DETERMINANTS OF MALE AND FEMALE FECUNDITY AND FERTILITY-DATA COORDINATING CENTER

为了解决越来越多的人认识到，许多夫妇试图怀孕是不成功的，进行了一项前瞻性怀孕研究，以确定男性和女性生育力和生育力的决定因素。先前涉及实验动物和野生动物种群的研究报告了一系列与暴露于环境有害活性物质（哈斯）相关的不良生殖和发育影响。几乎没有基于人群的流行病学研究已经解决了这个问题，尽管越来越多的公众关注的化学品和环境污染物对人类生殖的影响，从而作为研究的动力。此外，还研究了据称影响人类生殖的几种生活方式行为。这将是美国第一项使用基于夫妇的方法研究生育力和生育力决定因素的研究，特别是评估生活方式和哈斯之间的相互作用。这将是第一个估计不孕症发病率的国家，因为目前只有流行率数据。这项研究的成功完成将有助于阐明人类生殖力和生育力受损的机制。 招募了一组501对希望怀孕的夫妇，并前瞻性地随访了12个高危月经周期，以确定哈斯和生活方式因素是否影响受孕、早孕丢失和不孕的可能性。夫妇完成了基线访谈，并提供了约20毫升的血液分析哈斯和代谢物的香烟烟雾，咖啡因和膳食补充剂。男性伴侣提供精液样本，以客观评估男性生殖力。夫妻使用日记记录每天使用香烟，酒精，咖啡因和膳食补充剂以及身体活动，生活压力和性交。指导妇女使用家庭生育监测仪和妊娠试剂盒，以确定排卵（雌二醇和LH筛查）和hCG确认的妊娠。目前正在分析数据，因为对夫妇的随访现已完成。 这是美国第一项使用基于夫妇的方法来研究生育力和生育力的决定因素的研究，特别是评估生活方式和环境中的生殖活性因子之间的相互作用。随后的数据将直接关系到负责将环境因子按生殖和发育毒性分类的监管机构，以及应对公众日益关注环境化学品对妊娠结果和生殖健康影响的公共卫生机构。这项研究也是第一个解决膳食补充剂对生殖和发育过程的影响，以及这种影响是否是母亲，父亲或父母介导的。这项研究是直接响应NICHD的战略框架，通过解决前概念，围概念和子宫内对人类生殖和发育的影响。它响应了NICHD的几个目标（即，生殖健康的后遗症，增加良好生育结果的可能性，并帮助描述健康差异的发展根源）。

To address growing recognition that many couples attempting pregnancy are unsuccessful, a prospective pregnancy study was conducted to identify determinants of male and female fecundity and fertility. Previous studies involving experimental animals and wildlife populations report a spectrum of adverse reproductive and developmental effects associated with exposure to environmental hormonally active agents (HAAs). Virtually no population based epidemiologic studies have addressed this issue, despite increasing public concern about the effect of chemicals and environmental contaminants on human reproduction and, thereby, serves as the impetus for study. In addition, several lifestyle behaviors alleged to affect human reproduction were studied as well. This will be the first study in the US to use a couple-based approach to study determinants of fecundity and fertility and, specifically, to assess the interplay between lifestyle and HAAs. It will be the first to estimate the incidence of infertility as only prevalence data currently exist. Successful completion of this study will help delineate mechanisms that underlie impaired human fecundity and fertility. A cohort of 501 couples desiring pregnancy were recruited and prospectively followed for 12 at- risk menstrual cycles to determine whether HAAs and lifestyle factors affect the probability of conception, early pregnancy loss, and infertility. Couples completed baseline interviews and provided approximately 20 ml of blood for the analysis of HAAs and metabolites of cigarette smoke, caffeine, and dietary supplements. Male partners provided semen samples for an objective assessment of male fecundity. Couples use journals to record daily use of cigarettes, alcohol, caffeine, and dietary supplements as well as physical activity, life stressors and intercourse. Women were instructed in the use of home fertility monitors and pregnancy kits to determine ovulation (screening for estradiol and LH) and hCG-confirmed pregnancies. The data are currently being analyzed, given that follow up of couples is now complete. This is the first study in the US to use a couple-based approach to study determinants of fecundity and fertility and, specifically, to assess the interplay between lifestyle and hormonally active agents in the environment. The ensuing data will be directly relevant to regulatory agencies charged with classifying environmental agents as to reproductive and developmental toxicity, and public health agencies that respond to growing public concern about the effects of environmental chemicals on pregnancy outcomes and reproductive health. This study is also the first to address the effect of dietary supplements on reproductive and developmental processes and whether the effect is maternally, paternally or parentally mediated. The study is directly responsive to the strategic framework of NICHD by addressing preconception, periconception and in utero influences on human reproduction and development. It is responsive to several of NICHD¿s goals (viz., sequelae of reproductive health, increasing the probability of good birth outcomes, and helping to delineate the developmental origins of health disparities).