Descriptive results
From January 2013 to December 2014, 260 men whose partners experience RPL were received the set of study questionnaires at their first clinic visit. A total of 236 men (response rate, 90.8 %) completed questionnaires. Another 236 male volunteers who had at least one child were enrolled from our health examination center as a control group. Men in RPL group discontinued the study for the following reasons: withdrawal of consent (
N = 12), loss to follow-up (
N = 8), incomplete information (
N = 2), and other reasons (
N = 2). The background characteristics of the participants are summarized in Table
1.
Table 1
Demographics information of men in RPL group and control group
Age, years | | | 0.297 |
20-29 | 137 (58.1 %) | 142 (60.2 %) | |
30-39 | 63 (26.7 %) | 61 (25.8 %) | |
40-49 | 36 (15.3 %) | 33 (14.0 %) | |
BMI, kg/m2 | 25.32 ± 5.27 | 25.51 ± 5.01 | 0.802 |
Cigarette smoking | | | 0.424 |
Yes | 94 (39.8 %) | 102 (43.2 %) | |
No | 142 (60.2 %) | 134 (56.8 %) | |
Alcohol consumption | | | |
Yes | 65 (27.5 %) | 72 (30.5 %) | |
No | 171 (72.5 %) | 164 (69.5 %) | |
Educational status | | | 0.794 |
Primary school | 15 (6.4 %) | 12 (5.0 %) | |
Middle school | 39 (16.5 %) | 42 (17.8 %) | |
High school | 78 (33.1 %) | 83 (35.2 %) | |
University | 104 (44.0 %) | 99 (42.0 %) | |
Monthly income (RMB) | | | 0.507 |
< 3000 | 51 (21.6 %) | 59 (25.0 %) | |
3000-5000 | 79 (33.5 %) | 81 (34.3 %) | |
> 5000 | 106 (44.9 %) | 96 (40.7 %) | |
Length of marriage (year) | 4.43 ± 3.77 (1–19) | 4.81 ± 3.92 (1–21) | 0.213 |
Number of past pregnancy losses | 2.90 ± 0.97 (2–6) | N/A | |
Interval after the latest loss | | N/A | |
< 1 month | 46 (19.49 %) | | |
1-3 months | 122 (51.69 %) | | |
4-6 months | 57 (24.15 %) | | |
> 6 months | 11 (4.66 %) | | |
When compared with men from the control group, men in RPL group reported significantly higher rates of sexual dysfunction and psychological burden, including ED, anxiety, and depression symptoms (
P < 0.001 for all) (Table
2).
Table 2
IIEF-5, SAS, and SDS scores of men in RPL group and control group
ISS | 58.01 ± 15.11 | 39.32 ± 12.27 | 0.021 |
IIEF-5, scores | | | <0.001 |
5-7 | 0 (0 %) | 0 (0 %) | |
8-11 | 16 (6.78 %) | 3 (1.27 %) | |
12-21 | 29 (12.29 %) | 15 (6.36 %) | |
22-25 | 191 (80.93 %) | 218 (92.37 %) | |
Mean ± SD | 21.46 ± 5.96 | 24.61 ± 4.71 | 0.010 |
SAS, scores | | | <0.001 |
< 50 | 149 (63.14 %) | 79.24 (21.6 %) | |
50-59 | 48 (20.33 %) | 25 (10.59 %) | |
60-69 | 22 (9.32 %) | 16 (6.78 %) | |
≥ 70 | 17 (7.20 %) | 8 (3.39 %) | |
Mean ± SD | 39.11 ± 15.73 | 24.23 ± 16.37 | <0.001 |
SDS, scores | | | <0.001 |
<53 | 174 (73.73 %) | 218 (92.37 %) | |
53-62 | 25 (10.59 %) | 13 (5.51 %) | |
63-72 | 37 (15.68 %) | 5 (2.12 %) | |
≥72 | 0 (0 %) | 0 (0 %) | |
Mean ± SD | 26.32 ± 17.66 | 12.79 ± 8.30 | <0.001 |
The mean ISS scores for the RPL group were higher than those for the control group (P = 0.021), indicating that the men from the RPL group were having poorer sexual contact experiences. In this group, 19 (8.05 %) men had scores over 70, which indicated they may have been having significant stress in their daily life.
When erectile function was assessed, the mean IEFF-5 scores for the RPL were lower than the control groups (P = 0.010). In the RPL group, a total of 45 men (19.07 %) reported overall ED (IIEF-5 score <22), and twenty-nine men reported a mild form (IIEF-5 score 12 – 21) and 16 a moderate form (score 8 – 11), whereas no patients reported a severe form (score 5 – 7). However, in the control group, 18 men (7.63 %) were diagnosed with ED. Fifteen (6.36 %) men reported mild ED and three (1.27 %) a moderate ED, whereas no men reported a severe ED.
According to the SAS and SDS results, 36.90 % (87/236) and 26.30 % (62/236) men of RPL group were diagnosed with anxiety and depression, respectively. Mean scores of the SAS and SDS for men with RPL partners were presented in Table
2. Among them, 20.33 % (48/236) reported mild anxiety, 9.32 % (22/236) moderate anxiety, and 7.20 % (17/236) severe anxiety. For the SDS, 10.60 % (25/236) reported mild depression and 15.68 % (37/236) moderate depression, whereas no patients reported severe depression. Additionally, the SAS and SDS scores were not reliably associated with the number of past pregnancy losses.
In contrast, the mean SAS and SDS scores reported by men in the control group were lower than those in the RPL group (P < 0.001). The incidences of anxiety and depression in the control group were 19.08 % (49/236) and 7.63 % (18/236), respectively, which were lower than those in the RPL group (P < 0.001 for all).
In addition, there were several associations among the sexual function and psychological distress variables (Table
3). After adjusting for age, negative relationships were observed between the IIEF-5 score and both SAS and SDS scores; positive relationships were observed between the ISS score and both SAS and SDS scores. Furthermore, plausible predictors for ED (IIEF-5 < 22) were examined using a multivariate logistic regression model. We found that age, whose partners experience a history of RPL, anxiety and depressive symptoms were significantly associated with a higher risk of ED (Table
4).
Table 3
Associations between the outcomes of the measures for sexual function and psychological distress
SAS | -0.40 | <0.001 | 0.49 | <0.001 |
SDS | -0.52 | <0.001 | 0.50 | <0.001 |
Table 4
Multivariate logistic regression analysis predicting factors associated with ED (IIEF-5<22)
Age | 1.10 | 1.03-1.24 | <0.001 |
Cigarette smoking | 1.20 | 0.93-1.58 | 0.142 |
Alcohol consumption | 0.96 | 0.90-1.06 | 0.258 |
RPL history | 1.47 | 1.18-2.29 | <0.001 |
Anxiety | 1.86 | 1.52-2.78 | <0.001 |
Depression | 1.58 | 1.28-2.64 | <0.001 |