High-risk human papillomavirus infection in female and subsequent risk of infertility: a population-based cohort study

OBJECTIVE: To study whether infection with high-risk human papillomavirus (HPV), registered both as a single HPV positive test and as HPV persistence, increases the risk of female factor infertility in later reproductive life.

DESIGN: Population-based cohort study.

SETTING: Not applicable.

PATIENT(S): A random sample of 11,088 women (20-29 years of age at enrollment) tested for cervical HPV at enrollment during 1991-93 and again after 2 years. Information on female factor infertility was obtained by linkage to the Danish Infertility Cohort.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Follow-up for each study participant was the period from the date of enrollment or date of the second visit until diagnosis of female factor infertility (main outcome), conception, death, emigration, disappearance, or end of study period. Data were analyzed by means of a Cox proportional hazards regression model. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HPV status and female factor infertility after adjustment for potentially confounding factors were determined.

RESULT(S): After relevant exclusions, 10,595 women were eligible for analysis, 1,861 (17.6%) of whom were high-risk HPV positive at the first visit. There was no association between a positive HPV test at first visit (HR = 0.88; 95% CI, 0.75-1.02) or positivity for the same high-risk HPV type at the first and second visit (persistence; HR = 0.97; 95% CI, 0.66-1.44) and subsequent risk of female factor infertility in reproductive life.

CONCLUSION(S): We found no association between a high-risk HPV infection and risk of female factor infertility, neither for a single HPV positive test nor for a persistent HPV infection.