Daijiworld Media Network - New Delhi
New Delhi, Oct 8: Infertility treatment has been associated with higher odds of hysterectomy around childbirth, according to a large US study that examined 16.7 million hospital deliveries over two decades.
The population-based study, published in Fertility and Sterility, analysed hospital births in the United States between 2000 and 2020 and examined whether conception following infertility treatment was associated with an increased likelihood of peripartum hysterectomy, a procedure performed before discharge from the hospital following delivery.
The researchers included fertility-enhancing drugs, artificial or intrauterine insemination and assisted reproductive technology under infertility treatment. Of the 16.7 million deliveries studied, 0.5% involved infertility treatment.
Peripartum hysterectomy occurred at a rate of 426 cases per 100,000 deliveries among those involving infertility treatment, compared with 184 cases per 100,000 deliveries among those without such treatment. This corresponds to approximately 0.43% and 0.18% of deliveries, respectively.
After researchers adjusted the analysis for potential confounding factors, infertility treatment was associated with 33% higher odds of peripartum hysterectomy, with an adjusted odds ratio of 1.33 and a 95% confidence interval of 1.20 to 1.48.
The researchers also examined whether the association varied according to race, maternal age, placental complications and postpartum haemorrhage. Among Black individuals, infertility treatment was associated with 30% higher odds of peripartum hysterectomy, while the increase was 26% among Hispanic individuals.
The association was also observed across different maternal age groups. The greatest increase was recorded among those aged 30 to 34 years, with 55% higher odds, followed by a 46% increase among those aged 40 to 44 years and a 26% increase among those aged 35 to 39 years.
Importantly, the increased odds remained even among patients without reported placental complications or postpartum haemorrhage, suggesting that the association was not limited to deliveries in which these complications had been documented.
Researchers used weighted logistic regression models and adjusted for potential confounders to assess the association between infertility treatment and peripartum hysterectomy. The study was designed as a population-based cross-sectional analysis and therefore cannot establish that infertility treatment itself causes hysterectomy.
The absolute risk nevertheless remained low in both groups. The researchers said the findings support heightened surveillance during pregnancies following infertility treatment, including monitoring for placental abnormalities and the risk of haemorrhage, as well as consideration of delivery planning in appropriately resourced facilities.
The study was authored by Shruthi Thiyagarajan, Mark V Sauer, Rachel Lee and Cande V Ananth and was published in the October 2026 issue of Fertility and Sterility.