title: Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics.
abstract: BACKGROUND
  Increased childhood adversity may be affect adult fertility, however, the mechanism through which this occurs is unclear. Menstrual cycle abnormalities are predictive of fertility difficulties, and stress influences menstrual cycle characteristics. Here, we assess whether adverse childhood experiences (ACEs) are associated with fertility difficulties and menstrual cycle dysregulation, offering a plausible mechanism for the link between lifetime stress and fertility.
  
  
  METHODS
  From April 2012 to February 2014, 742 pregnant and non-pregnant women aged 18-45 years residing in southeastern Louisiana provided information on childhood adversity and reproductive history. Associations between ACEs and fertility difficulties and menstrual cycle patterns were evaluated.
  
  
  RESULTS
  As the number of ACEs increased, risk of fertility difficulties and amenorrhea increased (RR = 1.09, 95% CI 1.05-1.13 and RR = 1.07, 95% CI 1.04-1.10, respectively), while fecundability decreased [fecundability ratio (FR) = 0.97, 95% CI 0.95-1.00]. Compared to women with no adversity, women in the high adversity group were more likely to experience both infertility and amenorrhea (RR = 2.75, 95% CI 1.45-5.21 and RR = 2.54, 95% CI 1.52-4.25, respectively), and reduced fecundability (FR = 0.75, 95% CI 0.56-1.00). Although similar patterns were seen for menstrual cycle irregularity, associations were diminished. Associations did not materially change following adjustment for age, body mass index, race, education, smoking and income. Results are constrained by the self-report nature of the study and the limited generalizability of the study population.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to present evidence of a link between childhood stressors, menstrual cycle disruption and fertility difficulties. The effect of childhood stress on fertility may be mediated through altered functioning of the HPA axis, acting to suppress fertility in response to less than optimal reproductive circumstances.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA and.
authors.forename: Marni B
authors.initials: MB
authors.lastname: Jacobs
authors.forename: Renee D
authors.initials: RD
authors.lastname: Boynton-Jarrett
authors.forename: Emily W
authors.initials: EW
authors.lastname: Harville
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000706:statistics & numerical data*; D017668:Age of Onset; D000568:Amenorrhea / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology*; D008145:Louisiana / Q000453:epidemiology; D008599:Menstruation Disturbances / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D011293:Premenstrual Syndrome / Q000453:epidemiology; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D016387:Women's Health; D055815:Young Adult
keywords: ACE; adverse childhood events; amenorrhea; fertility; menstrual cycle
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