The Association of Female and Male Preconception Dyslipidemia With Live Birth in Couples Seeking Fertility Treatment

Context: Dyslipidemia is common, and resultant endothelial dysfunction may impact reproductive outcomes. No prospective study has examined the effect of preconception lipid parameters in both female and male partners or their interaction on live birth. Objective: To determine whether live birth is associated with preconception lipids in both partners by planned fertility treatment. Design: Secondary analysis of the Folic Acid and Zinc Supplementation Trial, conducted between June 2013 and December 2017. Couples were followed for 9 months after randomization and until delivery. Setting: Multicenter study. Participants: Couples seeking fertility treatment (n = 2370; females 18-45 years, males ≥18 years). Exposures: Female, male, and couple abnormal vs normal preconception lipid concentrations [total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein, triglycerides]. Main Outcome Measures: Live birth. Results: Among 2370 couples, most males (84%) and females (76%) had at least 1 abnormal lipid parameter. Males planning in vitro fertilization (IVF, n = 373) with elevated LDL had lower probability of live birth than those with normal levels [47.4% vs 59.7%, adjusted relative risk (aRR) 0.79, 95% confidence interval (CI) 0.65-0.98]. In couples planning IVF where both partners had elevated TC or LDL, live birth was lower than those with normal levels (TC: 32.4% vs 58.0%, aRR 0.53, 95% CI 0.36-0.79; and LDL: 41.9% vs 63.8%, aRR 0.69, 95% CI 0.55-0.85). Lipid parameters were not associated with live birth for couples planning non-IVF treatments. Conclusion: Couples planning IVF where both partners had elevated TC or LDL and males planning IVF with elevated LDL had decreased probability of live birth. These findings may support lipid screening in patients seeking fertility treatment for prognostic information for reproductive outcomes.