Infertility and mortality - 29/02/20
, Nathanael Koelper, MS a, Kurt T. Barnhart, MD, MSCE a, Mary D. Sammel, ScD a, b, Suneeta Senapati, MD, MSCE aAbstract |
Background |
Infertility affects 1 in 10 American reproductive-age women. The impact of this disease beyond the reproductive years is largely unknown.
Objective |
The objective of the study was to determine the association of infertility history with all-cause and cause-specific mortality.
Study Design |
This secondary analysis of a multicenter randomized clinical trial included 75,784 women (aged 55–74 years) prospectively enrolled in the Prostate, Lung, Colorectal, and Ovarian cancer-screening trial from 1992 through 2001 and followed up a minimum of 10 years for health-related outcomes and death (856,935 person-years). We examined the association of infertility history (inability to conceive for 1 year or greater) of all-cause and cause-specific mortality using disease risk score–adjusted Cox-proportional hazard regression models.
Results |
Infertile women had a 10% increased risk of death (from any cause) during the study period compared with the unexposed (adjusted hazard risk, 1.10, 95% confidence interval, 1.02–1.18, P = .010). This effect was predominantly noted in women at an otherwise low risk of mortality who had a 26% increased risk of death (adjusted hazard risk, 1.26, 95% confidence interval, 1.12–1.42, P < .001). No differences in cardiovascular or diabetic mortality were noted. The risk of cancer death at any time over the study period was increased by 23% in infertile women compared with the unexposed (adjusted hazard risk, 1.23, 95% confidence interval, 1.10–1.37, P < .001). This effect was predominantly noted in women at an otherwise low risk of cancer mortality who had a 47% increased risk of cancer death (adjusted hazard risk, 1.47, 95% confidence interval, 1.25–1.73, P < .001). While no differences are seen in the risk of death from endometrial or ovarian cancer, the risk of death from breast cancer was more than doubled in infertile women at an otherwise low risk of breast cancer death compared with the unexposed (adjusted hazard risk, 2.64, 95% confidence interval, 1.71–4.08, P < .001).
Conclusion |
Infertility is a harbinger of future morbidity and mortality. Infertile women are at an increased risk of all-cause and cancer-related mortality. Consideration of infertility history in health care maintenance presents an opportunity for screening and early intervention for long-term health outcomes.
Le texte complet de cet article est disponible en PDF.Key words : cancer, infertility, long-term health, mortality
Plan
| Present address for Dr Stentz: Shady Grove Fertility, Atlanta, GA. |
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| The views expressed herein are those of the authors and do not represent or imply concurrence or endorsement by the National Cancer Institute. |
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| This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grants T32- HD007440 and 5K12HD001265. |
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| The authors report no conflict of interest. |
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| Cite this article as: Stentz NC, Koelper N, Barnhart KT et al. Infertility and mortality. Am J Obstet Gynecol 2020;222:251.e1-10. |
Vol 222 - N° 3
P. 251.e1-251.e10 - mars 2020 Retour au numéro
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