A prospective cohort study of endometriosis and subsequent risk of infertility
Abstract STUDY QUESTION Is there a temporal relationship between endometriosis and infertility? SUMMARY ANSWER Endometriosis is associated with a higher risk of subsequent infertility, but only among women age 50 000 women accurately classified as endometriosis-free, minimizing the impact of exposur...
Gespeichert in:
| Veröffentlicht in: | Human reproduction (Oxford) 2016-07, Vol.31 (7), p.1475-1482 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1482 |
|---|---|
| container_issue | 7 |
| container_start_page | 1475 |
| container_title | Human reproduction (Oxford) |
| container_volume | 31 |
| creator | Prescott, J. Farland, L.V. Tobias, D.K. Gaskins, A.J. Spiegelman, D. Chavarro, J.E. Rich-Edwards, J.W. Barbieri, R.L. Missmer, S.A. |
| description | Abstract
STUDY QUESTION
Is there a temporal relationship between endometriosis and infertility?
SUMMARY ANSWER
Endometriosis is associated with a higher risk of subsequent infertility, but only among women age 50 000 women accurately classified as endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates.
WIDER IMPLICATI |
| doi_str_mv | 10.1093/humrep/dew085 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4901880</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/humrep/dew085</oup_id><sourcerecordid>1795879319</sourcerecordid><originalsourceid>FETCH-LOGICAL-c512t-c973437d3a5e26b6dcf32892b8421af72577bc677948f675f8fbbda8d88b38273</originalsourceid><addsrcrecordid>eNqFkbtPwzAQxi0EoqUwsqKMLKF-JLGzIFUVL6mCBWbL8YMakjjYTlH_e1K1FJiY7qT76bu77wPgHMErBEsyXfaN191U6U_I8gMwRlkBU0xyeAjGEBcsRahAI3ASwhuEQ8uKYzDCFGUIZmgMHmdJ513otIx2pRPpls7HJMRerRNnEt0q1-jorQs2JKJVSeiroD963cbE2_C-gWxrtI-2tnF9Co6MqIM-29UJeLm9eZ7fp4unu4f5bJHKHOGYypKSjFBFRK5xURVKGoJZiSuWYSQMxTmllSwoLTNmCpobZqpKCaYYqwjDlEzA9Va366tGKzmc40XNO28b4dfcCcv_Tlq75K9uxbMSIsbgIHC5E_Bu-CZE3tggdV2LVrs-cETLnNGSoHJA0y0qB6OC12a_BkG-yYBvM-DbDAb-4vdte_rb9J_dru_-0foCNkqUxw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1795879319</pqid></control><display><type>article</type><title>A prospective cohort study of endometriosis and subsequent risk of infertility</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Prescott, J. ; Farland, L.V. ; Tobias, D.K. ; Gaskins, A.J. ; Spiegelman, D. ; Chavarro, J.E. ; Rich-Edwards, J.W. ; Barbieri, R.L. ; Missmer, S.A.</creator><creatorcontrib>Prescott, J. ; Farland, L.V. ; Tobias, D.K. ; Gaskins, A.J. ; Spiegelman, D. ; Chavarro, J.E. ; Rich-Edwards, J.W. ; Barbieri, R.L. ; Missmer, S.A.</creatorcontrib><description>Abstract
STUDY QUESTION
Is there a temporal relationship between endometriosis and infertility?
SUMMARY ANSWER
Endometriosis is associated with a higher risk of subsequent infertility, but only among women age <35 years.
WHAT IS KNOWN ALREADY
Endometriosis is the most commonly observed gynecologic pathology among infertile women undergoing laparoscopic examination. Whether endometriosis is a cause of infertility or an incidental discovery during the infertility examination is unknown.
STUDY DESIGN, SIZE, DURATION
This study included data collected from 58 427 married premenopausal female nurses <40 years of age from 1989 to 2005, who are participants of the Nurses' Health Study II prospective cohort.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Our exposure was laparoscopically confirmed endometriosis. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for infertility risk (defined as attempting to conceive for >12 months) among women with and without endometriosis.
MAIN RESULTS AND THE ROLE OF CHANCE
We identified 4612 incident cases of infertility due to any cause over 362 219 person-years of follow-up. Compared with women without a history of endometriosis, women with endometriosis had an age-adjusted 2-fold increased risk of incident infertility (HR = 2.12, 95% CI = 1.76–2.56) that attenuated slightly after accounting for parity. The relationship with endometriosis was only observed among women <35 years of age (multivariate HR <35 years = 1.77, 95% CI = 1.46–2.14; multivariate HR 35–39 years = 1.20, 95% CI = 0.94–1.53; P-interaction = 0.008). Risk of primary versus secondary infertility was similar subsequent to endometriosis diagnosis. Among women with primary infertility, 50% became parous after the endometriosis diagnosis, and among all women with endometriosis, 83% were parous by age 40 years.
LIMITATIONS, REASONS FOR CAUTION
We did not have information on participants' intentions to conceive, but by restricting the analytic population to married women we increased the likelihood that pregnancies were planned (and therefore infertility would be recognized). Women in our cohort with undiagnosed asymptomatic endometriosis will be misclassified as unexposed. However, the small proportion of these women are diluted among the >50 000 women accurately classified as endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates.
WIDER IMPLICATIONS OF THE FINDINGS
This study supports a temporal association between endometriosis and infertility risk. Our prospective analysis indicates a possible detection bias in previous studies, with our findings suggesting that the infertility risk posed by endometriosis is about half the estimates observed in cross-sectional analyses.
STUDY FUNDING/COMPETING INTERESTS
This work was supported by the National Institutes of Health (grant numbers: UM1 CA176726, HD52473, HD57210, T32DK007703, T32HD060454, K01DK103720). We have no competing interests to declare.</description><identifier>ISSN: 0268-1161</identifier><identifier>EISSN: 1460-2350</identifier><identifier>DOI: 10.1093/humrep/dew085</identifier><identifier>PMID: 27141041</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Endometriosis - complications ; Endometriosis - pathology ; Female ; Humans ; Infertility, Female - complications ; Infertility, Female - epidemiology ; Original ; Proportional Hazards Models ; Prospective Studies ; Risk Factors</subject><ispartof>Human reproduction (Oxford), 2016-07, Vol.31 (7), p.1475-1482</ispartof><rights>The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2016</rights><rights>The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c512t-c973437d3a5e26b6dcf32892b8421af72577bc677948f675f8fbbda8d88b38273</citedby><cites>FETCH-LOGICAL-c512t-c973437d3a5e26b6dcf32892b8421af72577bc677948f675f8fbbda8d88b38273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27141041$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Prescott, J.</creatorcontrib><creatorcontrib>Farland, L.V.</creatorcontrib><creatorcontrib>Tobias, D.K.</creatorcontrib><creatorcontrib>Gaskins, A.J.</creatorcontrib><creatorcontrib>Spiegelman, D.</creatorcontrib><creatorcontrib>Chavarro, J.E.</creatorcontrib><creatorcontrib>Rich-Edwards, J.W.</creatorcontrib><creatorcontrib>Barbieri, R.L.</creatorcontrib><creatorcontrib>Missmer, S.A.</creatorcontrib><title>A prospective cohort study of endometriosis and subsequent risk of infertility</title><title>Human reproduction (Oxford)</title><addtitle>Hum Reprod</addtitle><description>Abstract
STUDY QUESTION
Is there a temporal relationship between endometriosis and infertility?
SUMMARY ANSWER
Endometriosis is associated with a higher risk of subsequent infertility, but only among women age <35 years.
WHAT IS KNOWN ALREADY
Endometriosis is the most commonly observed gynecologic pathology among infertile women undergoing laparoscopic examination. Whether endometriosis is a cause of infertility or an incidental discovery during the infertility examination is unknown.
STUDY DESIGN, SIZE, DURATION
This study included data collected from 58 427 married premenopausal female nurses <40 years of age from 1989 to 2005, who are participants of the Nurses' Health Study II prospective cohort.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Our exposure was laparoscopically confirmed endometriosis. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for infertility risk (defined as attempting to conceive for >12 months) among women with and without endometriosis.
MAIN RESULTS AND THE ROLE OF CHANCE
We identified 4612 incident cases of infertility due to any cause over 362 219 person-years of follow-up. Compared with women without a history of endometriosis, women with endometriosis had an age-adjusted 2-fold increased risk of incident infertility (HR = 2.12, 95% CI = 1.76–2.56) that attenuated slightly after accounting for parity. The relationship with endometriosis was only observed among women <35 years of age (multivariate HR <35 years = 1.77, 95% CI = 1.46–2.14; multivariate HR 35–39 years = 1.20, 95% CI = 0.94–1.53; P-interaction = 0.008). Risk of primary versus secondary infertility was similar subsequent to endometriosis diagnosis. Among women with primary infertility, 50% became parous after the endometriosis diagnosis, and among all women with endometriosis, 83% were parous by age 40 years.
LIMITATIONS, REASONS FOR CAUTION
We did not have information on participants' intentions to conceive, but by restricting the analytic population to married women we increased the likelihood that pregnancies were planned (and therefore infertility would be recognized). Women in our cohort with undiagnosed asymptomatic endometriosis will be misclassified as unexposed. However, the small proportion of these women are diluted among the >50 000 women accurately classified as endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates.
WIDER IMPLICATIONS OF THE FINDINGS
This study supports a temporal association between endometriosis and infertility risk. Our prospective analysis indicates a possible detection bias in previous studies, with our findings suggesting that the infertility risk posed by endometriosis is about half the estimates observed in cross-sectional analyses.
STUDY FUNDING/COMPETING INTERESTS
This work was supported by the National Institutes of Health (grant numbers: UM1 CA176726, HD52473, HD57210, T32DK007703, T32HD060454, K01DK103720). We have no competing interests to declare.</description><subject>Adult</subject><subject>Endometriosis - complications</subject><subject>Endometriosis - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>Infertility, Female - complications</subject><subject>Infertility, Female - epidemiology</subject><subject>Original</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><issn>0268-1161</issn><issn>1460-2350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkbtPwzAQxi0EoqUwsqKMLKF-JLGzIFUVL6mCBWbL8YMakjjYTlH_e1K1FJiY7qT76bu77wPgHMErBEsyXfaN191U6U_I8gMwRlkBU0xyeAjGEBcsRahAI3ASwhuEQ8uKYzDCFGUIZmgMHmdJ513otIx2pRPpls7HJMRerRNnEt0q1-jorQs2JKJVSeiroD963cbE2_C-gWxrtI-2tnF9Co6MqIM-29UJeLm9eZ7fp4unu4f5bJHKHOGYypKSjFBFRK5xURVKGoJZiSuWYSQMxTmllSwoLTNmCpobZqpKCaYYqwjDlEzA9Va366tGKzmc40XNO28b4dfcCcv_Tlq75K9uxbMSIsbgIHC5E_Bu-CZE3tggdV2LVrs-cETLnNGSoHJA0y0qB6OC12a_BkG-yYBvM-DbDAb-4vdte_rb9J_dru_-0foCNkqUxw</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Prescott, J.</creator><creator>Farland, L.V.</creator><creator>Tobias, D.K.</creator><creator>Gaskins, A.J.</creator><creator>Spiegelman, D.</creator><creator>Chavarro, J.E.</creator><creator>Rich-Edwards, J.W.</creator><creator>Barbieri, R.L.</creator><creator>Missmer, S.A.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160701</creationdate><title>A prospective cohort study of endometriosis and subsequent risk of infertility</title><author>Prescott, J. ; Farland, L.V. ; Tobias, D.K. ; Gaskins, A.J. ; Spiegelman, D. ; Chavarro, J.E. ; Rich-Edwards, J.W. ; Barbieri, R.L. ; Missmer, S.A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c512t-c973437d3a5e26b6dcf32892b8421af72577bc677948f675f8fbbda8d88b38273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Endometriosis - complications</topic><topic>Endometriosis - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>Infertility, Female - complications</topic><topic>Infertility, Female - epidemiology</topic><topic>Original</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Prescott, J.</creatorcontrib><creatorcontrib>Farland, L.V.</creatorcontrib><creatorcontrib>Tobias, D.K.</creatorcontrib><creatorcontrib>Gaskins, A.J.</creatorcontrib><creatorcontrib>Spiegelman, D.</creatorcontrib><creatorcontrib>Chavarro, J.E.</creatorcontrib><creatorcontrib>Rich-Edwards, J.W.</creatorcontrib><creatorcontrib>Barbieri, R.L.</creatorcontrib><creatorcontrib>Missmer, S.A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Human reproduction (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Prescott, J.</au><au>Farland, L.V.</au><au>Tobias, D.K.</au><au>Gaskins, A.J.</au><au>Spiegelman, D.</au><au>Chavarro, J.E.</au><au>Rich-Edwards, J.W.</au><au>Barbieri, R.L.</au><au>Missmer, S.A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective cohort study of endometriosis and subsequent risk of infertility</atitle><jtitle>Human reproduction (Oxford)</jtitle><addtitle>Hum Reprod</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>31</volume><issue>7</issue><spage>1475</spage><epage>1482</epage><pages>1475-1482</pages><issn>0268-1161</issn><eissn>1460-2350</eissn><abstract>Abstract
STUDY QUESTION
Is there a temporal relationship between endometriosis and infertility?
SUMMARY ANSWER
Endometriosis is associated with a higher risk of subsequent infertility, but only among women age <35 years.
WHAT IS KNOWN ALREADY
Endometriosis is the most commonly observed gynecologic pathology among infertile women undergoing laparoscopic examination. Whether endometriosis is a cause of infertility or an incidental discovery during the infertility examination is unknown.
STUDY DESIGN, SIZE, DURATION
This study included data collected from 58 427 married premenopausal female nurses <40 years of age from 1989 to 2005, who are participants of the Nurses' Health Study II prospective cohort.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Our exposure was laparoscopically confirmed endometriosis. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for infertility risk (defined as attempting to conceive for >12 months) among women with and without endometriosis.
MAIN RESULTS AND THE ROLE OF CHANCE
We identified 4612 incident cases of infertility due to any cause over 362 219 person-years of follow-up. Compared with women without a history of endometriosis, women with endometriosis had an age-adjusted 2-fold increased risk of incident infertility (HR = 2.12, 95% CI = 1.76–2.56) that attenuated slightly after accounting for parity. The relationship with endometriosis was only observed among women <35 years of age (multivariate HR <35 years = 1.77, 95% CI = 1.46–2.14; multivariate HR 35–39 years = 1.20, 95% CI = 0.94–1.53; P-interaction = 0.008). Risk of primary versus secondary infertility was similar subsequent to endometriosis diagnosis. Among women with primary infertility, 50% became parous after the endometriosis diagnosis, and among all women with endometriosis, 83% were parous by age 40 years.
LIMITATIONS, REASONS FOR CAUTION
We did not have information on participants' intentions to conceive, but by restricting the analytic population to married women we increased the likelihood that pregnancies were planned (and therefore infertility would be recognized). Women in our cohort with undiagnosed asymptomatic endometriosis will be misclassified as unexposed. However, the small proportion of these women are diluted among the >50 000 women accurately classified as endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates.
WIDER IMPLICATIONS OF THE FINDINGS
This study supports a temporal association between endometriosis and infertility risk. Our prospective analysis indicates a possible detection bias in previous studies, with our findings suggesting that the infertility risk posed by endometriosis is about half the estimates observed in cross-sectional analyses.
STUDY FUNDING/COMPETING INTERESTS
This work was supported by the National Institutes of Health (grant numbers: UM1 CA176726, HD52473, HD57210, T32DK007703, T32HD060454, K01DK103720). We have no competing interests to declare.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>27141041</pmid><doi>10.1093/humrep/dew085</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-1161 |
| ispartof | Human reproduction (Oxford), 2016-07, Vol.31 (7), p.1475-1482 |
| issn | 0268-1161 1460-2350 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4901880 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adult Endometriosis - complications Endometriosis - pathology Female Humans Infertility, Female - complications Infertility, Female - epidemiology Original Proportional Hazards Models Prospective Studies Risk Factors |
| title | A prospective cohort study of endometriosis and subsequent risk of infertility |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T19%3A30%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20prospective%20cohort%20study%20of%20endometriosis%20and%20subsequent%20risk%20of%20infertility&rft.jtitle=Human%20reproduction%20(Oxford)&rft.au=Prescott,%20J.&rft.date=2016-07-01&rft.volume=31&rft.issue=7&rft.spage=1475&rft.epage=1482&rft.pages=1475-1482&rft.issn=0268-1161&rft.eissn=1460-2350&rft_id=info:doi/10.1093/humrep/dew085&rft_dat=%3Cproquest_pubme%3E1795879319%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1795879319&rft_id=info:pmid/27141041&rft_oup_id=10.1093/humrep/dew085&rfr_iscdi=true |