title: Women's Reproductive History Before the Diagnosis of Incident Endometriosis.
abstract: BACKGROUND
  Endometriosis is a gynecologic disease reported to be associated with infertility and, possibly, adverse pregnancy outcomes. While considerable research focuses on pregnancy outcomes following diagnosis and/or treatment, few data actually describe women's reproductive history before diagnosis for a more complete understanding of endometriosis and reproduction.
  
  
  METHODS
  The study sample comprised 473 women (aged 18-44 years) undergoing laparoscopies or laparotomies, irrespective of surgical indication at 14 clinical sites, during the period 2007-2009. Upon enrollment and before surgery, women were queried about pregnancy intentions and the time required to become pregnant for planned pregnancies. Endometriosis was defined as surgically visualized disease. Using discrete time survival analysis, we estimated fecundability odds ratios (FORs) and 95% confidence intervals (CIs) to assess time to pregnancy (TTP) after adjusting for potential confounders (age, body composition, cigarette smoking, site). Generalized estimating equations accounted for multiple pregnancy attempts per woman. FORs <1.0 denote a longer TTP or diminished fecundity.
  
  
  RESULTS
  Approximately 66% and 69% of women with and without endometriosis, respectively, reported having a planned pregnancy before surgery, respectively. After adjustment, an endometriosis diagnosis was associated with ≈29% reduction in fecundity or a longer TTP across all pregnancy-trying attempts (adjusted FOR = 0.71; 95% CI 0.46-1.10). While FORs were consistently <1.0, irrespective of endometriosis staging, CIs included 1.
  
  
  CONCLUSIONS
  Women with endometriosis had a longer TTP than unaffected women, irrespective of disease severity, although the findings did not achieve significance. Prior reproductive history may be informative for predicting fecundity and pregnancy outcomes following diagnosis/treatment.
authors.affiliation: 1 Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development , Rockville, Maryland.
authors.forename: Germaine M
authors.initials: GM
authors.lastname: Buck Louis
authors.affiliation: 1 Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development , Rockville, Maryland.|2 Division of Biomedical and Health Informatics, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine , Seattle, Washington.
authors.forename: Uba
authors.initials: U
authors.lastname: Backonja
authors.affiliation: 3 Epidemiology Branch, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development , Rockville, Maryland.|4 Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Schliep
authors.affiliation: 5 Glotech Corporation , Rockville, Maryland.
authors.forename: Liping
authors.initials: L
authors.lastname: Sun
authors.affiliation: 6 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, University of Utah , Salt Lake City, Utah.
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Peterson
authors.affiliation: 7 Biostatistics and Bioinformatics Branch, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development , Rockville, Maryland.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005298:Fertility; D006801:Humans; D015994:Incidence; D007247:Infertility, Female; D010535:Laparoscopy; D007813:Laparotomy; D011247:Pregnancy; D017584:Reproductive History; D061685:Time-to-Pregnancy; D055815:Young Adult
keywords: endometriosis; epidemiology; fertility