American Journal of Epidemiology Vol. 153, No. 6 : 566-571
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Association of Perforation of the Appendix with Female Tubal Infertility
1 Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
2 Clinical Epidemiology and Health Care Research Program, University of Toronto, Toronto, Ontario, Canada.
3 Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, Canada.
4 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
5 The Centre for Research in Women's Health, University of Toronto, Toronto, Ontario, Canada.
6 Department of Health Administration, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
7 Present affiliation: Departments of Surgery and Health Administration, University of Toronto, Toronto, Ontario, Canada.
Although perforation of the appendix is considered a risk factor for female tubal infertility, the epidemiologic evidence supporting this relation is inconsistent. Risk factors for tubal infertility were compared for 121 women with documented primary tubal infertility attending in vitro fertilization clinics in Toronto, Canada, from July to December 1998 and 490 controls who were pregnant during the same time period. Self-administered questionnaires and review of medical records were used to assess exposures. The authors found that neither history of acute appendicitis nor perforation of the appendix was a statistically significant risk factor for tubal infertility. The crude odds ratio for perforated appendicitis was 3.4 (95% confidence interval (CI): 0.9, 12.9), and the adjusted odds ratio was 1.4 (95% CI: 0.3, 6.2). In addition to increased age and annual income, cigarette smoking (odds ratio (OR) = 2.0, 95% CI: 1.2, 3.2), history of endometriosis (OR = 6.0, 95% CI: 2.8,12.8), and history of pelvic inflammatory disease (OR = 6.0, 95% CI: 2.8, 12.8) were significantly associated with tubal infertility in multivariate analysis. These data do not provide substantial evidence that perforation of the appendix is an important risk factor for female tubal infertility.
appendicitis; bias (epidemiology); case-control studies; causality; fallopian tube diseases; infertility, female; risk factors
Abbreviations: CI confidence interval; OR odds ratio
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