Hidradenitis Suppurativa Does Not Increase Female Infertility Risk, Study Finds

Rune Kjærsgaard Andersen, MD, PhD

Credit: Rune Kjærsgaard Andersen on LinkedIn

Results from a recent study suggest female patients with hidradenitis suppurativa (HS) do not have an increased risk of infertility, contrary to findings from previous research on fertility in this patient population.¹

The cross-sectional study of more than 150 female patients in Denmark found no significant difference in infertility between patients with HS, patients with other dermatological diseases, and healthy controls.¹

A chronic inflammatory skin condition characterized by painful lesions, the estimated prevalence of HS ranges from less than 1% to 4%. The condition frequently has ​​a negative psychosocial impact on affected patients because of the associated pain, involvement of sensitive locations, drainage, odor, disfigurement, and scarring. HS is also associated with a high burden of comorbidities, including obesity, metabolic syndrome, arthritis, and polycystic ovarian syndrome, but its correlation with infertility is not well understood.^1,2

“To our knowledge, studies aiming to isolate the effect of HS on fertility, adjusting for confounding factors known to increase infertility, have not been performed,” Rune Kjærsgaard Andersen, MD, PhD, a postdoctoral BRIDGE fellow at the University of Copenhagen Skin Immunology Research Center, and colleagues wrote.¹

To explore the connection between HS and infertility while accounting for the limitations of previous research on this association, investigators conducted a cross-sectional study of female patients ≥ 18 years of age seen at Zealand University Hospital from September 2019 to November 2021. Patients with HS, patients with other dermatological diseases, and health controls were invited to complete questionnaires aimed at evaluating their fertility.¹

A total of 319 individuals were invited to participate in the study. Of these, 93 declined the invitation. Among the 226 study participants, 52 did not finish and 13 failed to return the questionnaire, leaving 161 participants who were included in the final analysis.¹

Through the questionnaire, investigators collected information on basic demographics; the number of pregnancies, childbirths, or stillborn/abortions; whether participants attempted pregnancy, the length of time they tried, and whether IVF treatments were attempted. Information on factors known to influence fertility was also collected, including medical and surgical procedures; environmental factors; and diseases. Sexual function was additionally measured using the Female Sexual Function Index (FSFI) to assess the role of sexual function as a possible confounder.¹

Among the 161 study participants, 55 had HS, 55 had other dermatological diseases, and 51 were healthy controls. Investigators noted the HS group had a greater median BMI compared to the other dermatological disease group (P = .01). Additionally, they pointed out the HS group had a greater prevalence of smoking, as indicated by increased median smoking in pack-years before pregnancy, compared with both the other dermatological disease (P = .007) and health control (P = .001) groups.¹

Self-evaluated disease severity was also significantly increased in the HS group compared with the other dermatological disease group (P = .0002). However, no statistical differences were observed for age at the time of inclusion (P = .347), marital status (P = .276), the distribution of participants within each group regarding whether they had children or not (P = .19), or alcohol intake (P = .3611).¹

Based on the World Health Organization definition of infertility, 25.5% of the HS group, 18.2% of the other dermatological disease group, and 15.7% of the health control group were classified as infertile (P = 0.42). Investigators noted the lifetime median number of pregnancies was similar across the groups (P = .25) and no significant difference was observed in the percentage of participants who had received fertility treatment (P = .33). However, the median FSFI was lower for the HS group (22.4; interquartile range [IQR], 5.6-31.6) compared with the healthy control group (28.9; IQR, 22.2-32.9) (P = .03).¹

In the univariate logistic regression analysis, the only factor statistically significantly associated with infertility was diseases and symptoms during pregnancy (Odds ratio [OR], 3.19; 95% CI, 1.43–8.25; P = .01). However, in models adjusted for factors with influence on fertility, no statistical difference in infertility was observed among patients with HS:

• Model 1, adjusted for the effects of age and BMI at the first attempt at conception: OR, 2.61; 95% CI, 0.85–8.65; P = .10)
• Model 2, additionally adjusted for the effects of tobacco, alcohol, fertile period duration, and sexual function: OR, 2.36; 95% CI, 0.75–7.99; P = 0.15)
• Model 3, additionally adjusted for the effects of FSFI-score, HS severity, other dermatological disease severity, diseases before pregnancy, treatments before pregnancy, treatment during pregnancy, and male partner comorbidities before pregnancy: OR, 2.02; 95% CI, 0.37–10.75; P = 0.41)

Investigators acknowledged multiple limitations to these findings, including the study’s small sample size; the reliance on self-reported data; the single-center study design; and the lack of consideration of male infertility.¹

“Our study did not find a significant difference in infertility between patients with HS, those with other dermatological diseases, and healthy controls. This contrasts with previous studies that have reported a higher risk and prevalence of infertility among HS patients,” investigators concluded.¹ “These results suggest that a larger, more statistically powerful study is necessary to better investigate the independent relationship between HS and infertility. Despite the limitations of our study, our findings provide valuable insights into the potential impact of HS on female fertility and highlight the need for further research in this area.”

References

1. ^{Medianfar CE, Kursawe Larsen C, Saunte SK, et al. Hidradenitis suppurativa and female infertility: a pilot study conducted amongst 110 dermatological patients. Arch Dermatol Res. https://doi.org/10.1007/s00403-024-03390-6}
2. ^{Ballard K, Shuman VL. Hidradenitis Suppurativa. StatPearls. May 6, 2024. Accessed October 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK534867/}