Background: Asthma is common among women of reproductive age. Prior studies have revealed an association between asthma and fertility by reporting prolonged time to pregnancy and lower fecundability.
Objective: Investigate fertility in women treated with asthma medication compared to women without asthma.
Methods: All women born from 1976 to 1999, living in Denmark on their 18 birthday, were followed 1994 to 2017. Asthma was defined as repeated fulfilment of asthma medication prescriptions and severity was classified according to the Global Initiative for Asthma guidelines (GINA). Outcome was fertility treatment in women with asthma compared to women without asthma, applying a Cox regression model adjusted for age, calendar year, and education.
Results: The cohort comprised 765,606 women followed-up, starting on their 18 birthday, for a median time of 10.8 years [IQR 5.3-17.5]. Compared to women without asthma, women with asthma had a comparable proportion giving birth during follow-up, slightly more experienced fetal loss (17.0% vs. 15.8 %) and required fertility treatment (5.6% vs. 5.0%). The risk of fertility treatment was significantly higher in women with asthma: HR 1.10 (1.07-1.14). Women on GINA treatment step 4-5 had an even higher risk of fertility treatment HR 1.59 (1.41-1.80) and, likewise, women with ≥ 3 prior exacerbations of asthma, HR 1.36 (1.17-1.58).
Conclusion: Women with asthma have an increased use of fertility treatment, which correlates with asthma severity and exacerbation burden. However, asthma does not seem to affect number of live births.
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