, range 0–6) covered intake of fish, cabbage, rye bread, apples, pears, root vegetables and oatmeal. Pregnancy outcomes were identified through Danish medical registries or self-reported. We used Cox proportional hazards regression to compute hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for sociodemographics and lifestyle. Results Fifteen percent of participants had a first-trimester SAB. Compared with a DDGI score < 3, adjusted HRs (95% CIs) for scores 3 to < 4, 4 to < 5 and ≥ 5 were 0.85 (0.59–1.23), 0.78 (0.54–1.12) and 0.71 (0.44–1.13), respectively. Compared with an HNFI score < 2, adjusted HRs (95% CIs) for scores 2 to < 3, 3 to < 4, 4 to < 5 and ≥ 5 were 0.84 (0.62–1.15), 0.88 (0.66–1.19), 0.94 (0.69–1.28) and 0.69 (0.49–0.96), respectively. Conclusion Greater pre-pregnancy adherence to Danish dietary guidelines or a healthy Nordic diet was associated with a lower rate of first-trimester SAB, although estimates were imprecise.
... Obesity is often accompanied by changes in the levels of endocrine and reproductive hormones. Overweight women are more likely to suffer from polycystic ovary syndrome, menstrual disorders, infertility, miscarriage, poor pregnancy outcomes, and multiple pregnancy complications (including gestational diabetes, pre-eclampsia, and fetal macrosomia) (9)(10)(11)(12). Studies have shown that high female BMI is associated with reduced blastocyst formation rate during in vitro fertilization (IVF) (13), abnormal oocyte morphology (14), low clinical pregnancy rate (CPR), high abortion rate (AR), and low live birth rate (LBR) (15)(16)(17)(18)(19)(20)(21)(22)(23). ...
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Objective To investigate the effect of BMI in male and/or female partners on embryo development and clinical pregnancy outcome during ART.Methods Data of 11,130 cycles between January 2018 and December 2020 were retrospectively analyzed. They were divided into Group A, B, C, and D based on couples’ BMI values, also were divided into Group I, II, III and IV in IVF cycles and Group i, ii, iii, and iv in ICSI cycles. After grouping, inter-group indicators comparisons and logistic regression analysis were performed.ResultsIn IVF cycles, CPR in Group I and Group III were higher than Group IV. In Group III, it was higher than Group II. The AR in Group IV was higher, but the LBR was lower than Group I, Group II, and Group III. Logistic regression analysis results suggested that AR in Group IV was higher than that in Group I in IVF cycles, whereas LBR was lower.In ICSI cycles, high-quality embryo rate in Group i and Group ii were both higher than that in Group iii and Group iv. The CPR in Group i was higher than Group ii and Group iv, and in Group iii was higher than Group ii and Group iv. The AR in Group i was lower than Group iii and Group iv, and AR in Group ii was lower than Group iv. LBR, in Group I it was higher than Group ii, Group iii, and Group iv. Logistic regression analysis results suggested CPR in Group ii was significantly lower than that in Group i. AR in Group iii was considerably higher than that in Group i. LBR in Group ii and Group iv were significantly lower than that in Group i.Conclusion Female higher BMI was not conducive to the formation of high-quality embryos in ICSI cycle. Female and/or male BMI affected AR and LBR more than CPR not only in IVF cycles, but also in ICSI cycles.
... It was characterized by the lower consumption of trans fatty acids with the simultaneous increased supply of monounsaturated fatty acids, higher plant protein content and the presence of high-fat milk products, carbohydrate products with low glycemic index, and high iron content. Moreover, adhering to this dietary pattern was associated with a lower risk of fertility disorders caused by other factors [8]. It was suggested that particular benefits related to consuming the "fertility diet" were observed in women with PCOS, as adherence to the diet was linked to the occurrence of spontaneous ovulation with the overall fertility improvement in this group [21]. ...
Article
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Female infertility is commonly due to ovulation disorders. They are mostly related to polycystic ovary syndrome, which is currently viewed as one of the most common endocrine disorders in women of reproductive age. Ovulation-related female fertility is influenced by multiple factors which may include: age, smoking cigarettes, stress, use of psychoactive substances, and physical activity. Moreover, diet-related factors play an important role in the regulation of ovulation. Dietary components that exert a positive influence on ovulation include: carbohydrate products with low glycemic index, plant protein, monounsaturated and polyunsaturated fatty acids, folic acid, vitamin D, antioxidants, and iron. A diet based on the structure of the Mediterranean diet also seems beneficial. Components that have a negative influence mostly include high glycemic index carbohydrates, large amounts of animal protein, saturated fatty acids, and trans fatty acids, which are typically found in the Western model of nutrition. Due to the paucity of studies that presented a direct link between nutrition and the risk of anovulatory infertility, this study aimed to summarize the most recent research on the influence of dietary factors on ovulation disorders and indicate the possibilities of future research.
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Infertility is an increasing problem that affects couples attempting pregnancy. A growing body of evidence points to a link between diet and female fertility. In fact, data show that a diet high in trans fats, refined carbohydrates, and added sugars can negatively affect fertility. Conversely, a diet based on the Mediterranean dietary patterns, i.e., rich in dietary fiber, omega-3 (ɷ-3) fatty acids, plant-based protein, and vitamins and minerals, has a positive impact on female fertility. An unhealthy diet can disrupt microbiota composition, and it is worth investigating whether the composition of the gut microbiota correlates with the frequency of infertility. There is a lack of evidence to exclude gluten from the diet of every woman trying to become pregnant in the absence of celiac disease. Furthermore, there are no data concerning adverse effects of alcohol on female fertility, and caffeine consumption in the recommended amounts also does not seem to affect fertility. On the other hand, phytoestrogens presumably have a positive influence on female fertility. Nevertheless, there are many unanswered questions with regard to supplementation in order to enhance fertility. It has been established that women of childbearing age should supplement folic acid. Moreover, most people experience vitamin D and iodine deficiency; thus, it is vital to control their blood concentrations and consider supplementation if necessary. Therefore, since diet and lifestyle seem to be significant factors influencing fertility, it is valid to expand knowledge in this area.
Chapter
Updated in light of recent research findings on fertilization, implantation and early pregnancy, this new edition combines the expertise of a wide range of internationally renowned authors to produce an authoritative, multidisciplinary approach to the management of first-trimester complications. Several international guidelines and consensus statements have been released since publication of the first edition and this has stimulated new focussed research questions that are addressed. The book's key recommendations provide clinicians with the tools to improve the patient's experience of the management of first-trimester complications. By combining essential elements of scientific research and clinical care, Early Pregnancy continues to set a benchmark for evidence-based management and will be essential reading for obstetricians, gynaecologists, neonatologists, ultrasonographers, and nurses seeking an understanding of the reproductive science of early pregnancy.
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Pregnancy is a physiological stress that requires dynamic, regulated changes affecting maternal and fetal adiposity. Excessive accumulation of dysfunctional adipose tissue defined by metabolic and molecular alterations cause severe health consequences for mother and fetus. When subjected to sustained overnutrition, the cellular and lipid composition of the adipose tissue changes predisposing to insulin resistance, diabetes, and other metabolic disorders compromising the outcome of the pregnancy. Moreover, excessive maternal weight gain, usually in the context of obesity, predisposes to an increased flux of nutrients from mother to fetus throughout the placenta. The fetus of an obese mother will accumulate more adiposity and may increase the risk of future metabolic disorder later in life. Thus, further understanding of the interaction between maternal metabolism, epigenetic regulation of the adipose tissue, and their transgenerational transfer are required to mitigate the adverse health outcomes for the mother and the fetus associated with maternal obesity.
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Background Diet is a modifiable lifestyle factor linked with fertility in a growing number of studies. Objective The objective of this study was to evaluate the association between dietary energy density (ED), a summary measure of diet quality that estimates the amount of energy per unit food (kcal/g) consumed, and conception and pregnancy outcomes. Methods A prospective cohort study of couples planning their first pregnancy was conducted in the Northeast region of the USA. Dietary data were collected prior to conception via three unannounced interviewer-administered 24-hour dietary recalls. Multivariable-adjusted logistic regression (odds ratios (OR)) and Cox proportional hazard models (relative risk (RR) and 95% confidence intervals (CI)) were estimated for continuous and categorical (tertile (T)) variables of dietary ED. Results The majority of women (n = 80; 61%) achieved clinical pregnancy. Median time to conception (TTC) for those who conceived was 4.64 months with an interquartile range of 4.37 months. ED modeled as a continuous variable was not associated with clinical pregnancy, live birth or TTC after controlling for race, physical activity and male partner's ED. When ED was categorized to consider non-linear associations, 60%, 73%, and 50% of the participants in the tertiles (from lowest ED to highest) achieved clinical pregnancy. In multivariable logistic analyses with the middle group as the referent (ED = 1.37–1.60), membership in the highest ED group (ED > 1.60) was associated with lower odds of clinical pregnancy (OR = 0.30; 95% CI: 0.11, 0.81, p = 0.02). In Cox proportional hazards analyses, membership in the highest ED group was associated with significantly longer TTC compared to the middle category (HR = 0.41; 95% CI: 0.21–0.82, p = 0.01). Conclusions These results suggest that high dietary ED is associated with reduced fertility.
Article
Over the course of the reproductive life span, it is common for women to experience one or more of the most common gynecologic conditions, including sexual dysfunction, polycystic ovary syndrome, fibroids, endometriosis, and infertility. Although current management guidelines often turn to the established pharmaceutical approaches for each of these diagnoses, the scientific literature also supports an evidence-based approach rooted in the paradigm of food as medicine. Achieving healthy dietary patterns is a core goal of lifestyle medicine, and a plant-forward approach akin to the Mediterranean diet holds great promise for improving many chronic gynecologic diseases. Furthermore, creating an optimal preconception environment from a nutritional standpoint may facilitate epigenetic signaling, thus improving the health of future generations. This state-of-the-art review explores the literature connecting diet with sexual and reproductive health in premenopausal women.
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Zusammenfassung Die Bedeutung von Mikronährstoffen und einer insgesamt „gesunden Ernährung“ in der Schwangerschaft ist unstrittig. Im Gegensatz dazu ist die Datenlage zum Einfluss der perikonzeptionellen Ernährung auf die Konzeption, Implantation und den weiteren Schwangerschaftsverlauf weit weniger klar. Gesichert scheint, dass ein hoher Anteil von Vollkornprodukten, Früchten, Gemüse, Fisch und Olivenöl bei moderatem Anteil von Kohlenhydraten günstige Effekte entfaltet. Bei Kinderwunsch ist heute die Folsäuresubstitution obligat, diese kann nach aktuellen Leitlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften durch Vitamin D ergänzt werden.
Chapter
The present chapter deals with the effect of exercise and nutrition intervention for female fertility. It addresses the evidence-based recommendations on exercise training and a physically active lifestyle approach to improving health and fertility. Furthermore, it addresses the critically important issue of the role of sound nutrition practices with regards to macro and micronutrients intake considered important for optimal fertility. While not a primary focus, elements of these points relative to pregnancy are briefly addressed. Other common aspects of daily life, like the exposure to endocrine disruptors, substances that interfere with the proper functioning of the hormonal system, and therefore may alter human reproductive potential, are also addressed.
Article
Background: One in seven couples are impacted by infertility in the UK, and female infertility is often associated with several health conditions impacted by nutrition. Despite many studies aimed at identifying the critical role of nutrition in infertility, there is currently no screening tool that identifies nutritional risk factors for infertility. Aim: To propose a self-administered screening tool to identify women who would benefit from nutritional intervention to promote fertility. Methods: A narrative review was carried out to identify and summarise modifiable nutritional risk factors that can influence female fertility, including comorbidities that can influence nutrition intake, absorption, and metabolism. Key findings: A nutrition screening tool outlining modifiable nutrition risk factors potentially improving female fertility has been proposed, comprising of BMI, medical history and quality of diet and lifestyle which would aid in designing evidence based dietetic services for female infertility.
Article
The aim of this study was to clarify the associations between menstrual cycle disorders, food frequency intake, dietary habits, and physical activity levels in women with and without Polycystic Ovary Syndrome (PCOS). 114 women with PCOS and 341 without PCOS (CONTROL) participated in the study. They were also divided into women with menstrual disorders(MD), and those with regular cycle (RC). Each of them completed a medical and Kompan questionnaires. In women with PCOS and menstrual disorders (PCOS-MD), intake of wholemeal products, meat and meat products, fats and alcoholic beverages was higher in comparison to those in the control group with menstrual disorders (CONTROL-MD). Women in the PCOS-MD group also reported significantly more frequent snacking between meals, higher Pro-Healthy Diet Index (pHDI-14), and a lower level of physical activity at leisure time than CONTROL-MD. Women with PCOS differed from those in CONTROL due to a higher consumption of meat and meat products, fats, fruits and vegetables, juices and alcoholic beverages, and a lower intake of whitemeal products, sweets, and fruits. Women with PCOS more frequently snacked, but the number of their meals was also lower. In women with PCOS, menstrual disorders may be related not only with diet quality and physical activity but also with snacking and skipping meals.
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Research question : Have women with polycystic ovary syndrome (PCOS) a different fat intake pattern? Design : A case-control study of 276 women between 20 and 35 years old from the Region of Murcia (Spain). Cases (n=121) were attended at Department of Gynecology and Obstetrics of the University Clinical Hospital and diagnosed with PCOS using Rotterdam criteria. Controls (n=155) were women without PCOS attending the gynecological outpatient clinic for routine gynecological examinations. Data from clinical, gynecological and analytical exams were collected, including a food frequency questionnaire. Associations between fat intake and presence of PCOS and its phenotypes were examined using multiple logistic regression, adjusting for potential confounding factors. Results : Although we did not find associations between fatty acids intake and PCOS, we observed significant associations for some PCOS phenotypes. The PCOS phenotype characterized by hyperandrogenism + oligo/amenorrhoea + polycystic ovarian morphology (“H+O+POM”) was significantly associated with a higher intake of polyunsaturated fat [OR=4.0; 95%CI=1.1-14.2; fourth quartile of highest intake (Q4) vs. lowest intake quartile as reference (Q1)] and omega-6 fatty acids (OR=3.5; 95%CI=1.01-12.4; Q3 vs. Q1). The “H+O” phenotype was positively associated with saturated fat intake (OR=6.9; CI95%=1.1-41.6; Q4 vs. Q1). Conclusion : This exploratory study suggests that higher intakes of specific fatty acids is related to some PCOS phenotypes although no association was found for PCOS globally considered. It would be recommendable that studies with larger sample size be performed to explore further these associations, thus contributing to stablish recommendations about fat intake adapted to different PCOS phenotypes
Article
Female reproductive health has been historically understudied and underfunded. Here, we present the advantages of using a free-living nematode, Caenorhabditis elegans, as an animal system to study fundamental aspects of female reproductive health. C. elegans is a powerful high-throughput model organism that shares key genetic and physiological similarities with humans. In this review, we highlight areas of pressing medical and biological importance in the 21st century within the context of female reproductive health. These include the decline in female reproductive capacity with increasing chronological age, reproductive dysfunction arising from toxic environmental insults, and cancers of the reproductive system. C. elegans has been instrumental in uncovering mechanistic insights underlying these processes, and has been valuable for developing and testing therapeutics to combat them. Adopting a convenient model organism such as C. elegans for studying reproductive health will encourage further research into this field, and broaden opportunities for making advancements into evolutionarily conserved mechanisms that control reproductive function.
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Background In spontaneous pregnancies, evidence shows that maternal weight and gestational diabetes are independent risk factors for macrosomia and large for gestational age newborns. Maternal body mass index (BMI) ≥ 25 kg/m² is also associated with worse neonatal vitality, classified as Apgar score less than 7 at 5th minute of life. However, little studies have been conducted on the influence of BMI on perinatal outcomes considering pregnancy resulting from assisted reproductive techniques (ART). Therefore, the purpose of the present study was to analyze if perinatal outcomes of ART could be influenced by BMI. Methods Retrospective cohort study performed at a Reproductive Medicine Center. Patients undergoing ART (2013–2020) were divided into three groups according to BMI (kg/m²): Group 1, < 25; Group 2, 25-29.9 and Group 3, ≥ 30. A total of 1753 in vitro fertilization (IVF) embryo transfer cycles were included. Data were expressed as mean ± standard deviation, or frequency (%). ANOVA and Chi-square test was performed on groups comparison. To consider patients and the number of cycles for these analyses, generalized estimating equations (GEE) were performed, considering p < 0.05. Results When comparing groups according to the BMI, the following results were found (%), respectively: live birth rates (LBR) (33.5 vs. 32.3 vs. 29.9, p = 0.668); preeclampsia (2.9 vs. 6.1 vs. 6.3, p = 0.268); small for gestational age newborns (23 vs. 23.2 vs. 21.7, p = 0.965); microsomal newborns (1.9 vs. 0.9 vs. 2.7, p = 0.708); Apgar score > 7 fifth minute (97.6 vs. 98.2 vs. 100, p = 0.616); preterm birth (29.6 vs. 30.1 vs. 35.1, p = 0.970). Conclusions In this study, perinatal outcomes of ART were not influenced by overweight and obesity. However, even with not statistically different, clinically relevant lower chances of LBR were found the higher was the BMI, along with higher chances of premature labor and preeclampsia.
Article
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Polycystic ovary syndrome (PCOS) is a common endocrine condition in women of reproductive age associated with infertility and menstrual dysfunction and an increase in risk factors for cardiovascular disease and diabetes mellitus. Although weight loss has been shown to improve metabolic and reproductive fitness in this group (1), the effect of varying diet composition has not been researched. Recently there has been increased community interest in a high protein/low carbohydrate diet. This may aid in increased weight loss (2) due to the increased satiating power of protein and may improve insulin sensitivity through maintenance of lean body mass with weight loss (3). This randomised controlled trial examined the differential effects of replacing dietary protein with carbohydrate in weight loss on reproductive and metabolic physiology. Overweight women (mean BMI 37.7 ± 6.5 m2) were randomised to either a low protein (LP) (n = 14) (30% fat, 55% carbohydrate, 15% protein) or a high protein (HP) (n = 14) (30% fat, 40% carbohydrate, 30% protein) diet. The diet consisted of 12 weeks energy restriction (~ 6000 kJ) followed by 4 weeks weight maintenance with a weekly exercise and support group throughout. Improvements in menstrual cyclicity (ovulation and menstrual cycle lengths), insulin homeostasis and lipid profile and decreases in weight (7.5%) and abdominal fat (12.5%) occurred independent of diet composition. 3 pregnancies additionally resulted (2 HP, 1 LP). Improvements in menstrual cyclicity were associated with greater decreases in insulin resistance, as measured by the homeostasis model, and fasting insulin (P = 0.011). On the LP diet, high-density lipoprotein cholesterol (HDL-C) decreased 10% in energy restriction (P = 0.008) and free androgen index (FAI) increased 44 % in weight maintenance (P = 0.027). There were no changes in HDL-C in energy restriction or FAI in weight maintenance for the HP diet. Each group was provided with a representative HP or LP test meal for that intervention and post-prandial insulin and glucose analysed as the area under the curve (AUC). Test meal AUC glucose was higher for the LP compared to the HP diet at weeks 0 and 16 (Figure 1).
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The use of a mailed, self-administered, semiquantitative food frequency questionnaire to describe past dietary intake was evaluated in 1984 among a group of 150 Boston-area women who had completed four one-week diet records three to four years previously. Correlation coefficients comparing calorie-adjusted nutrient intakes computed from the questionnaire with those obtained from a compressed version of the questionnaire completed during diet record keeping ranged from 0.44 for total carbohydrate to 0.62 for vitamin C including supplements. Coefficients comparing calorie-adjusted nutrient intakes measured by questionnaire with those assessed by the diet records completed three to four years previously ranged from 0.28 for iron without supplements to 0.61 for total carbohydrate. An evaluation of the incremental contribution provided by several open-ended sections of the questionnaire to the estimation of nutrient intake suggested that in this population most of these items might be eliminated without material loss of information. These findings demonstrate that useful estimates of nutrient intake several years previously can be obtained by a relatively inexpensive, mailed, self-administered questionnaire.
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To examine the relation of regular vigorous exercise to ovulatory infertility, we interviewed 346 infertile women, in whom there was evidence of ovulatory failure, regarding their exercise patterns during the year preceding their unsuccessful effort to conceive. Their responses were compared with similar exercise histories in women who had successfully conceived at the time the infertile women started trying to become pregnant. Vigorous exercise for an hour or more per day was reported more commonly in nulligravid cases (n = 187) than by their primiparous controls. The difference was particularly great in the subgroup of cases without additional evidence of tubal dysfunction (relative risk = 6.2, 90% confidence interval = 1.0 - 39.8). This association was not seen among infertile women who had previously been pregnant. Vigorous exercise for an average of less than one hour per day was not associated with either primary or secondary infertility.
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Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.
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Young female ballet dancers attending professional schools or dancing in companies in which thinness is much admired restrict their food intake and are highly active. The unusual eating habits and levels of activity of some of these dancers have been related to lack of menstrual cycles. Amenorrhea and late menarche among girls and women with average activity levels are associated with undernutrition and weight loss in the range of 10 to 15 per cent of the normal weight for height; such weight loss apparently reduces the fat/lean ratio to less than a critical level. The authors report here on 89 young ballet dancers among whom there was a high incidence of primary amenorrhea, secondary amenorrhea, irregular cycles, and delayed menarche - an incidence correlated with excessive thinness.
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A significantly higher rate of conceptions occurred after preconceptional multivitamin supplementation in comparison with a placebo-like trace element supplementation in the Hungarian randomised, double-blind, controlled trial. This difference was explained by 5% shorter time in the achievement of conception.
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Thousands of cycles of in vitro fertilization (IVF) are performed each year. In the US, multiple births occur after 39% of IVF cycles, whereas in Europe, the figure is 26%. Indeed, multiple births are a major factor in the costs attributable to IVF. Reducing the multiple birth rate may reduce the overall costs of IVF, and providing insurance coverage of IVF may contribute to lowering multiple birth rates. The use of IVF is likely to expand in response to increases in infertility and scientific advances.
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The aim of this study was to evaluate the reproducibility and validity of a 61-item semiquantitative food frequency questionnaire used in a large prospective study among women. This form was administered twice to 173 participants at an interval of approximately one year (1980-1981), and four one-week diet records for each subject were collected during that period. Intraclass correlation coefficients for nutrient intakes estimated by the one-week diet records (range = 0.41 for total vitamin A without supplements to 0.79 for vitamin B6 with supplements) were similar to those computed from the questionnaire (range = 0.49 for total vitamin A without supplements to 0.71 for sucrose), indicating that these methods were generally comparable with respect to reproducibility. With the exception of sucrose and total carbohydrate, nutrient intakes from the diet records tended to correlate more strongly with those computed from the questionnaire after adjustment for total caloric intake. Correlation coefficients between the mean calorie-adjusted intakes from the four one-week diet records and those from the questionnaire completed after the diet records ranged from 0.36 for vitamin A without supplements to 0.75 for vitamin C with supplements. Overall, 48% of subjects in the lowest quintile of calorie-adjusted intake computed from the diet records were also in the lowest questionnaire quintile, and 74% were in the lowest one of two questionnaire quintiles. Similarly, 49% of those in the highest diet record quintile were also in the highest questionnaire quintile, and 77% were in the highest one or two questionnaire quintiles. These data indicate that a simple self-administered dietary questionnaire can provide useful information about individual nutrient intakes over a one-year period.
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We analyzed a two- to seven-year follow-up of 1145 infertile couples to determine the frequency of pregnancy occurring independently of treatment. Pregnancy occurred in 246 of 597 treated couples (41 per cent) and in 191 of 548 untreated couples (35 per cent). Thirty-one per cent of the pregnancies in treated couples occurred more than 3 months after the last medical treatment or more than 12 months after adnexal surgery. These pregnancies plus the 191 pregnancies in untreated couples constituted the category of "treatment-independent pregnancies" and accounted for 61 per cent of all pregnancies; for 44 per cent of those among couples with ovulation deficiency; for 61 per cent of those in couples with endometriosis, tubal defects, or seminal deficiencies; and for 96 per cent of those in couples with cervical factors or idiopathic infertility. We conclude that the potential for a spontaneous cure of infertility is high, that treatment for many classes of infertility should be evaluated by randomized clinical trials, and that in such trials random assignment of subjects to untreated control groups would be ethically acceptable.
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The authors compared recalled weight at age 18 and self-reported current height among 118 participants in the Nurses' Health Study II cohort, aged 25-42 years in 1989, with records from physical examinations conducted at college or nursing school entrance. The correlation between recalled and measured past weight was 0.87 and between reported current height and measured past height was 0.94. Mean body mass index (BMI) values were 21.6 kg/m2 for BMI calculated using recalled weight and 22.1 kg/m2 using weight from medical records; the correlation was 0.84. Participants slightly under-reported weight at age 18 (mean difference = 1.4 kg). The validity of recalled weight at 18 years of age and self-reported height as an estimate of height at age 18 appears to be high among women in this cohort.
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The reproducibility and validity of self-administered questionnaires on physical activity and inactivity were examined in a random (representative) sample of the Nurses' Health Study II cohort and a random sample of African-American women in that cohort. Repeat questionnaires were administered 2 years apart. Past-week activity recalls and 7-day activity diaries were the referent methods; these instruments were sent to participants four times over a 1-year period. The 2-year test-retest correlation for activity was 0.59 for the representative sample (n = 147) and 0.39 for the African-American sample (n = 84). Correlations between activity reported on recalls and that reported on questionnaire were 0.79 and 0.83 for the representative and African-American samples, respectively. Correlations between activity reported in diaries and that reported on questionnaire were 0.62 and 0.59, respectively. Test-retest coefficients for inactivity were 0.52 and 0.55, respectively. Correlations between inactivity reported in diaries and that reported on questionnaire were 0.41 and 0.44, respectively. The simple, short questionnaires on activity and inactivity used in the Nurses' Health Study II are reasonably valid measures for epidemiological research.
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The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so, to what extent. We investigated the cost of a successful delivery with in vitro fertilization. We calculated the cost per successful delivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease (who have a better chance of success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success). Information on charges per cycle of in vitro fertilization was obtained from six facilities across the country; delivery rates with this procedure were estimated from the literature. On average, the cost incurred per successful delivery with in vitro fertilization increases from $66,667 for the first cycle of in vitro fertilization to $114,286 by the sixth cycle. The cost increases because with each cycle in which fertilization fails, the probability that a subsequent effort will be successful declines. Sensitivity analyses indicated that the cost per delivery ranges from $44,000 to $211,940. For couples with a better chance of successful in vitro fertilization (i.e., those with a diagnosis of tubal disease), it costs $50,000 per delivery for the first cycle and $72,727 for the sixth. For couples in which the woman is older and there is a diagnosis of male-factor infertility, the cost rises from $160,000 for the first cycle to $800,000 for the sixth. The debate about insurance coverage for in vitro fertilization must take into account ethical judgments and social values. But analyses of costs and cost effectiveness help elucidate the economic implications of using in vitro fertilization and thus inform the policy discussion.