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Pregravid contraceptive use and fecundability: prospective cohort study.

ABSTRACT: OBJECTIVE:To evaluate the association between pregravid use of a variety of contraceptive methods and subsequent fecundability. DESIGN:Prospective cohort study. SETTING:Denmark and North America, 2007-19. PARTICIPANTS:17?954 women who had tried to conceive for up to six menstrual cycles at study entry. At baseline, participants reported their contraceptive histories, and personal, medical, and lifestyle characteristics. MAIN OUTCOME MEASURES:Pregnancy, determined by bimonthly follow-up questionnaires for up to 12 months. RESULTS:Approximately 38% (n=6735) of participants had recently used oral contraceptives, 13% (n=2398) had used long acting reversible contraceptive methods, and 31% (n=5497) had used barrier methods. Women who had recently stopped using oral contraceptives, the contraceptive ring, and some long acting reversible contraceptive methods experienced short term delays in return of fertility compared with users of barrier methods. Use of injectable contraceptives was associated with decreased fecundability compared with use of barrier methods (fecundability ratio 0.65; 95% confidence interval 0.47 to 0.89). Users of injectable contraceptives had the longest delay in return of normal fertility (five to eight menstrual cycles), followed by users of patch contraceptives (four cycles), users of oral and ring contraceptives (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles). Lifetime length of use of hormonal contraceptive methods was not associated with fecundability. CONCLUSIONS:Use of some hormonal contraceptive methods was associated with delays in return of fertility, with injectable contraceptives showing the longest delay. The findings indicated little or no lasting effect of long term use of these methods on fecundability.

SUBMITTER: Yland JJ

PROVIDER: S-EPMC7656314 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Pregravid contraceptive use and fecundability: prospective cohort study.

Yland Jennifer J JJ Bresnick Kathryn A KA Hatch Elizabeth E EE Wesselink Amelia K AK Mikkelsen Ellen M EM Rothman Kenneth J KJ Sørensen Henrik T HT Huybrechts Krista F KF Wise Lauren A LA

BMJ (Clinical research ed.) 20201111

<h4>Objective</h4>To evaluate the association between pregravid use of a variety of contraceptive methods and subsequent fecundability.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Denmark and North America, 2007-19.<h4>Participants</h4>17 954 women who had tried to conceive for up to six menstrual cycles at study entry. At baseline, participants reported their contraceptive histories, and personal, medical, and lifestyle characteristics.<h4>Main outcome measures</h4>Pregnancy, determi ...[more]

PMID: 33177047

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Project description:Study questionWhat is the magnitude of the association between a woman's gestational age at her own birth and her fecundability (cycle-specific probability of conception)?Summary answerWe found a 62% decrease in fecundability among women born <34 weeks of gestation relative to women born at 37-41 weeks of gestation, whereas there were few differences in fecundability among women born at later gestational ages.What is known alreadyOne study, using retrospectively collected data on time-to-pregnancy (TTP), and self-reported data on gestational age, found a prolonged TTP among women born <37 gestational weeks (preterm) and with a birthweight ?1500 g. Other studies of women's gestational age at birth and subsequent fertility, based on data from national birth registries, have reported a reduced probability of giving birth among women born <32 weeks of gestation.Study design, size, durationWe used data from a prospective cohort study of Danish pregnancy planners ('Snart-Gravid'), enrolled during 2007-2011 and followed until 2012. In all, 2814 women were enrolled in our study, of which 2569 had complete follow-up.Participants/materials, setting, methodsWomen eligible to participate were 18-40 years old at study entry, in a relationship with a male partner, and attempting to conceive. Participants completed a baseline questionnaire and up to six follow-up questionnaires until the report of pregnancy, discontinuation of pregnancy attempts, beginning of fertility treatment, loss to follow-up or end of study observation after 12 months.Main results and the role of chanceAmong women born <34 gestational weeks, the cumulative probability of conception was 12, 28 and 48% within 3, 6 and 12 cycles, respectively. Among women born at 37-41 weeks of gestation, cumulative probability of conception was 47, 67 and 84% within 3, 6 and 12 cycles, respectively. Relative to women born at 37-41 weeks' gestation, women born <34 weeks had decreased fecundability (fecundability ratio (FR) 0.38, 95% confidence interval (CI): 0.17-0.82). Our data did not suggest reduced fecundability among women born at 34-36 weeks of gestation or at ?42 weeks of gestation (FR 1.03, 95% CI: 0.80-1.34, and FR 1.13, 95% CI: 0.96-1.33, respectively).Limitations, reasons for cautionData on gestational age, obtained from the Danish Medical Birth Registry, were more likely to be based on date of last menstrual period than early ultrasound examination, possibly leading to an overestimation of gestational age at birth. Such overestimation, however, would not explain the decrease in fecundability observed among women born <34 gestational weeks. Another limitation is that the proportion of women born before 34 weeks of gestation was low in our study population, which reduced the precision of the estimates.Wider implications of the findingsBy using prospective data on TTP, our study elaborates on previous reports of impaired fertility among women born preterm, suggesting that women born <34 weeks of gestation have reduced fecundability.Study funding/competing interestsThe study was supported by the National Institute of Child Health and Human Development (R21-050264), the Danish Medical Research Council (271-07-0338), and the Health Research Fund of Central Denmark Region (1-01-72-84-10). The authors have no competing interests to declare.

Project description:ObjectiveTo examine the association between history of miscarriage and fecundability (the cycle-specific probability of conception).DesignNationwide prospective cohort study using web-based questionnaires.SettingDenmark, 2007-2012.Participants977 women attempting to conceive, not using fertility treatment, and with a reproductive history of only miscarriage or only live birth.Exposure and outcome measuresInformation on previous pregnancy outcomes, including miscarriage, came from self-report or from relevant registries. Participants were followed for up to 12 months or until they reported a pregnancy, stopped trying to conceive or started fertility treatment, whichever came first. We used Kaplan-Meier methods to estimate cumulative probabilities of conception for women whose reproductive history included only miscarriage or only live birth. Using proportional probabilities regression modelling, we computed fecundability ratios (FR) with 95% CI comparing women with a history of only miscarriage with women with a history of only live birth.ResultsAfter adjustment for potential confounders, the cumulative probabilities of conception within 12 cycles of follow-up were 85% (95% CI 81% to 89%) for women with a history of 1 miscarriage, 85% (95% CI 73% to 92%) for women with a history of ≥2 miscarriages and 88% (95% CI 87% to 89%) for women whose reproductive history included only live birth. Adjusted FRs were 0.87 (95% CI 0.71 to 1.07) and 0.65 (95% CI 0.36 to 1.17) for women with a history of 1 and ≥2 miscarriages, respectively.ConclusionsOur results indicate that women with a history of miscarriage may have slightly reduced fecundability compared with women with a history of only live birth. The reduction in fecundability was greater for women with repeated miscarriages, although the estimates were imprecise. Despite a potential delay in conception, women with previous miscarriage may have similar probability of pregnancy by 12 cycles of attempts to women with proven fertility.

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Pregravid contraceptive use and fecundability: prospective cohort study.

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Pregravid contraceptive use and fecundability: prospective cohort study.

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