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American Journal of Epidemiology Advance Access originally published online on February 8, 2007
American Journal of Epidemiology 2007 165(9):1088-1095; doi:10.1093/aje/kwk111
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American Journal of Epidemiology Copyright © 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

PRACTICE OF EPIDEMIOLOGY

Effects of Sexual Intercourse Patterns in Time to Pregnancy Studies

Joseph B. Stanford1 and David B. Dunson2

1 Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
2 Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC

Correspondence to Dr. Joseph B. Stanford, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108 (e-mail: joseph.stanford{at}utah.edu).

Received for publication April 5, 2006. Accepted for publication October 19, 2006.

Time to pregnancy, typically defined as the number of menstrual cycles required to achieve a clinical pregnancy, is widely used as a measure of couple fecundity in epidemiologic studies. Time to pregnancy studies seldom utilize detailed data on the timing and frequency of sexual intercourse and the timing of ovulation. However, the simulated models in this paper illustrate that intercourse behavior can have a large impact on time to pregnancy and, likewise, on fecundability ratios, especially under conditions of low intercourse frequency or low fecundity. Because intercourse patterns in the menstrual cycles may vary substantially among groups, it is important to consider the effects of sexual behavior. Where relevant and feasible, an assessment should be made of the timing and frequency of intercourse relative to ovulation. Day-specific probabilities of pregnancy can be used to account for the effects of intercourse patterns. Depending on the research hypothesis, intercourse patterns may be considered as a potential confounder, mediator, or outcome.

coitus; confounding factors (epidemiology); fertility; fertilization

Abbreviations: TTP, time to pregnancy


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