Increased Likelihood of Pregnancy Using an App-Connected Ovulation Test System: A Randomized Controlled Trial.

Background: Women trying to conceive are increasingly using fertility-tracking software applications to time intercourse. This study evaluated the difference in conception rates between women trying to conceive using an application-connected ovulation test system, which measures urinary luteinizing hormone and an estrogen metabolite, versus those trying without using ovulation testing. Materials and Methods: This home-based study involved 844 volunteers aged 18-40 years seeking to conceive. Volunteers randomized to the test arm were required to use the test system for the duration of the study while those randomized to the control arm were instructed not to use ovulation testing. Pregnancy rate differences across one and two cycles between the two groups were examined. Results: Volunteers in the test (n = 382) and control arms (n = 403) had similar baseline demographics. The proportion of women pregnant after one cycle was significantly greater in the test arm (25.4%) compared with the control arm (14.7%; p < 0.001). After two cycles, there continued to be a greater proportion of women pregnant in the test arm compared with the control arm (36.2% vs. 28.6%; p = 0.026). In the test arm, volunteers had intercourse less frequently per cycle compared with those not using ovulation testing (9 [range: 1-60] vs. 10 [range: 1-50]; p = 0.027), but were more likely to target intercourse to a particular part of their cycle compared with those not using ovulation testing (88.5% vs. 57.8%; p < 0.001). Conclusion: Using the test system to time intercourse within the fertile window increases the likelihood of conceiving within two menstrual cycles.

Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants.

The present study was designed to compare milk production and hormone responses (prolactin [PRL], oxytocin [OT]) and to determine associations of hormone levels with milk production in mothers of preterm (PT) and term (TM) infants during the first 6 weeks postpartum. Mothers of PT infants (n = 95) were all pump dependent; mothers of TM infants (n = 98) were all feeding their infant at breast. Mothers of nonnursing PT infants produced less milk over time compared to mothers of TM infants. A higher proportion of PT mothers had lower basal PRL levels compared with TM mothers. PRL and frequency of breast stimulation combined positively influenced milk production in PT mothers. OT levels were higher in PT versus TM mothers, but OT was not related to milk production. Further study is warranted regarding interventions to enhance milk production, particularly in pump-dependent mothers of PT infants.

A randomized study of low-dose conjugated estrogens on sexual function and quality of life in postmenopausal women.

OBJECTIVE: To evaluate the effects of combined vaginal and oral low-dose estrogen plus progestogen therapy (EPT) on the frequency and severity of dyspareunia, sexual function, and quality of life in recently postmenopausal women. METHODS: This outpatient, double-blind, randomized, placebo-controlled trial enrolled 285 healthy, sexually active postmenopausal women aged 45 to 65 years. Women received either one daily oral low-dose conjugated estrogens (0.45 mg)/medroxyprogesterone (1.5 mg) tablet for six 28-day cycles along with 1 g conjugated estrogens vaginal cream (0.625 mg), intravaginally for the first 6 weeks of the trial or a placebo cream and placebo tablet. Efficacy was evaluated using the McCoy Female Sexuality Questionnaire, self-reported daily diary cards, the Brief Index of Sexual Functioning-Women (BISF-W), and the Women's Health Questionnaire. RESULTS: The EPT group had a significant decrease in the frequency of dyspareunia compared with baseline and placebo in an analysis of responses to the McCoy Female Sexuality Questionnaire. Also, EPT was associated with a significant improvement in a woman's level of sexual interest, frequency of orgasm, and pleasure of orgasm. There was no effect of EPT use on coital frequency. The EPT group had significant improvement in receptivity/initiation and relationship satisfaction, although not in other BISF-W domains, versus placebo (BISF-W analysis) and significant improvement versus placebo on most Women's Health Questionnaire responses. CONCLUSIONS: EPT provided a statistically significant improvement compared with placebo in dyspareunia, sexual experience, and quality of life as measured in this study. In general, EPT also improved self-reported sexual perception and enjoyment significantly compared with placebo.

Prolactin levels in Western Lowland gorillas.

Hyperprolactinemia is known to cause menstrual irregularity and infertility in humans. However, little is known about the role of prolactin in menstruation and fertility in Western Lowland gorillas. To create a database of prolactin values in gorillas, we have performed immunoassays on serum specimens dating back to 1983 from nine female gorillas at the Brookfield Zoo. We matched these samples with documented behavioral data to correlate menstrual timing. In addition, we ran other reproductive hormones both to aid in determining the phase of the menstrual cycle and to evaluate the effect of the prolactin on suppression of these hormones during the premenarchal and postpartum phases. We found that values for luteinizing hormone, follicle-stimulating hormone, estradiol and progesterone cycle in very similar patterns to humans. Based on the 59 available samples, prolactin was found to be higher in gorillas than in humans in nearly every phase of the menstrual cycle (range 49.9-93.7 ng/mL) and such levels do not appear to alter the reproductive axis as it does in humans. Thus, prolactin may have a different impact on fertility in gorillas than it does in humans.

Using cervical mucus and other easily observed biomarkers to identify ovulation in prospective pregnancy trials.

To help fulfil the objectives of prospective studies of pregnancy and human development, such as the National Children's Study, there is a need to pinpoint ovulation and conception in a cohort of women. This paper discusses the suitability of using natural and easily observed markers of ovulation for detection of the most likely day of ovulation and conception. Of the biomarkers supported by clinical data, the use of cervical mucus is emphasised as it appears most promising. A considerable amount of data suggests that observation of changes in vaginal discharge from cervical mucus can closely approximate the day of ovulation, is easy to learn and suitable for a large group of women. While this approach could also be cost-effective, a significant drawback may be the learning phase which may take 2-3 instructional sessions for women to fully identify recurring changes across the menstrual cycle.

Relationship between soft tissue body composition and bone mass in perimenopausal women.

OBJECTIVES: Perimenopause, the transition into menopause, marks the beginning of accelerated bone loss, contributing to the development of osteoporosis, a major public health problem. This perimenopausal transition has also been associated with a decrease in body lean mass, an increase in fat mass, and an increase in body weight. How these changes in fat mass and lean mass may influence bone mineral density (BMD) is currently unknown. The purpose of this study is to determine the independent effect and relative contribution of lean mass and fat mass to BMD in perimenopausal women. MATERIAL AND METHODS: The sample consisted of 43 sedentary perimenopausal women (age: mean = 49.6; S.D. = 3.2) with an intact uterus and ovaries, participating in a study of exercise and perimenopausal symptoms. Total body BMD, regional BMD, and soft tissue body composition were measured by dual-energy X-ray absorptiometry. Other measures including age, height, weight, and serum FSH and E2 were also obtained. RESULTS: Findings revealed that 14% of these perimenopausal women had low bone mass (osteopenia) in the lumbar spine and/or the femoral neck. Overall body fat mass and lean mass had positive relationships with BMD of lumber spine and the femur. However, using multiple regression analyses, only lean mass and ethnicity remained significant predictors for BMD of the femoral neck (r2 = 45%) with lean mass explaining more variance than ethnicity. Lean mass was the sole predictor of total proximal femur BMD explaining 38% of the variance. Fat mass was not a significant predictor of BMD at any skeleton site. CONCLUSIONS: These findings suggest that body lean mass, not fat mass, is a significant contributor to femoral BMD in perimenopausal women.

Relationship between sperm characteristics and hormonal parameters in normal couples.

OBJECTIVE: To examine the relationships between hormone profiles and semen analysis measures and fertility in the male partners of presumed normal couples. DESIGN: Prospective clinical study. SETTINGS: Healthy volunteers in an academic research environment. PATIENT(S): One hundred forty-five reproductive age couples without known risk factors for infertility and who had discontinued contraception to achieve pregnancy completed this component of this study. Each couple was followed for < or =12 menstrual cycles while they attempted to conceive. INTERVENTION(S): Semen quality measures for the first ejaculates were obtained at the start of the study along with a single blood sample. Levels of FSH, bioactive FSH, inhibin B, LH, and T were measured for each man. MAIN OUTCOME MEASURE(S): Semen analysis, FSH, inhibin B, LH, T, and clinical pregnancy. RESULTS: Significant positive relationships were observed between the two measures of FSH as well as between both of the FSH measures and LH. Follicle-stimulating hormone as measured by RIA was significantly negatively correlated with inhibin B. Inhibin B showed a marginally significant negative correlation with LH, and LH and T had a marginally significant positive correlation. Inhibin B increased significantly, and both measures of FSH activity showed significant decreases, with increasing levels in several semen quality measures. There was no significant relationship between the measured hormones and the pregnant and nonpregnant groups or time to pregnancy. CONCLUSION(S): These results contribute additional information on the utility of reproductive hormone measurements for predicting semen quality in couples without known reduced fertility.

Laparoscopic appendectomy in an outpatient setting.

STUDY OBJECTIVE: To determine the ability to perform laparoscopic appendectomy on an outpatient basis. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: University ambulatory surgery center. PATIENTS: Forty-two consecutive patients. INTERVENTION: Laparoscopic appendectomy. MEASUREMENTS AND MAIN RESULTS: After performing five laparoscopic appendectomies, three women required hospitalization. Thus a new multimodal protocol was implemented and admission and recovery times were monitored. After the new protocol was implemented, only 1 of 37 patients required hospitalization. Discharge times were similar to those for women undergoing gynecologic laparoscopy without appendectomy. CONCLUSION: With attention to surgical and anesthetic protocols, appendectomy can be performed at the time of gynecologic laparoscopy in an ambulatory setting without a significant delay in discharge.