Marlene B. Goldman’s research while affiliated with Geisel School of Medicine at Dartmouth and other places

Objective To evaluate long-term reproductive outcomes in couples who were enrolled in a large randomized controlled trial that studied optimal treatment for unexplained infertility. Design Telephone survey, administered between March 2019 and February 2020. Setting Large urban university-affiliated fertility center. Patient(s) Couples who enrolled in the Fast Track and Standard Treatment Trial (FASTT). Intervention(s) None. Main Outcomes Measure(s) Number of live births, methods of conception, adoption, and satisfaction regarding family size. Result(s) Of the 503 couples enrolled in FASTT, 311 (61.8%) were contacted and 286 (56.9%) consented to participate. The mean age and follicle-stimulating hormone level at the time of enrollment in FASTT were 33.1 ± 3.2 years and 6.8 ± 2.2 mIU/mL, respectively, for those who participated in this study. The mean age at follow-up was 49.5 ± 3.4 years. Of the 286 women, 194 (67.8%) had a live birth during the trial and 225 (78.7%) continued to try to conceive after FASTT. Of those who tried to conceive without treatment, 101 of 157 (64.3%) had a successful live birth, whereas 12 (5.3%) women had a live birth via intrauterine insemination and 82 (36.4%) via autologous oocyte in vitro fertilization. Overall, 182 (80.9%) women achieved a live birth after FASTT. Conclusion(s) The majority of couples were able to achieve a live birth after FASTT. Only 19 (6.6%) never achieved a live birth during their reproductive years. Moving to treatment sooner allows the opportunity to achieve >1 live birth, which is associated with increased satisfaction regarding family size. This further supports access to care and insurance coverage for infertility treatment.

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.

Objective Dietary quality (DQ), as assessed by the Alternative Healthy Eating Index for Pregnancy (AHEI-P), and conception and pregnancy outcomes were evaluated. Design In this prospective cohort study on couples planning their first pregnancy. Cox proportional hazards regression assessed the relationship between AHEI-P score and clinical pregnancy, live birth and pregnancy loss. Setting Participants were recruited from the Northeast region of the USA. Participants: Healthy, nulliparous couples (females, n 132; males, n 131; one male did not enrol). Results There were eighty clinical pregnancies, of which sixty-nine resulted in live births and eleven were pregnancy losses. Mean ( sd ) female AHEI-P was 71·0 (13·7). Of those who achieved pregnancy, those in the highest tertile of AHEI-P had the greatest proportion of clinical pregnancies; however, this association was not statistically significant ( P = 0·41). When the time it took to conceive was considered, females with the highest AHEI-P scores were 20 % and 14 % more likely to achieve clinical pregnancy (model 1: hazard ratio (HR) = 1·20; 95 % CI 0·66, 2·17) and live birth (model 1: HR = 1·14; 95 % CI 0·59, 2·20), respectively. Likelihood of achieving clinical pregnancy and live birth increased when the fully adjusted model, including male AHEI-P score, was examined (clinical pregnancy model 4: HR = 1·55; 95 % CI 0·71, 3·39; live birth model 4: HR = 1·36; 95 % CI 0·59, 3·13). Conclusions The present study is the first to examine AHEI-P score and achievement of clinical pregnancy. DQ was not significantly related to pregnancy outcomes, even after adjustments for covariates.

Background Dietary energy density (ED) is a novel measure of diet quality that estimates the amount of energy per unit of food (kcal/g) consumed. Consuming an energy dense diet has been positively associated with obesity and risk of chronic disease. Objective We evaluated the association between ED and conception and pregnancy outcomes among participants of the ISIS study, a prospective cohort study of healthy, nulliparous women (n = 132) planning their first pregnancy (mean age± SD = 29.79 ± 3.21 and BMI = 24.30 ± 5.37 kg/m ² ). Methods Dietary data were collected prior to conception using a series of three unannounced, telephone 24‐hour dietary recalls, and ED was calculated from food (without beverages). Outcomes of interest included confirmed clinical pregnancy (CCP; hCG ≥ 20mIU/mL) and time to pregnancy (TTP; months). Results Mean ED was 1.50 ± 0.36 kcal/g. The majority of participants (n=80; 61%) achieved CCP and the median TTP for those who conceived was 4.64 months with an interquartile range of 4.37 months. Preliminary data analyses, using Cox proportional hazards regression models, revealed that after controlling for race, physical activity and male partner's ED, higher dietary ED (continuous) among females was associated with longer TTP which approached statistical significance (HR= 0.48; 95% CI: 0.21–1.14, p=0.09). When ED was categorized into tertiles to consider non‐linear associations, 60%, 73%, and 50% of the participants in the tertiles (from lowest ED to highest) achieved CCP. In multivariable 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 longer TTP (HR= 0.41; 95% CI: 0.21–0.82, p=0.01). The estimated TTP for women in the lowest ED group (ED=0.85–1.36) was longer; but not statistically significant (HR=0.77; 95% CI: 0.42–1.42, p=0.40). Conclusions Results of this study suggest that ED may be associated with TTP. Support or Funding Information Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Numbers R01HD049762 and 3R01HD049762S1. Partial support provided by the CTSI (GCRC) at Penn State University NIH M01 107 32.