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. 2019 Jul;46(7):446-451.
doi: 10.1097/OLQ.0000000000000996.

Self-Reported Infertility and Associated Pelvic Inflammatory Disease Among Women of Reproductive Age-National Health and Nutrition Examination Survey, United States, 2013-2016

Gloria Ebelechukwu Anyalechi, Jaeyoung Hong, Kristen Kreisel, Elizabeth Torrone, Sheree Boulet  1 , Rachel Gorwitz, Robert D Kirkcaldy, Kyle Bernstein
Affiliations

Self-Reported Infertility and Associated Pelvic Inflammatory Disease Among Women of Reproductive Age-National Health and Nutrition Examination Survey, United States, 2013-2016

Gloria Ebelechukwu Anyalechi et al. Sex Transm Dis. 2019 Jul.

Abstract

Background: Sexually transmitted diseases, including chlamydia and gonorrhea, cause of pelvic inflammatory disease (PID) and infertility. We estimated the prevalence of infertility and infertility health care seeking.

Methods: We analyzed self-reported lifetime infertility and infertility health care-seeking in women aged 18 to 49 years in the 2013 and 2015 National Health and Nutrition Examination Surveys. Weighted prevalence of infertility and infertility health care seeking, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated.

Results: Among 2626 eligible women, 13.8% had self-reported infertility (95% CI, 12.3-15.3) with higher prevalence by age: 960, 18 to 29 years (PR, 6.4%; 95% CI, 4.8-8.0); 799, 30 to 39 years (PR, 14.8%; 95% CI, 12.2-17.3); and 867, 40 to 49 years (PR, 20.8%; 95% CI, 17.2-24.4). Non-Hispanic white women (PR, 15.4%; 95% CI, 13.0-17.8; n = 904) and non-Hispanic black women (PR, 12.9%; 95% CI, 10.3-15.5; n = 575) had the highest infertility prevalences. Women reporting PID treatment (n = 122) had higher infertility prevalence (PR, 24.2%; 95% CI, 16.2-32.2) than women without PID treatment (PR, 13.3%; 95% CI, 11.6-15.0; n = 2,485), especially among 18- to 29-year-old women (PR, 3.8; 95% CI, 1.8-8.0). Of 327 women with infertility, 60.9% (95% CI, 56.1-65.8) sought health care. Women without health care insurance sought care less frequently than women with insurance.

Conclusions: In a nationally representative sample, 13.8% of reproductive-age women reported a history of infertility, of whom 40% did not access health care. Self-reported PID was associated with infertility, especially in young women. Annual chlamydia and gonorrhea screening to avert PID may reduce the burden of infertility in the United States.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: The authors declare no conflicts of interest. There was no funding source for this project.

Figures

Figure 1
Figure 1. Prevalence of self-reported infertility among sexually-experienced women aged 18–49 years by age and race-ethnicity, National Health and Nutrition Examination Survey, 2013–20161
1Based on initial sample size of N=2,509. Women of other or multirace categories (n=117) are excluded because of small sample size. * Statistically significant difference from non-Hispanic white women (p<0.05, Rao-Scott chi-square)
Figure 2
Figure 2. Prevalence of self-reported infertility among sexually-experienced women aged 18–49 years by age and PID1 treatment history, National Health and Nutrition Examination Survey, 2013–20162
1PID: Pelvic inflammatory disease 2Based on initial sample size of N=2,607. Women without available data for PID treatment are excluded (n=19). * Infertility prevalence ratio for PID to no PID is 3.8 (95% CI 1.8–8.0), p<0.01. Relative standard error > 30% for infertility prevalence among 18–29 year old women with PID
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