Infertility Among Married and Cohabiting Women Aged 18-44 Years in the U.S. Military and Civilian Populations.

INTRODUCTION

Infertility is a significant health concern that impacts the military as well as the general civilian population. This study aims to investigate prevalence of infertility as our primary outcome, and more specifically (1) compare prevalence estimates of infertility in U.S. military versus civilian populations, and (2) investigate differences in these estimates across key demographic subgroups within these populations.

MATERIALS AND

METHODS

The 2020 Department of Defense Women's Reproductive Health Survey (WRHS, n = 14,443 active duty servicewomen aged 18-44 years) was used to conduct secondary analysis related to our research questions. The cohort from the WRHS was compared to 2,125 civilian women similarly aged 18-44 years from the National Health and Nutrition Examination Survey (NHANES, 2013-2020).

RESULTS

The weighted prevalence of infertility was 19.8% (95% CI: 18.9-20.7) among active duty servicewomen and 15.7% (95% CI: 13.7-17.6) among civilian women. The likelihood of infertility was greater for those aged 35-44 compared to those between the ages of 18 and 24 years in both populations. Participants who characterized their race as non-White had significantly greater odds of infertility in the military population, but not in the civilian population (aOR = 1.128, 95% CI: 1.003-1.269). Female service members in the Air Force, Marine Corps, Navy, and Coast Guard were less likely than female service members in the Army to report infertility.

CONCLUSIONS

This study demonstrated a much higher prevalence estimates in both civilian and military populations than reported in prior studies. Female service members experienced a significantly higher prevalence of infertility than their civilian counterparts. Within the military population, there are significant differences in infertility prevalence with respect to pay grade, age, service branch, and race, despite access to a single payer health system. Studies are needed to evaluate the impact of demographics and additional exposures, to include the potential of certain hazardous or noxious military-specific environmental exposures on infertility in the active duty population.