Association between pelvic inflammatory disease and infertility in American women : Results from the National Health and Nutrition Survey 2013 to 2018

Introduction Recently, the incidence of pelvic inflammatory disease (PID)-associated infertility has gradually increased. Understanding the relationship between PID and infertility is crucial in the fields of healthcare and public health. This study aimed to clarify the association between PID and infertility and describe the implications of this association. Methods This retrospective cross-sectional study included 2,819 female participants aged 20–44 years from the United States, using data from the National Health and Nutrition Examination Survey (NHANES). NHANES employs a complex multi-stage probabilistic design, and data were collected through questionnaires, physical examinations, and laboratory tests. We used multivariate logistic regression models to evaluate the association between pelvic inflammatory disease (PID) and infertility. Additionally, we applied the propensity score matching (PSM) method to match the infertility group with a comparable baseline cohort from the general population, allowing for a more robust analysis of the correlation between PID and infertility. Furthermore, we performed stratification and interaction analyses to assess the consistency of this relationship across different subgroups. Results Among the 2,819 eligible women, 315 had infertility. A multivariable logistic regression analysis revealed that women who received treatment for PID were positively correlated with infertility (odds ratio: 2.20; 95% confidence interval: 1.42–3.41; P  = 0.001) after controlling for all other factors. Subgroup analysis showed a consistent association pattern, with no significant difference in the interaction test. The PID incidence had positive correlation with infertility after PSM (odds ratio: 2.01; 95% confidence interval: 1.38–2.95; P< 0.001). Moreover, additional sensitivity analysis confirmed the robustness of the main findings. Conclusions Our study suggests a potential positive correlation between PID and infertility, emphasizing the importance of considering this association in managing infertility in clinical practice.