A North American preconception cohort study of cannabis use and semen quality.
Background: Recreational and medicinal use of cannabis is increasing among North American reproductive-aged couples. Studies of cannabis use and semen quality are limited and have produced inconsistent findings.
Objective: We examined the association between male cannabis use and semen parameters.
Methods: We analyzed data from 1654 semen samples contributed by 921 male participants in Pregnancy Study Online (PRESTO), a North American preconception cohort study. Participants aged ≥21 years completed a baseline questionnaire on which they reported their cannabis use within the past 2 months. After enrollment, we invited participants to perform at-home semen testing. We used linear regression to estimate percent differences in mean semen parameter values (%D) and 95% confidence intervals (CI) for associations between cannabis use and semen volume (mL), total sperm count (TSC, million), sperm concentration (million/mL), motility (%), and total motile sperm count (TMSC, million), controlling for potential confounders. We used log-binomial regression to estimate risk ratios (RRs) for low semen quality based on 2021 World Health Organization cut-points.
Results: Overall, 22.6% of participants reported current cannabis use and 3.3% reported daily use. Nearly 6% of participants had low semen volume (≤1.5 mL), 13% low sperm concentration (≤15 million/L), 8% low TSC (≤39 million), 25% low sperm motility (≤40%), and 11% low TMSC (≤16 million). Adjusted %Ds (95% CIs) comparing current cannabis use versus non-use were -3.2 (-9.1, 2.7) for semen volume, 3.5 (-10.3, 19.5) for sperm concentration, -0.6 (-14.3, 15.3) for TSC, 2.5 (-2.9, 8.0) for motility, and 3.0 (-13.4, 22.4) for TMSC. Cannabis use ≥1 times/week (vs. non-use) was associated with low semen volume (RR = 2.16, 95% CI = 0.93-5.04). Associations were imprecise and showed no monotonic association between frequency of cannabis use and the semen parameters evaluated.
Conclusions: In this North American preconception cohort study, current cannabis use was not appreciably associated with semen quality.