Increased risk of incident chronic medical conditions in infertile women: analysis of US claims data

Background The risk of common chronic medical conditions among infertile women is not known. Objective The objective of the study was to study the association between female infertility and the risk of incident chronic disease. Study Design This was a retrospective cohort analysis using the Optum deidentified Clinformatics Datamart from 2003 through 2016. A total of 64,345 infertile women were identified by infertility diagnosis, testing, or treatment and compared with 3,128,345 noninfertile patients seeking routine gynecologic care. Women with a prior diagnosis of the relevant chronic disease or cancer or with either diagnosis within 6 months of the index event were excluded. The main outcome was a diagnosis of incident chronic disease as identified by International Classification of Diseases, ninth revision/International Classification of Diseases, 10th revision codes. Results were adjusted for age, index year, nulliparity, race, smoking, obesity, number of visits per year, and highest level of education. Results Infertile patients were more likely to develop diabetes (adjusted hazard risk, 1.44, confidence interval, 1.38–1.49), renal disease (adjusted hazard risk, 1.22, confidence interval, 1.12–1.32), liver disease (adjusted hazard risk, 1.25, confidence interval, 1.20–1.30), cerebrovascular disease (adjusted hazard risk, 1.26, confidence interval, 1.15–1.38), ischemic heart disease (adjusted hazard risk, 1.16, confidence interval, 1.09–1.24), other heart disease (adjusted hazard risk, 1.16, confidence interval, 1.12–1.20), and drug abuse (adjusted hazard risk, 1.24, confidence interval, 1.15–1.33) compared with noninfertile patients. Infertile patients were significantly less likely to develop alcohol abuse (adjusted hazard risk, 0.86, confidence interval, 0.79–0.95) compared with noninfertile patients. Risk associations were similar after excluding women with polycystic ovarian syndrome and premature ovarian insufficiency. In subgroup analyses of women who underwent pregnancy and childbirth during enrollment, several previously noted risk associations were attenuated compared with the overall cohort. Conclusion While the absolute risk of chronic disease is low, infertility is associated with an increased risk of incident chronic disease compared with a group of noninfertile women.