July 11, 2023
A Mayo Clinic study found that women who experience primary infertility are 1.7 times more likely to have a subsequent bilateral oophorectomy. The researchers published these findings in the October 2022 issue of Obstetrics & Gynecology.
For this study, Alessandra (Ali) J. Ainsworth, M.D., a reproductive endocrinology and fertility specialist at Mayo Clinic in Minnesota, and colleagues used the Rochester Epidemiology Project, a medical database of cases in Olmsted County and surrounding counties. They identified women with primary infertility diagnosed between 1980 and 1999 and compared them to age-matched women without primary infertility. Each group totaled 1,001 women. In each case of primary infertility, the investigators evaluated the type of infertility and related treatment administered.
Study findings and potential rationale for association
Dr. Ainsworth and her fellow investigators discovered that women with primary infertility who had hysterectomy were more likely than women who did not have primary infertility to have their ovaries removed in the same surgery. In contrast, those who did not have primary infertility were more likely to have ovarian-sparing hysterectomy.
Until recently, gynecologists often removed the ovaries while in the pelvic region for hysterectomy, with a "might as well take them out" rationale.
"The practice has now changed, so if you don't have a reason to remove the ovaries, you don't," says Dr. Ainsworth.
This difference in decision-making, whether to remove the ovaries at the time of hysterectomy or not, seemed to explain the increased risk of bilateral oophorectomy, she says.
The investigators on Dr. Ainsworth's team considered other reasons for this difference. One potential factor in why oophorectomy may be linked with primary infertility is the association of infertility treatments with ovarian tumors, which has been discovered in previous studies but did not explain the difference in this study. The investigators also looked at causes of infertility such as endometriosis, for which gynecologists regularly remove patients' ovaries. However, even if the investigators controlled for this, the association persisted. The investigators looked at whether pregnancy, following infertility treatment, might influence future oophorectomy. Yet they found nothing statistically significant. Dr. Ainsworth and fellow investigators wondered if women who have experienced infertility have a different view of their own reproductive organs than women who have not experienced infertility, leading to a greater willingness to have an oophorectomy. However, this question was not investigated in this study.
Notably, the investigators found hysterectomy, unlike oophorectomy, had no connection to primary infertility. However, for women whose primary infertility was related to endometriosis, an association existed with future hysterectomy. The researchers also found that in the primary infertility group and in the group with no primary infertility, some women simply had an oophorectomy not accompanied by a hysterectomy, though this was more unusual.
Application of study findings
Dr. Ainsworth sees potential implications of these findings. First, she says the findings represent consideration of fertility as a marker of overall health and future healthcare decisions for women. She notes that for men, that association has already been discovered in male infertility's association with higher levels of testicular cancer. Second, she feels it is worth researchers' time to include whether female participants have had oophorectomy in any clinical study as there are long-term health effects from oophorectomy.
Dr. Ainsworth does not see an immediate effect of this study's findings on her patient care, however.
"While this is a really intriguing association that deserves additional research, there is no profound effect on my current care — no change in my counseling of patients at this time," she says.
For more information
Ainsworth AJ, et al. Women with a history of primary infertility and increased rates of bilateral oophorectomy. Obstetrics & Gynecology. 2022;140:643.
Refer a patient to Mayo Clinic.