男性和女性体重、吸烟及性交频率对多囊卵巢综合征女性活产的影响
Impact of Male and Female Weight, Smoking, and Intercourse Frequency on Live Birth in Women With Polycystic Ovary Syndrome.
作者信息
Polotsky Alex J, Allshouse Amanda A, Casson Peter R, Coutifaris Christos, Diamond Michael P, Christman Gregory M, Schlaff William D, Alvero Ruben, Trussell J C, Krawetz Stephen A, Santoro Nanette, Eisenberg Esther, Zhang Heping, Legro Richard S
机构信息
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.
出版信息
J Clin Endocrinol Metab. 2015 Jun;100(6):2405-12. doi: 10.1210/jc.2015-1178. Epub 2015 Apr 9.
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.
背景
精液参数正常的肥胖男性生育能力降低，但前瞻性数据较少。
目的
本研究旨在确定多囊卵巢综合征II型（PPCOS II）参与者中男性因素和体重的影响。
方法
这是对PPCOS II试验的二次分析。总共750名患有多囊卵巢综合征（PCOS）的不孕女性被随机分配接受多达五个周期的来曲唑或枸橼酸氯米芬治疗。女性年龄在18至39岁之间，其男性伴侣的精子浓度至少为1400万/mL，且同意定期进行性交。分析仅限于拥有完整男性伴侣信息的夫妇（n = 710）。
结果
未能受孕的夫妇中男性体重指数（BMI）较高（29.5kg/m²对28.2kg/m²；P = 0.039），未实现活产的夫妇中男性BMI也较高（29.5kg/m²对28.1kg/m²；P = 0.047）。548对夫妇（77.1%）中至少有一方肥胖。共有261对夫妇双方都肥胖（36.8%）。在调整女性BMI后，男性BMI与活产之间的关联不再显著（优势比[OR]=0.85；95%置信区间[CI]，0.68 - 1.05；P = 0.13）。与非吸烟者相比，双方都吸烟的夫妇活产几率较低（OR = 0.20；95%CI，0.08 - 0.52；P = 0.02），而女性或男性单独吸烟没有显著影响。与性交频率较低的夫妇相比，在过去4周（基线报告）至少有三次性交尝试的夫妇更有可能活产（OR = 4.39；95%CI，1.52 - 12.4；P < 0.01）。
结论
在这个大型的肥胖PCOS女性队列中，男性肥胖的影响可由女性BMI来解释。双方都吸烟的夫妇成功率较低。肥胖和吸烟在PCOS女性及其伴侣中很常见，并导致生育治疗成功率降低。
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