Alex J Polotsky1, Amanda A Allshouse1, Peter R Casson1, Christos Coutifaris1, Michael P Diamond1, Gregory M Christman1, William D Schlaff1, Ruben Alvero1, J C Trussell1, Stephen A Krawetz1, Nanette Santoro1, Esther Eisenberg1, Heping Zhang1, Richard S Legro1. 1. Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033.
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.
RCT Entities:
CONTEXT: Obesemen 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 obesewomen 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.
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