Laura Fredriksen, Ulrich Schaff, Sara Naab, Kirk Harmon, Raymond Naval, April Culver, Jesper Verhey, Michael Eisenberg, and Greg Sommer

Journal of Urology, Volume 199 Issue 4S, April 2018; e222

 

Introduction and Objective

General health and lifestyle factors can impact male reproductive health. In May 2015 we launched a 30-question online fertility risk assessment questionnaire of established male fertility risk factors based on a literature review, including age, body size, medical history, diet, exercise, sleep, and exposure to known toxins. A summary “risk score” was calculated by weighting responses from each man based on literature studies and a priori assumptions on risk of male infertility, subfertility, and sperm quality. The current study evaluates the correlation between the risk score and respondents’ time trying to conceive (TTC).

Methods

Anonymized responses to the free online risk assessment questionnaire were compiled and analyzed. Risk scores were normalized on a scale of -30 to 100 and correlated with TTC using ordinal logistic regression and binomial logistic regression models. 1-way ANOVA or t-test was used to evaluate risk score differentiability between TTC category response groups divided into four categories (< 6 mo, 6-12 mo, 12-24 mo, and ≥ 24 mo).

Results

As of August 2017, 10,237 total responses were gathered, of which 6,945 men were actively trying to conceive. The average age of the respondents was 34 (± 8.5 years). Using 1-way ANOVA of the risk scores for each TTC category show a significant difference between groups (p < 0.0001), with the average risk scores generally increasing for increasing TTC. The average score for the < 6 mo group was 4.7, 6-12 mo was 4.6, 12-24 mo was 8.6, and ≥ 24 mo was 10.2. For each 10 unit increase in the risk score, the odds of being in a longer TTC group increased by a factor of 11.1 (95% CI 11.0 – 11.2). Using 2-category TTC discrimination (< 12 mo or ≥ 12 mo), 2-sided t-test of the risk scores show a significant difference between the two TTC groups (p < 0.0001). The average score for the <12 mo group was 4.7 and the >12 mo group was 9.4. Additionally, from the binomial logistic regression model, we were able predict probability of clinical infertility (≥ 12 mo TTC) given the preliminary risk score, with an AUC of 0.73.

Conclusions

The analysis demonstrated an association between a priori assumptions of men’s health and lifestyle risk factors and TTC. By demonstrating predictive power, this preliminary risk assessment tool may help engage men earlier in the conception process with health and lifestyle changes in addition to improving access to specialized care. Further analysis of correlations with specific risk factors such as BMI, smoking, diet, exercise, and other exposures is needed.

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