OBJECTIVE: 

To evaluate the association of primary infertility with subsequent bilateral oophorectomy and hysterectomy, using a population-based cohort of women with primary infertility and age-matched women in a referent group.

METHODS: 

The Rochester Epidemiology Project record-linkage system was used to assemble a population-based cohort of women with primary infertility diagnosed between 1980 and 1999 (index date). Women were age-matched (±1 year) 1:1 to women without a history of infertility or hysterectomy at the index date (referent group). Cox proportional hazards models were fit to compare long-term risks of bilateral oophorectomy and hysterectomy, respectively, between women with infertility and women in the referent group.

RESULTS: 

Among both groups of 1,001 women, the mean age at the index date was 29.2±4.4 years. Median duration of follow-up was 23.7 years for both groups. Women with primary infertility were 1.7 times (adjusted hazard ratio [aHR] 1.69, 95% CI 1.22–2.33) more likely to undergo bilateral oophorectomy compared with women in the referent group. In a sensitivity analysis that excluded women with a diagnosis of infertility related to endometriosis and their matched referent group participants, this association persisted (aHR 1.50, 95% CI 1.06–2.14). Women with primary infertility did not have a significant increased risk of hysterectomy (aHR 0.98, 95% CI 0.79–1.23). However, risk of hysterectomy was increased in those with primary infertility related to endometriosis (aHR 1.94, 95% CI 1.12–3.34). We observed that women with primary infertility were more likely to undergo hysterectomy with bilateral oophorectomy. Women in the referent group were more likely to undergo hysterectomy with ovarian conservation. Few women in either group had isolated bilateral oophorectomy.

CONCLUSION: 

Primary infertility, with and without a diagnosis of endometriosis, is associated with an increased risk of bilateral oophorectomy. In women with endometriosis-related infertility, there is an association with future hysterectomy. These findings represent important confounders in the evaluation of long-term health outcomes related to primary infertility.

中文翻译：

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有原发性不孕史且双侧卵巢切除率增加的女性

客观的： 

使用基于人群的原发性不孕女性队列和参照组中年龄匹配的女性，评估原发性不孕与随后的双侧卵巢切除术和子宫切除术的关联。

方法： 

罗切斯特流行病学项目记录链接系统用于收集 1980 年至 1999 年（索引日期）期间诊断出的原发性不孕症女性人群。将女性与在索引日期没有不孕史或子宫切除史的女性进行年龄匹配（±1岁）1:1（参照组）。Cox比例风险模型适合比较不孕女性和参照组女性分别进行双侧卵巢切除术和子宫切除术的长期风险。

结果： 

在两组 1,001 名女性中，索引日期的平均年龄为 29.2±4.4 岁。两组的中位随访时间均为 23.7 年。与参考组女性相比，原发性不孕女性接受双侧卵巢切除术的可能性高 1.7 倍（调整后风险比 [aHR] 1.69，95% CI 1.22-2.33）。在一项敏感性分析中，排除了诊断为子宫内膜异位症相关不孕症的女性及其匹配的参照组参与者，这种关联仍然存在（aHR 1.50，95% CI 1.06-2.14）。原发性不孕女性接受子宫切除术的风险并未显着增加（aHR 0.98，95% CI 0.79-1.23）。然而，子宫内膜异位症相关原发性不孕症患者的子宫切除术风险增加（aHR 1.94，95% CI 1.12-3.34）。我们观察到，原发性不孕女性更有可能接受子宫切除术和双侧卵巢切除术。参考组中的女性更有可能接受子宫切除术并保留卵巢。两组中都很少有女性接受孤立性双侧卵巢切除术。

结论： 

原发性不孕症，无论是否诊断为子宫内膜异位症，都与双侧卵巢切除术的风险增加相关。对于患有子宫内膜异位症相关不孕症的女性，与未来的子宫切除术有关。这些发现代表了评估与原发性不孕症相关的长期健康结果的重要混杂因素。