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Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study

Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study
Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study

Background: Female sexual dysfunction (FSD) is a prevalent problem, affecting up to 41% of reproductive aged women worldwide. However, the association between female sexual function (FSF) and fecundability in women attempting to conceive remains unclear. We aimed 1) to examine the association between FSF in reproductive-aged preconception Asian women and fecundability, as measured by time-to-pregnancy in menstrual cycles, and 2) to examine lifestyle and behavioral factors associated with FSF. Methods: From the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) prospective cohort, we evaluated FSF using the 6-item Female Sexual Function Index (FSFI-6) and ascertained time-to-pregnancy within a year of baseline assessment. We estimated fecundability ratio (FR) and 95% confidence interval (CI) using the discrete-time proportional hazards model, accounting for left-truncation and right censoring. We used multivariable logistic and linear regression models to identify potential factors related to FSF. Results: Among 513 participants, 58.9% had low FSF as defined by a total FSFI-6 score at or below the median value of 22. Compared to women with high FSF, those with low FSF had a 27% reduction in fecundability (FR 0.73; 95% CI 0.54, 0.99), with adjustment for age, ethnicity, education, parity and body mass index. Overall, the FRs generally reduced with decreasing FSFI-6 scores. Physical activity, obesity, absence of probable depression and anxiety were independently associated with reduced odds of low FSF and increased FSFI-6 scores, after adjusting for sociodemographic characteristics. Conclusions: Low FSF is associated with a longer time-to-pregnancy. Early evaluation and optimization of FSF through increased physical activity and optimal mental health may help to improve female fecundity. The finding of obese women having improved FSF remains uncertain which warrants further investigations on plausibly mechanisms. In general, the current finding highlights the importance of addressing FSF in preconception care service for general women, which is currently lacking as part of the fertility promotion effort in the country.

Fecundability, Female sexual function index, Fertility, Preconception, Pregnancy planning, Sexual dysfunction, Time-to-pregnancy
1471-2393
Loy, See Ling
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Ku, Chee Wai
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Cheung, Yin Bun
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Godfrey, Keith
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Chong, Yap-Seng
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Shek, Lynette P.
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Tan, K.H.
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Yap, Fabian
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Bernard, Jonathan Y.
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Chen, Helen
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Chan, Shiao-Yng
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Tan, Tse Yeun
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Chan, Jerry Kok Yen
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Loy, See Ling
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Ku, Chee Wai
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Cheung, Yin Bun
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Godfrey, Keith
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Chong, Yap-Seng
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Shek, Lynette P.
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Tan, K.H.
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Yap, Fabian
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Bernard, Jonathan Y.
c831fc27-9e1a-46ca-b335-859e14c5083b
Chen, Helen
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Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293
Tan, Tse Yeun
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Chan, Jerry Kok Yen
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Loy, See Ling, Ku, Chee Wai, Cheung, Yin Bun, Godfrey, Keith, Chong, Yap-Seng, Shek, Lynette P., Tan, K.H., Yap, Fabian, Bernard, Jonathan Y., Chen, Helen, Chan, Shiao-Yng, Tan, Tse Yeun and Chan, Jerry Kok Yen (2021) Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study. BMC Pregnancy and Childbirth, 21 (1), [444]. (doi:10.1186/s12884-021-03892-5).

Record type: Article

Abstract

Background: Female sexual dysfunction (FSD) is a prevalent problem, affecting up to 41% of reproductive aged women worldwide. However, the association between female sexual function (FSF) and fecundability in women attempting to conceive remains unclear. We aimed 1) to examine the association between FSF in reproductive-aged preconception Asian women and fecundability, as measured by time-to-pregnancy in menstrual cycles, and 2) to examine lifestyle and behavioral factors associated with FSF. Methods: From the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) prospective cohort, we evaluated FSF using the 6-item Female Sexual Function Index (FSFI-6) and ascertained time-to-pregnancy within a year of baseline assessment. We estimated fecundability ratio (FR) and 95% confidence interval (CI) using the discrete-time proportional hazards model, accounting for left-truncation and right censoring. We used multivariable logistic and linear regression models to identify potential factors related to FSF. Results: Among 513 participants, 58.9% had low FSF as defined by a total FSFI-6 score at or below the median value of 22. Compared to women with high FSF, those with low FSF had a 27% reduction in fecundability (FR 0.73; 95% CI 0.54, 0.99), with adjustment for age, ethnicity, education, parity and body mass index. Overall, the FRs generally reduced with decreasing FSFI-6 scores. Physical activity, obesity, absence of probable depression and anxiety were independently associated with reduced odds of low FSF and increased FSFI-6 scores, after adjusting for sociodemographic characteristics. Conclusions: Low FSF is associated with a longer time-to-pregnancy. Early evaluation and optimization of FSF through increased physical activity and optimal mental health may help to improve female fecundity. The finding of obese women having improved FSF remains uncertain which warrants further investigations on plausibly mechanisms. In general, the current finding highlights the importance of addressing FSF in preconception care service for general women, which is currently lacking as part of the fertility promotion effort in the country.

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Accepted/In Press date: 21 May 2021
Published date: 25 June 2021
Additional Information: Funding Information: This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore - NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. YBC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA/0039/2012). KMG is supported by the UK Medical Research Council (MC_UU_12011/4) and the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042)) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004). SYC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA-INV/0010/2016). JKYC is supported by a Clinician Scientist Award from the Singapore NMRC (CSA(SI)/008/2016). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Funding Information: KMG, YSC and FKYP have received reimbursement to speak at conferences sponsored by companies selling nutritional products. KMG, YSC and SYC are part of an academic consortium who have received research funding from Abbott, Nutrition, Nestle and Danone. Other authors declare that they have no competing interests. Funding Information: We thank the S-PRESTO staff, participants and the study group, including Anne Eng Neo Goh, Anne Rifkin-Graboi, Anqi Qiu, Bee Wah Lee, Bernard Chern, Bobby Cheon, Christiani Jeyakumar Henry, Ciaran Gerard Forde, Claudia Chi, Doris Fok, Elaine Quah, Elizabeth Tham, Evelyn Chung Ning Law, Evelyn Xiu Ling Loo, Faidon Magkos, Falk Mueller-Riemenschneider, George Seow Heong Yeo, Heng Hao Tan, Hugo P S van Bever, Izzuddin Bin Mohd Aris, Joanne Yoong, Joao N. Ferreira., Jonathan Tze Liang Choo, Kenneth Kwek, Kuan Jin Lee, Lieng Hsi Ling, Ling Wei Chen, Lourdes Mary Daniel, Marielle V. Fortier, Mary Foong-Fong Chong, Mei Chien Chua, Melvin Leow, Michael Meaney, Mya Thway Tint, Neerja Karnani, Ngee Lek, Oon Hoe Teoh, Peter D. Gluckman, Queenie Ling Jun Li, Sendhil Velan, Sharon Ng, Shephali Tagore, Shirong Cai, Shu E Soh, Sok Bee Lim, Stella Tsotsi, Stephen Chin-Ying Hsu, Sue Anne Toh, Teng Hong Tan, Tong Wei Yew, Victor Samuel Rajadurai, Wee Meng Han, Wei Wei Pang, Yiong Huak Chan, Yung Seng Lee. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Fecundability, Female sexual function index, Fertility, Preconception, Pregnancy planning, Sexual dysfunction, Time-to-pregnancy

Identifiers

Local EPrints ID: 449634
URI: http://eprints.soton.ac.uk/id/eprint/449634
ISSN: 1471-2393
PURE UUID: dcc11db2-e7b7-4ebf-9fe4-493645c92535
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

Catalogue record

Date deposited: 09 Jun 2021 16:34
Last modified: 26 Nov 2021 02:35

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Contributors

Author: See Ling Loy
Author: Chee Wai Ku
Author: Yin Bun Cheung
Author: Keith Godfrey ORCID iD
Author: Yap-Seng Chong
Author: Lynette P. Shek
Author: K.H. Tan
Author: Fabian Yap
Author: Jonathan Y. Bernard
Author: Helen Chen
Author: Shiao-Yng Chan
Author: Tse Yeun Tan
Author: Jerry Kok Yen Chan

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