A North American preconception cohort study of cannabis use and semen quality

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.

We examined the association between male cannabis use and semen parameters.

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.

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.

In this North American preconception cohort study, current cannabis use was not appreciably associated with semen quality.