Fertility outcomes in asthma: a clinical study of 245 women with unexplained infertility

Abstract

Evidence is increasing of an association between asthma and aspects of female reproduction. However, current knowledge is limited and furthermore relies on questionnaire studies or small populations. In a prospective observational cohort study to investigate whether time to pregnancy, the number of fertility treatments, and the number of successful pregnancies differ significantly between women with unexplained infertility with and without asthma.245 women with unexplained infertility (aged 23-45 years) underwent questionnaires and asthma and allergy testing while undergoing fertility treatment. 96 women entering the study had either a former doctor's diagnosis of asthma or were diagnosed with asthma when included. After inclusion they were followed for a minimum of 12 months in fertility treatment, until they had a successful pregnancy, stopped treatment, or the observation ended.The likelihood of achieving pregnancy was lower in women with asthma compared with those without asthma: median total time to pregnancy was 32.3 months in non-asthmatic women versus 55.6 months in those with asthma, hazard ratio 0.50 (95% confidence interval 0.34-0.74) p<0.001.Women with asthma had fewer successful pregnancies during fertility treatment, 39.6 versus 60.4% ( p=0.002). Increasing age was of negative importance for expected time to pregnancy, especially among asthmatic women (interaction between age and asthma on time to pregnancy, p=0.001). Female asthmatics had a longer time to pregnancy and less often became pregnant than non-asthmatic women. Increasing age reduced the chances of conceiving especially among asthmatic women. The causal relationship between asthma and subfertility remains unclear. @ERSpublications Asthma can be a cause of subfertility: increasing time to pregnancy and decreasing successful number of pregnancies

Is there a link between female asthma and a reduction in fertility?

“…In a study from North America published more than 20 years ago focusing on women with ovulatory dysfunction as the cause of infertility, compared to women admitted to hospital for a life birth, Grodstein et al [6] reported that use of asthma medication for more than 6 months increased the risk of infertility, and, furthermore, the risk of ovulatory infertility was higher in women using beta2-agonists, whereas no significant increase was found in women treated with theofyllin. As described above, the study by Gade et al [5] revealed that among women with unexplained infertility, women with asthma were less likely to conceive than non-asthmatic women following fertility treatment, especially in women over 35 years of age with pregnancy rates were 26% and 57%, respectively, for asthmatic and non-asthmatic women. Overall, women not conceiving during the observation period were significantly older than those with successful fertility treatment (37 vs. 35 years of age).…”

“…However, women with asthma prescribed any asthma therapy tended to have a lower prevalence of abnormal TTP compared to untreated women with asthma (24% and 31%, respectively). In a further prospective study by the same group [5], 245 women with unexplained infertility, including 81 women with current asthma, undergoing fertility treatment was followed. All enrolled women underwent clinical evaluation for asthma, including spirometry and bronchial challenge testing.…”

ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases

“…GADE et al [3] found an association between untreated asthma (defined as no regular inhalers) and time to pregnancy, as well as between use of daily inhaled corticosteroid (ICS) and longer time to pregnancy, although it was not possible to differentiate between asthma severity per se and the level of treatment [3]. However, this was not found in a subsequent clinical study [7]. Recently, interesting data from the Screening for Pregnancy Endpoints (SCOPE) study have shown that women with self-reported asthma only using short-acting β 2 -agonists (SABAs) had prolonged time to pregnancy and reduced fertility [6], yet those with self-reported asthma who were prescribed ICS had no reduction in fertility.…”

“…This suggests that undertreatment of asthma with systemic inflammation may reduce fertility [6]. Given this data, women with asthma should be informed of the risk of reduced fertility especially if not on maintenance ICS therapy and particularly above 35 years of age [7,8].…”

“…Pregnancy occurs commonly in women with asthma [83,84], although some studies have noted a reduced ability to conceive [6,7]. Control of asthma triggers and comorbidities is recommended during pregnancy, including rhinitis [85], obesity [86] snoring and sleep disordered breathing [87], cigarette smoking [88], and viral infection [89].…”