Impact of female sexual dysfunction on assisted reproductive technology outcome

Background Despite its high prevalence in infertile women and known impact on natural conception, the specific influence of female sexual dysfunction (FSD) on assisted reproductive technology (ART) outcomes, which bypass intercourse, remains unclear. Aim To investigate the association between female sexual function and ART outcomes, including live birth. Methods In this prospective cohort study, 300 women undergoing their first ART cycle completed the Female Sexual Function Index (FSFI) prior to treatment. Multivariable regression models were used to assess the association between FSFI measures (FSD status, total score, and domain scores) and ART outcomes, adjusting for key clinical confounders. Outcomes The primary outcome was live birth rate following in vitro fertilization or intracytoplasmic sperm injection treatment, with secondary outcomes including biochemical pregnancy, clinical pregnancy rate, ovarian response, and embryology parameters. Results Participants with FSD (n = 200) exhibited significantly lower biochemical pregnancy rates (55.5% vs. 82%, P < .01), clinical pregnancy rates (51% vs. 78%, P < .01), and live birth rates (36.5% vs. 54%, P < .01) compared to those without (n = 100). After adjusting for confounders, female sexual function, as measured by FSFI, held independent predictive value for these critical pregnancy outcomes. Furthermore, when analyzed as a continuous variable, higher total FSFI scores positively correlated with indicators of improved parameters of embryo development and increased pregnancy success rates. Notably, all six FSFI domains also demonstrated significant positive associations with key ART outcomes. Compared to the standard 26.55 threshold, a data-driven FSFI threshold of 20.70 showed higher Youden index values for predicting ART outcomes. Clinical Implications Evaluating FSD should be considered part of routine infertility treatment, as addressing it may offer a novel strategy to improve ART outcomes. Strengths & Limitations Key strengths are the prospective cohort design establishing temporality and use of a validated FSFI scale. However, as an observational study, it cannot establish causality; other limitations include the single-center design, potential unmeasured confounders, and the subjective nature of self-reported FSFI scores. Conclusion Lower female sexual function is significantly associated with poorer outcomes following ART, including substantially reduced live birth rates.