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Comparative Study
.2013 Jun;99(7):1958-64.
doi: 10.1016/j.fertnstert.2013.02.040. Epub 2013 Mar 18.

Volitional determinants and age-related decline in fecundability: a general population prospective cohort study in Denmark

Affiliations
Comparative Study

Volitional determinants and age-related decline in fecundability: a general population prospective cohort study in Denmark

Kenneth J Rothman et al. Fertil Steril.2013 Jun.

Abstract

Objective: To quantify the natural decline in fecundability by age and assess the effect of selected volitional factors.

Design: Prospective cohort study of women attempting conception.

Setting: Not applicable.

Participant(s): A total of 2,820 women without infertility, trying to conceive for less than 3 cycles at study entry.

Intervention(s): None.

Main outcome measure(s): Fecundability.

Result(s): Age had little effect on fecundability except for women 35-40 years, for whom it was 0.77 relative to women aged 20-24 years. Male age showed a similar but smaller decrease, declining to 0.95 for men aged 35-39 years. The effect of age differed for parous and nulliparous women, with the latter experiencing much stronger age-related declines relative to fecundability at age 20 years. Frequency of intercourse, use of nonhormonal birth control as the last method, and timing of intercourse, each had small effects on fecundability. Women who were in the high-fecundability categories for all three of these volitional factors had an estimated probability of conceiving of 88% (95% confidence interval 83%-93%). Unlike age, these factors represent individual choices that together can offset some of the age-related decline in fecundability.

Conclusion(s): Fecundability peaks around age 30 years, slightly earlier for nulliparous than for parous women, and then declines. The decline with age is more modest for men. Couples will experience a compounded effect of their separate age-related declines. At age 40 years, a couple's fecundability would be approximately half of what it was at age 30 years, but some of this decline can be counteracted by volitional factors affecting conception.

Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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Conflict of interest statement

We have no conflicts of interest to declare.

Competing interests

All authors have completed the Unified Competing Interest form athttp://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization other than the NICHD for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.

Figures

figure 1
figure 1
Association between age and fecundability, fitted by restricted cubic splines. Reference level for FR is 20 years. All curves used 3 knots located at 25, 30, and 35 years, except for the male curves, which have an additional knot at age 40. In the first two panels, the unadjusted curve controls for cycle number only, and the adjusted curve controls for cycle number, partner’s age, vigorous physical activity, BMI, vocational training, alcohol intake, current smoking, pack-years of smoking (ever smokers), partner smoking, partner BMI, cycle length, cycle regularity, parity, intercourse frequency, last method of contraception, and methods used to time intercourse. In the third panel, both curves control for cycle number, female age, vigorous physical activity, BMI, vocational training, alcohol intake, current smoking, pack-years of smoking (ever smokers), partner smoking, partner BMI, cycle length, cycle regularity, parity, intercourse frequency, last method of contraception, and methods used to time intercourse.
figure 1
figure 1
Association between age and fecundability, fitted by restricted cubic splines. Reference level for FR is 20 years. All curves used 3 knots located at 25, 30, and 35 years, except for the male curves, which have an additional knot at age 40. In the first two panels, the unadjusted curve controls for cycle number only, and the adjusted curve controls for cycle number, partner’s age, vigorous physical activity, BMI, vocational training, alcohol intake, current smoking, pack-years of smoking (ever smokers), partner smoking, partner BMI, cycle length, cycle regularity, parity, intercourse frequency, last method of contraception, and methods used to time intercourse. In the third panel, both curves control for cycle number, female age, vigorous physical activity, BMI, vocational training, alcohol intake, current smoking, pack-years of smoking (ever smokers), partner smoking, partner BMI, cycle length, cycle regularity, parity, intercourse frequency, last method of contraception, and methods used to time intercourse.
figure 1
figure 1
Association between age and fecundability, fitted by restricted cubic splines. Reference level for FR is 20 years. All curves used 3 knots located at 25, 30, and 35 years, except for the male curves, which have an additional knot at age 40. In the first two panels, the unadjusted curve controls for cycle number only, and the adjusted curve controls for cycle number, partner’s age, vigorous physical activity, BMI, vocational training, alcohol intake, current smoking, pack-years of smoking (ever smokers), partner smoking, partner BMI, cycle length, cycle regularity, parity, intercourse frequency, last method of contraception, and methods used to time intercourse. In the third panel, both curves control for cycle number, female age, vigorous physical activity, BMI, vocational training, alcohol intake, current smoking, pack-years of smoking (ever smokers), partner smoking, partner BMI, cycle length, cycle regularity, parity, intercourse frequency, last method of contraception, and methods used to time intercourse.
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