Abstract
Purpose
Many physicians and other healthcare professionals are often asked questions on interfering factors for conception by couples with a desire for children. Such possible disturbances include, for example, the very common minor diseases, stress and also sexual intercourse during the suspected implantation period. Non-scientifically based statements about disturbances in conception cycles, as found in many layman publications and on the internet, can strongly unsettle couples with a desire for children and force them into corset of rules of conduct. Therefore, a systematic scientific evaluation of the impact of disturbances on conception is urgently needed.
Methods
A search for possible disturbances in natural conception cycles together with up to three of the respective pre-cycles in a large cycle database from users of the symptothermal method of natural family planning in Germany was performed. Disturbances were qualified by scientific panel decision and analysed statistically with their effects on the chances of spontaneous conception. Mixed logistical regression models and survival time analyses were used.
Results
A total of 237 women with a total of 747 cycles could be included in the analysis. In 61% of all 237 conception cycles, disturbances occurred. The statistical analysis shows that disturbances in natural conception cycles unexpectedly increase the likelihood of pregnancy by an overall factor of 1.32 (95% CI 1.04–1.70). Sexual intercourse in the window of implantation does not decrease the chances of conception. Relaxation states at the time of ovulation and/or during the implantation period have no representable effect and do not increase the chance of pregnancy.
Conclusions
Couples trying to conceive should at least be informed that disturbances in conception cycles, such as minor diseases, stress or sexual intercourse during the implantation period do not interfere with conception. Relaxation has no effect in favour of success. This takes away the guilty feeling of couples, fearing that they possibly did something wrong in cycles without the desired pregnancy.
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Notes
Best definition: Bundesmantelvertrag-Ärzte der Kassenärztlichen Bundesvereinigung, Appendix 28, §4, of 2017.
Serious diseases that would have required further medical diagnosis and/or therapy were not present. Corresponding cycle series would have been excluded. In this case, diseases refer to so called minor diseases (see footnote 1).
R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL: https://www.R-project.org/.
R package multcomp, Torsten Hothorn, Frank Bretz and Peter Westfall (2008). Simultaneous inference in general parametric models. Biometrical Journal 50 (3), 346–363. URL: https://cran.r-project.org/web/packages/multcomp/vignettes/generalsiminf.pdf.
Edward L. and Paul Meier (1958). Nonparametric estimation from incomplete observations. Journal of the American statistical association 53 (282), pp 457–481. URL: http://www.jstor.org/stable/2281868
R package survival, Therneau T (2015). A Package for Survival Analysis in S. version 2.38.
Steven M Snapinn, Qi Jiang, Boris Iglewicz (2005). Illustrating the Impact of a Time-Varying Covariate With an Extended Kaplan–Meier Estimator, The American Statistician, 59:4, 301–307, https://doi.org/10.1198/000313005X70371; Terry Therneau, Cindy Crowson, Elizabeth Atkinson. Using Time Dependent Covariates and Time Dependent Coefficients in the Cox Model (2013). URL: https://cran.r-project.org/web/packages/survival/vignettes/timedep.pdf.
D. R. Cox (1972). Regression models and life-tables. Journal of the Royal Statistical Society. Series B (Methodological) Vol. 34, No. 2, p 187–220.
References
ASRM (2008) Optimizing natural fertility. Fertil Steril 90:S1–S6
Frank-Herrmann P, Baur S, Freundl G, Gnoth C, Rabe T, Strowitzki T (2015) Natürliche Familienplanung—aktueller Stand. Gynäkolge 14:1–8
Gnoth C, Frank-Herrmann P, Bremme M, Freundl G, Godehardt E (1996) How do self-observed cycle symptoms correlate with ovulation? Zentralbl Gynakol 118:650–654
Bigelow JL, Dunson DB, Stanford JB, Ecochard R, Gnoth C, Colombo B (2004) Mucus observations in the fertile window: a better predictor of conception than timing of intercourse. Hum Reprod 19:889–892
Frank-Herrmann P, Heil J, Gnoth C, Toledo E, Baur S, Pyper C, Jenetzky E, Strowitzki T, Freundl G (2007) The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple’s sexual behaviour during fertile time: a prospective longitudinal study. Hum Reprod 22:1310–1319
Frank-Herrmann P, Gnoth C, Baur S, Strowitzki T, Freundl G (2005) Determination of the fertile window: reproductive competence of women—European cycle databases. Gynecol Endocrinol 20:305–312
Gnoth C (2005) Natural fertility in couples and epidemiological aspects of subfertility. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:1633–1641
Gnoth C, Godehardt E, Frank-Herrmann P, Friol K, Tigges J, Freundl G (2005) Definition and prevalence of subfertility and infertility. Hum Reprod 20:1144–1147
Gnoth C, Frank-Herrmann P, Freundl G, Godehardt D, Godehardt E (2003) Time to pregnancy: results of the English prospective study and impact on the management of infertility. Hum Reprod 18:1959–1966
Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:457–481
Hyde KJ, Schust DJ (2016) Immunologic challenges of human reproduction: an evolving story. Fertil Steril 106:499–510
Lee JY, Lee M, Lee SK (2011) Role of endometrial immune cells in implantation. Clin Exp Reprod Med 38:119–125
Gleicher N, Kushnir VA, Barad DH (2017) Redirecting reproductive immunology research toward pregnancy as a period of temporary immune tolerance. J Assist Reprod Genet 34:425–430
Manders M, McLindon L, Schulze B, Beckmann MM, Kremer JAM, Farquhar C (2015) Timed intercourse for couples trying to conceive. Cochrane Database System Rev. https://doi.org/10.1002/14651858.cd011345.pub2
Steiner AZ, Pritchard DA, Young SL, Herring AH (2014) Peri-implantation intercourse lowers fecundability. Fertil Steril 102:178–182
Tremellen KP, Valbuena D, Landeras J, Ballesteros A, Martinez J, Mendoza S, Norman RJ, Robertson SA, Simon C (2000) The effect of intercourse on pregnancy rates during assisted human reproduction. Hum Reprod 15:2653–2658
Nawroth F, Wolff M (2018) Seminal plasma activity to improve implantation in vitro fertilization-how can it be used in daily practice? Front Endocrinol 9:208
Robertson SA, Sharkey DJ (2016) Seminal fluid and fertility in women. Fertil Steril 106:511–519
Rooney KL, Domar AD (2016) The impact of stress on fertility treatment. Curr Opin Obstet Gynecol 28:198–201
Quant HS, Zapantis A, Nihsen M, Bevilacqua K, Jindal S, Pal L (2013) Reproductive implications of psychological distress for couples undergoing IVF. J Assist Reprod Genet 30:1451–1458
Akhter S, Marcus M, Kerber RA, Kong M, Taylor KC (2016) The impact of periconceptional maternal stress on fecundability. Ann Epidemiol 26:710–716
Sominsky L, Hodgson DM, McLaughlin EA et al (2017) Linking stress and infertility: a novel role for ghrelin. Endocr Rev 38:432–467. https://doi.org/10.1210/er.2016-1133
Lynch CD, Sundaram R, Maisog JM et al (2014) Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study. Hum Reprod 29(1):067–1075
Massey AJ, Campbell BK, Raine-Fenning N et al (2016) Relationship between hair and salivary cortisol and pregnancy in women undergoing IVF. Psychoneuroendocrinology 74:397–405
Massey AJ, Campbell B, Raine-Fenning N et al (2014) The association of physiological cortisol and IVF treatment outcomes: a systematic review. Reprod Med Biol 13:161–176
Boivin J, Griffiths E, Venetis CA (2011) Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ 342:d223
Bhide A (2018) Fertility treatment: getting stressed about stress. Acta Obstet Gynecol Scand 97:233–234
Verkuijlen J, Verhaak C, Nelen WLDM, Wilkinson J, Farquhar C (2016) Psychological and educational interventions for subfertile men and women. Cochrane Database System. https://doi.org/10.1002/14651858.cd011034.pub2
Cesta CE, Johansson ALV, Hreinsson J, Rodriguez-Wallberg KA, Olofsson JI, Holte J, Wramsby H, Wramsby M, Cnattingius S, Skalkidou A, Nyman Iliadou A (2018) A prospective investigation of perceived stress, infertility-related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate. Acta Fruit Gynecol Scand 97:258–268
Domar AD, Gross J, Rooney K, Boivin J (2015) Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in vitro fertilization patients. Fertil Steril 104:440–451
Acknowledgements
The authors would like to thank Mrs. Dr. Petra Frank-Herrmann and Dr. rer. nat. Caroline Merino León for their valuable support of this research and discussions on this paper. This paper is dedicated to Prof. Dr. Günter Freundl who unexpectedly died in 2019. He tirelessly supported research on natural fertility for many years.
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CG: main author, research idea, study design, statistical analysis, writing of the manuscript. A-KK: data recording, data analysis, writing of the manuscript. JS: statistical analysis, writing of the R progam codes. SH: research idea, data recording. PM: writing of the manuscript. GF: research idea, study design, writing of the manuscript. TS: study design, writing of the manuscript
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Christian Gnoth is a principal investigator of clinical trials for the development and evaluation of fertility monitors and receives support from SPD Development Company, Bedfort, UK. No conflicts of interest of the other authors.
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Ethical approval was obtained by the Section of Natural Fertility of the German Society of Gynecological Endocrinology and Fertility Medicine at the University of Heidelberg. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki of 1964 and its later amendments.
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All participants have signed informed consents and agreed in using their anonymized data for scientific purposes. All participants were free to withdraw at any time.
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Gnoth, C., Keil, AK., Schiffner, J. et al. The impact of disturbances in natural conception cycles. Arch Gynecol Obstet 301, 1069–1080 (2020). https://doi.org/10.1007/s00404-020-05464-y
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DOI: https://doi.org/10.1007/s00404-020-05464-y