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To evaluate the association between the vaginal microenvironment and fecundability among women. Register-based nationwide cohort study. Chinese National Free Pre-conception Check-up Project from 2015 to 2018. Our study included a total of 3388554 eligible women who were attempting to become pregnant. We assessed the vaginal microenvironment at baseline by considering four indices vaginal pH, clue cell examination, whiff test and vaginal cleanliness grading. If any of these indicators was abnormal, the vaginal microenvironment was defined as
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