Universal SARS-CoV-2 polymerase chain reaction screening and assisted reproductive technology in a coronavirus disease 2019 pandemic epicenter: screening and cycle outcomes from a New York City fertility center.

OBJECTIVE: To evaluate the prevalence of coronavirus disease 2019 (COVID-19) and efficacy of a universal screening program in patients undergoing controlled ovarian stimulation (COS). DESIGN: Single-center retrospective cohort study. SETTING: Academic fertility center in an epicenter of the COVID-19 pandemic. PATIENT(S): All patients undergoing COS from June 17, 2019, to February 28, 2021. INTERVENTION(S): Universal COVID-19 screening starting June 17, 2020, with SARS-CoV-2 polymerase chain reaction testing within 5 days of oocyte retrieval, patient-reported symptom screening, and temperature monitoring. MAIN OUTCOMES MEASURE(S): The primary outcome was the number of positive COVID-19 cases in patients undergoing COS cycles. The secondary outcomes were cycle outcomes compared with before COVID-19 COS cycles, adverse outcomes in COVID-canceled cycles, and center-specific COVID-19 detection rates compared with New York City cases. RESULT(S): From June 17, 2020, to February 28, 2021, 1,696 COS cycles were initiated with only seven positive COVID-19 cases for an overall positivity rate of 0.4%. When compared with before COVID cycles from June 17, 2019, to February 28, 2020, the volume of COS cycles were higher, while the overall cycle cancelation rate was lower during COVID-19. Cycle outcomes including oocyte yield and blast utilization rates were unchanged from pre-COVID cycles. Cases of COVID-19, while very low, occurred more frequently during surges in New York City rates. CONCLUSION(S): Assisted reproductive technology can be performed during the COVID-19 pandemic utilizing frequent universal screening and safe practices with low SARS-CoV-2 positivity, low cycle cancelation rates, and positive patient outcomes.

Intra-uterine insemination for unexplained subfertility.

BACKGROUND: Intra-uterine insemination (IUI) is a widely-used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rates. OBJECTIVES: To determine whether, for couples with unexplained subfertility, the live birth rate is improved following IUI treatment with or without OH compared to timed intercourse (TI) or expectant management with or without OH, or following IUI treatment with OH compared to IUI in a natural cycle. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers up to 17 October 2019, together with reference checking and contact with study authors for missing or unpublished data. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing IUI with TI or expectant management, both in stimulated or natural cycles, or IUI in stimulated cycles with IUI in natural cycles in couples with unexplained subfertility. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, quality assessment and data extraction. Primary review outcomes were live birth rate and multiple pregnancy rate. MAIN RESULTS: We include 15 trials with 2068 women. The evidence was of very low to moderate quality. The main limitation was very serious imprecision. IUI in a natural cycle versus timed intercourse or expectant management in a natural cycle It is uncertain whether treatment with IUI in a natural cycle improves live birth rate compared to treatment with expectant management in a natural cycle (odds ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT, 334 women; low-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle to be 16%, that of IUI in a natural cycle would be between 15% and 34%. It is uncertain whether treatment with IUI in a natural cycle reduces multiple pregnancy rates compared to control (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT, 334 women; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a stimulated cycle It is uncertain whether treatment with IUI in a stimulated cycle improves live birth rates compared to treatment with TI in a stimulated cycle (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs, 208 women; I2 = 72%; low-quality evidence). If we assume the chance of achieving a live birth with TI in a stimulated cycle was 26%, the chance with IUI in a stimulated cycle would be between 23% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle reduces multiple pregnancy rates compared to control (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, 316 women; I2 = 0%; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a natural cycle In couples with a low prediction score of natural conception, treatment with IUI combined with clomiphene citrate or letrozole probably results in a higher live birth rate compared to treatment with expectant management in a natural cycle (OR 4.48, 95% CI 2.00 to 10.01; 1 RCT; 201 women; moderate-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle was 9%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle results in a lower multiple pregnancy rate compared to control (OR 3.01, 95% CI 0.47 to 19.28; 2 RCTs, 454 women; I2 = 0%; low-quality evidence). IUI in a natural cycle versus timed intercourse or expectant management in a stimulated cycle Treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with expectant management in a stimulated cycle (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, 342 women: moderate-quality evidence). If we assume the chance of a live birth with expectant management in a stimulated cycle was 13%, the chance of a live birth with IUI in a natural cycle would be between 14% and 34%. It is uncertain whether treatment with IUI in a natural cycle results in a lower multiple pregnancy rate compared to control (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT, 342 women; low-quality evidence). IUI in a stimulated cycle versus IUI in a natural cycle Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle (OR 2.07, 95% CI 1.22 to 3.50; 4 RCTs, 396 women; I2 = 0%; low-quality evidence). If we assume the chance of a live birth with IUI in a natural cycle was 14%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 36%. It is uncertain whether treatment with IUI in a stimulated cycle results in a higher multiple pregnancy rate compared to control (OR 3.00, 95% CI 0.11 to 78.27; 2 RCTs, 65 women; low-quality evidence). AUTHORS' CONCLUSIONS: Due to insufficient data, it is uncertain whether treatment with IUI with or without OH compared to timed intercourse or expectant management with or without OH improves cumulative live birth rates with acceptable multiple pregnancy rates in couples with unexplained subfertility. However, treatment with IUI with OH probably results in a higher cumulative live birth rate compared to expectant management without OH in couples with a low prediction score of natural conception. Similarly, treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with timed intercourse with OH. Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle.

Comparison of woman-picked, expert-picked, and computer-picked Peak Day of cervical mucus with blinded urine luteinising hormone surge for concurrent identification of ovulation.

BACKGROUND: Previous research has demonstrated that women instructed in fertility awareness methods can identify the Peak Day of cervical mucus discharge for each menstrual cycle, and the Peak Day has high agreement with other indicators of the day of ovulation. However, previous studies enrolled experienced users of fertility awareness methods or were not fully blinded. OBJECTIVE: To assess the agreement between cervical mucus Peak Day identified by fertile women without prior experience on assessing cervical mucus discharge with the estimated day of ovulation (1 day after urine luteinising hormone surge). METHODS: This study is a secondary analysis of data from a randomised trial of the Creighton Model FertilityCareTM System (CrM), conducted 2003-2006, for women trying to conceive. Women who had no prior experience tracking cervical mucus recorded vulvar observations daily using a standardised assessment of mucus characteristics for up to seven menstrual cycles. Four approaches were used to identify the Peak Day. The referent day was defined as one day after the first identified day of luteinising hormone (LH) surge in the urine, assessed blindly. The percentage of agreement between the Peak Day and the referent day of ovulation was calculated. RESULTS: Fifty-seven women with 187 complete cycles were included. A Peak Day was identified in 117 (63%) cycles by women, 185 (99%) cycles by experts, and 187 (100%) by computer algorithm. The woman-picked Peak Day was the same as the referent day in 25% of 117 cycles, within ±1 day in 58% of cycles, ±2 days in 84%, ±3 days in 87%, and ±4 days in 92%. The ±1 day and ± 4 days' agreement was 50% and 90% for the expert-picked and 47% and 87% for the computer-picked Peak Day, respectively. CONCLUSIONS: Women's daily tracking of cervical mucus is a low-cost alternative for identifying the estimated day of ovulation.

Is there a difference toward strength, muscular endurance, anaerobic power and hormonal changes between the three phase of the menstrual cycle of active girls? / ¿Existe diferencia entre fuerza y resistencia muscular, potencia anaeróbica y cambios hormonales entre las tres fases del ciclo menstrual de las jóvenes activas?

BACKGROUND: Menstrual cycles are affected by the concentration of estrogen and progesterone hormones affecting the individual's functional and physical factors. Aims: The purpose of this study was to investigate the difference (and relationship) toward strength, muscular endurance, anaerobic power and hormonal changes between the three (follicular, ovulation, luteal) phases of the menstrual cycle of active young girls. METHODS: Twenty young girls were selected randomly and purposefully in the age group from 20 to 30. Hormonal changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), one repetition maximum (1RM or strength) of upper body and lower body, and muscular endurance test with 60% 1RM of upper body and lower body in the three phases of the menstrual cycle were measured. Also, running-based anaerobic sprint test (RAST) was used to estimate anaerobic power. RESULTS: The results of this study showed that there was no significant difference between muscular strength and endurance in the three phases of the menstrual cycle (upper and lower body muscle strength: P = 0.13, P = 0.23; muscular endurance: P = 0.33, P = 0.5, respectively). Also, the results indicated no significant difference in anaerobic power in the three phases of the menstrual cycle (P = 0.45). In contrast, there was a significant difference between LH and FSH levels in the menstrual cycle phases (P = 0.001). CONCLUSIONS: The different phases of the menstrual cycle practically do not limit the physical and physiological performance of active young girls, and girls can participate in sports activities without worrying about a drop in performance

ANTECEDENTES: Los ciclos menstruales son afectados por la concentración de estrógeno y progesterona, que afectan a los factores funcional y físico del individuo. OBJETIVO: El objetivo de este estudio fue investigar la diferencia (y relación) entre fuerza y resistencia muscular, potencia anaeróbica y cambios hormonales entre las tres fases (folicular, ovulación, lútea) del ciclo menstrual de las jóvenes activas. MÉTODOS: Se seleccionaron veinte chicas intencionada y aleatoriamente del grupo de edad comprendido entre 20 y 30 años. Se midieron los cambios hormonales de la hormona folículo-estimulante (FSH), la hormona luteinizante (LH), una repetición máxima (1RM o fuerza) del tren superior y el tren inferior, y la prueba de resistencia muscular con un 60% de 1RM del tren superior y el tren inferior en las tres fases del ciclo. Se utilizó también la prueba de carrera anaeróbica en sprint (RAST) para calcular la potencia anaeróbica. RESULTADOS: Los resultados de este estudio reflejaron que no existía diferencia significativa entre fuerza y resistencia muscular en las tres fases del ciclo menstrual (fuerza muscular de los trenes superior e inferior: p = 0,13, p = 0,23, y resistencia muscular: p = 0,33, p = 0,5, respectivamente). Los resultados indicaron también que no existía diferencia significativa en cuanto a potencia anaeróbica en las tres fases del ciclo menstrual (p = 0,45). Por contra, existía una diferencia significativa entre los niveles de LH y FSH en las fases del ciclo menstrual (p = 0,001). CONCLUSIONES: Las diferentes fases del ciclo menstrual no limitan prácticamente el desempeño físico y fisiológico de las jóvenes activas, pudiendo participar las chicas en actividades deportivas sin preocuparse acerca de la caída de rendimiento

Ovulatory Shifts in Sexual Desire But Not Mate Preferences: An LH-Test-Confirmed, Longitudinal Study.

The presented data are part of a longitudinal within-subject study designed to examine ovulatory shifts in human sexuality in a diverse German sample using validated questionnaires. The final sample consists of 78 individuals (76 female, 2 agender) who declared to be mainly or exclusively attracted to males. Questionnaires were completed anonymously online at three cycle phases. Following the gold standard, the fertile window was calculated through the reverse cycle day method and confirmed via urinary tests detecting luteinizing hormone. The questionnaire included the Sexual Desire Inventory, Dresdner Body Image Inventory, the Revised Sociosexual Orientation Inventory, and an adjective list to measure mate preferences. One hundred eighty-four questionnaires were included in the data analysis using linear mixed models. Findings support previous research reporting heightened sexual desire and an improved body image during the fertile window. No shifts were found for mate preference or sociosexual orientation, thus adding to a growing body of literature contesting parts of the ovulatory shift hypothesis.

The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy.

INTRODUCTION: In recent years there has been an explosion in the development of medical apps, with more than 40,000 apps now available. Nearly 100 apps allow women to track their fertility and menstrual cycles and can be used to avoid or achieve pregnancy. Apps offer a convenient way to track fertility biomarkers. However, only some use evidence-based fertility awareness-based methods (FABMs), which with ideal use have rates of effectiveness similar to those of commonly used forms of hormonal birth control. Since having a baby or preventing a pregnancy are important responsibilities, it is critical that women and couples have access to reliable, evidence-based apps that allow them to accurately track their fertility. METHODS: We developed a tool to evaluate and rate fertility apps. This tool is specifically designed to help couples avoid pregnancy. RESULTS: Results showed that the majority of fertility apps are not based on evidence-based FABMs or include a disclaimer discouraging use for avoiding pregnancy. However, at least 1 app in each FABM category (except symptohormonal methods) had a perfect score on accuracy. CONCLUSION: Relying solely on an app to use an FABM, without appropriate training in the method, may not be sufficient to prevent pregnancy.

Intra-uterine insemination for unexplained subfertility.

BACKGROUND: Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive thAppendixan in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rate. This is an update of a Cochrane review (Veltman-Verhulst 2012) originally published in 2006 and updated in 2012. OBJECTIVES: To determine whether, for couples with unexplained subfertility, IUI improves the live birth rate compared with timed intercourse (TI), or expectant management, both with and without ovarian hyperstimulation (OH). SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (formerly Cochrane Menstrual Disorders and Subfertility Group) Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, inception to Issue 11, 2015), Ovid MEDLINE, Ovid EMBASE, PsycINFO and trial registers, all from inception to December 2015 and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. The evidence is current to December 2015. SELECTION CRITERIA: Truly randomised controlled trial (RCT) comparisons of IUI versus TI, in natural or stimulated cycles. Only couples with unexplained subfertility were included. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, quality assessment and data extraction. We extracted outcomes, and pooled data and, where possible, we carried out subgroup and sensitivity analyses. MAIN RESULTS: We included 14 trials including 1867 women. IUI versus TI or expectant management both in natural cycleLive birth rate (all cycles)There was no evidence of a difference in cumulative live births between the two groups (Odds Ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT; n = 334; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI was assumed to be 16%, that of IUI would be between 15% and 34%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT; n = 334; moderate quality evidence). IUI versus TI or expectant management both in stimulated cycleLive birth rate (all cycles)There was no evidence of a difference between the two treatment groups (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs; n = 208; I(2) = 72%; moderate quality evidence). The evidence suggested that if the chance of achieving a live birth in TI was assumed to be 26%, the chance of a live birth with IUI would be between 23% and 50%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rates between the two treatment groups (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, n = 316; I(2) = 0%; low quality evidence). IUI in a natural cycle versus IUI in a stimulated cycle Live birth rate (all cycles)An increase in live birth rate was found for women who were treated with IUI in a stimulated cycle compared with those who underwent IUI in natural cycle (OR 0.48, 95% CI 0.29 to 0.82; 4 RCTs, n = 396; I(2) = 0%; moderate quality evidence). The evidence suggested that if the chance of a live birth in IUI in a stimulated cycle was assumed to be 25%, the chance of a live birth in IUI in a natural cycle would be between 9% and 21%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 0.33, 95% CI 0.01 to 8.70; 2 RCTs; n = 65; low quality evidence). IUI in a stimulated cycle versus TI or expectant management in a natural cycleLive birth rate (all cycles)There was no evidence of a difference in live birth rate between the two treatment groups (OR 0.82, 95% CI 0.45 to 1.49; 1 RCT; n = 253; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI or expectant management in a natural cycle was assumed to be 24%, the chance of a live birth in IUI in a stimulated cycle would be between 12% and 32%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 2.00, 95% CI 0.18 to 22.34; 2 RCTs; n = 304; moderate quality evidence). IUI in natural cycle versus TI or expectant management in stimulated cycle Live birth rate (all cycles)There was evidence of an increase in live births for IUI (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, n = 342; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI in a stimulated cycle was assumed to be 13%, the chance of a live birth in IUI in a natural cycle would be between 14% and 34%.Multiple pregnancy rateThere was no evidence of a difference in multiple pregnancy rate between the groups (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT; n = 342; moderate quality evidence).The quality of the evidence was assessed using GRADE methods. Quality ranged from low to moderate, the main limitation being imprecision in the findings for both live birth and multiple pregnancy.. AUTHORS' CONCLUSIONS: This systematic review did not find conclusive evidence of a difference in live birth or multiple pregnancy in most of the comparisons for couples with unexplained subfertility treated with intra-uterine insemination (IUI) when compared with timed intercourse (TI), both with and without ovarian hyperstimulation (OH). There were insufficient studies to allow for pooling of data on the important outcome measures for each of the comparisons.

Effects of ovarian hormones and oral contraceptive pills on cardiac vagal withdrawal at the onset of dynamic exercise.

The purpose of this study was to investigate the effects of the ovarian hormones and the use of oral contraceptive pills (OCP) on cardiac vagal withdrawal at the onset of dynamic exercise. Thirty physically active women aged 19-32 years were divided into two groups: OCP users (n = 17) and non-OCP users (n = 13). Participants were studied randomly at three different phases of the menstrual cycle: early follicular (day 3.6 ± 1.2; range 1-5), ovulatory (day 14.3 ± 0.8; range 13-16) and midluteal (day 21.3 ± 0.8; range 20-24), according to endogenous (in non-OCP users) or exogenous (in OCP users) estradiol and progesterone variations. The cardiac vagal withdrawal was represented by the cardiac vagal index (CVI), which was obtained by the 4-s exercise test. Additionally, resting heart rate, systolic (SBP) and diastolic blood pressure (DBP) were obtained. The CVI was not significantly different between the three phases of the menstrual cycle in either the non-OCP users (early follicular: 1.58 ± 0.1; ovulatory: 1.56 ± 0.1; midluteal: 1.58 ± 0.1, P > 0.05) or OCP users (early follicular: 1.47 ± 0.1; ovulatory: 1.49 ± 0.1; midluteal: 1.47 ± 0.1, P > 0.05) (mean ± SEM). Resting cardiovascular responses were not affected by hormonal phase or OCP use, except that the SBP was higher in the OCP users than non-OCP users in all phases of the cycle (P < 0.05). In summary, our results demonstrate that cardiac vagal withdrawal at the onset of dynamic exercise was not impacted by the menstrual cycle or OCP use in physically active women.

Women's genital sexual arousal to oral versus penetrative heterosexual sex varies with menstrual cycle phase at first exposure.

Reproductive-aged women show increased interest in sexual activity during the fertile phase of the menstrual cycle that can motivate sexual behavior and thereby increase the likelihood of conception. We examined whether women demonstrated greater sexual responses (subjective and genital sexual arousal) to penetrative versus oral sexual activities during the fertile versus non-fertile phases of their cycles, and whether women's arousal responses were influenced by the phase during which they were first exposed to these sexual stimuli (e.g., Slob et al., 1991; Wallen and Rupp, 2010). Twenty-two androphilic women completed two identical sexual arousal assessments in which genital responses were measured with a vaginal photoplethysmograph and their feelings of sexual arousal were recorded. Women viewed an array of 90s films varying by couple type (female-female, male-male, female-male) and sexual activity type (oral or penetrative), during the fertile (follicular) and non-fertile (luteal) phases of their menstrual cycle, with the order of cycle phase at the first testing session counter-balanced. Women tested first in the fertile phase showed significantly greater genital arousal to female-male penetrative versus oral sex in both testing sessions, whereas self-reports of sexual arousal were not affected by cycle phase or testing order. These results contribute to a growing body of research suggesting that fertility status at first exposure to sexual stimuli has a significant effect on subsequent sexual responses to sexual stimuli, and that this effect may differ for subjective versus genital sexual arousal.

Changes in women's attractiveness perception of masculine men's dances across the ovulatory cycle: preliminary data.

Women's preferences for putative cues of genetic quality in men's voices, faces, bodies, and behavioral displays are stronger during the fertile phase of the ovulatory cycle. Here we show that ovulatory cycle-related changes in women's attractiveness perceptions of male features are also found with dance movements, especially those perceived as highly masculine. Dance movements of 79 British men were recorded with an optical motion-capture system whilst dancing to a basic rhythm. Virtual humanoid characters (avatars) were created and converted into 15-second video clips and rated by 37 women on masculinity. Another 23 women judged the attractiveness of the 10 dancers who scored highest and those 10 who scored lowest on masculinity once in days of high fertility and once in days of low fertility of their ovulatory cycle. High-masculine dancers were judged higher on attractiveness around ovulation than on other cycle days, whilst no such perceptual difference was found for low-masculine dancers. We suggest that women may gain fitness benefits from evolved preferences for masculinity cues they obtain from male dance movements.

Intra-uterine insemination for unexplained subfertility.

BACKGROUND: Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rate. OBJECTIVES: To determine whether, for couples with unexplained subfertility, IUI improves the live birth rate compared with timed intercourse (TI), both with and without ovarian hyperstimulation (OH). SEARCH METHODS: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched July 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 7), MEDLINE (1966 to July 2011), EMBASE (1980 to July 2011), PsycINFO (1806 to July 2011), SCIsearch and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. SELECTION CRITERIA: Truly randomised controlled trials (RCTs) with at least one of the following comparisons were included: IUI versus TI, both in a natural cycle; IUI versus TI, both in a stimulated cycle; IUI in a natural cycle versus IUI in a stimulated cycle; IUI with OH versus TI in a natural cycle; IUI in a natural cycle versus TI with OH. Only couples with unexplained subfertility were included. DATA COLLECTION AND ANALYSIS: Quality assessment and data extraction were performed independently by two review authors. Outcomes were extracted and the data were pooled. Subgroup and sensitivity analyses were done where possible. MAIN RESULTS: One trial compared IUI in a natural cycle with expectant management and showed no evidence of increased live births (334 women: odds ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.8). In the six trials where IUI was compared with TI, both in stimulated cycles, there was evidence of an increased chance of pregnancy after IUI (six RCTs, 517 women: OR 1.68, 95% CI 1.13 to 2.50). A significant increase in live birth rate was found for women where IUI with OH was compared with IUI in a natural cycle (four RCTs, 396 women: OR 2.07, 95% CI 1.22 to 3.50). However the trials provided insufficient data to investigate the impact of IUI with or without OH on several important outcomes including live births, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in pregnancy rate for IUI with OH compared with TI in a natural cycle (two RCTs, total 304 women: data not pooled). The final comparison of IUI in natural cycle to TI with OH showed a marginal, significant increase in live births for IUI (one RCT, 342 women: OR 1.95, 95% CI 1.10 to 3.44). AUTHORS' CONCLUSIONS: There is evidence that IUI with OH increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to TI in stimulated cycles. One adequately powered multicentre trial showed no evidence of effect of IUI in natural cycles compared with expectant management. There is insufficient data on multiple pregnancies and other adverse events for treatment with OH. Therefore couples should be fully informed about the risks of IUI and OH as well as alternative treatment options.

Influence of female hormonal fluctuation on maximum occlusal force.

Hormonal fluctuations during the menstrual cycle may influence on muscular tensions and probably alter occlusal force. The aim of this study was to evaluate whether hormonal levels affect maximum occlusal force (MOF) of healthy women throughout the different phases of the menstrual cycle. Sixty complete dentate subjects who were not under use of oral contraceptives were selected to participate in this study. MOF was bilaterally evaluated on the molar region, during 3 complete menstrual cycles, using 5.65 mm-wide sensors. Measurements were carried out during each of the following menstrual cycle phases: menstrual, follicular, periovulatory and luteal, presumed by ovulation test. Data were analyzed by one-way ANOVA and Tukey-Kramer test (p<0.05). Comparisons among menstrual cycle phases showed no differences on MOF (p = 0.27). Under the conditions of this study, it may be concluded that hormonal fluctuations during the menstrual cycle do not affect MOF of a sample of healthy women.

Feeding behavior and nutrient intake in spiny forest-dwelling ring-tailed lemurs (Lemur catta) during early gestation and early to mid-lactation periods: compensating in a harsh environment.

Strong resource seasonality in Madagascar has led to the evolution of female feeding priority and weaning synchrony in most lemur species. For these taxa, pregnancy/early lactation periods coincide with low food availability, and weaning of infants is timed with increased resources at the onset of the rainy season. Reproductive females experience high metabolic requirements, which they must accommodate, particularly when food resources are scarce. Female ring-tailed lemurs (Lemur catta) residing in spiny forest habitat must deal with resource scarcity, high temperatures (∼36-40°C) and little shade in early to mid-lactation periods. Considered "income breeders," these females must use resources obtained from the environment instead of relying on fat stores; thus, we expected they would differ from same-sized males in time spent on feeding and in the intake of food and nutrients. We investigated these variables in two groups (N = 11 and 12) of Lemur catta residing in spiny forest habitat during early gestation and early to mid-lactation periods. Focal animal data and food plant samples were collected, and plants were analyzed for protein, kcal, and fiber. We found no sex differences for any feeding or nutrient intake variable for the top five food species consumed. Females in early gestation spent more time feeding compared with early/mid-lactation. Physiological compensation for spiny forest-dwelling females may be tied to greater time spent resting compared with gallery forest conspecifics, consuming foods high in protein, calories, and water, reduced home range defense in a sparsely populated habitat, and for Lemur catta females in general, production of relatively dilute milk compared with many strepsirrhines.

Physical cues of ovulatory status: a failure to replicate enhanced facial attractiveness and reduced waist-to-hip ratio at high fertility.

We investigated women's facial attractiveness and body shape as a function of menstrual cycle phase, with the expectation from previous research that both would be enhanced during the high fertile phase. To control for the effects of women's daily behaviors on their appearance and waistline, we visited 37 normally cycling women twice in their dorm, where we photographed and measured them at low and high fertile days of their cycle immediately upon their waking. Seventy-four judges from a separate institution chose, for each woman, the picture they thought was more attractive. We analyzed a subset of 20 women who, by forward counting, had a High Fertility visit between Days 10-13 and a Low Fertility visit between Days 20-23; and we also analyzed a subsample of 17 women who, by reverse counting, had a High Fertility visit on the days leading to ovulation and a Low Fertility visit one week after ovulation. In neither set of analyses were women's waist- to-hip ratios lower nearer ovulation, and in neither set were women's high fertile pictures chosen at an above-chance rate by either male or female judges. We did not find evidence that facial attractiveness and waist-to-hip ratio are reliable physical cues of ovulatory status.

Influence of female hormonal fluctuation on maximum occlusal force

Hormonal fluctuations during the menstrual cycle may influence on muscular tensions and probably alter occlusal force. The aim of this study was to evaluate whether hormonal levels affect maximum occlusal force (MOF) of healthy women throughout the different phases of the menstrual cycle. Sixty complete dentate subjects who were not under use of oral contraceptives were selected to participate in this study. MOF was bilaterally evaluated on the molar region, during 3 complete menstrual cycles, using 5.65 mm-wide sensors. Measurements were carried out during each of the following menstrual cycle phases: menstrual, follicular, periovulatory and luteal, presumed by ovulation test. Data were analyzed by one-way ANOVA and Tukey-Kramer test (p<0.05). Comparisons among menstrual cycle phases showed no differences on MOF (p=0.27). Under the conditions of this study, it may be concluded that hormonal fluctuations during the menstrual cycle do not affect MOF of a sample of healthy women.

As flutuações hormonais durante o ciclo menstrual podem influenciar as tensões musculares e possivelmente alterar a força oclusal. O objetivo deste estudo foi avaliar se os níveis hormonais afetam a força máxima oclusal (FMO) de mulheres saudáveis durante as diferentes fases do ciclo menstrual. Sessenta pacientes completamente dentadas que não usavam contraceptivos orais foram selecionadas para participar neste estudo. FMO foi avaliada bilateralmente na região dos molares, durante 3 ciclos menstruais completos, utilizando sensores de 5,65 mm de espessura. As mensurações foram realizadas durante cada fase do ciclo menstrual: menstrual, folicular e lútea periovulatória, identificadas por teste ovulatório. Os dados foram analisados por ANOVA um critério seguido do teste de Tukey-Kramer (p<0,05). As comparações entre as fases do ciclo menstrual não apresentaram diferenças na FMO (p=0,27). Segundo as condições deste estudo, pode-se concluir que as flutuações hormonais durante o ciclo menstrual não afetaram a FMO de mulheres saudáveis.

A female signal reflects MHC genotype in a social primate.

BACKGROUND: Males from many species are believed to advertise their genetic quality through striking ornaments that attract mates. Yet the connections between signal expression, body condition and the genes associated with individual quality are rarely elucidated. This is particularly problematic for the signals of females in species with conventional sex roles, whose evolutionary significance has received little attention and is poorly understood. Here we explore these questions in the sexual swellings of female primates, which are among the most conspicuous of mammalian sexual signals and highly variable in size, shape and colour. We investigated the relationships between two components of sexual swellings (size and shape), body condition, and genes of the Major Histocompatibility Complex (MHC) in a wild baboon population (Papio ursinus) where males prefer large swellings. RESULTS: Although there was no effect of MHC diversity on the sexual swelling components, one specific MHC supertype (S1) was associated with poor body condition together with swellings of small size and a particular shape. The variation in swelling characteristics linked with the possession of supertype S1 appeared to be partially mediated by body condition and remained detectable when taking into account the possession of other supertypes. CONCLUSIONS: These findings suggest a pathway from immunity genes to sexual signals via physical condition for the first time in females. They further indicate that mechanisms of sexual selection traditionally assigned to males can also operate in females.

Female giant panda (Ailuropoda melanoleuca) chirps advertise the caller's fertile phase.

Although female mammal vocal behaviour is known to advertise fertility, to date, no non-human mammal study has shown that the acoustic structure of female calls varies significantly around their fertile period. Here, we used a combination of hormone measurements and acoustic analyses to determine whether female giant panda chirps have the potential to signal the caller's precise oestrous stage (fertile versus pre-fertile). We then used playback experiments to examine the response of male giant pandas to female chirps produced during fertile versus pre-fertile phases of the caller's reproductive cycle. Our results show that the acoustic structure of female giant panda chirps differs between fertile and pre-fertile callers and that male giant pandas can perceive differences in female chirps that allow them to determine the exact timing of the female's fertile phase. These findings indicate that male giant pandas could use vocal cues to preferentially associate and copulate with females at the optimum time for insemination and reveal the likely importance of female vocal signals for coordinating reproductive efforts in this critically endangered species.

Relationship between sexual interactions and the timing of the fertile phase in captive female Japanese macaques (Macaca fuscata).

Japanese macaques live in multi-male/multi-female social groups in which competition between males, female mate choice, and alternative male mating strategies are important determinants of mating and reproductive success. However, the extent to which adult males rely on female behavior to make their mating decisions as well as the effect of social rank on mating success are not clear as results are inconclusive, varying from study to study. In this study, we combined behavioral and endocrine data of 14 female Japanese macaques to examine the relationship between ovarian cycle phase and frequency of sexual behaviors, and to investigate how social rank influences sexual behavior in this species. We found that there was no increase in female proceptive behaviors during the fertile phase of the ovarian cycle, suggesting that female behaviors did not clearly signal the probability of conception. In spite of that, the frequencies of ejaculatory copulations were highest during this phase, indicating that the attractivity of females increased significantly during the period with higher probability of conception. Males, and especially the highest ranking male, were able to discriminate females nearing ovulation and to concentrate their mating effort, implying that the timing of ovulation was not concealed from them. The alpha male seemed able to monopolize most female matings, which is probably due in part to the low number of females simultaneously ovulating and to the limited number of inconspicuous places that the lower ranking males have to mate with females and avoid alpha male aggression. All together, these results suggest that different males may have access to different signals of ovulation and/or are differentially restrained as to how they can act on that information. The exact nature of the estrogen-related cues males use to recognize female reproductive status, and to what extent males use them warrants further investigation.

Baboon sexual swellings: information content of size and color.

Primate sexual swellings are hormone-dependent sexual signals that play a key role in determining patterns of behavior. They are among the most conspicuous signals exhibited by any mammal, and their large size and bright coloration have fascinated evolutionary biologists for well over a century. A number of different adaptive hypotheses have been proposed for the evolution of sexual swellings, and there have been several recent attempts to test some of these using precise swelling measurements made in the field. Most of these studies have focused only on the size element of the swelling, and those that have measured other aspects of swellings, such as color, have done so only crudely. A focus solely on swelling size is inconsistent with most theoretical models of mate choice, which emphasize the importance of multiple cues within sexual signals. Here, we present data on baboon (Papio hamadryas anubis) sexual swellings, including measures of both swelling size and color, measured objectively using digital photography at Gashaka-Gumti National Park, Nigeria. We combined these measurements with detailed data on fecal progestogen and estrogen levels, and estimates of the timing of ovulation and the fertile period around ovulation based on those levels. We show that swelling color and size vary independently, and that, consistent with results in other species, swelling size contains information about the timing of ovulation and the fertile period. However, we show that swelling color does not contain such information. In addition, swelling size contains information about female parity, and we found some evidence to suggest that color may also contain such information. These results indicate that baboon sexual swellings may contain information about multiple aspects of female fertility. We discuss the implications of these results for understanding the nature of swellings as behavioral signals, and the role of swellings in mate choice.