Sociodemographic and lifestyle factors associated with semen status among men undergoing infertility evaluation

Background: Male infertility is multifactorial, and semen abnormalities may be associated with sociodemographic and lifestyle factors. This study evaluated associations between demographic, behavioural, lifestyle, and socioeconomic factors and distinct semen-status categories among men undergoing infertility evaluation. Methods: An observational study was conducted among 501 men undergoing infertility evaluation at an infertility care centre, Raipur, from 2023 to 2026. Participants were classified as having normozoospermia, non-azoospermic abnormal semen parameters, or azoospermia. Sociodemographic, lifestyle, behavioural, and socioeconomic factors were assessed. Pearson’s chi-square test was used for unadjusted associations, followed by multinomial logistic regression with normozoospermia as the reference outcome. The model was adjusted for age, BMI, smoking, alcohol, smokeless tobacco, education, computer use, fast-food consumption, mobile-phone use, sleep duration, physical activity, and annual family income. Results: Among 501 men, unadjusted analyses showed significant associations with smoking (p=0.002), alcohol consumption (p=0.007), educational attainment (p<0.001), and computer use (p=0.029). The multinomial regression model was significant (χ2=71.8, df=46, p=0.009; McFadden pseudo-R2=0.084). Educational attainment remained significantly associated with semen status (LR χ2=13.555, df=6, p=0.035). Low educational attainment was associated with higher adjusted odds of azoospermia compared with graduation-level education (AOR=3.617, 95% CI 1.098-11.920; p=0.035). No other individual adjusted comparison was statistically significant. Conclusions: Smoking and alcohol consumption were significantly associated with semen status in unadjusted analyses. After adjustment, educational attainment remained significantly associated with semen status, with low education associated with higher odds of azoospermia. These findings highlight the relevance of lifestyle and sociodemographic factors in male infertility.