Background and objective:Several lifestyle factors, such as smoking and obesity, have consistently been associated with infertility. The impact of metabolic syndrome (MetS), which is typically a consequence of adverse lifestyle factors, has not been assessed in relation to fertility. The study aimed to determine the association between MetS and infertility, and to examine associations between individual and number of MetS components and infertility.
Methods:Low-risk, nulliparous women recruited to the multi-centre, international, prospective SCOPE (Screening for Pregnancy Endpoints) cohort were assessed for a range of demographic, lifestyle and metabolic health variables at 15 ± 1 weeks’ gestation.MetS was defined according to the International Diabetes Federation for adults. Infertility was defined as taking more than 12 months to conceive. Generalized linear models were conducted to estimate relative risks (RR) and 95% CIs associated with infertility, adjusted for a range of maternal and paternal factors.
Results:Of the 5500 women included, 12.3% (n=679) had MetS. Compared to women without MetS, women with MetS had a higher risk of infertility (adjusted RR 1.53; 1.25-1.88). Risk of infertility increased with reduced levels of high-density lipoprotein cholesterol (1.48; 1.12-1.95) and with raised levels of triglycerides (1.26; 1.07-1.49), but not with raised blood pressure, raised glucose or high waist circumference. Having more than one MetS component increased risk of infertility by up to 73% (0 metabolic components [reference] vs. 1 [0.95; 0.75-1.19], 2 [1.05; 0.82-1.34], 3 [1.48; 1.11-1.97], ≥4 [1.73; 1.13-2.64]).
Conclusions: MetS appears to be an independent risk factor for infertility. Future studies are needed to replicate our findings and to determine whether individual or a combination of components of MetS pose greater risk for reduced fertility. Assessment of metabolic profile and advice on improving metabolic health may be beneficial for women who experience difficulty in conceiving.