Objective: To determine whether cotinine levels provide stronger evidence for an association between smoking and semen quality than the number of cigarettes smoked per day or years smoked controlling for potential confounders and effect modifiers.
Design: Cross-sectional study.
Setting: Male volunteers at the Reproductive Endocrinology-Fertility Laboratory.
Participants: Eighty-eight men (ages 18 to 35 years) provided a semen, urine, and blood specimen and completed a self-administered questionnaire concerning smoking and demographic information as well as caffeine and alcohol consumption. Urine, blood, and semen cotinine levels were analyzed via RIA.
Main outcome measure: Standard clinical semen analysis.
Results: Number of cigarettes smoked per day, years smoked, and log-transformed cotinine levels were associated negatively with semen quality (density, total count, and motility). The association was evident among men age > or = 22 years. For example, the correlation coefficient for the overall association between logged urine cotinine and logged sperm density was -0.23; those stratified by age were 0. 13 (age < 22 years) and - 0. 39 (age > or = 22 years). Potential confounders included in regression models did not diminish the associations.
Conclusions: Smoking is associated with lowered semen quality.