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

STUDY QUESTION: Does sexual intercourse enhance the cycle fecundability in women without known subfertility? SUMMARY ANSWER: Sexual intercourse (regardless of timing during the cycle) was associated with cycle characteristics suggesting higher fecundability, including longer luteal phase, less premenstrual spotting and more than 2 days of cervical fluid with estrogen-stimulated qualities. WHAT IS KNOWN ALREADY: Human females are spontaneous ovulators, experiencing an LH surge and ovulation cyclically, independent of copulation. Natural conception requires intercourse to occur during the fertile window of a woman's menstrual cycle, i.e. the 6-day interval ending on the day of ovulation. However, most women with normal fecundity do not ovulate on Day 14, thus the timing of the hypothetical fertile window varies within and between women. This variability is influenced by age and parity and other known or unknown elements. While the impact of sexual intercourse around the time of implantation on the probability of achieving a pregnancy has been discussed by some researchers, there are limited data regarding how sexual intercourse may influence ovulation occurrence and menstrual cycle characteristics in humans. STUDY DESIGN SIZE DURATION: This study is a pooled analysis of three cohorts of women, enrolled at Creighton Model FertilityCare centers in the USA and Canada: 'Creighton Model MultiCenter Fecundability Study' (CMFS: retrospective cohort, 1990-1996), 'Time to Pregnancy in Normal Fertility' (TTP: randomized trial, 2003-2006) and 'Creighton Model Effectiveness, Intentions, and Behaviors Assessment' (CEIBA: prospective cohort, 2009-2013). We evaluated cycle phase lengths, bleeding and cervical mucus patterns and estimated the fertile window in 2564 cycles of 530 women, followed for up to 1 year. PARTICIPANTS/MATERIALS SETTING METHODS: Participants were US or Canadian women aged 18-40 and not pregnant, who were heterosexually active, without known subfertility and not taking exogenous hormones. Most of the women were intending to avoid pregnancy at the start of follow-up. Women recorded daily vaginal bleeding, mucus discharge and sexual intercourse using a standardized protocol and recording system for up to 1 year, yielding 2564 cycles available for analysis. The peak day of mucus discharge (generally the last day of cervical fluid with estrogen-stimulated qualities of being clear, stretchy or slippery) was used to identify the estimated day of ovulation, which we considered the last day of the follicular phase in ovulatory cycles. We used linear mixed models to assess continuous cycle parameters including cycle, menses and cycle phase lengths, and generalized linear models using Poisson regression with robust variance to assess dichotomous outcomes such as ovulatory function, short luteal phases and presence or absence of follicular or luteal bleeding. Cycles were stratified by the presence or absence of any sexual intercourse, while adjusting for women's parity, age, recent oral contraceptive use and breast feeding. MAIN RESULTS AND THE ROLE OF CHANCE: Most women were <30 years of age (75.5%; median 27, interquartile range 24-29), non-Hispanic white (88.1%), with high socioeconomic indicators and nulliparous (70.9%). Cycles with no sexual intercourse compared to cycles with at least 1 day of sexual intercourse were shorter (29.1 days (95% CI 27.6, 30.7) versus 30.1 days (95% CI 28.7, 31.4)), had shorter luteal phases (10.8 days (95% CI 10.2, 11.5) versus 11.4 days (95% CI 10.9, 12.0)), had a higher probability of luteal phase deficiency (<10 days; adjusted probability ratio (PR) 1.31 (95% CI 1.00, 1.71)), had a higher probability of 2 days of premenstrual spotting (adjusted PR 2.15 (95% CI 1.09, 4.24)) and a higher probability of having two or fewer days of peak-type (estrogenic) cervical fluid (adjusted PR 1.49 (95% CI 1.03, 2.15)). LIMITATIONS REASONS FOR CAUTION: Our study participants were geographically dispersed but relatively homogeneous in regard to race, ethnicity, income and educational levels, and all had male partners, which may limit the generalizability of the findings. We cannot exclude the possibility of undetected subfertility or related gynecologic disorders among some of the women, such as undetected endometriosis or polycystic ovary syndrome, which would impact the generalizability of our findings. Acute illness or stressful events might have reduced the likelihood of any intercourse during a cycle, while also altering cycle characteristics. Some cycles in the no intercourse group may have actually had undocumented intercourse or other sexual activity, but this would bias our results toward the null. The Creighton Model FertilityCare System (CrM) discourages use of barrier methods, so we believe that most instances of intercourse involved exposure to semen; however, condoms may have been used in some cycles. Our dataset lacks any information about the occurrence of female orgasm, precluding our ability to evaluate the independent or combined impact of female orgasm on cycle characteristics. WIDER IMPLICATIONS OF THE FINDINGS: Sexual activity may change reproductive hormonal patterns, and/or levels of reproductive hormones may influence the likelihood of sexual activity. Future work may help with understanding the extent to which exposure to seminal fluid, and/or female orgasm and/or timing of intercourse could impact menstrual cycle function. In theory, large data sets from women using menstrual and fertility tracking apps could be informative if women can be appropriately incentivized to record intercourse completely. It is also of interest to understand how cycle characteristics may differ in women with gynecological problems or subfertility. STUDY FUNDING/COMPETING INTERESTS: Funding for the research on the three cohorts analyzed in this study was provided by the Robert Wood Johnson Foundation #029258 (Creighton Model MultiCenter Fecundability Study), the Eunice Kennedy Shriver National Institute of Child Health and Human Development 1K23 HD0147901-01A1 (Time to Pregnancy in Normal Fertility) and the Office of Family Planning, Office of Population Affairs, Health and Human Services 1FPRPA006035 (Creighton Model Effectiveness, Intentions, and Behaviors Assessment). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: a cross-sectional study.

OBJECTIVE: To investigate perinatal outcomes associated with fertility treatments, including assisted reproductive technology (ART), intrauterine insemination with ovulation stimulation (IUI), and ovulation stimulation alone (OS). DESIGN: Population-representative cross-sectional survey of women with live births, 2004-2008. SETTING: Florida, Maryland, and Utah, USA. SAMPLE: 21 803 women, weighted to represent 1 022 597 women. METHODS: Survey and birth certificate data were analysed with logistic regression models adjusted for age, education, race, income, and parity, using separate models for singletons and all births. We used two referent groups: (1) women who never used fertility treatment and (2) subfertile women conceiving without treatment. MAIN OUTCOME MEASURES: Preterm birth (<37 weeks), very preterm birth (<34 weeks), low birthweight (<2500 g), and very low birthweight (<1500 g). RESULTS: Referent group 1: In singletons, ART was associated with preterm birth (OR 3.28; 95% CI 1.74, 6.20) and low birthweight (OR 2.91; 95% CI 1.99, 4.26). OS was also associated with low birthweight (OR 1.62; 95% CI 1.19, 2.19). Including all births, treatment was associated with preterm birth and low birthweight: ART (OR 6.21; 95% CI 4.21, 9.16 and OR 6.51; 95% CI 4.85, 8.73); IUI (OR 2.10; 95% CI 1.24, 3.56 and OR 2.41; 95% CI 1.54, 3.76); OS (OR 1.40; 95% CI 1.01, 1.94 and OR 2.10; 95% CI 1.60, 2.75), respectively. Referent group 2: ART was associated with both outcomes in all births, but not singletons. CONCLUSIONS: Preterm birth and low birthweight associated with fertility treatments are largely attributable to multiple gestation, but are also related to underlying subfertility. TWEETABLE ABSTRACT: Preterm birth is associated with subfertility, and with fertility treatments through multiple gestation.

Risk factors for recurrent preterm birth in multiparous Utah women: a historical cohort study.

OBJECTIVE: To describe risk factors for recurrent preterm birth (PTB) in the second and third birth. DESIGN: Historical cohort study. SETTING: Utah, USA. POPULATION: Women who had their first three singleton live births in Utah between 1989 and 2007 and a preterm first or second birth were included. METHODS: Maternally linked birth records were used. Multivariable-adjusted risk ratios were calculated for recurrent PTB. Results were stratified by spontaneous and indicated PTB and by pattern of birth outcomes. MAIN OUTCOME MEASURES: Risk ratios and 95% confidence intervals for risk factors for recurrent PTB. RESULTS: Among women with PTB in their first or second live birth, recurrent PTB occurred in 21% of second live births (n = 1011/4805) and 22% of third live births (n = 1872/8468). Risk factors for recurrence included short inter-pregnancy interval, underweight prepregnancy body mass index, pre-existing maternal medical conditions, history of PTB at 28-32 weeks of gestation (versus 33-36 weeks), the presence of a fetal anomaly, and young maternal age. Risk factors for spontaneous, but not indicated PTB included young maternal age and less than appropriate gestational weight gain. Risk factors also varied in women experiencing a first versus second recurrence in their third birth. CONCLUSIONS: Risk factors may vary by the clinical subtype of the most recent PTB and the pattern of term and preterm outcomes across births 1-3; some of the risk factors identified in this study may be modifiable through interventions targeted at women in the inter-conception period.

Dietary structured triacylglycerols containing docosahexaenoic acid given from birth affect visual and auditory performance and tissue fatty acid profiles of rats.

To examine whether it is possible to enhance the level of 22:6(n-3) in the central nervous system, newborn rats were fed dietary supplements containing oils with either specific or random triacylglycerol structure, but similar concentrations of polyunsaturated fatty acids. In the specific structured oil, 22:6(n-3) was located in the sn-2 position, whereas it was equally distributed among the three positions in the triacylglycerol molecule in the randomized oil. A reference group was fed rat milk before weaning and nonpurified diet after weaning. After 12 wk, the levels of 22:6(n-3) in brain and liver phospholipids were higher in the groups fed the experimental diets than in the reference group. The specific structured oil resulted in the highest level of 22:6(n-3) in the brain, whereas the level of 22:6(n-3) was highest in the liver of the group fed randomized oil, indicating differences in metabolism of fatty acids resulting from their position in the dietary triacylglycerol molecule. The higher levels of 22:6(n-3) were accompanied by significantly lower levels of the long-chain (n-6) polyunsaturated fatty acids compared with the reference group. The fatty acid profiles, including the level of 22:6(n-3), in the retina phospholipids were not affected by the three different diets apart from a lower level of 20:4(n-6) in rats fed the experimental diets, indicating a strong tendency to maintain a high level of 22:6(n-3) in the retina. The changes in the fatty acid profiles did not result in differences in learning ability, but caused changes in visual function, evidenced by higher latency of the b-wave and lower oscillatory potential, and in auditory brainstem response, evidenced by generally greater amplitude of wave Ia in the group fed specific structured oil.

Reappraisal of a short-wavelength-sensitive (S-cone) recording technique in routine clinical electroretinography.

The recording of blue cone (S-cone) responses as described by Gouras and MacKay was slightly modified and incorporated into our routine ganzfeld electroretinogram protocol. We found a mean S-cone amplitude of 5.0 microV (range 2.9-6.9 microV) and a mean S-cone implicit time of 41.5 msec (range 40-46 msec). Separation between the combined red and green cone (L-M-cone) response and the S-cone response was obtained with blue flash stimuli on a yellow adapting background.

Retinal cone dysfunction of supernormal rod ERG type. Five new cases.

Five patients, not related to each other, showed clinical signs, including electroretinograms, of a retinal dysfunction which mainly affected the cone system, but also involved the rod responses in a peculiar way. ERG b-wave threshold under dark adapted conditions was elevated. In contrast, rod b-wave sensitivity was enhanced with medium to high intensity flash stimulation. Furthermore, all patients had a severe reduction of the oscillatory potentials. The findings are discussed with special emphasis on a hypothetical disturbance in the cyclic guanosine monophosphate metabolism, involving both photoreceptors and cells of the inner plexiform layer responsible for retinal feedback mechanisms.

Financial circumstances of the elderly in Denmark--now and in the coming years. Pension systems and other economic possibilities.

The situation concerning pensions in Denmark has been changing in recent years. There is a trend for the population itself has to pay into private pension to ensure a satisfactory financial situation after retirement. There are three categories of pensions and supplementary grants influencing the financial situation of the elderly: social-political grants, labour market political grants, and private arrangements. The national retirement pension is paid to everyone in accordance with certain rules. One condition is residence in Denmark for 40 years after reaching the age of 15. The pension age is 67 years. It is possible to receive early retirement pay or to obtain partial pension from the age of 60. This means that the age for retirement from the labour market on average is 62 years. Supplements to the national pension can be given as a net sum. Such a payment, however, makes it more difficult for the elderly person to overview his or her financial circumstances in retirement. The partial pension is a new form of pension which was introduced in 1986. About 2% of the 60-66 year-olds have taken advantage of this possibility, most of them independent trade men. In contrast, 105,000 wage earners are receiving early retirement pay, which is based on unemployment insurance. Certain considerations apply when the social pension is paid in a gross amount. This amount will not be free of tax. A number of special grants for the elderly will be included in the gross amount of the social pension. A system of that sort will make the financial circumstances of the retired person more clear.(ABSTRACT TRUNCATED AT 250 WORDS)

Autosomal dominant stationary night-blindness. A large family rediscovered.

In 1909, 2 years after the famous publication by Nettleship, a large family with congenital stationary night-blindness of the 'Nougaret type' was published by the Danish district surgeon, Sigurd Rambusch. In 1990 the 'Rambusch family', still resident in the original area, was sought out and rediscovered, at which time the reconstructed part of the pedigree comprised more than 200 affected persons in 11 generations. Dark adaptometry and electroretinography were performed on a few affected family members, including a descendant with a uniocular affection. The pedigree is presented and recordings of dark adaptation courses and electroretinographical responses from a few family members are demonstrated.

Aland eye disease (Forsius-Eriksson-Miyake syndrome) with probability established in a Danish family.

A reinvestigation of a Danish family with X-linked inherited congenital nystagmus through 6 generations revealed a congenital stationary retinal dysfunction syndrome with characteristics of both incomplete congenital stationary night blindness and Aland Eye Disease. In spite of rather uniform electrophysiological findings in our patients, this retinal disorder which affects both cones and rods demonstrated considerable intrafamilial diversity with respect to visual acuity, nystagmus, refractive state and fundus pigmentation.

Oscillatory potential and nyctometry in insulin-dependent diabetics.

The study draws a comparison between the oscillatory potential of the electroretinogram and the initial dark-adaptation measured by nyctometry, with the aim of assessing the predictive value of nyctometry in juvenile diabetics. The study included 61 insulin-dependent juvenile diabetics, aged 18-49 years, with a disease duration of more than five years. A statistically highly significant correlation could be demonstrated between alterations in the oscillatory potential and in the initial dark-adaptation. The results justify the assumption that nyctometry can be used as an easily handled clinical tool in selecting those at risk of developing proliferative retinopathy in their subsequent 6-8 years.

The value of the oscillatory potential in selecting juvenile diabetics at risk of developing proliferative retinopathy.

A prospective long-term study of the predictive value of the oscillatory potential in the development of proliferative diabetic retinopathy has been made in 137 diabetics. Follow-ups 6-8 and 13-15 years later demonstrated that recording the oscillatory potential in juvenile diabetics with a disease duration of more than 5 years is valuable in selecting those at risk of developing proliferative retinopathy within 6 years at any rate. The predictive value of the oscillatory potentials is probably more limited in women who later become pregnant.