Human Reproduction, Vol. 17, No. 2, 503-515,
February 2002
© 2002 European Society of Human Reproduction and Embryology
Time to pregnancy and semen parameters: a cross-sectional study among fertile couples from four European cities
1 INSERM U292, Research in Public Health, 82 rue du Général Leclerc, 94276 Le Kremlin-Bicêtre cedex, France, 2 Service de Biologie de la Reproduction, Université Paris V, Groupe Hospitalier Cochin, 123 Boulevard de Port-Royal, FR-75014 Paris, France, 3 Department of Growth and Reproduction, Rigshospitalet, The Juliane Marie Centre, Section GR-5064, Blegdamsvej 9, DK-2100 Copenhagen, Denmark, 4 Department of Epidemiology & Public Health, Imperial College of Medicine at St Mary's, Norfolk Place, London W21PG, UK, Departments of 5 Anatomy, 6 Physiology and 7 Paediatrics, University of Turku, Kiinamyllynkatu 10, FIN-20520 Turku, Finland, 8 MRC Human Reproductive Sciences Unit, Centre for Reproductive Biology, 37 Chalmers Street, Edinburgh EH3 9ET, UK, 9 The Fertility Clinic, Rigshospitalet, The Juliane Marie Centre, Section 4071, Blegdamsvej 9, DK-2100 Copenhagen, and 10 Department of Biostatistics, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
BACKGROUND: In fertile populations, little is known about the association between semen parameters and time to pregnancy (TTP). METHODS: Pregnant women from Copenhagen, Edinburgh, Paris and Turku who conceived without medical intervention were asked for their TTP (942 couples), and their partners provided a semen sample. The proportion of morphologically normal sperm and the multiple anomalies index (MAI, ratio of the total number of anomalies to the number of abnormal sperm) were centrally estimated. We estimated rate ratios for the occurrence of a pregnancy by a discrete survival model, adjusted for sexual activity and female factors affecting fecundity. RESULTS: Increasing sperm concentration influenced TTP up to 55x106/ml. The proportion of morphologically normal sperm influenced TTP up to 39% according to David's criteria, and this association held among the subjects with a sperm concentration >55x106/ml. For strict criteria, the threshold value was 19% normal sperm. An increase of 0.5 in MAI was associated with an adjusted rate ratio for the occurrence of a pregnancy of 0.68 (95% confidence interval: 0.54–0.85). CONCLUSIONS: These results highlight the importance of sperm morphology parameters and indicate that the effect of proportion of normal sperm on TTP may be independent of sperm concentration.
Key words: fecundability/semen/sperm morphology/threshold values of semen characteristics/time to pregnancy
11 To whom correspondence should be addressed. E-mail: slama{at}vjf.inserm.fr
Submitted on March 8, 2001; resubmitted on June 4, 2001
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