Background-Human papillomavirus (HPV) vaccines have been recommended as primary prevention of HPV-related cancers for over 10 years in the United States, and evidence reveals decreased incidence of HPV infections following vaccination. However, concerns have been raised that HPV vaccines could decrease fertility. This study examined the relationship between HPV immunization and self-reported infertility in a nationally representative sample. Methods-Data from the 2013-2016 National Health and Nutrition Examination Survey were analyzed to asses likelihood of self-reported infertility among women aged 20 to 33, who were young enough to have been offered HPV vaccines and old enough to have been queried about infertility (n=1,114). Two logistic regression models, stratified by marital history, examined potential associations between HPV vaccination and infertility. Model 1 assessed the likelihood of infertility among women who had never been pregnant or whose pregnancies occurred prior to HPV vaccination. Model 2 accounted for the possibility of latent and/or non-permanent postvaccine infertility by including all women 20-33 years old who reported any 12-month period of infertility.

Our objective was to develop and test a new approach to obtaining parental policy guidance about disclosure of incidental findings of newborn screening for cystic fibrosis (CF), including heterozygote carrier status and the conditions known as CFTR-related metabolic syndrome (CRMS) and/or cystic fibrosis screen positive inconclusive diagnosis, CFSPID. The participants were parents of infants up to 6 months old recruited from maternity hospitals/clinics, parent education classes and stores selling baby products. Data were collected using an anonymous, one-time Internet-based survey. The survey introduced two scenarios using novel, animated videos. Parents were asked to rank three potential disclosure policies—Fully Informed, Parents Decide, and Withholding Information. Regarding disclosure of information about Mild X (analogous to CRMS/CFSPID), 57% of respondents ranked Parents Decide as their top choice, while another 41% ranked the Fully Informed policy first. Similarly, when considering disclosure of information about Disease X (CF) carrier status, 50% and 43% gave top rankings to the Fully Informed and Parents Decide policies, respectively. Less than 8% ranked the Withholding Information policy first in either scenario. Data from value comparisons suggested that parents believed knowing everything was very important even if they became distressed. Likewise, parents preferred autonomy even if they became distressed. However, when there might not be enough time to learn everything, parents showed a slight preference for deferring decision-making. Because most parents strongly preferred the policies of full disclosure or making the decision, rather than the withholding option for NBS results, these results can inform disclosure policies in NBS programs, especially as next-generation sequencing increases incidental findings.

INTRODUCTION: Human papillomavirus (HPV) infections are associated with adverse human reproductive health outcomes: miscarriages, preterm delivery, lower pregnancy rates, and poor semen quality. Fecundity may also be reduced by surgery for HPV-related cervical dysplasia. HPV immunizations could improve fertility by preventing HPV infections. Claims have been made suggesting HPV vaccines negatively affect reproductive capacity. This study examined the relationship between HPV immunization status and infertility using data from a nationally-representative sample. METHODS: Data were analyzed from the 2013-2016 National Health and Nutrition Examination Surveys, which included queries regarding respondents' intentions and unsuccessful attempts to become pregnant, as a proxy for infertility. To confine the sample to respondents who were young enough to be offered HPV vaccine and old enough to have infertility concerns, only females between 18 and 33 years old (N=1,092) were included. Logistic regression models, stratified by marital status, were performed to examine the association between the proxy measure of infertility and HPV vaccination. RESULTS: Univariate models indicate that HPV vaccination is inversely associated with infertility among women who have ever been married (OR 0.46, 95% CI 0.23-0.93), but not associated for women never married (OR 0.87, 95% CI 0.39-1.95). After adjustment for age, race/ethnicity, family income levels, and education, there is no association between HPV vaccination and infertility for ever-married females (OR 0.61, 95% CI 0.35-1.08) or never-married females (OR 0.84, 95% CI 0.34-2.08). CONCLUSION: There was no association between HPV immunization and inability to become pregnant when desired. This information is valuable given public concerns regarding vaccine safety and persistently low HPV immunization rates.

Background: Human papillomavirus (HPV) vaccines have been recommended as primary prevention of HPV-related cancers for over 10 years in the United States, and evidence reveals decreased incidence of HPV infections following vaccination. However, concerns have been raised that HPV vaccines could decrease fertility. This study examined the relationship between HPV immunization and self-reported infertility in a nationally representative sample. Methods: Data from the 2013-2016 National Health and Nutrition Examination Survey were analyzed to asses likelihood of self-reported infertility among women aged 20 to 33, who were young enough to have been offered HPV vaccines and old enough to have been queried about infertility (n=1,114). Two logistic regression models, stratified by marital history, examined potential associations between HPV vaccination and infertility. Model 1 assessed the likelihood of infertility among women who had never been pregnant or whose pregnancies occurred prior to HPV vaccination. Model 2 accounted for the possibility of latent and/or non-permanent post-vaccine infertility by including all women 20-33 years old. Results: 8.1% reported any infertility. Women who had ever been married and had received an HPV vaccine were less likely to report infertility (OR 0.04, 95% CI 0.01-0.57) in model 1. No other associations between HPV and infertility were found. Conclusion: There was no evidence of increased infertility among women who received the HPV vaccine. These results provide further evidence of HPV vaccine safety and should give providers confidence in recommending HPV vaccination. Further research should explore protective effects of HPV vaccines on female and male fertility. What is already known on this subject? Despite evidence that HPV vaccines are safe and effective, concerns persist regarding a purported link between HPV vaccination and infertility. These concerns were refuted by a recent population-based cohort study that found no association between the HPV vaccine and primary ovarian insufficiency. What this study adds? This study broadens the existing evidence by exploring possible associations between HPV vaccination and any self-reported infertility. There was no evidence of infertility among women 20-33 years old who received one or more doses of HPV vaccine. This result provides further evidence of HPV vaccine safety, diminishing remaining concerns among clinicians and the public.