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

• Authors: Gloria Ebelechukwu Anyalechi, Centers for Disease Control and Prevention; Jaeyoung Hong, Centers for Disease Control and Prevention; Kristen Kreisel, Centers for Disease Control and Prevention; Elizabeth Torrone, Centers for Disease Control and Prevention; Sheree Boulet, Emory University; Rachel Gorwitz, Centers for Disease Control and Prevention; Robert D. Kirkcaldy, Centers for Disease Control and Prevention; Kyle Bernstein, Emory University
• Journal Title: Sexually Transmitted Diseases
• Volume: Volume 46, Number 7
• Publisher: Lippincott Williams & Wilkins | 2019-07-01, Pages 446-451
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/OLQ.0000000000000996
• Subjects: Health Sciences, Public Health; Health Sciences, Obstetrics and Gynecology; Health Sciences, Nutrition
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Infection; Fertility

Abstract

Background Sexually transmitted diseases (STDs) including chlamydia and gonorrhea, cause pelvic inflammatory disease and infertility. We estimated the prevalence of infertility and infertility healthcare seeking. Methods We analyzed self-reported lifetime infertility and infertility healthcare-seeking in women aged 18–49 years in the 2013 and 2015 National Health and Nutrition Examination Surveys. Weighted prevalence of infertility and infertility healthcare seeking, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated. Results Among 2,626 eligible women, 13.8% had self-reported infertility [95% CI 12.3–15.3] with higher prevalence by age: 6.4% [95% CI 4.8–8.0], n=960 18–29 year olds; 14.8% [95 % CI 12.2–17.3], n=799 30–39 year olds; and 20.8% [95% CI 17.2–24.4], n=867 40–49 year olds. Non-Hispanic white women (15.4% [95% CI 13.0–17.8]; n=904) and non-Hispanic black women (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 (24.2% [95% CI 16.2–32.2]) than women without PID treatment (13.3% [95% CI 11.6–15.0], n=2,485), especially among 18–29 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 healthcare. Women without healthcare 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 healthcare. 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 US.