Fecundability among Danish women with a history of miscarriage
A prospective cohort study
Wildenschild, C., Riis, A. H., Ehrenstein, V., Hatch, E. E., Wise, L. A., Rothman, K. J., Sørensen, H. T., & Mikkelsen, E. M. (2019). Fecundability among Danish women with a history of miscarriage: A prospective cohort study. BMJ Open, 9(1), Article e023996. https://doi.org/10.1136/bmjopen-2018-023996
OBJECTIVE: To examine the association between history of miscarriage and fecundability (the cycle-specific probability of conception).
DESIGN: Nationwide prospective cohort study using web-based questionnaires.
SETTING: Denmark, 2007-2012.
PARTICIPANTS: 977 women attempting to conceive, not using fertility treatment, and with a reproductive history of only miscarriage or only live birth.
EXPOSURE AND OUTCOME MEASURES: Information on previous pregnancy outcomes, including miscarriage, came from self-report or from relevant registries. Participants were followed for up to 12 months or until they reported a pregnancy, stopped trying to conceive or started fertility treatment, whichever came first. We used Kaplan-Meier methods to estimate cumulative probabilities of conception for women whose reproductive history included only miscarriage or only live birth. Using proportional probabilities regression modelling, we computed fecundability ratios (FR) with 95% CI comparing women with a history of only miscarriage with women with a history of only live birth.
RESULTS: After adjustment for potential confounders, the cumulative probabilities of conception within 12 cycles of follow-up were 85% (95% CI 81% to 89%) for women with a history of 1 miscarriage, 85% (95% CI 73% to 92%) for women with a history of ≥2 miscarriages and 88% (95% CI 87% to 89%) for women whose reproductive history included only live birth. Adjusted FRs were 0.87 (95% CI 0.71 to 1.07) and 0.65 (95% CI 0.36 to 1.17) for women with a history of 1 and ≥2 miscarriages, respectively.
CONCLUSIONS: Our results indicate that women with a history of miscarriage may have slightly reduced fecundability compared with women with a history of only live birth. The reduction in fecundability was greater for women with repeated miscarriages, although the estimates were imprecise. Despite a potential delay in conception, women with previous miscarriage may have similar probability of pregnancy by 12 cycles of attempts to women with proven fertility.