Fran Lowry

October 30, 2017

For women with infertility issues, the risk for death is elevated, especially from breast cancer and diabetes, according to results from a new study.

"Infertility might lead to disease because of long-term inflammation or other hormonal perturbations, but this remains to be seen with further research," said Natalie Stentz, MD, from the University of Pennsylvania in Philadelphia.

"An association between infertility and medical disease has been noted in the male population, but such an association in females is largely unknown," Dr Stentz said at the American Society for Reproductive Medicine 2017 Scientific Congress in San Antonio.

"We wanted to get a better understanding of the link between infertility and mortality in women," she told Medscape Medical News.

In their study, Dr Stentz and her colleagues assessed women 55 to 74 years of age who were prospectively enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial from 1992 to 2001.

Of the 75,784 women for whom fertility history was available, 11,006 (14.5%) were infertile, defined as not having conceived despite a year of intercourse.

After parity, socioeconomic risk factors, and underlying comorbidities were controlled for, risk for death during the 13-year follow-up period was 10% higher in women with infertility issues than without (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03 - 1.17; P = .005).

In addition, infertile women were almost 70% more likely to die from diabetes than fertile women (HR, 1.69; 95% CI, 1.15 - 2.49; P = .007), even though the prevalence of diabetes was similar in the two cohorts, and were 43% more likely to die from breast cancer (HR, 1.43; 95% CI, 1.06 - 1.94; P = .019).

There was no association between infertility and risk for ovarian cancer, risk for endometrial cancer, risk for death from cardiovascular disease risk, or for death from ovarian cancer. Mean age at death was 73 years in the two cohorts.

We certainly do not want this research to be taken from an alarmist perspective.

Dr Stentz was asked if infertile women should ask their doctors for special screening, especially for diabetes and breast cancer.

It is premature at this point, she explained. "We are not recommending any change in the current standard of care for screening guidelines for cardiovascular disease, breast cancer, or any other disease."

"We certainly do not want this research to be taken from an alarmist perspective. We simply want to raise awareness that infertility deserves to be acknowledged," she added.

The more we know about the genetic nature of infertility in both men and women, the more we realize that the condition may be related to general health.

This "very interesting study" follows a previous study that found a relation between male infertility and mortality (Hum Reprod. 2014;29:1567-1574), said Alexander Pastuszak, MD, PhD, from the Baylor College of Medicine in Houston.

"The actual increased risk of mortality is slightly higher than that observed in the male study, but it is still quite small," he told Medscape Medical News.

"The more we know about the genetic nature of infertility in both men and women, the more we realize that the condition may be related to general health," he explained.

"The PLCO database is an excellent data source and lends credibility to the work," said Dr Pastuszak. However, he pointed out, it would have been interesting if the researchers had included "a third group of women with a common benign female condition not linked to mortality or fertility."

"Women should realize that the risk of mortality is low," he added, noting that these results "have not been confirmed by other studies, and we do not understand why this would be occurring on a physiological, genetic, or molecular level."

In addition, "fertile and infertile women lived to be the same average age. As such, we need to take this study in context and understand that it's a first look," he explained. More work is needed to confirm the association.

Dr Stentz and Dr Pastuszak have disclosed no relevant financial relationships. The study authors acknowledge the National Cancer Institute for permission to access their database.

American Society for Reproductive Medicine (ASRM) 2017 Scientific Congress: Abstract O-6. Presented October 30, 2017.

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