Feasibility of surveillance of changes in human fertility and semen quality

There is concern that male fertility is declining, but this is difficult to study because few men volunteer for studies of semen quality, and recruitm ent bias may over-represent the subfertile, The Human Reproduction Programm e of the World Health Organization developed a protocol for multicentre stu dies of fertility involving a questionnaire for pregnant women to obtain ti me to pregnancy (TTP): the number of menstrual cycles taken to conceive. Ma le characteristics and semen quality will be determined in a subset of the partners, Our aim was to validate the TTP questionnaire, and to examine pot ential recruitment bias and feasibility of conducting large-scale surveilla nce of fertility, The questionnaire was administered to 120 pregnant women (16-32 weeks). Validation included internal reliability by consistency of r esponses, test-re-test reliability by repeat administration (20 women) and accuracy by comparison of gestational age from first antenatal ultrasound a nd menstrual dates. Internal reliability was high, Agreement between catego rical responses on re-testing was very good (k > 0.8). In both the re-test and gestational age analysis, differences in TTP of 1 cycle were found (sta ndard deviation <0.25 cycles), In this small pilot study there was no evide nce of recruitment bias, Response rates indicate the feasibility of surveil lance of fertility in large maternity centres.