Spousal concordance in assisted conception: prospective cohort study of couples undertaking their first IVF cycle

Abstract

Assortative mating and cohabitation concordance cause married/cohabiting couples to share similar traits, with spousal concordance known to contribute to cardiovascular disease and be associated with worse treatment outcomes in other medical specialities. Maternal and paternal characteristics/behaviors are known to affect both natural fertility and success of IVF treatment but the contribution of concordance is unknown. This study was designed to examine the extent to which heterosexual couples undergoing IVF are concordant with respect to baseline characteristics/behaviors and whether this impacts upon outcome? Prospective cohort study of consecutive couples undertaking their first IVF cycle. Couples were assessed prior to undertaking NHS Scotland funded IVF treatment, with assessment of demographic, anthropometric, lifestyle and medical factors. Spousal concordance was assessed by spearman correlation for continuous variables, whilst kappa analysis was employed for categorical variables, with regression modelling for their association with outcomes. There were 306 couples with complete baseline data, of which 264 underwent fresh embryo transfer, with 125 ongoing pregnancies (47.3%). Couples were strongly concordant for age (r=0.59 p<0.000), alcohol consumption (k=0.661), educational attainment (k=0.655) and smoking status (k=0.45) but not BMI (r=0.11, p=0.44). Only exercise concordance was significantly associated with outcome, with exercise discordance a predictor of biochemical pregnancy (OR: 1.86; 95% CI 1.18-2.92 p=0.008). Furthermore, females in discordant couples were significantly less physically active than females in concordant couples (mean difference = 0.4527 times/week, p=0.003). Couples undertaking assisted conception are concordant for many baseline characteristics, with couples with discordant exercise habits having increased rates of biochemical pregnancy. Shared education and public health initiatives to attain spousal concordance of lifestyle factors may be beneficial for overall health outcomes if they converge towards healthy behaviors, but concordance per se had limited impact on clinical ART outcomes.