Characteristics of menstrual cycles with or without intercourse in women with no known subfertility.
Characteristics of menstrual cycles with or without intercourse in women with no known subfertility.
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DOI：
10.1093/hropen/hoac039
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发表时间：
2022
影响因子：
8.3
通讯作者：
中科院分区：
文献类型：
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性交是否能提高无生育能力低下妇女的周期生育能力？性交（无论在月经周期中的哪个时间）与表明较高生育能力的周期特征相关，包括较长的黄体期，较少的经前期斑点和超过2天的具有雌激素刺激性质的宫颈液。人类女性是自发排卵者，经历黄体生成素激增和周期性排卵，独立于交配。自然受孕需要在女性月经周期的生育窗口期进行性交，即在排卵日结束的6天间隔。然而，大多数生育能力正常的女性在第14天不会排卵，因此假设的生育窗口时间在女性内部和女性之间是不同的。这种变异受年龄、胎次和其他已知或未知因素的影响。虽然一些研究人员已经讨论了着床前后性交对成功怀孕概率的影响，但关于性交如何影响人类排卵发生和月经周期特征的数据有限。本研究是对美国和加拿大Creighton模型生育护理中心注册的三个妇女队列的汇总分析：“Creighton模型多中心生育能力研究”（CMFS：回顾性队列，1990-1996），“正常生育的怀孕时间”（TTP：随机试验，2003-2006）和“Creighton模型有效性，意图和行为评估”（CEIBA：前瞻性队列，2009-2013）。我们评估了周期长度、出血和宫颈粘液模式，并估计了530名妇女的2564个周期的可生育窗口，随访时间长达1年。参与者是美国或加拿大的女性，年龄在18-40岁之间，没有怀孕，异性恋活跃，没有已知的生育能力低下，没有服用外源性激素。大多数妇女在随访开始时都打算避免怀孕。妇女使用标准化的方案和记录系统记录长达1年的每日阴道出血、粘液排出和性交，产生2564个周期可用于分析。黏液排出的高峰日（通常是雌激素刺激的宫颈液清澈、有弹性或光滑的最后一天）被用来确定估计的排卵日，我们认为这一天是排卵周期中卵泡期的最后一天。我们使用线性混合模型来评估连续周期参数，包括周期、月经和周期周期长度，并使用具有鲁棒方差的泊松回归的广义线性模型来评估二分类结果，如排卵功能、短黄体期和是否存在卵泡或黄体出血。周期按有无性交进行分层，同时根据妇女的胎次、年龄、最近口服避孕药的使用和母乳喂养进行调整。大多数妇女年龄<30岁（75.5%；中位数为27，四分位数范围为24-29），非西班牙裔白人（88.1%），社会经济指标高，未生育（70.9%）。与至少有1天性交的周期相比，无性交的周期更短（29.1天（95% CI 27.6, 30.7） vs 30.1天（95% CI 28.7, 31.4）），黄体期更短（10.8天（95% CI 10.2, 11.5） vs 11.4天（95% CI 10.9, 12.0）），黄体期缺乏的可能性更高(<10天；调整概率比（PR） 1.31 (95% CI 1.00, 1.71))，出现2天经前斑疹的概率较高（调整PR 2.15 (95% CI 1.09, 4.24)），出现2天或更短时间峰型（雌激素）宫颈积液的概率较高（调整PR 1.49 (95% CI 1.03, 2.15)）。我们的研究参与者在地理上分散，但在种族、民族、收入和教育水平方面相对均匀，并且都有男性伴侣，这可能限制了研究结果的普遍性。我们不能排除在一些女性中未被发现的低生育能力或相关妇科疾病的可能性，如未被发现的子宫内膜异位症或多囊卵巢综合征，这将影响我们研究结果的普遍性。急性疾病或压力事件可能会降低月经周期内发生性行为的可能性，同时也会改变月经周期的特征。在没有性交的组中，有些人可能确实有过没有记录的性交或其他性活动，但这会使我们的结果偏向于零。Creighton模型生育保健系统（CrM）不鼓励使用屏障方法，因此我们认为大多数性交涉及暴露于精液；然而，避孕套可能在某些周期中使用过。我们的数据缺乏关于女性性高潮发生的任何信息，这妨碍了我们评估女性性高潮对周期特征的独立或联合影响的能力。性活动可能改变生殖激素的模式，和/或生殖激素的水平可能影响性活动的可能性。未来的工作可能有助于了解暴露于精液，和/或女性高潮和/或性交时间对月经周期功能的影响程度。从理论上讲，如果可以适当地激励女性完整地记录性交，那么使用月经和生育跟踪应用程序的女性的大量数据集可能会提供信息。了解有妇科问题或生育能力低下的妇女的周期特征有何不同也很有趣。本研究中分析的三个队列的研究资金由罗伯特·伍德·约翰逊基金会#029258（克赖顿模型多中心生育能力研究）、尤尼斯·肯尼迪·施莱弗国家儿童健康与人类发展研究所1K23 HD0147901-01A1（正常生育的怀孕时间）和计划生育办公室、人口事务、卫生和人类服务办公室1FPRPA006035（克赖顿模型有效性、意图和行为评估）提供。作者声明他们没有利益冲突。N / A。
Does sexual intercourse enhance the cycle fecundability in women without known subfertility? 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. 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. 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 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. 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)). 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. 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. 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. N/A.
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影响因子：
6.7
作者：
Ecochard, Rene;Duterque, Olivia;Vigil, Pilar
通讯作者：
Vigil, Pilar
影响因子：
5.2
作者：
Blackwell LF;Cooke DG;Brown S
通讯作者：
Brown S
影响因子：
3.5
作者：
Caruso, Salvatore;Agnello, Carmela;Cianci, Stefano
通讯作者：
Cianci, Stefano
影响因子：
6.1
作者：
Bigelow, JL;Dunson, DB;Colombo, B
通讯作者：
Colombo, B
DOI：
10.1186/1472-6874-14-4
发表时间：
2014-01-08
期刊：
BMC women's health
影响因子：
--
作者：
Porucznik CA;Cox KJ;Schliep KC;Stanford JB
通讯作者：
Stanford JB