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PubMed1987

Prognostic assessment of female fecundity.

A clomiphene citrate (CC) challenge test was used to prospectively assess future fertility potential in 51 women aged 35 or more with unexplained infertility. Baseline (day 2-3 of the menstrual cycle) and response levels (day 9-11) of follicle stimulating hormone (FSH), luteinising hormone (LH), and 17-beta oestradiol were measured before and after administration of 100 mg clomiphene on days 5-9 of the menstrual cycle. Although all the women had a normal baseline FSH, 18 had an exaggerated FSH response of 26 mIU/ml or more (over 2 standard deviations above control values); this was regarded as a diminished ovarian reserve (DOR). In the DOR group mean response FSH was 38.9 mIU/ml (SD 13.8) and in 33 women with adequate ovarian reserve (AOR) it was 11.5 (4.9) mIU/ml (p less than 0.0001). In the DOR group 1 of 18 patients and in the AOR group 14 of 33 (42%) conceived (p less than 0.05). It is suggested that despite apparently normal ovulatory cycles, the DOR group has a compromised follicular apparatus. Disparity between normal oestradiol secretory capacity of the granulosa and diminished capacity to secrete inhibin could explain the inappropriately high FSH levels in response to the CC challenge.

Adult↗
PubMed1996

Contraceptive choice, sexually transmitted diseases, HIV infection, and future fecundity.

Because contraception affects not only the risk of unplanned pregnancy but also that of sexually transmitted infections, the choice of particular methods is important to future fertility. However, certain trade-offs are necessary. Contraceptives with the best record of preventing pregnancy provide little protection against sexually transmitted diseases (STDs). Conversely, those barrier methods with higher failure rates for pregnancy can reduce the risk of acquiring or transmitting an STD. For example, condoms used correctly and consistently provide the best protection against infection. Although spermicides reduce lower genital tract bacterial STDs, their effectiveness against HIV is still unknown. In contrast to barrier methods, the IUD is associated with an increased risk for developing upper genital tract infection, primarily in the first month after insertion. Current literature raises paradoxical questions regarding the role of hormonal contraception in STDs and pelvic inflammatory disease. Moreover, epidemiological studies are equivocal regarding the public health value of recommending dual methods of contraception, one to prevent unplanned pregnancy and the other to prevent STDs. Investigations to date have focused on the use of the male condom added to other methods of contraception. In general, where participants were using primary methods other than the condom, the more effective the primary contraceptive method was in preventing pregnancy, the lower the level of consistent use of the male condom. Continued biologic and behavioral research will be necessary to disentangle these complex relationships.

Biology↗
PubMed1984

Menstrual history and fecundity of women exposed and unexposed in utero to diethylstilbestrol.

Sequential examination and interview of diethylstilbestrol-exposed (DES-exposed) and -unexposed women verified that DES exposure has no effect on age at menarche and indicated no differences in the age at first coitus, pregnancy and live birth. Analysis of variance indicated that there is an age-related increase in oligomenorrhea in DES-exposed women as compared to unexposed women that disappears as the patients reach their late 20s. Prospective data collection is required to substantiate this finding. There appears to be no substantial effect of in utero exposure to DES on women's ability to conceive.

Abortion, Induced↗
PubMed2004

Effects of occupational solvent exposure on reproductive hormone concentrations and fecundability in men.

BACKGROUND: Little is known about the effects of organic solvents on male reproductive health. To assess fertility and reproductive endocrine function in solvent-exposed men, we investigated time-to-pregnancy using a retrospective cohort design and cross-sectionally measured reproductive hormone concentrations in painters and millwrights compared to a reference group of carpenters. METHODS: Detailed occupational, exposure, medical, and time-to-pregnancy histories were obtained by telephone interview. Plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone concentrations were determined by immunoassay. Exposure indices, which summarized working life exposure to total solvents, chlorinated solvents, aromatic solvents, and thinners, degreasers, varnishes, and adhesives as a category were calculated from exposure histories. RESULTS: FSH concentrations increased significantly with increasing exposure indices for all solvents and for chlorinated solvents. There were no significant associations of solvent exposure indices with LH or testosterone levels. LH, FSH, and testosterone concentrations also did not differ by job title. Using Cox regression, time-to-pregnancy was non-significantly longer in the painters and millwrights than the carpenters. There was no significant association between time-to-pregnancy and any of the solvent exposure indices; however, it should be noted that some of the pregnancies occurred more than 20 years previously, potentially reducing the reliability of the retrospectively collected pregnancy and exposure data. CONCLUSIONS: The significant associations between FSH levels and solvent exposure indices suggest the potential for adverse effects of solvent exposures on reproductive function in men.

Adult↗