Smoking in infertile women with polycystic ovary syndrome

Baseline validation of self-report and effects on phenotype

Richard S. Legro, Gang Chen, Allen R. Kunselman, William D. Schlaff, Michael Peter Diamond, Christos Coutifaris, Sandra A. Carson, Michael P. Steinkampf, Bruce R. Carr, Peter G. Mcgovern, Nicholas A. Cataldo, Gabriella G. Gosman, John E. Nestler, Evan R. Myers, Heping Zhang, Jonathan Foulds

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

STUDY QUESTION Do women with polycystic ovary syndrome (PCOS) seeking fertility treatment report smoking accurately and does participation in infertility treatment alter smoking? SUMMARY ANSWER Self-report of smoking in infertile women with PCOS is accurate (based on serum cotinine levels) and smoking is unlikely to change over time with infertility treatment. WHAT IS KNOWN ALREADY Women with PCOS have high rates of smoking and it is associated with worse insulin resistance and metabolic dysfunction. STUDY DESIGN, SIZE, DURATION Secondary study of smoking history from a large randomized controlled trial of infertility treatments in women with PCOS (N = 626) including a nested case-control study (N = 148) of serum cotinine levels within this cohort to validate self-report of smoking. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with PCOS, age 18-40, seeking fertility who participated in a multi-center clinical trial testing first-line ovulation induction agents conducted at academic health centers in the USA. MAIN RESULT(S) AND THE ROLE OF CHANCE Overall, self-report of smoking in the nested case-control study agreed well with smoking status as determined by measure of serum cotinine levels, at 90% or better for each of the groups at baseline (98% of never smokers had cotinine levels <15 ng/ml compared with 90% of past smokers and 6% of current smokers). There were minor changes in smoking status as determined by serum cotinine levels over time, with the greatest change found in the smoking groups (past or current smokers). In the larger cohort, hirsutism scores at baseline were lower in the never smokers compared with past smokers. Total testosterone levels at baseline were also lower in the never smokers compared with current smokers. At end of study follow-up insulin levels and homeostatic index of insulin resistance increased in the current smokers (P < 0.01 for both) compared with baseline and with non-smokers. The chance for ovulation was not associated with smoking status, but live birth rates were increased (non-significantly) in never or past smokers. LIMITATIONS, REASONS FOR CAUTION The limitations include the selection bias involved in our nested case-control study, the possibility of misclassifying exposure to second hand smoke as smoking and our failure to capture self-reported changes in smoking status after enrollment in the trial. WIDER IMPLICATIONS OF THE FINDINGS Because self-report of smoking is accurate, further testing of smoking status is not necessary in women with PCOS. Because smoking status is unlikely to change during infertility treatment, extra attention should be focused on smoking cessation in current or recent smokers who seek or who are receiving infertility treatment.

Original languageEnglish (US)
Pages (from-to)2680-2686
Number of pages7
JournalHuman Reproduction
Volume29
Issue number12
DOIs
StatePublished - Jun 26 2014

Fingerprint

Polycystic Ovary Syndrome
Self Report
Smoking
Phenotype
Cotinine
Infertility
Case-Control Studies
Serum
Fertility
Insulin Resistance
Therapeutics
Hirsutism
Tobacco Smoke Pollution
Selection Bias
Ovulation Induction
Birth Rate
Live Birth
Smoking Cessation
Ovulation

Keywords

  • anovulation
  • cigarette smoking
  • hyperandrogenism
  • infertility
  • obesity

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Smoking in infertile women with polycystic ovary syndrome : Baseline validation of self-report and effects on phenotype. / Legro, Richard S.; Chen, Gang; Kunselman, Allen R.; Schlaff, William D.; Diamond, Michael Peter; Coutifaris, Christos; Carson, Sandra A.; Steinkampf, Michael P.; Carr, Bruce R.; Mcgovern, Peter G.; Cataldo, Nicholas A.; Gosman, Gabriella G.; Nestler, John E.; Myers, Evan R.; Zhang, Heping; Foulds, Jonathan.

In: Human Reproduction, Vol. 29, No. 12, 26.06.2014, p. 2680-2686.

Research output: Contribution to journalArticle

Legro, RS, Chen, G, Kunselman, AR, Schlaff, WD, Diamond, MP, Coutifaris, C, Carson, SA, Steinkampf, MP, Carr, BR, Mcgovern, PG, Cataldo, NA, Gosman, GG, Nestler, JE, Myers, ER, Zhang, H & Foulds, J 2014, 'Smoking in infertile women with polycystic ovary syndrome: Baseline validation of self-report and effects on phenotype', Human Reproduction, vol. 29, no. 12, pp. 2680-2686. https://doi.org/10.1093/humrep/deu239
Legro, Richard S. ; Chen, Gang ; Kunselman, Allen R. ; Schlaff, William D. ; Diamond, Michael Peter ; Coutifaris, Christos ; Carson, Sandra A. ; Steinkampf, Michael P. ; Carr, Bruce R. ; Mcgovern, Peter G. ; Cataldo, Nicholas A. ; Gosman, Gabriella G. ; Nestler, John E. ; Myers, Evan R. ; Zhang, Heping ; Foulds, Jonathan. / Smoking in infertile women with polycystic ovary syndrome : Baseline validation of self-report and effects on phenotype. In: Human Reproduction. 2014 ; Vol. 29, No. 12. pp. 2680-2686.
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abstract = "STUDY QUESTION Do women with polycystic ovary syndrome (PCOS) seeking fertility treatment report smoking accurately and does participation in infertility treatment alter smoking? SUMMARY ANSWER Self-report of smoking in infertile women with PCOS is accurate (based on serum cotinine levels) and smoking is unlikely to change over time with infertility treatment. WHAT IS KNOWN ALREADY Women with PCOS have high rates of smoking and it is associated with worse insulin resistance and metabolic dysfunction. STUDY DESIGN, SIZE, DURATION Secondary study of smoking history from a large randomized controlled trial of infertility treatments in women with PCOS (N = 626) including a nested case-control study (N = 148) of serum cotinine levels within this cohort to validate self-report of smoking. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with PCOS, age 18-40, seeking fertility who participated in a multi-center clinical trial testing first-line ovulation induction agents conducted at academic health centers in the USA. MAIN RESULT(S) AND THE ROLE OF CHANCE Overall, self-report of smoking in the nested case-control study agreed well with smoking status as determined by measure of serum cotinine levels, at 90{\%} or better for each of the groups at baseline (98{\%} of never smokers had cotinine levels <15 ng/ml compared with 90{\%} of past smokers and 6{\%} of current smokers). There were minor changes in smoking status as determined by serum cotinine levels over time, with the greatest change found in the smoking groups (past or current smokers). In the larger cohort, hirsutism scores at baseline were lower in the never smokers compared with past smokers. Total testosterone levels at baseline were also lower in the never smokers compared with current smokers. At end of study follow-up insulin levels and homeostatic index of insulin resistance increased in the current smokers (P < 0.01 for both) compared with baseline and with non-smokers. The chance for ovulation was not associated with smoking status, but live birth rates were increased (non-significantly) in never or past smokers. LIMITATIONS, REASONS FOR CAUTION The limitations include the selection bias involved in our nested case-control study, the possibility of misclassifying exposure to second hand smoke as smoking and our failure to capture self-reported changes in smoking status after enrollment in the trial. WIDER IMPLICATIONS OF THE FINDINGS Because self-report of smoking is accurate, further testing of smoking status is not necessary in women with PCOS. Because smoking status is unlikely to change during infertility treatment, extra attention should be focused on smoking cessation in current or recent smokers who seek or who are receiving infertility treatment.",
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AU - Kunselman, Allen R.

AU - Schlaff, William D.

AU - Diamond, Michael Peter

AU - Coutifaris, Christos

AU - Carson, Sandra A.

AU - Steinkampf, Michael P.

AU - Carr, Bruce R.

AU - Mcgovern, Peter G.

AU - Cataldo, Nicholas A.

AU - Gosman, Gabriella G.

AU - Nestler, John E.

AU - Myers, Evan R.

AU - Zhang, Heping

AU - Foulds, Jonathan

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N2 - STUDY QUESTION Do women with polycystic ovary syndrome (PCOS) seeking fertility treatment report smoking accurately and does participation in infertility treatment alter smoking? SUMMARY ANSWER Self-report of smoking in infertile women with PCOS is accurate (based on serum cotinine levels) and smoking is unlikely to change over time with infertility treatment. WHAT IS KNOWN ALREADY Women with PCOS have high rates of smoking and it is associated with worse insulin resistance and metabolic dysfunction. STUDY DESIGN, SIZE, DURATION Secondary study of smoking history from a large randomized controlled trial of infertility treatments in women with PCOS (N = 626) including a nested case-control study (N = 148) of serum cotinine levels within this cohort to validate self-report of smoking. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with PCOS, age 18-40, seeking fertility who participated in a multi-center clinical trial testing first-line ovulation induction agents conducted at academic health centers in the USA. MAIN RESULT(S) AND THE ROLE OF CHANCE Overall, self-report of smoking in the nested case-control study agreed well with smoking status as determined by measure of serum cotinine levels, at 90% or better for each of the groups at baseline (98% of never smokers had cotinine levels <15 ng/ml compared with 90% of past smokers and 6% of current smokers). There were minor changes in smoking status as determined by serum cotinine levels over time, with the greatest change found in the smoking groups (past or current smokers). In the larger cohort, hirsutism scores at baseline were lower in the never smokers compared with past smokers. Total testosterone levels at baseline were also lower in the never smokers compared with current smokers. At end of study follow-up insulin levels and homeostatic index of insulin resistance increased in the current smokers (P < 0.01 for both) compared with baseline and with non-smokers. The chance for ovulation was not associated with smoking status, but live birth rates were increased (non-significantly) in never or past smokers. LIMITATIONS, REASONS FOR CAUTION The limitations include the selection bias involved in our nested case-control study, the possibility of misclassifying exposure to second hand smoke as smoking and our failure to capture self-reported changes in smoking status after enrollment in the trial. WIDER IMPLICATIONS OF THE FINDINGS Because self-report of smoking is accurate, further testing of smoking status is not necessary in women with PCOS. Because smoking status is unlikely to change during infertility treatment, extra attention should be focused on smoking cessation in current or recent smokers who seek or who are receiving infertility treatment.

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