title: Prevalence of female infertility in the UK Armed Forces
title: The prevalence of female infertility in the UK Armed Forces
titleType: AlternativeTitle
Creators: name: Thiel, Magdalena Adelina
Publisher: name: The University of Edinburgh
Year: 2024
Subjects: subject: infertility
subject: prevalence
subject: military
subject: women

description: INTRODUCTION: Military employment is associated with numerous potential occupational hazards and behaviours that may be relevant to fertility. These include physical and psychological stress, smoking, drinking alcohol and other lifestyle factors. While few studies have compared infertility prevalence of servicewomen with civilians, no studies have reported the prevalence of infertility in UK servicewomen and none has compared the prevalence of infertility with other occupations. The aims of this study were to determine the prevalence of self-reported infertility among regular UK servicewomen, compare the prevalence to non-military groups and identify which factors were associated with infertility in this population. METHODS: A cross-sectional study was undertaken. All eligible servicewomen and Metropolitan Police Service (MPS) officers were invited to participate with sisters of participants recruited as controls using a snowball technique. A questionnaire was developed, piloted and adapted for electronic distribution. Data including pregnancy history, time to each pregnancy and self-reported infertility risk factors were collected. Prevalence of infertility was defined as the proportion of women at risk of pregnancy who had not become pregnant within 12 months. Only women with pregnancy outcomes, or fully tested fertility (12 months or more of exposure), were included in the denominator. Univariable and multivariable logistic regression models were used to describe the association between occupational group and infertility. RESULTS: Participants included 4836 women serving in the UK Armed Forces (33% of the eligible sample), 1237 female MPS officers and 435 non-military, non-MPS sisters (biological, half, step or adopted) of both groups. Prevalence of self-reported infertility was 31.7% (95% CI: 29.9 - 33.5) in servicewomen, 36.3% (95% CI: 33.1 - 39.7) in MPS officers and 24.4% (95% CI: 19.6 - 29.8) in sisters. Variables associated with infertility in this study in univariable models included age, selected medical and surgical conditions, several lifestyle factors and aspects of reproductive history, the majority of which are accepted risk factors. Age, history of polycystic ovary syndrome, endometriosis, fibroids, tubal and pelvic surgery, hysterectomy and a short General Health Questionnaire (GHQ-12) score of &gt;4 (suggesting a common mental health condition) were identified for inclusion in multivariable logistic regression models The adjusted odds ratio (aOR) of infertility in servicewomen was 1.0 (95% CI: 0.8 - 1.2) compared with MPS officers and 1.5 (95% CI: 1.1 - 2.0) in both servicewomen and MPS officers compared with sisters. DISCUSSION: These data suggest that the prevalence of self-reported infertility is higher in servicewomen and female MPS officers than in civilian women. After adjusting for identified confounders service occupations were found to have 50% higher odds of experiencing infertility than non-occupational controls. Future studies should focus on identifying and changing modifiable risk factors for female infertility, as these seem to be relevant to many women in service occupations, rather than being military-specific.