BUSPH Launches Largest U.S. Internet-Based Study of Fertility.

Do women who take antidepressants have a harder time getting pregnant? Do men who carry their cell phones in their pants’ pockets have an increased risk of infertility?

Those are among the questions that researchers from the BU School of Public Health and the Slone Epidemiology Center are probing in the recently launched PRESTO (Pregnancy Study Online) project – the largest Internet-based study of fertility in the U.S.

The study – which has begun enrolling 2,500 women, ages 21 to 45 – will rely on Internet-based methods to recruit and follow participants, in an effort to identify lifestyle factors such as diet, exercise and medication use that may impact fertility and pregnancy outcomes.

“The process of studying people via the Internet is really still in its early days,” said lead investigator Lauren Wise, associate professor of epidemiology at BUSPH and a researcher with BU’s Slone Epidemiology Center. Wise and colleagues are working on a similar Internet-based study of over 8,500 women in Denmark.

“We’re testing several ideas here, including: Will this kind of research method work in the U.S?” Wise said. “If it does, we hope to break new ground in identifying factors associated with successful pregnancy – everything from soda consumption to antidepressant use to dietary choices. We have a lot of hypotheses from the Danish study that we want to explore.”

The Danish study, launched in 2007, has produced a number of findings, including that over-exercising may make it harder for healthy-weight women to conceive, while moderate exercising is beneficial. The Danish study also has found that fertility peaks around age 30 for men and women, and declines slightly later than suggested in previous studies: Women aged 35-40 had on average 23 percent less chance of conceiving in each menstrual cycle than women aged 20-24.

Fertility rates in the U.S. hit a record low for the second year in a row in 2012 for women aged 15-44, due in part to a decline in the number of teenage pregnancies. In Massachusetts, the Department of Public Health reports that fertility rates are dropping and remain 16 percent below the national average.

Ten to 15 percent of American couples suffer from infertility, which is correlated with psychological stress and economic burden, among other factors.

The BUSPH researchers are trying to identify factors that improve fertility by casting a wide net that looks beyond age, to factors such as menstrual cycle characteristics, lubricant use, consumption of caffeine and energy drinks, medication use, diet and exercise. They note that infertility treatments, including IVF, can be expensive, invasive and time-consuming.

“With women waiting longer to start a family, we really need to identify factors that lead to a successful pregnancy in older women – and we just don’t know enough yet,” Wise said. Coupled with the data from the Danish study, findings generated from PRESTO “could alter the ways in which researchers understand predictors of fertility –and also revolutionize the methods used to study epidemiology in the U.S. and globally,” she said.

PRESTO participants – women actively trying to get pregnant, without fertility treatments – are asked to complete one online questionnaire at enrollment and follow-up questionnaires every two months for up to 12 months or until pregnancy occurs. The follow-up questionnaires take about 10 to 15 minutes to complete. Ten days after the first questionnaire, participants are asked to complete a dietary questionnaire (30-40 minutes). Their male partners also are invited to enroll.

Among the new areas that PRESTO will explore is whether use of SSRIs, or antidepressants, impacts fertility among women. Men will be asked about everything from their bicycling habits to where they carry their phones.

The team also hopes to refine research findings from the Danish study on caffeine consumption. Although that study found that total caffeine intake was not related to fertility, soda consumption was associated with lower fertility, and tea consumption was associated with increased fertility.

The research team is partnering with a company that produces a web-based software program, FertilityFriend.com, that allows women to chart menstrual cycles and record their fertility signs. Half of the PRESTO female participants will be randomly selected to receive a free premium subscription to FertilityFriend.com, in an effort to gauge whether participation in the web program has any influence on pregnancy outcomes.

In addition, researchers plan to track birth outcomes for study participants’ children who are born in Massachusetts, through the state’s birth registry – affording new information on factors that may contribute to adverse outcomes.

Kenneth Rothman, a co-investigator on the study and professor of epidemiology at BUSPH, was one of the first U.S. researchers to suggest using on-line methods to conduct research on fertility. He said Internet-based research is a new frontier for epidemiology that could prove more cost-effective and efficient than traditional methods.

Rothman said another strength of PRESTO is its inclusion of male partners.

“While a woman is getting older and her fertility is declining, the same is happening to her partner. And the combined effect of aging for the couple can be quite noticeable,” he said. In the Danish study, “we estimated that a couple aged 40 might have half the prospect of having a baby with any given attempt than a similar couple at age 25 or so.”

Elizabeth Hatch, professor of epidemiology at BUSPH, is a co-investigator on the study and lead investigator of the Danish study.

PRESTO is actively seeking participants aged 21-45 who have recently started trying to conceive or plan to start trying within the next six months. The researchers are particularly interested in reaching minority participants.

Although the participation of male partners is optional, the study team is offering couples incentives for male participation, including a gift of one iPad mini for every 250 couples enrolled.

More information is available at the study’s site and on Facebook.