Use of time to pregnancy to study environmental exposures.

There is need in reproductive epidemiology for sensitive and convenient screening tools that can be used to study environmental and occupational exposures. The measurement of fecundability (the probability of pregnancy in each cycle) by ascertaining how long it takes couples to conceive, may be useful for this purpose. Theoretically, exposures that interfere with any of the biologic processes involved in achieving pregnancy could lower fecundability among exposed men or women. To evaluate problems with collecting data on time to pregnancy, telephone interviews were conducted with nearly 700 pregnant women who reported having planned their pregnancies. Power curves were developed based on the distribution of time to pregnancy in the interviewed population. These curves indicate that relatively small sample sizes are sufficient for investigating an exposure. For example, the authors estimate that to detect a given 50% drop in mean fecundability with 80% power would require data from 55 exposed and 55 unexposed women who are pregnant. Disadvantages of using time to pregnancy as a reproductive endpoint include susceptibility to selection bias and need for data on several potential confounding variables. The next step in evaluating time to pregnancy as a reproductive endpoint is to apply it in studies of environmental or occupational exposures.