Impact of Male and Female Weight, Smoking, and Intercourse Frequency on Live Birth in Women With Polycystic Ovary Syndrome

Abstract

Context: Obese men with normal semen parameters exhibit reduced fertility but few prospective data are available.

Objective: This study aimed to determine the effect of male factors and body mass among the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) participants.

Methods: This is a secondary analysis of the PPCOS II trial. A total of 750 infertile women with polycystic ovary syndrome (PCOS) were randomly assigned to up to receive five cycles of letrozole or clomiphene citrate. Females were 18-39-years-old and had a male partner with sperm concentration of at least 14 million/mL who consented to regular intercourse. Analysis was limited to couples with complete male partner information (n = 710).

Results: Male body mass index (BMI) was higher in couples who failed to conceive (29.5 kg/m(2) vs 28.2 kg/m(2); P = .039) as well as those who did not achieve a live birth (29.5 kg/m(2) vs 28.1 kg/m(2); P = .047). At least one partner was obese in 548 couples (77.1%). A total of 261 couples were concordant for obesity (36.8%). After adjustment for female BMI, the association of male BMI with live birth was no longer significant (odds ratio [OR] = 0.85; 95 % confidence interval [CI], 0.68-1.05; P = .13). Couples in which both partners smoked had a lower chance of live birth vs nonsmokers (OR = 0.20; 95 % CI, 0.08-0.52; P = .02), whereas there was not a significant effect of female or male smoking alone. Live birth was more likely in couples with at least three sexual intercourse attempts over the previous 4 weeks (reported at baseline) as opposed to couples with lesser frequency (OR = 4.39; 95 % CI, 1.52-12. 4; P < .01).

Conclusions: In this large cohort of obese women with PCOS, effect of male obesity was explained by female BMI. Lower chance of success was seen among couples where both partners smoked. Obesity and smoking are common among women with PCOS and their partners and contribute to a decrease in fertility treatment success.

Figure 1.

Association of live birth with measures of erectile function by IIEF at study baseline. Unadjusted prevalence of male sexual function measures by live birth. Each bar represents responses to IIEF questions that classified as inadequate/unsatisfactory. Higher prevalence of infrequent sexual intercourse (<3 attempts during the past 4 weeks) was more likely in couples who did not achieve a live birth (11.2% vs 3%). No significant differences were observed for any other measure.

Figure 2.

Likelihood of live birth in PPCOSII by specified determinant multivariable logistic regression analysis with adjustment for age, smoking and BMI of both partners, as well as intercourse frequency (≥3 intercourse attempts during the past 4 weeks vs fewer as assessed at baseline). Smoking is categorized as a four-category variable: present in partners, female only, male only vs neither partner smoking.

Figure 3.

Lack of an association for BMI with reported frequency of sexual activity in PPCOS II. Unadjusted prevalence of sexual intercourse frequency by male and female BMI. Each cluster represents responses to IIEF question 6, assessed at study baseline: “How many times have you attempted sexual intercourse over the past 4 weeks?”