Survey Finds Women With HS Possess Higher Infertility Rates

Women with hidradenitis suppurativa (HS) reported high infertility rates compared to the general population, with most reporting no change in HS symptoms with fertility treatments, according to a study in Dermatology.

This may be helpful for clinicians to keep in mind during family planning conversations; however, more research in the area of HS and fertility is needed.

There is little research on the link between HS and fertility, and the study authors were trying to understand the perspectives of women with HS and how their disease impacts reproductive health, how fertility treatments impact HS, and how HS impact fertility treatments.

An anonymous, online survey was conducted through HS support groups from June 2022 to July 2022. Respondents aged 18 to 50 who were assigned female sex at birth were eligible to participate. Comparative statistics were undertaken using t-tests/Chi-squared tests to evaluate connections between respondents’ demographics and survey responses.

Amid the 312 total respondents, (80.8% White; mean [SD] age, 35.7 [7.4]), two-thirds of respondents (66.6%; n = 207/311) had been pregnant previously and 79.5% (n = 248/312) had ever tried to conceive. A total of 41.5% (n = 103/248) had ineffectively tried to conceive for 12 months or more. Of the 59 respondents who had never tried to conceive, 39% reported that HS had impacted this decision.

Top obstacles to fertility treatments amongst respondents who experienced fertility challenges but did not pursue fertility treatments included worries about financial support/insurance coverage (47.5%; n = 29/61) and fertility treatments worsening HS (21.3%; n = 13/61).

Most respondents who used fertility treatments reported either no change (73.7%, 28/38 or 77.8%, 14/18) or improvement (15.8%, 6/38 or 11.1%, 2/18) in their HS symptoms with oral or injectable medications,” said the study authors.

Most respondents who used oral or injectable medications reported either no change (73.7% or 77.8%, respectively) or no improvement (15.8% or 11.1%, respectively) in their HS symptoms.

Respondents were most worried about the oral antibiotic effects (44.9%; n = 140/312), and then hormonal medications (38.8%; n = 121/312) and biologics (35.9%; n = 112/312) on fertility.

a woman looks distressed while seated

Of note, “Though obesity is a known risk factor for infertility, there was no difference in rates of obesity between those respondents who reported infertility versus those who did not,” said the study authors.

The reported fertility rate among the total amount of study respondents was distinctly higher than the infertility rate in the US population of 6% to 8%.

Participants who experienced infertility had a higher likelihood of having comorbid polycystic ovary syndrome (PCOS), that might partially account for augmented fertility rates. PCOS prevalence among patients with HS has been noted to be greater than the general population (9% vs 2.9%; P < .0001).

Additionally, chronic inflammation in HS might cause anovulation in patients with HS. Also, patients with HS possess a higher risk of sexual dysfunction because of the appearance of HS lesions, pain drainage, fatigue, and embarrassment. Consequently, lower rates of sexual activity might also have aided to the high rate of infertility in the study population. 

Having open dialogue with patients, especially patients’ part of minority communities, about the impact of HS on reproductive health might assist providers in their ability to mitigate possible barriers to intimate relationships and family planning.

“Importantly, an earlier HS survey study found that topic of sexual health is best discussed with great sensitivity, only after establishing rapport,” emphasized the authors.

Some study limitations that were present were recall bias, self-reported Hurley stage, and mostly White respondents that limited the generalizability of the findings. Additionally, 38.8% of respondents had a bachelor’s degree or higher that might have skewed the results.

“Overall, females with HS have concerns regarding their reproductive health in the context of their skin condition. Dermatologists can play a vital role in educating and counseling patients during family planning discussions and likely improve HS treatment adherence in those who are concerned about the impact of HS treatments on fertility,” concluded the authors.

Reference

Masson R, Shih T, Park S, et al. Patient perspectives on hidradenitis suppurativa and infertility: a survey study. Dermatology. Published online June 29, 2023. doi:10.1159/000531727