In the Journals

Fertility drugs in obese women with PCOS less effective when both partners smoke

Among infertile women with polycystic ovary syndrome and their male partners, obesity and smoking appear to be associated with lower fertility treatment success, according to recent findings.

The influence of male partner obesity, however, was not significant after adjusting for female BMI and other parameters, the researchers wrote.

In a secondary analysis of the PPCOS II trial, Alex J. Polotsky, MD, MS, of the University of Colorado Denver, and colleagues evaluated 750 women aged 18 to 39 years with PCOS and infertility and their male partners. The PPCOS II was a double blind, prospective randomized trial of letrozole or clomiphene citrate for treatment of infertility among women with PCOS. 

Male participants had a sperm concentration of a least 14 million/mL in at least one ejaculate within the past year, and all couples agreed to regular intercourse. The researchers collected biometric and hormonal measures at baseline and measured female height and weight to the nearest 0.1 cm and 0.1 kg, respectively. Male anthropometric measures were obtained through self-report. Women were randomly assigned to treatment with up to five cycles of ovulation induction with letrozole or clomiphene citrate.

Information about smoking history was acquired by questionnaire at baseline in both men and women. The primary outcome was live birth during the treatment period.

The researchers found that in couples who did not conceive, the BMI of men was higher (29.5 kg/m2) compared with those who did conceive (28.2 kg/m2; P = .039). The BMI of men also was higher among couples who did not achieve a live birth (29.5 kg/m2) compared with those who did (28.1 kg/m2; P = .047). A negative association was found with pregnancy and live birth for infrequent intercourse among sexual function measures among men.

At least one partner had obesity in 77.1% of couples and both had obesity in 36.8%.

After adjustment for BMI of women, correlation between BMI of men and live birth was no longer significant. A lower chance of live birth was found among couples who were both smokers compared with nonsmokers (OR = 0.2; 95% CI, 0.08-0.53).

Live births were associated with frequent sexual intercourse at baseline (OR = 4.39; 95% CI, 1.52-12.4).

“Couples in which both partners were current smokers had a lower take home baby rate,” the researchers wrote. “Obesity and smoking, potentially modifiable risks, are highly prevalent among women with PCOS and their partners and negatively impact success of fertility treatment. Low intercourse frequency as a potential factor influencing success of fertility treatment may be underappreciated by patients and practitioners alike and warrants consideration. Overall, our findings could be regarded as hypothesis generating: Could including male partners in studies of lifestyle modifications for obese and smoking women result in improved outcomes? Dedicated prospective studies are needed to answer this question.” – by Jennifer Byrne

Disclosure: Polotsky reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.

Among infertile women with polycystic ovary syndrome and their male partners, obesity and smoking appear to be associated with lower fertility treatment success, according to recent findings.

The influence of male partner obesity, however, was not significant after adjusting for female BMI and other parameters, the researchers wrote.

In a secondary analysis of the PPCOS II trial, Alex J. Polotsky, MD, MS, of the University of Colorado Denver, and colleagues evaluated 750 women aged 18 to 39 years with PCOS and infertility and their male partners. The PPCOS II was a double blind, prospective randomized trial of letrozole or clomiphene citrate for treatment of infertility among women with PCOS. 

Male participants had a sperm concentration of a least 14 million/mL in at least one ejaculate within the past year, and all couples agreed to regular intercourse. The researchers collected biometric and hormonal measures at baseline and measured female height and weight to the nearest 0.1 cm and 0.1 kg, respectively. Male anthropometric measures were obtained through self-report. Women were randomly assigned to treatment with up to five cycles of ovulation induction with letrozole or clomiphene citrate.

Information about smoking history was acquired by questionnaire at baseline in both men and women. The primary outcome was live birth during the treatment period.

The researchers found that in couples who did not conceive, the BMI of men was higher (29.5 kg/m2) compared with those who did conceive (28.2 kg/m2; P = .039). The BMI of men also was higher among couples who did not achieve a live birth (29.5 kg/m2) compared with those who did (28.1 kg/m2; P = .047). A negative association was found with pregnancy and live birth for infrequent intercourse among sexual function measures among men.

At least one partner had obesity in 77.1% of couples and both had obesity in 36.8%.

After adjustment for BMI of women, correlation between BMI of men and live birth was no longer significant. A lower chance of live birth was found among couples who were both smokers compared with nonsmokers (OR = 0.2; 95% CI, 0.08-0.53).

Live births were associated with frequent sexual intercourse at baseline (OR = 4.39; 95% CI, 1.52-12.4).

“Couples in which both partners were current smokers had a lower take home baby rate,” the researchers wrote. “Obesity and smoking, potentially modifiable risks, are highly prevalent among women with PCOS and their partners and negatively impact success of fertility treatment. Low intercourse frequency as a potential factor influencing success of fertility treatment may be underappreciated by patients and practitioners alike and warrants consideration. Overall, our findings could be regarded as hypothesis generating: Could including male partners in studies of lifestyle modifications for obese and smoking women result in improved outcomes? Dedicated prospective studies are needed to answer this question.” – by Jennifer Byrne

Disclosure: Polotsky reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.