{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T01:31:58Z","timestamp":1787275918477,"version":"build-2736575974"},"reference-count":31,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,10,9]],"date-time":"2022-10-09T00:00:00Z","timestamp":1665273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008376","name":"Helsingin ja Uudenmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["TYH2018232 & TYH2020207"],"award-info":[{"award-number":["TYH2018232 & TYH2020207"]}],"id":[{"id":"10.13039\/100008376","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003125","name":"Suomen Kulttuurirahasto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Currently, recurrent pregnancy loss (RPL) examinations focus on the woman, although paternal factors are also involved. Men in couples with RPL have higher sperm DNA fragmentation levels than fertile men, but the effect of sperm DNA damage on couple's later prognosis is unknown. Advanced maternal age and obesity are associated with RPL, but paternal lifestyle factors are less studied. Therefore, we aimed to study the associations of couples' lifestyle factors, causes of RPL, and sperm DNA fragmentation with their prognosis of future live birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This descriptive cohort study comprised 506 couples investigated for RPL at Helsinki University Hospital, Finland, between 2007 and 2016, linked with national health and population registers. The primary outcome was couple's live birth after RPL investigations. Data on couple's background factors, including age, body mass index, smoking, and alcohol use, were collected from medical records. Sperm DNA fragmentation index was analyzed from 211 men using the sperm chromatin dispersion test. The associations between background factors, sperm DNA fragmentation, and cumulative probability of live birth over time were analyzed using cross\u2010tabulations and age\u2010adjusted Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 352 of 506 couples (69.6%) achieved live birth. Maternal age, unexplained RPL, prolonged pregnancy attempts before investigations, paternal obesity, and maternal smoking were associated with prognosis: unadjusted hazard ratio for couple's live birth for women aged 35\u201339 vs younger than 30\u2009years was 0.63 (95% confidence interval [CI] 0.47\u20130.84), and for 40\u2009years or older was 0.36 (95% CI 0.22\u20130.58). Age\u2010adjusted hazard ratio for unexplained vs explained RPL was 1.39 (95% CI 1.12\u20131.72), for couple's pregnancy attempt at least 4\u2009years vs less than 2\u2009years was 0.50 (95% CI 0.33\u20130.76), for paternal body mass index at least 30\u2009kg\/m<jats:sup>2<\/jats:sup> vs less than 25\u2009kg\/m<jats:sup>2<\/jats:sup> was 0.67 (95% CI 0.46\u20130.98), and for maternal smoking was 0.71 (95% CI 0.51\u20130.99). Altogether, 96\/135 (71.1%) couples with normal (&lt;15%), 38\/60 (63.3%) with intermediate (15\u201330%), and 11\/16 (68.8%) with high sperm DNA fragmentation index achieved live birth (<jats:italic>p\u2009=<\/jats:italic>\u00a00.56).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In couples with RPL, prolonged pregnancy attempts, a cause found in RPL examinations, lifestyle factors, and maternal age are negatively associated with their prognosis of future live birth. Sperm DNA fragmentation was not associated, but the number of men with damaged spermatozoa was small. We suggest that clinicians include women and men in RPL counseling because couple's joint lifestyle seems to determine their later prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14469","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T11:34:46Z","timestamp":1665401686000},"page":"1374-1385","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The effect of paternal and maternal factors on the prognosis of live birth in couples with recurrent pregnancy loss"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6841-0757","authenticated-orcid":false,"given":"Pirkko\u2010Liisa","family":"Peuranp\u00e4\u00e4","sequence":"first","affiliation":[{"name":"The Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare  Helsinki Finland"},{"name":"Academic Primary Health Care Center, Region Stockholm &amp; Department of Molecular Medicine and Surgery Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Peltopuro","sequence":"additional","affiliation":[{"name":"The Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aila","family":"Tiitinen","sequence":"additional","affiliation":[{"name":"The Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Hautam\u00e4ki","sequence":"additional","affiliation":[{"name":"The Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoy004"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dey362"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2021.08.037"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-052661"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.10.016"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.21037\/tau.2017.06.15"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2019.03.003"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13860"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.07.1290"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823c0413"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-86445-2"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt334"},{"key":"e_1_2_12_14_1","first-page":"227","article-title":"Paternal smoking is associated with an increased risk of pregnancy loss in a dose\u2010dependent manner: a systematic review and meta\u2010analysis","volume":"2","author":"Foss\u00e9 NA","year":"2021","journal-title":"Fertil Steril Rev"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2014.912228"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)59942-7"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.01753.x"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh098"},{"key":"e_1_2_12_19_1","first-page":"2010","volume-title":"WHO laboratory manual for the examination and processing of human semen","author":"WHO. 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