Archives of Gynecology and Obstetrics

, Volume 286, Issue 5, pp 1307–1314 | Cite as

Prevalence of behaviour-related fertility disorders in a clinical sample: results of a pilot study

  • Kathrin Schilling
  • Bettina Toth
  • Sabine Rösner
  • Thomas Strowitzki
  • Tewes Wischmann
Reproductive Medicine



There is no doubt that lifestyle factors can be detrimental to fertility. The aim of the present pilot study was to identify initial prevalence rates for behaviour-related fertility disorders in a clinical sample of couples wanting a child.


Between February 2010 and August 2010, all patients coming for the first time to Heidelberg University’s Women’s Hospital for consultation on involuntary childlessness were asked to fill out a questionnaire designed by the authors of this article. The questionnaire was based on a review of the relevant literature, with special reference to the latest research findings on behaviour detrimental to fertility. Of the 156 couples addressed, 110 women and 100 men took part in the study.


For behaviour-related infertility, 9 % of the women and 3 % of the men in our sample were classified on the basis of BMI <18.5, sexual disorders, or abuse of anabolic steroids. If we include smokers, these figures increase: 11 % female smokers and 18 % male smokers. A further 19 % of the women practised sport to an excessive degree; and 26 % of the women and 53 % of the men had a BMI ≥25.


The prevalence of behaviour-related fertility disorders should not be underestimated. For the prevention of behaviour-related fertility disorders, it is important to inform the population about lifestyle-mediated fertility risks.


Body mass index Sexual behaviour Psychological distress Lifestyle Risk factors 



We are grateful to the women and men for their willingness to participate in this study.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.


  1. 1.
    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–S504PubMedGoogle Scholar
  2. 2.
    Anderson K, Nisenblat V, Norman R (2010) Lifestyle factors in people seeking infertility treatment—a review. Aust NZ J Obstet Gynaecol 50(1):8–20CrossRefGoogle Scholar
  3. 3.
    Anderson K, Norman R, Middleton P (2010) Preconception lifestyle advice for people with subfertility. Cochrane Rev 11Google Scholar
  4. 4.
    Apfel RJ, Keylor RG (2002) Psychoanalysis and infertility—myths and realities. Int J Psychoanal 83:85–103PubMedCrossRefGoogle Scholar
  5. 5.
    Berner M, Schmidt E, Weinhäupl C, Günzler C, Kriston L, Zahradnik HP (2010) Prävalenz, Diagnostik und Therapie weiblicher sexueller Funktionsstörungen in der gynäkologischen Praxis—Eine deutschlandweite Repräsentativbefragung. Geburtsh Frauenheilk 70(04):281–287Google Scholar
  6. 6.
    Boivin J, Bunting L, Collins JA, Nygren KG (2007) International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 22(6):1506–1512PubMedCrossRefGoogle Scholar
  7. 7.
    Boivin J, Griffiths E, Venetis CA (2011) Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. Br Med J 342:d223CrossRefGoogle Scholar
  8. 8.
    Bundesärztekammer (2006) (Muster-)Richtlinie zur Durchführung der assistierten Reproduktion—Novelle 2006. Dtsch Ärztebl 20:A1392–A1403Google Scholar
  9. 9.
    Cappelleri JC, Althof SE, Siegel RL, Shpilsky A, Bell SS, Duttagupta S (2004) Development and validation of the self-esteem and relationship (SEAR) questionnaire in erectile dysfunction. Int J Impot Res 16(1):30–38PubMedCrossRefGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention (CDC) (2011) Reproductive Health. Infertility FAQs.
  11. 11.
    Derbyshire E (2007) Taking it a step too far? Physical activity and infertility. Nutr Food Sci 37(5):313–318CrossRefGoogle Scholar
  12. 12.
    Eggert J, Theobald H, Engfeldt P (2004) Effects of alcohol consumption on female fertility during an 18-year period. Fertil Steril 81(2):379–383PubMedCrossRefGoogle Scholar
  13. 13.
    Frey KA, Navarro SM, Kotelchuck M, Lu MC (2008) The clinical content of preconception care: preconception care for men. Am J Obstet Gynecol 199(6, Suppl 2):S389–S395Google Scholar
  14. 14.
    Grodstein F, Goldman MB, Cramer DW (1994) Body mass index and ovulatory infertility. Epidemiology 5(2):247–250PubMedCrossRefGoogle Scholar
  15. 15.
    Gudmundsdottir SL, Flanders WD, Augestad LB (2009) Physical activity and fertility in women: the North-Trondelag Health Study. Hum Reprod 24(12):3196–3204PubMedCrossRefGoogle Scholar
  16. 16.
    Hammiche F, Laven JSE, van Mil N, de Cock M, de Vries JH, Lindemans J, et al (2011) Tailored preconceptional dietary and lifestyle counselling in a tertiary outpatient clinic in the Netherlands. Hum Reprod 24(9):2432–2441Google Scholar
  17. 17.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093Google Scholar
  18. 18.
    Hassan MAM, Killick SR (2004) Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril 81(2):384–392PubMedCrossRefGoogle Scholar
  19. 19.
    Homan GF, Davies M, Norman R (2007) The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update 13(3):209–223PubMedCrossRefGoogle Scholar
  20. 20.
    Klonoff-Cohen H (2005) Female and male lifestyle habits and IVF: what is known and unknown. Hum Reprod Update 11(2):180–204CrossRefGoogle Scholar
  21. 21.
    Künzle R, Mueller MD, Hänggi W, Birkhäuser MH, Drescher H, Bersinger NA (2003) Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril 79(2):287–291PubMedCrossRefGoogle Scholar
  22. 22.
    Li Y, Lin H, Li Y, Cao J (2011) Association between socio-psycho-behavioral factors and male semen quality: systematic review and meta-analyses. Fertil Steril 95(1):116–123PubMedCrossRefGoogle Scholar
  23. 23.
    Morris SNMD, Missmer SAS, Cramer DWMD, Powers RDMD, McShane PMMD, Hornstein MDMD (2006) Effects of lifetime exercise on the outcome of in vitro fertilization. Obstet Gynecol 108(4):938–945PubMedCrossRefGoogle Scholar
  24. 24.
    Nguyen RHN, Wilcox AJ, Skjaerven R, Baird DD (2007) Men’s body mass index and infertility. Hum Reprod 22(9):2488–2493PubMedCrossRefGoogle Scholar
  25. 25.
    Olive DL (2010) Exercise and fertility: an update. Curr Obst Gynaecol 22:259–263CrossRefGoogle Scholar
  26. 26.
    Paasch U, Grunewald S, Kratzsch J, Glander H-J (2010) Obesity and age affect male fertility potential. Fertil Steril 94:2898–2901PubMedCrossRefGoogle Scholar
  27. 27.
    Pasqualotto FF, Lucon AM, Sobreiro BP, Pasqualotto EB, Arap S (2004) Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility. Rev Hosp Clin Fac Med S Paulo 59:375–382PubMedGoogle Scholar
  28. 28.
    Ragheb AM, Sabanegh ES (2009) Smoking and male fertility: a contemporary review. Arch Med Sci 5(1A):S13–S19Google Scholar
  29. 29.
    Read J (2011) Sexual problems and infertility. BICA PublicationsGoogle Scholar
  30. 30.
    Rich-Edwards WJ, Goldman BM, Willett CW, et al (1994) Adolescent body mass index and infertility caused by ovulatory disorder, vol 171. Elsevier, New YorkGoogle Scholar
  31. 31.
    Rich-Edwards JW, Spiegelman D, Garland M, Hertzmark E, Hunter DJ, Colditz GA et al (2002) Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology 13(2):184–190PubMedCrossRefGoogle Scholar
  32. 32.
    Strauß B, Bettge S, Bindt C, Brähler E, Felder H, Gagel D et al (2000) Psychosomatik in der Reproduktionsmedizin. Leitlinien. Reproduktionsmed 16(5):326–331CrossRefGoogle Scholar
  33. 33.
    Tao P, Coates R, Maycock B (2011) The impact of infertility on sexuality: a literature review. Australas Med J 4(11):620–627CrossRefGoogle Scholar
  34. 34.
    van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbema JD, te Velde ER, Karbaat J (1991) Delaying childbearing: effect of age on fecundity and outcome of pregnancy. Br Med J 302(6789):1361–1365CrossRefGoogle Scholar
  35. 35.
    Warren M, Perlroth N (2001) The effects of intense exercise on the female reproductive system. J Endocrinol 170(1):3–11PubMedCrossRefGoogle Scholar
  36. 36.
    Waylen AL, Metwally M, Jones GL, Wilkinson AJ, Ledger WL (2009) Effects of cigarette smoking upon clinical outcomes of assisted reproduction: a meta-analysis. Hum Reprod Update 15:31–44PubMedCrossRefGoogle Scholar
  37. 37.
    WHO (1997) BMI classification.
  38. 38.
    WHO (2011) Prevalence of overweight & obesity map. Retrieved 16 June 2011 from
  39. 39.
    Wischmann T (2003) Psychogenic infertility—myths and facts. J Assist Reprod Genet 20(12):485–494PubMedCrossRefGoogle Scholar
  40. 40.
    Wischmann TH (2010) Sexual disorders in infertile couples. J Sex Med 7(5):1868–1876PubMedCrossRefGoogle Scholar
  41. 41.
    Zenzes MT, Bielecki R, Reed TE (1999) Detection of benzo(a)pyrene diol epoxide-DNA adducts in sperm of men exposed to cigarette smoke. Fertil Steril 72(2):330–335PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Kathrin Schilling
    • 1
  • Bettina Toth
    • 2
  • Sabine Rösner
    • 2
  • Thomas Strowitzki
    • 2
  • Tewes Wischmann
    • 1
  1. 1.Centre for Psychosocial Medicine, Institute of Medical PsychologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Gynaecological Endocrinology and Reproductive Medicine, Women’s HospitalUniversity of HeidelbergHeidelbergGermany

Personalised recommendations