INFERTILITY TREATMENT is associated with higher odds of hysterectomy around childbirth, according to a large US study, highlighting the importance of pregnancy surveillance and delivery planning.
The population-based analysis examined 16.7 million hospital deliveries over two decades. Although peripartum hysterectomy remained uncommon, researchers identified an association with infertility treatment that persisted after adjustment for confounding factors.
Researchers investigated hospital births in the USA between 2000 and 2020, with infertility treatment reported in 0.5% of deliveries. Treatment included fertility-enhancing drugs, artificial or intrauterine insemination, and assisted reproductive technology.
The primary outcome was peripartum hysterectomy performed before hospital discharge. The team also examined whether the association differed according to maternal age, race, and the presence of reported placental complications or postpartum haemorrhage.
Using weighted logistic regression models, researchers calculated adjusted odds ratios to account for potential confounders. This allowed them to assess the association beyond the initial comparison of hysterectomy rates between the two groups.
Hysterectomy occurred in 426 per 100,000 deliveries involving infertility treatment, compared with 184 per 100,000 deliveries without treatment. These figures correspond to approximately 0.43% and 0.18%, respectively.
After adjustment, infertility treatment was associated with 33% higher odds of peripartum hysterectomy. The adjusted estimate describes the difference in odds after accounting for confounders, rather than the difference between the unadjusted rates.
Analyses by race identified 30% higher odds among Black individuals and 26% higher odds among Hispanic individuals in the infertility treatment group.
The association also varied across maternal age groups. The greatest increase was observed among those aged 30–34 years, at 55%, followed by 46% among those aged 40–44 years and 26% among those aged 35–39 years. Elevated odds persisted among patients without reported placental complications or postpartum haemorrhage.
The cross-sectional study demonstrates an association and cannot establish that infertility treatment causes hysterectomy. Its findings should also be considered alongside the low absolute frequency of the outcome in both groups.
Nevertheless, the authors highlight the need for heightened surveillance during pregnancies conceived following infertility treatment. They recommend monitoring for placental abnormalities and haemorrhage risk, alongside consideration of delivery in appropriately resourced facilities. The practical emphasis is on recognising potential complications and preparing care around individual patient needs.
Thiyagarajan S et al. Infertility treatment is associated with peripartum hysterectomy: a population-based cross-sectional study. Fertil Steril. 2026;126(4):701–711.
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