Salivary progesterone levels and rate of ovulation are significantly lower in poorer than in better-off urban-dwelling Bolivian women

Vitzthum, Virginia J.; Bentley, Gillian R.; Spielvogel, Hilde; Caceres, Esperanza; Thornburg, Jonathan; Jones, Lary; Shore, Sarah; Hodges, Kelly R.; Chatterton, Robert T.

doi:10.1093/humrep/17.7.1906

Cited by 68 publications

(58 citation statements)

References 20 publications

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“…Ovarian cycle length in rural Aymara women averaged 29.1 days, which falls within the observed range for sea level [ 13 ]. The proportion of ovulatory cycles, as assessed by progesterone levels, was comparable in a sample of Chicago women and economically advantaged women in La Paz, Bolivia (91 % and 88 % respectively); however, it was far lower (45 %) in the poorer women of La Paz [ 14 ]. Mean progesterone levels in ovulatory cycles among poor women were lower than those in better off peers and substantially lower than in Chicago women.…”

Section: Fertilitysupporting

confidence: 62%

Reproduction and Growth

Niermeyer

2013

High Altitude

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Reproduction and development during infancy and childhood present critical, vulnerable periods in the individual lifecycle and the health of a population. For humans living permanently at high altitude, the environment they inhabit adds risks for maternal and child health and survival. In addition to hypoxia, many high-altitude regions impose other constraints on the circumstances necessary for optimal fetal development and infant/child survival. These include impoverished living conditions, social inequalities, physically demanding livelihoods, nutritional defi ciencies, and infectious diseases. Such determinants infl uence fertility, fetal loss and growth, neonatal survival, and child development. Populations resident at high altitude for millennia, for example the Tibetans in the Himalaya and the Aymara and Quechua of South America, attest to possibility of not only surviving but also thriving, Hypoxia, as well as other environmental and social factors, shapes reproduction and fetal/infant growth at high altitude. Although fertility and early fetal loss differ little from patterns observed at lower altitude, placental development does differ and the medical complications of pre-eclampsia and post-partum hemorrhage pose greater risks at altitude. Reduction in birth weight with increasing altitude of gestation occurs across high-altitude regions, resulting in an increased proportion of lowbirth-weight infants (<2,500 g). However, the magnitude of reduction in fetal growth varies among population groups, depending on maternal ventilation, plasma volume expansion, blood fl ow to the uteroplacental circulation, and nutrient transport. Neonatal, infant, and child mortality are increased at high altitude. Respiratory problems account for the majority of neonatal and infant deaths. Exposure to hypoxia during the fetal and neonatal periods may have consequences that extend into adult life and span generations.

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Section: Fertilitysupporting

confidence: 62%

Reproduction and Growth

Niermeyer

2013

High Altitude

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“…Within populations, midluteal progesterone in ovulatory cycles is positively correlated with stature in Bolivian women (10). In U.S. women, associations of measures of body size and levels of hormones and sex-hormone-binding globulin have also been observed (22,23).…”

Section: Figmentioning

confidence: 94%

“…In U.S. women, relatively lower progesterone is associated with subfecundity among patients at infertility clinics, perhaps signaling failure to ovulate or luteal insufficiency (7), and is also associated with a reduction in risk of conception (8). Yet studies of women from nonindustrialized populations have consistently observed progesterone levels averaging only about two-thirds of the average levels of U.S. women (9)(10)(11)(12)(13). Does the typically much lower progesterone observed among women in nonindustrialized populations signal a significant impairment of reproductive function relative to U.S. women?…”

mentioning

confidence: 99%

“…Although a luteal rise in progesterone is characteristic of normal ovulation, there is no definitive threshold of salivary progesterone below which ovulation can be said not to have occurred. In a previous study of urban Bolivian women we developed an algorithm to distinguish ovulatory from nonovulatory cycles and ascribed ovulation to any cycle having a mPL Ͼ110 pmol͞liter (10). In the present study, the progesterone profile of each cycle was first visually inspected for an apparent luteal rise relative to the previous follicular phase.…”

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confidence: 99%

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Interpopulational differences in progesterone levels during conception and implantation in humans

Vitzthum

Spielvogel

Thornburg

2004

Proc. Natl. Acad. Sci. U.S.A.

101

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Clinical studies of women from the United States demonstrate a sensitivity of the ovarian system to energetic stress. Even moderate exercise or caloric restriction can lead to lower progesterone levels and failure to ovulate. Yet women in many nonindustrial populations experience as many as a dozen pregnancies in a lifetime despite poor nutritional resources, heavy workloads, and typical progesterone levels only about two-thirds of those of U.S. women. Previous cross-sectional studies of progesterone may, however, suffer from inadvertent selection bias. In a noncontracepting population, the most fecund women, who might be expected to have the highest progesterone, are more likely to be pregnant or breastfeeding and hence unavailable for a crosssectional study of the ovarian cycle. The present longitudinal study was designed to ascertain whether lower progesterone also characterizes conception, implantation, and gestation in women from nonindustrialized populations. We compared rural Bolivian Aymara women (n ‫؍‬ 191) to women from Chicago (n ‫؍‬ 29) and found that mean-peak-luteal progesterone in the ovulatory cycles of Bolivian women averaged Ϸ71% that of the women from Chicago. In conception cycles, progesterone levels in Bolivian women during the periovulatory period were Ϸ63%, and during the peri-implantation period were Ϸ50%, those of the U.S. women. These observations argue that lower progesterone levels typically characterize the reproductive process in Bolivian women and perhaps others from nonindustrialized populations. We discuss the possible proximate and evolutionary explanations for this variation and note the implications for developing suitable hormonal contraceptives and elucidating the etiology of cancers of the breast and reproductive tract.I n an evaluation of demographic data from populations worldwide, Bongaarts (1) concluded that, except in cases of famine, nutritional factors play a relatively minor role in determining human fecundity (capacity to conceive) or fertility (number of live births). Despite characteristically marginal nutritional status and the demands of arduous activities, women in less developed countries often average seven to eight pregnancies, some having 12 or more during a lifetime. Differences among populations, or reductions from a theoretical maximum, appear fully attributable to a limited set of behavioral and physiological proximate fertility determinants apparently little affected by nutritional factors. If neither fecundity nor fertility is thus significantly influenced, neither is fecundability (the monthly probability of conception). Yet clinical studies of women from the United States indicate a sensitivity of ovarian function to both relatively low energy intake and͞or high energy expenditure. The most extreme response, failure to ovulate, may occur in the face of only moderate energetic stress (2-4) and, of course, reduces fecundity and fecundability to 0. Short of anovulation, milder disruptions of ovarian function may also reduce fecundability. Why should o...

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“…Because saliva can be readily collected from subjects on multiple occasions, it is possible to compare steroid levels across entire menstrual cycles among different women rather than relying on one or a few timed blood samples. Salivary levels of ovarian steroids have been used by many investigators to demonstrate adaptive shifts in ovarian function under conditions of energy constraint in adult women (15,(19)(20)(21)(22)(23)(24)(25)(26)(27). Salivary estradiol (E2) levels are particularly sensitive indicators, with a shift to lower levels being associated with energy constraint and lower probability of conception (18).…”

mentioning

confidence: 99%

Fatness at birth predicts adult susceptibility to ovarian suppression: An empirical test of the Predictive Adaptive Response hypothesis

Jasieńska

Thune

Ellison

2006

Proc. Natl. Acad. Sci. U.S.A.

146

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Poor fetal environments are thought to produce adaptive changes in human developmental trajectories according to the Predictive Adaptive Response hypothesis. Although many studies have demonstrated correlations between indicators of fetal environment and negative adult health outcomes, the adaptive significance of these outcomes is unclear. Our study explicitly tests the adaptive nature of fetal programming in humans. We show that differences in nutritional status at birth are associated with adaptive differences in the sensitivity of adult ovarian function to energetic stress. Women who were born as relatively fat babies do not exhibit ovarian suppression in response to moderate levels of physical activity at adulthood, in contrast to women who were born as skinnier babies. The levels of estradiol in women born in the highest tertile of ponderal index (an indicator of neonatal nutritional status) were 37% and 46% higher, respectively, than levels of estradiol in women born in the low and middle ponderal index tertiles. These findings suggest that fetal programming of reproductive function results in developmentally plastic, but essentially adaptive, shifts in set points of ovarian response to energetic stress, such that women who were gestated under conditions of energetic constraint show greater sensitivity to energetic stress in adulthood. Our results have practical implications in terms of behavioral strategies for reducing the risk of breast cancer. We suggest that the amount of activity necessary to reduce levels of estrogen, which may in turn reduce cancer risk, can depend on a woman's nutritional status at birth. birth weight ͉ cancer prevention ͉ fetal programming ͉ ovarian function ͉ physical activity H uman biologists have long recognized developmental plasticity as an important adaptive characteristic of human growth and development (1). Recently, epidemiological studies have demonstrated particularly strong relationships between indices of fetal development, such as size at birth, and health outcomes associated with chronic disease conditions decades later (2-5). These observations have led to the advance of the Predictive Adaptive Response (PAR) hypothesis, which posits that conditions experienced by the human embryo and fetus affect subsequent trajectories of development and set points for physiological function in various systems in ways that would promote the fitness of the developing organism in later years (6-8). In particular, it is hypothesized that conditions of energy constraint during gestation result in physiological changes that improve the fitness of the adult organism in energy-restricted environments. The adaptive nature of these changes is difficult to demonstrate, however, because the outcomes associated with poor fetal environments are most often associated with increased incidence and severity of pathologies that compromise life expectancy, such as hypertension or type II diabetes. A second hypothesis, the Environmental Mismatch (EM) hypothesis, must be posited, supplementing the...

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Salivary progesterone levels and rate of ovulation are significantly lower in poorer than in better-off urban-dwelling Bolivian women

Cited by 68 publications

References 20 publications

Reproduction and Growth

Reproduction and Growth

Interpopulational differences in progesterone levels during conception and implantation in humans

Fatness at birth predicts adult susceptibility to ovarian suppression: An empirical test of the Predictive Adaptive Response hypothesis

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