Background
The consequences of an infertility diagnosis extend beyond the pursuit of family building,
because women with infertility also face increased risks for severe maternal morbidity,
cancer, and chronic disease.
Objective
This study aimed to examine the association between female infertility and all-cause
mortality.
Study Design
This retrospective analysis compared 72,786 women with infertility, identified in
the Optum Clinformatics Datamart from 2003 to 2019 by infertility diagnosis, testing,
and treatment codes, with 3,845,790 women without infertility seeking routine gynecologic
care. The baseline comorbidities were assessed using the presence of ≥1 metabolic
syndrome diagnoses and the Charlson Comorbidity Index. The primary outcome, which
was all-cause mortality, was identified by linkage to the Social Security Administration
Death Master File outcomes and medical claims. The association between infertility
and mortality was examined using a Cox proportional hazard regression by adjusting
for age, hypertension, hyperlipidemia, type II diabetes, year of evaluation, smoking,
number of visits per year, nulliparity, obesity, region of the country, and race.
Results
Among 16,473,458 person-years of follow-ups, 13,934 women died. Women with infertility
had a 32% higher relative risk for death from any cause (0.42% vs 0.35%, adjusted
hazard ratio, 1.32; 95% confidence interval, 1.18–1.48) than women without infertility.
The mean follow-up time per patient was 4.0±3.7 years vs 4.2±3.8 years for women with
and without infertility, respectively. When stratified by age of <35 or ≥35 years
or baseline medical comorbidity, the association between infertility and mortality
remained. Women with infertility who delivered a child during the follow-up period
faced a similar increased risk for mortality than the overall infertile group. Finally,
receiving fertility treatment was not associated with a higher risk for death than
receiving an infertility diagnosis or testing alone.
Conclusion
Although the absolute risk for death was low in both groups, women with infertility
faced a higher relative risk for mortality than women without infertility. The association
remained across all age, race and ethnicity groups, morbidities, and delivery strata.
Importantly, infertility treatment was not associated with an increased risk for death.
These findings reinforce the disease burden associated with infertility and its potential
for long-term sequelae.
Key words
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Article Info
Publication History
Published online: February 09, 2021
Accepted:
February 2,
2021
Received in revised form:
January 25,
2021
Received:
October 12,
2020
Footnotes
B.L. reports serving as a research consultant for the Society for Assisted Reproductive Technology. R.J.A. reports serving as a scientific advisor for Hannah Life Technologies and Orchid Biosciences.
Financial support for this work was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number 1K12HD103084.
Cite this article as: Murugappan G, Li S, Alvero RJ, et al. Association between infertility and all-cause mortality: analysis of US claims data. Am J Obstet Gynecol 2021;225:57.e1-11.
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