Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
Department of Epidemiology, Boston University School of Public Health, Boston, MA 617857, USA.
Hum Reprod. 2020 Apr 28;35(4):816-825. doi: 10.1093/humrep/dez294.
Does male alcohol consumption affect fecundability?
In data pooled across Danish and North American preconception cohort studies, we found little evidence of an association between male alcohol consumption and reduced fecundability.
Experimental and clinical studies have shown that alcohol affects male reproductive physiology, mainly by altering male reproductive hormones and spermatogenesis. However, few epidemiologic studies have examined the association between alcohol consumption and male fertility.
STUDY DESIGN, SIZE, DURATION: Data were collected from two ongoing prospective preconception cohort studies: the Danish 'SnartForaeldre' (SF) study (662 couples) and the North American 'Pregnancy Study Online' (PRESTO) (2017 couples). Participants included in the current analysis were enrolled from August 2011 through June 2019 (SF) and from June 2013 through June 2019 (PRESTO).
PARTICIPANTS/MATERIALS, SETTING, METHODS: Eligible men were aged ≥18 years in SF and ≥21 years in PRESTO, in a stable relationship with a female partner and not using contraception or receiving fertility treatment. In both cohorts, alcohol consumption/serving size was self-reported as number of beers (330 mL/12 oz.), glasses of white or red wine (120 mL/4 oz. each), dessert wine (50 mL/2 oz.) and spirits (20 mL/1.5 oz.). Overall alcohol consumption was categorized as none, 1-5, 6-13 and ≥14 standard servings per week. Total menstrual cycles at risk were calculated using data from female partners' follow-up questionnaires, which were completed every 8 weeks until self-reported pregnancy or 12 menstrual cycles, whichever came first. Analyses were restricted to couples that had been trying to conceive for ≤6 cycles at study entry. Proportional probability regression models were used to compute fecundability ratios (FRs) and 95% confidence interval (CIs). We adjusted for male and female age, female partner's alcohol consumption, intercourse frequency, previous history of fathering a child, race/ethnicity, education, BMI, smoking and consumption of sugar-sweetened beverages and caffeine.
The cumulative proportion of couples who conceived during 12 cycles of follow-up were 1727 (64.5%). The median (interquartile range) of total male alcohol consumption was 4.5 (2.0-7.8) and 4.1 (1.0-8.6) standard servings per week in the SF and PRESTO cohorts, respectively. In pooled analyses, adjusted FRs for male alcohol consumption of 1-5, 6-13 and ≥14 standard servings per week compared with no alcohol consumption were 1.02 (95% CI: 0.90-1.17), 1.10 (95% CI: 0.96-1.27) and 0.98 (95% CI: 0.81-1.18), respectively. For SF, adjusted FRs of 1-5, 6-13 and ≥14 standard servings per week compared with no alcohol consumption were 0.97 (95% CI: 0.73-1.28), 0.81 (95% CI: 0.60-1.10) and 0.82 (95% CI: 0.51-1.30), respectively. For PRESTO, adjusted FRs of 1-5, 6-13 and ≥14 standard servings per week compared with no alcohol consumption were 1.02 (95% CI: 0.88-1.18), 1.20 (95% CI: 1.03-1.40) and 1.03 (95% CI: 0.84-1.26), respectively.
LIMITATIONS, REASONS FOR CAUTION: Male alcohol consumption was ascertained at baseline only, and we did not distinguish between regular and binge drinking. In addition, we had insufficient numbers to study the effects of specific types of alcoholic beverages. As always, residual confounding by unmeasured factors, such as dietary factors and mental health, cannot be ruled out. Comorbidities thought to play a role in the reproductive setting (i.e. cancer, metabolic syndrome) were not considered in this study; however, the prevalence of cancer and diabetes was low in this age group. Findings for the highest categories of alcohol consumption (6-13 and ≥14 servings/week) were not consistent across the two cohorts.
Despite little evidence of an association between male alcohol consumption and reduced fecundability in the pooled analysis, data from the Danish cohort might indicate a weak association between reduced fecundability and consumption of six or more servings per week.
STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the National Institutes of Health (R01-HD060680, R01-HD086742, R21-HD050264, R21-HD072326, R03-HD090315), the Novo Nordisk Foundation, Oticon Fonden, Politimester J.P.N. Colind og hustru Asmine Colinds mindelegat and Erna og Peter Houtveds studielegat. PRESTO receives in-kind donations from FertilityFriend.com, Kindara.com, Swiss Precision Diagnostics and Sandstone Diagnostics for the collection of data pertaining to fertility. Dr Wise serves as a consultant on uterine leiomyomata for AbbVie.com. All other authors declare no conflict of interest.
男性饮酒会影响生育能力吗？
在丹麦和北美孕前队列研究的数据汇总中，我们几乎没有发现男性饮酒与生育能力降低之间存在关联。
实验和临床研究表明，酒精会影响男性生殖生理，主要通过改变男性生殖激素和精子发生。然而，很少有流行病学研究调查饮酒与男性生育力之间的关系。
研究设计、大小和持续时间：数据来自两项正在进行的前瞻性孕前队列研究：丹麦的“SnartForaeldre”（SF）研究（662 对夫妇）和北美“怀孕在线研究”（PRESTO）（2017 对夫妇）。当前分析中包括的参与者于 2011 年 8 月至 2019 年 6 月（SF）和 2013 年 6 月至 2019 年 6 月（PRESTO）期间招募。
参与者/材料、设置、方法：符合条件的男性年龄≥18 岁 SF 组和≥21 岁 PRESTO 组，与女性伴侣关系稳定，不使用避孕措施或接受生育治疗。在这两个队列中，酒精摄入量/用量以啤酒（330 毫升/12 盎司）、白葡萄酒或红葡萄酒（120 毫升/4 盎司）、甜酒（50 毫升/2 盎司）和烈酒（20 毫升/1.5 盎司）的数量报告。总饮酒量分为无、1-5、6-13 和≥14 个每周标准份。使用女性伴侣随访问卷中的数据计算风险中的总月经周期，问卷每 8 周完成一次，直至报告怀孕或 12 个月经周期，以先到者为准。分析仅限于在研究入组时尝试怀孕≤6 个周期的夫妇。使用比例概率回归模型计算生育力比（FR）和 95%置信区间（CI）。我们调整了男性和女性的年龄、女性伴侣的饮酒量、性交频率、以前生育孩子的历史、种族/民族、教育、BMI、吸烟以及糖饮料和咖啡因的摄入量。
在 12 个周期的随访中，1727 对夫妇累计受孕率为 64.5%。SF 和 PRESTO 队列中男性总饮酒量的中位数（四分位距）分别为 4.5（2.0-7.8）和 4.1（1.0-8.6）个每周标准份。在汇总分析中，与不饮酒相比，1-5、6-13 和≥14 个每周标准份的男性饮酒量的调整后 FR 分别为 1.02（95%CI：0.90-1.17）、1.10（95%CI：0.96-1.27）和 0.98（95%CI：0.81-1.18）。对于 SF，1-5、6-13 和≥14 个每周标准份与不饮酒相比的调整后 FR 分别为 0.97（95%CI：0.73-1.28）、0.81（95%CI：0.60-1.10）和 0.82（95%CI：0.51-1.30）。对于 PRESTO，1-5、6-13 和≥14 个每周标准份与不饮酒相比的调整后 FR 分别为 1.02（95%CI：0.88-1.18）、1.20（95%CI：1.03-1.40）和 1.03（95%CI：0.84-1.26）。
局限性、谨慎的原因：男性饮酒量仅在基线时确定，我们没有区分常规饮酒和狂饮。此外，我们的研究数量不足以研究特定类型的酒精饮料的影响。与未测量的因素（如饮食因素和心理健康）相关的残余混杂，如生殖环境中发挥作用的因素（即癌症、代谢综合征），在本研究中未予考虑；然而，在这个年龄组中，癌症和糖尿病的患病率较低。最高类别（6-13 和≥14 份/周）的饮酒量与两个队列之间的一致性不一致。
尽管汇总分析中男性饮酒与生育能力降低之间几乎没有关联，但丹麦队列的数据可能表明，生育能力降低与每周饮酒六份或更多份之间存在微弱关联。
研究资金/利益冲突：本研究由美国国立卫生研究院（R01-HD060680、R01-HD086742、R21-HD050264、R21-HD072326、R03-HD090315）、诺和诺德基金会、Oticon 基金会、Politimester J.P.N. Colind 和他的妻子 Asmine Colind 纪念基金以及 Erna 和 Peter Houtved 研究基金资助。PRESTO 从 FertilityFriend.com、Kindara.com、瑞士精密诊断和 Sandstone 诊断公司获得与生育能力相关的数据捐赠。Wise 博士担任 AbbVie.com 子宫平滑肌瘤的顾问。所有其他作者均声明不存在利益冲突。
