Women’s Health
Infertility and long-term mortality among Mexican women Leslie V Farland* Leslie Farland Farland Farland Farland Farland Farland Farland Farland Farland Farland Farland University of Arizona
Background: Evidence suggests that infertility may serve as an early-life marker for mortality; however most research is among high-income non-Hispanic White women (NHWW). Therefore, our goal was to estimate the relationship of infertility to mortality among Hispanic women, who are 70% more likely to experience infertility compared NHWW.
Methods: We followed 90,561 women in the Mexican Teachers Cohort study from 2008-2019, who were 44y at baseline. Women with infertility were compared to parous women without infertility. Infertility diagnoses (fallopian tube, polycystic ovary syndrome (PCOS), ovulatory, endometriosis, uterine factor, or male factor) were analyzed separately. Mortality was ascertained via cross-linkage with national registries. Cox proportional hazard models adjusted for a priori confounders were used to estimate hazard ratios and 95% confidence intervals for all-cause and cause-specific mortality (cardiometabolic [CM], breast cancer [BC], gynecologic cancer [GC; ovarian, endometrial]).
Results: At baseline, 22% reported infertility. Over 10.6 years of follow-up, there were 1,541 deaths (377 CM, 139 BC, and 65 GC). Women with infertility had a 17% higher rate of all-cause mortality compared to parous women without infertility (95% CI: 1.04-1.32). Infertility was associated with a 46% increased rate of CM mortality (95% CI: 1.16-1.83) and a 2.66-fold increased rate of GC mortality (1.61-4.41). There was no association with BC mortality (HR 0.67, 95% CI: 0.42-1.08). Infertility attributed to PCOS (HR 1.45, 95% CI: 1.06-1.98), fallopian tube (HR 1.26, 95% CI: 0.94-1.67), ovulatory (HR 1.19, 95% CI: 0.89-1.59), and endometriosis (HR 1.19, 95% CI: 0.78-1.82) were positively associated with all-cause mortality, but some estimates were imprecise.
Conclusions: Infertility was associated with increased all-cause, CM, and GC mortality. PCOS, fallopian tube, ovulatory, and endometriosis-related infertility may individually confer an elevated rate of death.