WOMEN who experienced infertility without fertility treatment had a higher incidence of systemic autoimmune rheumatic disease (SARD) up to nine years after delivery than those who did not experience infertility, even after adjusting for adverse pregnancy outcomes.
Infertility is increasingly recognised as a potential risk marker for chronic diseases in women. Despite evidence linking abnormal immune activity with infertility, the association between infertility and the development of autoimmune diseases like SARD, which often occur during reproductive years, remains unclear. A recent study investigated whether infertility, with or without fertility treatment, is associated with an increased risk of SARD among women who gave birth.
The population-based cohort study analysed data from 568,053 singleton births among 465,078 women aged 18–50 years in Ontario, Canada, from 2012 to 2021. Participants were grouped into four categories: no infertility (88.0%), infertility without fertility treatment (9.2%), infertility with non-invasive treatment (1.4%), and infertility with invasive treatment (1.4%). SARD diagnoses were identified using validated diagnostic codes and measured from the delivery date. Over a median follow-up of 6.5 years, the incidence of SARD was 9.3 per 10,000 person-years in women without infertility, 12.5 per 10,000 person-years in those with untreated infertility, and 10.9 per 10,000 person-years in women who underwent fertility treatment (non-invasive or invasive). Infertility without treatment was associated with a higher risk of SARD (HR 1.25, 95% CI 1.12–1.40), even after adjusting for adverse pregnancy outcomes. However, non-invasive (HR 1.06, 95% CI 0.79–1.42) and invasive treatments (HR 0.97, 95% CI 0.69–1.36) were not linked to increased SARD risk.
These findings highlight infertility without treatment as a significant risk marker for SARD. Clinicians should consider increased vigilance for SARD symptoms in women with untreated infertility, facilitating earlier diagnosis and management during the reproductive years. Future research should explore underlying mechanisms and incorporate lifestyle and social factors to better understand this relationship. Enhanced provider awareness can improve reproductive and long-term health outcomes for affected women.
Abigail Craig, EMJ
Reference
Scime NV et al. Association between infertility and incident onset of systemic autoimmune rheumatic disease after childbirth: a population-based cohort study. Hum Reprod. 2024 DOI: 10.1093/humrep/deae253.
