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

Anyalechi, Gloria Ebelechukwu MD, MPH*; Hong, Jaeyoung PhD, MS*; Kreisel, Kristen PhD*; Torrone, Elizabeth PhD, MSPH*; Boulet, Sheree PhD, MPH; Gorwitz, Rachel MD, MPH*; Kirkcaldy, Robert D. MD, MPH*; Bernstein, Kyle PhD, MS*

Sexually Transmitted Diseases: July 2019 - Volume 46 - Issue 7 - p 446–451
doi: 10.1097/OLQ.0000000000000996
Original Studies

Background Sexually transmitted diseases, including chlamydia and gonorrhea, cause of pelvic inflammatory disease (PID) and infertility. We estimated the prevalence of infertility and infertility health care seeking.

Methods We analyzed self-reported lifetime infertility and infertility health care-seeking in women aged 18 to 49 years in the 2013 and 2015 National Health and Nutrition Examination Surveys. Weighted prevalence of infertility and infertility health care seeking, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated.

Results Among 2626 eligible women, 13.8% had self-reported infertility (95% CI, 12.3–15.3) with higher prevalence by age: 960, 18 to 29 years (PR, 6.4%; 95% CI, 4.8–8.0); 799, 30 to 39 years (PR, 14.8%; 95% CI, 12.2–17.3); and 867, 40 to 49 years (PR, 20.8%; 95% CI, 17.2–24.4). Non-Hispanic white women (PR, 15.4%; 95% CI, 13.0–17.8; n = 904) and non-Hispanic black women (PR, 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 (PR, 24.2%; 95% CI, 16.2–32.2) than women without PID treatment (PR, 13.3%; 95% CI, 11.6–15.0; n = 2,485), especially among 18- to 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 health care. Women without health care 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 health care. 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 United States.

Of the 13.8% of reproductive-age women reporting any lifetime infertility, 40% did not access health care. Self-reported pelvic inflammatory disease was associated with infertility, especially among young women.

From the *Division of STD Prevention, Centers for Disease Control and Prevention;

Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA

Correspondence: Gloria Anyalechi, MD, MPH, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA 30329. E-mail:

Conflicts of interest and source of funding: none declared.

Received for publication January 9, 2019, and accepted March 10, 2019.

Online date: March 15, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association