{"id":246138,"date":"2024-10-25T15:39:00","date_gmt":"2024-10-25T19:39:00","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?post_type=bu-article&#038;p=246138"},"modified":"2024-10-26T15:43:33","modified_gmt":"2024-10-26T19:43:33","slug":"can-we-predict-our-ability-to-conceive","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2024\/can-we-predict-our-ability-to-conceive\/","title":{"rendered":"Can We Predict Our Ability to Conceive?"},"content":{"rendered":"\t<div class=\"wp-block-editorial-leadin sphnews-block-editorial-leadin is-style-text-over-image has-media has-media-focus-right-middle has-text-position-x-center\">\n\t\t<div class=\"container-lockup\">\n\n\t\t\t<div class=\"wp-block-leadin-media\">\n\t\t\t\t\n\t\t\t\t<img width=\"1200\" height=\"260\" src=\"\/sph\/files\/2024\/10\/PRESTO-pink.png\" class=\"\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-pink.png 1200w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-pink-636x138.png 636w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-pink-1024x222.png 1024w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-pink-768x166.png 768w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-pink-755x164.png 755w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-pink-900x195.png 900w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\n\t\t\t\n\t\t\t\t<div class=\"container-words-outer\">\n\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"container-words-inner\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"wp-prepress-tag\">Epidemiology<\/span>\n\t\t\t\t\t\t\t\t<h1 class=\"head\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tCan We Predict Our Ability to Conceive?\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/h1>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"deck\">For more than a decade, researchers for Boston University\u2019s Pregnancy Study Online (PRESTO) have been uncovering lifestyle, environmental, and medical factors that may affect people&#8217;s chances of conceiving and having successful pregnancies. <\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\n\t\t<\/div>\n\n\t\t\n\t<\/div>\n\n\t\n<div class=\"wp-prepress-component-metabar sphnews-prepress-layout-metabar\">\n\t<div class=\"wp-prepress-component-metabar-wrapper\">\n\t\t\t\t\t<div class=\"wp-prepress-component-metabar-date\">October 25, 2024<\/div>\n\t\t\n\t\t\t\t<div class=\"wp-prepress-component-metabar-credits\">\n\t\t\t\t\t\t\t\t<ul data-credit-type=\"By\">\n\t\t\t\t\t\t<li><a href=\"https:\/\/www.bu.edu\/sph\/news\/authors\/jillian-mckoy\/\">Jillian McKoy<\/a><\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"wp-prepress-component-metabar-share js-bu-prepress-share-tools\">\n\t\t\t<span class=\"icon-twitter\"><span>Twitter<\/span><\/span>\n\t\t\t<span class=\"icon-facebook\"><span>Facebook<\/span><\/span>\n\t\t\t<span class=\"icon-action\"><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t\n\n\n<p>After a brief uptick during the COVID-19 pandemic, the birth rate in the United States resumed its decades-long decline in 2023, <a href=\"https:\/\/www.cdc.gov\/nchs\/data\/vsrr\/vsrr035.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">dropping<\/a> by three percent in 2023 to the lowest rate in a century.<\/p>\n\n\n\n<p>Many experts attribute this decline to educational, economic, and social factors that have slowed teen birth rates and prompted a growing trend in delayed childrearing until older ages.&nbsp;<\/p>\n\n\n\n<p>But, too often, people who actively try to conceive encounter obstacle after obstacle, and what should be the start of a joyous time turns into a frustrating and emotional experience.&nbsp;<\/p>\n\n\n\n<p>For more than a decade, researchers for <a href=\"https:\/\/sites.bu.edu\/presto\/\">Pregnancy Study Online<\/a> (PRESTO) at the School of Public Health have uncovered lifestyle, environmental, and medical factors that may affect fertility and pregnancy outcomes. The web-based preconception cohort study is the largest of its kind worldwide, following thousands of individuals ages 21-45 who are trying to conceive.&nbsp;<\/p>\n\n\n\n<p>Its goal: to identify modifiable changes that may increase one\u2019s chances of conceiving and having a successful pregnancy.&nbsp;<\/p>\n\n\n\n<p>\u201cIn one of our first <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28917614\/\" target=\"_blank\" rel=\"noreferrer noopener\">PRESTO papers<\/a> we examined age as a predictor of fertility and found that around age 32 or 33, there is a noticeable drop in the chances of conception for females,\u201d says <a href=\"https:\/\/www.bu.edu\/sph\/profile\/lauren-wise\/\">Lauren Wise<\/a>, professor of epidemiology and PRESTO lead investigator. \u201cWe still see that age-related fertility decline today, so as pregnancy planners age, it\u2019s important to share practical changes that they can make to improve their chances of natural conception.\u201d<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" width=\"1024\" height=\"683\" src=\"\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-1024x683.jpg\" alt=\"\" class=\"wp-image-246141\" srcset=\"https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-1024x683.jpg 1024w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-636x424.jpg 636w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-768x512.jpg 768w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-1536x1024.jpg 1536w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-2048x1365.jpg 2048w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-755x503.jpg 755w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-1500x1000.jpg 1500w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-900x600.jpg 900w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-450x300.jpg 450w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-600x400.jpg 600w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-1920x1280.jpg 1920w, https:\/\/www.bu.edu\/sph\/files\/2024\/10\/PRESTO-9Q1A7362-1200x800.jpg 1200w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><figcaption><br>Members of the PRESTO team, from L to R: Kipruto Kirwa, assistant professor of environmental health&nbsp;and PRESTO co-investigator; Krystal Kuan (SPH&#8217;24), research data analyst; Dmitrii Krivorotko, research data analyst; Lauren Wise, professor of epidemiology and PRESTO principal investigator; Mary Willis, assistant professor of epidemiology and PRESTO co-investigator; Amelia Wesselink (SPH&#8217;18), research assistant professor of epidemiology and PRESTO co-investigator; Chad Coleman (SPH&#8217;17, 25),&nbsp;recent PhD graduate&nbsp;in epidemiology; Ruth Geller, PhD&nbsp;candidate&nbsp;in epidemiology; and Eliza Pentz, MS student in epidemiology and PRESTO research assistant. See the full list of <a href=\"https:\/\/sites.bu.edu\/presto\/research-team\/\">investigators<\/a> and other <a href=\"https:\/\/sites.bu.edu\/presto\/research-team\/research-consultants\/\">research staff<\/a>. <br><\/figcaption><\/figure><\/div>\n\n\n\n<p>Wise launched PRESTO in 2013 with <a href=\"https:\/\/www.bu.edu\/sph\/profile\/kenneth-rothman\/\">Kenneth Rothman<\/a>, professor of epidemiology, and <a href=\"https:\/\/www.bu.edu\/sph\/profile\/elizabeth-hatch\/\">Elizabeth Hatch<\/a>, adjunct professor of epidemiology who retired this year from her full-time position. Funded by the National Institutes of Health, PRESTO spurred from its Danish counterpart, <em>Snart Foraeldre<\/em> (\u201csoon parents\u201d), which the professors launched in 2006. Female-identifying participants in every state and all Canadian provinces are invited to complete questionnaires for one year (or until they conceive) about their diet, exercise, medication use, sexual activity, stress levels, and other factors, with the option for their male partners to enroll. They can also opt to use fertility tracking apps.<\/p>\n\n\n\n<p>The <a href=\"https:\/\/sites.bu.edu\/presto\/research-team\/\">team<\/a> of faculty investigators, postdoctoral associates, masters-level research fellows, and doctoral student researchers have published dozens of findings, among them: higher intake of <a rel=\"noreferrer noopener\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5860620\/\" target=\"_blank\">trans<\/a><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5860620\/\"> fats<\/a> and <a rel=\"noreferrer noopener\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5882510\/\" target=\"_blank\">sugar-sweetened beverages<\/a>, as well as <a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30576495\/\" target=\"_blank\">current smoking<\/a>, were linked to lower fecundability (per-cycle probability of conception), but <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3321066\/\">caffeine<\/a> was not; and taking <a rel=\"noreferrer noopener\" href=\"https:\/\/www.nature.com\/articles\/ejcn201594\" target=\"_blank\">folic acid supplements<\/a> increased fecundability. Male partners\u2019 cannabis use was strongly associated with increased miscarriage risk. <a rel=\"noreferrer noopener\" href=\"https:\/\/www.bmj.com\/content\/354\/bmj.i4262\" target=\"_blank\">Moderate alcohol use<\/a>&nbsp; and the <a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28881394\/\" target=\"_blank\">HPV vaccine<\/a> during the preconception period appear to pose no fertility risks.<\/p>\n\n\n\n<p>Danes seem to have slightly higher fecundability than Americans, despite studies that suggest Danish males have lower sperm counts, Hatch says. The team hasn\u2019t formally explored this finding, but she wonders if this difference reflects the different social and lifestyle factors between the two countries.<\/p>\n\n\n\n<p>\u201cCompared to Americans, Danes\u2019 perceived stress is lower, they exercise more, their education and healthcare are paid for,\u201d says Hatch, who was principal investigator of the Danish component. \u201cSociety is much more level there, while inequality in America is enormous, and getting worse.\u201d<\/p>\n\n\n\n<div class=\"wp-block-bu-pullquote sphnews-block-bu-pullquote has-image-focus-center-middle\"><div class=\"wp-block-bu-pullquote-inner\"><figure><\/figure><blockquote><div class=\"container-lockup\"><div class=\"container-icon-outer\"><div class=\"container-icon-inner\"><\/div><\/div><div class=\"container-text\"><hr\/><div class=\"quote-sizing\">Because of PRESTO\u2019s flexible design, we had the ability to answer in a way that I don\u2019t think anyone else really could.<\/div><footer class=\"caption\">Amelia Wesselink, research associate professor of epidemiology and PRESTO co-investigator<\/footer><hr\/><\/div><\/div><\/blockquote><\/div><\/div>\n\n\n\n<p>US inequality was on stark display during the COVID-19 pandemic, but the global crisis enabled PRESTO researchers to refute rampant misinformation on COVID-19 vaccines. Coinvestigator <a href=\"https:\/\/www.bu.edu\/sph\/profile\/amelia-wesselink\/\">Amelia Wesselink<\/a> (SPH\u201918), research assistant professor of epidemiology, and researchers added COVID-related questions to the surveys and quickly published an analysis showing that vaccines do not cause infertility\u2014a finding that earned a mention on <em>Saturday Night Live\u2019s<\/em> <a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2022\/sph-on-snl\/\">\u201cWeekend Update\u201d<\/a>.<\/p>\n\n\n\n<p>\u201cWe were able to immediately address a pressing public health question,\u201d says Wesselink, who has been a part of PRESTO since its inception while she was an epidemiology doctoral student. \u201cBecause of PRESTO\u2019s flexible web-based design, we had the ability to answer this question in a way that I don&#8217;t think anyone else really could.\u201d<\/p>\n\n\n\n<p>As climate change worsens, PRESTO researchers are also analyzing how the environment affects reproductive health. Wesselink leads projects examining the impacts of air pollution and heat on fertility and miscarriage, finding in a 2022 study that miscarriage risk increases during hotter seasons. She also serves as coinvestigator of the <a href=\"https:\/\/sites.bu.edu\/presto\/e-presto\/\">E-PRESTO<\/a> substudy, for which researchers collect participants\u2019 blood and urine samples in the clinic and by mail to assess individual health risks based on environmental contaminants.&nbsp;In collaboration with <a href=\"https:\/\/silentspring.org\/\">Silent Spring Institute<\/a>, Wesselink designed a \u201creport-back\u201d website where participants receive results from their blood and urine tests, learn how their chemical levels compare with other cohort members and the general population, and receive information about ways to reduce their exposure.<\/p>\n\n\n\n<p>This work also represents PRESTO\u2019s shift in recent years to structural and neighborhood-level factors that shape reproductive health. Coinvestigator <a href=\"https:\/\/www.bu.edu\/sph\/profile\/mary-willis\/\">Mary Willis<\/a>, assistant professor of epidemiology, has published studies that suggest living in <a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2793793\">socieconomically disadvantaged neighborhoods<\/a> is linked to reductions in fertility, and that exposure to <a href=\"https:\/\/ehp.niehs.nih.gov\/doi\/full\/10.1289\/EHP10648\">residential green space<\/a> slightly increases one\u2019s chances of becoming pregnant. Her research has also identified potential challenges for data collection and health research in a post-<em>Roe<\/em> era; Willis <a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2024\/following-dobbs-presto-pregnancy-planners-reduced-engagement-with-fertility-app\/\">led a study earlier this year<\/a> that found that PRESTO participants who lived in states where abortion was banned or severely restricted were less likely to share personal health information in the fertility tracking app that PRESTO offers. <\/p>\n\n\n\n<p>\u201cGenerating multi-pronged epidemiologic evidence is a key step towards figuring out what options may yield policy that could protect population health,\u201d says Willis, who is the first BU faculty member to receive NIH\u2019s <a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2022\/professor-receives-early-career-award-from-nih\/\">Early Independence Award<\/a>, in which she is studying the effects of oil and gas development on reproductive health.<\/p>\n\n\n\n<div class=\"wp-block-bu-pullquote sphnews-block-bu-pullquote has-image-focus-center-middle\"><div class=\"wp-block-bu-pullquote-inner\"><figure><\/figure><blockquote><div class=\"container-lockup\"><div class=\"container-icon-outer\"><div class=\"container-icon-inner\"><\/div><\/div><div class=\"container-text\"><hr\/><div class=\"quote-sizing\">\u201cI\u2019m hoping to redefine what stress means in the context of the built and social environment, and its effect on health.\u201d<\/div><footer class=\"caption\">Sharonda Lovett, PhD candidate in epidemiology <\/footer><hr\/><\/div><\/div><\/blockquote><\/div><\/div>\n\n\n\n<p>Doctoral students are an integral part of PRESTO, driving much of the study\u2019s&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/academic.oup.com\/aje\/advance-article-abstract\/doi\/10.1093\/aje\/kwae085\/7680565?redirectedFrom=fulltext&amp;login=false\" target=\"_blank\">cutting-edge research<\/a>.&nbsp;Willis collaborates with and mentors Sharonda Lovett, a PhD candidate in epidemiology who received an SPH pilot grant this year to study the impact of residential segregation on fertility. These pilot funds will be used to compile and annotate a spatial-temporal dataset of several neighborhood exposures. Lovett is also leading work on individual-level stressors, including <a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38794905\/\" target=\"_blank\">adverse childhood experiences<\/a> and discrimination. <\/p>\n\n\n\n<p>\u201cI\u2019m hoping to redefine what stress means in the context of the built and social environment, and its effect on health,\u201d Lovett says.<\/p>\n\n\n\n<p>Chad Coleman (SPH&#8217;17, &#8217;25), a recent graduate of the PhD program in epidemiology, is making strides on his dissertation work pertaining to sleep quality and reproductive health, analyzing Fitbit data from participants to examine how the amount and quality of sleep affect various outcomes. Early analyses indicate that participants with more fragmented sleep&nbsp;have slightly greater difficulty conceiving.<\/p>\n\n\n\n<p>\u201cI really enjoy my sleep work because it presents modifiable public health interventions that can be implemented to improve sleep and increase the chances of conception,\u201d Coleman says.<\/p>\n\n\n\n<p>In a presidential election year largely defined by significant federal and statewide restrictions on reproductive rights, being able to make informed decisions about family planning is critically important. PRESTO is charging ahead, and making concerted efforts to expand and diversify its participants. The team has made inclusive changes to the questionnaire; instead of asking for participants\u2019 sex and gender, they ask if they have an intact uterus.<\/p>\n\n\n\n<p>\u201cOur studies inform the broader body of literature on fertility and enable us to embrace a model of what inclusive reproductive epidemiology should look like,\u201d Wesselink says.<\/p>\n\n\n\t<aside class=\"wp-block-editorial-relatedstories is-style-card has-three sphnews-block-editorial-relatedstories\">\n\t\t<h3 class=\"wp-block-editorial-relatedstories-title\">Related<\/h3>\n\t\t<ul class=\"wp-block-editorial-relatedstories-list\">\n\t\t\t\t\t\t\t<li class=\"wp-block-editorial-relatedstories-list-item\">\n\t\t\t\t\t<article class=\"wp-block-editorial-relatedstories-article\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-block-editorial-relatedstories-article-image\">\n\t\t\t\t\t\t\t\t\t<img width=\"600\" height=\"362\" src=\"\/sph\/files\/2024\/06\/fertility-tracking-600.jpeg\" class=\"attachment-post-thumbnail size-post-thumbnail wp-post-image\" alt=\"A woman waiting for pregnancy test results, holding her phone.\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-editorial-relatedstories-article-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-category\"><span>women&#039;s health<\/span><\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"wp-block-editorial-relatedstories-article-title\"><a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2024\/following-dobbs-presto-pregnancy-planners-reduced-engagement-with-fertility-app\/\" class=\"wp-block-editorial-relatedstories-article-title-link\">Following Dobbs, PRESTO Pregnancy Planners Reduced Engagement with Fertility App<\/a><\/h4>\n\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-date\">June 14, 2024<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/article>\n\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"wp-block-editorial-relatedstories-list-item\">\n\t\t\t\t\t<article class=\"wp-block-editorial-relatedstories-article\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-block-editorial-relatedstories-article-image\">\n\t\t\t\t\t\t\t\t\t<img width=\"600\" height=\"362\" src=\"\/sph\/files\/2024\/07\/oil-and-gas-and-mental-health-THUMB-600x362-1.jpg\" class=\"attachment-post-thumbnail size-post-thumbnail wp-post-image\" alt=\"Woodbridge NJ town aerial panoramic view is a small town in USA near oil refinery industrial tank\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-editorial-relatedstories-article-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-category\"><span>Research<\/span><\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"wp-block-editorial-relatedstories-article-title\"><a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2024\/living-near-oil-and-gas-activity-linked-to-poor-mental-health-during-preconception\/\" class=\"wp-block-editorial-relatedstories-article-title-link\">Living Near Oil and Gas Activity Linked to Poor Mental Health Among People Trying to Conceive<\/a><\/h4>\n\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-date\">July 12, 2024<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/article>\n\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"wp-block-editorial-relatedstories-list-item\">\n\t\t\t\t\t<article class=\"wp-block-editorial-relatedstories-article\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-block-editorial-relatedstories-article-image\">\n\t\t\t\t\t\t\t\t\t<img width=\"600\" height=\"362\" src=\"\/sph\/files\/2023\/05\/sexual-dysfunction-600.jpeg\" class=\"attachment-post-thumbnail size-post-thumbnail wp-post-image\" alt=\"Black female doctor talking to a woman during medical appointment in the hospital.\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-editorial-relatedstories-article-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-category\"><span>reproductive health<\/span><\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"wp-block-editorial-relatedstories-article-title\"><a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2023\/many-patients-dont-discuss-sexual-dysfunction-distress-or-pain-with-doctors\/\" class=\"wp-block-editorial-relatedstories-article-title-link\">Many Patients Don\u2019t Discuss Sexual Dysfunction, Distress, or Pain with Doctors<\/a><\/h4>\n\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-date\">May 26, 2023<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/article>\n\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t<\/aside>\n\t","protected":false},"excerpt":{"rendered":"<p>After a brief uptick during the COVID-19 pandemic, the birth rate in the United States resumed its decades-long decline in 2023, dropping by three percent in 2023 to the lowest rate in a century. Many experts attribute this decline to educational, economic, and social factors that have slowed teen birth rates and prompted a growing [&hellip;]<\/p>\n","protected":false},"author":15205,"featured_media":246407,"comment_status":"closed","ping_status":"closed","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"","_bu_prepress_primary_term_manual":""},"tags":[2209,2158,3577],"bu-publication":[3516],"sphnews-article-category":[3519,3530,3531,3540],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[3094,3680,319,480,498,3484],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/246138"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/15205"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=246138"}],"version-history":[{"count":34,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/246138\/revisions"}],"predecessor-version":[{"id":246450,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/246138\/revisions\/246450"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/246407"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=246138"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=246138"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=246138"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=246138"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=246138"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=246138"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=246138"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=246138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}