Patient Perspectives on Hidradenitis Suppurativa and Infertility: A Survey Study

Abstract

<b><i>Background:</i></b> Hidradenitis suppurativa (HS) is an inflammatory skin condition which predominantly affects women of childbearing age in the USA. There is a lack of research on the association between HS and fertility. <b><i>Objectives:</i></b> The aim of this study was to understand the perspectives of females with HS regarding the impact of their disease on reproductive health, the impact of fertility treatments on HS, and the impact of HS treatments on fertility. <b><i>Methods:</i></b> An anonymous, online survey was disseminated through HS support groups from June to July 2022. Respondents aged 18–50 who were assigned female sex at birth were eligible for participation. Comparative statistics were performed using <i>t</i> tests/χ<sup>2</sup> tests to assess associations between respondents’ demographics and survey responses. <b><i>Results:</i></b> Among the 312 respondents (80.8% White, mean age 35.7 ± 7.4 [range 18–50]), two-thirds of respondents (66.6%, 207/311) had been pregnant before and 79.5% (248/312) had ever tried to conceive. 41.5% (103/248) had unsuccessfully tried to conceive for 12 months or more. Of the 59 respondents who had never attempted to conceive, 39% reported that HS had impacted this decision. Amongst respondents who experienced fertility challenges but did not pursue fertility treatments, top barriers to fertility treatments include concerns about financial support/insurance coverage (47.5%, 29/61) and fertility treatments worsening HS (21.3%, 13/61). Most respondents who used fertility treatments reported either no change (73.7%, 28/38 or 77.8%, 14/18) or improvement (15.8%, 6/38 or 11.1%, 2/18) in their HS symptoms with oral or injectable medications. Respondents were most concerned about the effects of oral antibiotics (44.9%, 140/312), followed by hormonal medications (38.8%, 121/312) and biologics (35.9%, 112/312) on fertility. <b><i>Conclusion:</i></b> Females with HS reported high rates of infertility compared to the general population. The majority reported no change in HS symptoms with fertility treatments, and clinicians can use this finding to help counsel patients during family planning discussions. Further research in the field of HS and fertility is needed.