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Hum. Reprod. Advance Access originally published online on December 17, 2004
Human Reproduction 2005 20(3):657-664; doi:10.1093/humrep/deh670
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Human Reproduction Vol. 20 No. 3 © The Author 2004; all rights reserved

Is previous aberrant reproductive outcome predictive of subsequently reduced fecundity?

M.A.M. Hassan1 and S.R. Killick

University of Hull Postgraduate Medical Institute, Hull and York Medical School, The Academic Department of Obstetrics and Gynaecology, Hull, UK

1 To whom correspondence should be addressed at: The Reproductive Medicine Unit, Clarendon Wing, Leeds General Infirmary, Leeds LS2 9NS, UK. Email: mamhassan{at}yahoo.com

BACKGROUND: Effect of past reproductive performance on subsequent fecundity is uncertain. METHODS: A total of 2983 consecutive pregnant women self-completed questionnaires about time to pregnancy (TTP), pregnancy planning, previous pregnancies, contraceptive use, age, and individual/lifestyle variables. Outcome measures were: TTP, conception rates (CR) and, subfecundity odds ratio (OR; with 95% confidence intervals) before and after each outcome of last pregnancy. RESULTS: After miscarriage, TTP was longer than before miscarriage [2.1 (1.4–3.0), P<0.001] and than TTP after livebirth [OR=2.1 (1.6–2.6), P<0.001]. Also subfecundity OR after miscarriage increased [1.7 (1.2–2.4), 1.8 (1.2–2.5), P=0.001, 0.002 respectively]. This effect was more evident in older and obese women. Compared with livebirth, time to ectopic pregnancy (EP) was longer [OR=13.8 (1.8–108.5), P=0.001] but TTP after EP was not significantly different. Subfecundity OR relative to livebirth were 12.8 (3.6–45.0) (P<0.001) before, and 3.9 (1.4–11.0) (P=0.01) after, EP. The CR after EP increased 3-fold (1.1–8.3) over those prior to EP. Time to the terminated pregnancies even without contraceptive failures was shorter than that to livebirth [OR=0.5 (0.3–0.7), P=0.001] and than TTP after termination [0.35 (0.1–0.8), P=0.001]. Also subfecundity OR increased after termination [7.2 (1.8–29.7), P=0.02]. CONCLUSIONS: Miscarriers should be counselled about short-term reduction in subsequent fecundity, and earlier investigations should be considered in those who have other potential risk factors for reduced fertility. Further studies are required to clarify the relatively favourable effect on fecundity following EP and the relative reduction in fecundity after termination of pregnancy.

Key words: ectopic pregnancy/miscarriage/subfecundity/time to pregnancy


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