Infertility & mortality

Abstract

OBJECTIVE: Epidemiologic studies have suggested that nulligravid women have a shorter life span than their parous counterparts. The effect of infertility, as opposed to elective nulligravidity, on mortality is unclear. Our objective was to determine the association of a history of infertility with all-cause mortality.DESIGN: Retrospective cohort study MATERIALS AND METHODS: This study included women (age 55-74) who were prospectively enrolled in the Prostate Lung, Colorectal, and Ovarian (PLCO) Cancer screening trial from 1992-2001 and followed for health-related outcomes including cause of death. We examined the effect of self-reported infertility (inability to conceive for one year or greater) on all-cause mortality and primary cause of death, as established by the National Center for Health Statistics. Outcomes were analyzed using multivariable linear, logistic, and cox regression modeling as appropriate with stepwise backward selection to adjust for relevant confounders.RESULTS: A total of 78,214 women from the PLCO database were included and followed for 13 years or until study withdrawal or death, 75,784 of which had data on fertility history. Infertility was reported in 14.5% (n¼11,006) of the study population. At the completion of follow up, infertile women were more likely to be deceased when compared to fertile women (HR1.10, 95%CI 1.03, 1.17, p¼0.005), however women from each cohort died at a similar age (Fertile: 73.83AE5.70 years, Infertile: 73.79AE5.88 years; p¼0.424). When examining primary cause of death, women with infertility were more likely to die from diabetes (HR 1.69, 95%CI 1.15, 2.49, p¼0.007) as compared to their fertile counterparts despite having a comparable prevalence of diabetes (Fertile: 6.34% (N¼4082), Infertile: 6.80% (N¼745). Infertility was not associated with an increased risk of ovarian cancer (HR 1.12, 95%CI 0.87, 1.45, p¼0.381) or greater risk of death from ovarian (HR 1.28, 95%CI 0.91, 1.80, p¼0.155) or endometrial cancers (HR 0.97, 95%CI 0.49, 1.93, p¼0.939). Notably, patients with infertility were 43% more likely to die of breast cancer (HR 1.43, 95%CI 1.06, 1.94, p¼0.019).CONCLUSIONS: Subfertility may be a harbinger of disease later in life. The present large retrospective study demonstrates increased risk of death from endocrine related diseases including diabetes and breast cancer among the infertile population. While these associations need to be confirmed in prospective studies, routine infertility care may present an opportunity for early screening and intervention for long-term health outcomes.

Sex and Gender Differences in Prevention of Type 2 Diabetes

“…A recently presented large retrospective study at the American Society for Reproductive Medicine Scientific Congress including more than 78,000 women demonstrated that women with infertility have higher all-cause mortality compared to fertile women ( 133 ). Interestingly, diabetes was identified as a main primary cause of mortality, although similar diabetes prevalence in both groups was found.…”

In vitro effects of aqueous extract of unfermented rooibos on human spermatozoa

“…Millions of couples worldwide have experienced infertility leading to social segregation, with the female being considered the main culprit (Stentz et al, 2019). The inability to conceive after 1 year of regular unprotected sexual intercourse is regarded as infertility (Vander Borght & Wyns, 2018).…”