| Extensive monitoring of women undergoing superovulation treatment for unexplained infertility places a substantial burden on the patient and physician. The exploration of factors which potentially reduce the likelihood of pregnancy will help to understand disorders of reproduction, thus improve treatment.; Data from a clinical trial evaluating the efficacy of superovulation, with human menopausal gonadotropin (hMG), with or without intrauterine insemination (IUI), in the treatment of unexplained infertility were used to explore the interrelationships between age, lifestyle variables, ovarian response to hMG and conception. The first paper examines the relationship between age and ovarian response. Next, the association between ovarian response and conception was examined. Finally, the associations between smoking, alcohol and caffeine and conception were examined. The possible mediating role of ovarian response in the association between lifestyle variables and conception was also explored.; Nonlinear associations between age and the number of follicles, and estradiol concentration (E2) at both cycle day 8 and the day prior to insemination (p < .001) were found. The data suggest that ovarian response begins to wane at age 29.5. E2 and the number of mature follicles on the day prior to insemination were associated with conception. The odds of conception increased until E2 reached 1450ρg/ml and then decreased. Having more than one mature follicle (2–8 follicles) was associated with an increased odds of conception (odds ratio = 3.6 95%CI: 0.5–22.0). Lastly, smoking was not associated with conception (OR = 1.1 95%CI: 0.4–2.6), while both alcohol (OR = 0.5 95%CI: 0.3–1.1) and caffeine use (OR = 0.5 95%CI: 0.2–1.2), respectively were associated with a decreased risk of conception. Mediation of ovarian response in the association between alcohol or caffeine and conception did not explain these decreased risks.; These results suggest non-linear associations between age and ovarian response, and ovarian response and conception. In women with unexplained infertility, ovarian function declines at an earlier age than previously thought. Further, while smoking was not associated with conception, current alcohol and caffeine use was associated with a 50% decreased odds of conception. Further exploration of pathways through which conception is compromised may offer new opportunities for intervention. |
