Infertility treatment is associated with peripartum hysterectomy: a population-based cross-sectional study

To study the association between infertility treatment and the risk of peripartum hysterectomy, and to examine whether this association is influenced by placental complications, postpartum hemorrhage, maternal age, and race.

Population-based cross-sectional study.

Hospital births in the United States, 2000 to 2020.

Infertility treatment, including fertility-enhancing drugs, artificial insemination, or intrauterine insemination, or assisted reproductive technology.

The primary outcome was peripartum hysterectomy before hospital discharge. We also examined whether infertility treatment-peripartum hysterectomy was associated with the presence or absence of reported placental complications and postpartum hemorrhage, and across different racial and age subgroups. Associations were expressed as odds ratios (ORs) and 95% confidence intervals (CIs), derived from weighted logistic regression models adjusted for confounders.

Among 16.7 million hospital deliveries in the United States from 2000 to 2020, 0.5% involved infertility treatments. The incidence risk of peripartum hysterectomy among those with and without infertility treatment was 426 (n = 361) and 184 (n = 30,688) per 100,000 deliveries, respectively (adjusted OR = 1.33; 95% CI: 1.20-1.48). Stratified analyses by race revealed a 30% increase in peripartum hysterectomy odds among Black individuals and a 26% increase among Hispanic individuals in the infertility treatment group. Elevated odds persisted even among patients without reported placental complications and postpartum hemorrhage. Increased hysterectomy odds associated with infertility treatment were in addition observed across maternal age categories, with the greatest increase in the 30-34 age group (55%), followed by the 40-44 (46%) and 35-39 (26%) groups.

Conception occurring as a result of infertility treatment is associated with an increased risk of peripartum hysterectomy. These findings underscore the need for heightened surveillance during pregnancy within the infertile population, including monitoring for placental abnormalities and hemorrhage risk, as well as consideration of delivery planning in appropriately resourced facilities.