Prospective evaluation of the impact of intermenstrual bleeding on natural fertility

Capsule:
An episode of intermenstrual bleeding statistically significantly decreases the odds of conception in the current cycle but does not appear to negatively impact a woman’s future reproductive potential.

Authors:
Natalie M. Crawford, M.D., David A. Pritchard, M.S., Amy H. Herring, Sc.D., Anne Z. Steiner, M.D., M.P.H.

Volume 105, Issue 5, Pages 1294-1300

Abstract:

Objective:
To evaluate the impact of an episode of intermenstrual bleeding on the probability of conception in a menstrual cycle (fecundability).

Design:
Prospective, time-to-pregnancy cohort study.

Setting:
Community-based cohort.

Patient(s):
Women trying to conceive, ages 30 to 44 years, without known infertility.

Intervention(s):
Not applicable.

Main Outcome Measure(s):
Current cycle and subsequent cycle fecundability.

Result(s):
A total of 549 women provided 1,552 complete cycles for analysis. Intermenstrual and luteal bleeding were reported in 36% and 34% of cycles, respectively. Ninety-three percent of all intermenstrual bleeding was luteal. Cycles in which women had intermenstrual bleeding or luteal bleeding were statistically significantly less likely to result in conception (fecundability ratio [FR] 0.23; 95% confidence interval [CI], 0.16–0.34; and FR 0.22; 95% CI, 0.14–0.33). Women with an episode of intermenstrual and luteal bleeding had a statistically significant increase in the probability of pregnancy in the subsequent cycle (FR 1.61; 95% CI, 1.15–2.25; and FR 2.01; 95% CI, 1.52–2.87, respectively).

Conclusion(s):
Intermenstrual bleeding statistically significantly decreases the odds of conceiving in that cycle but does not appear to negatively impact a woman’s immediate future reproductive potential.

Clinical Trial Registration Number:
NCT01028365.

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