Atopic dermatitis (AD) is a common dermatologic condition often associated with a variety of different comorbidities which can prove challenging to manage and can further negatively impact the quality of life of patients far beyond their cutaneous eczematous symptoms. A recent study1 found that patients with AD have an increased prevalence of infertility, underscoring the need for appropriate consultation and treatment management in this patient population.
“In recent years, studies have demonstrated associations between AD and extracutaneous medical conditions, including a comorbidity linkage between atopy and infertility, revealing that atopic women had fewer children than non-atopic women,” wrote Amir Horev, MD, Pediatric Dermatology Service, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel, and head author of the study.
Estimated to affect approximately 10% adults and 30% of children world-wide, AD or atopic eczema is a chronically relapsing inflammatory skin condition associated with various morphology, distribution, and disease severity and course. Still having an unclear pathophysiology, AD appears to be the result of both genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic dysregulation, and skin microbiota dysbiosis, leading to the typical clinical picture of AD.
Some of the most common causes of infertility include ovulatory disorders, endometriosis, pelvic adhesions, tubal abnormalities, hyperprolactinemia, sperm count, morphology, and function disorders. Nevertheless, infertility remains unexplained after standard medical investigation in approximately 30-40 percent of cases. According to the study authors, infertility and AD share common pathophysiological factors and mechanisms and therefore may also have an epidemiologic association.
“The etiologies of these comorbid conditions are complex and are likely multifactorial, involving epidermal structure abnormalities and dysfunction of barrier elements. Similarly, barrier dysfunctions are closely related to the development of infertility, as barrier function is needed for maintaining the immune privilege functions of several sites along the reproductive system,” the study authors wrote.
Horev and fellow colleagues recently performed a retrospective cohort study to evaluate the prevalence of infertility in patients with AD as well as investigate the association between AD and infertility in a real-life setting in a broad community-based population. Using the Clalit Health Services (CHS) medical database (the second largest healthcare organization provider world-wide), the researchers conducted a search between 2002 and 2018 and identified 127,150 patients with dermatologist diagnosis-confirmed diagnosis of AD and 127,071 comparison enrollees in the gender and age-matched control group to be included in the final evaluation. Study participants were subdivided according to age into adults and children, and further subdivided according to their AD severity which was classified either as mild or moderate to severe according to AD-related drug use and healthcare utilization services.
The researchers found that AD was associated with a higher prevalence of infertility in the general population compared to controls (1.4 and 1.1 percent, respectively). Data showed that the prevalence of infertility, per 1,000 patient-years, was increased in patients with AD compared to that of the control group (2.17 and 1.7, respectively). The researchers also found that regardless of the severity of symptoms whether mild or moderate to severe, AD was a key risk factor for infertility in both male and female subjects.
“Given that AD is an inflammatory disorder, and as other inflammatory disorders such as rheumatoid arthritis and asthma have been associated with infertility, it is reasonable to hypothesize that systemic inflammation related to AD may account for, at least in some part, some cases of infertility,” the study authors wrote.
In a systematic review2, Bláfoss et al. investigated the impact of female asthma and atopy on fertility and found that there was a clear trend toward an association between female atopy and a reduction of fertility; hence, higher rates of atopic women require fertility treatments.
The results of the current study offer further epidemiological evidence on the significant association between AD and infertility and suggests that infertility may be an additional manifestation of the characteristically cutaneous disease. According to the study authors, further research should be performed to help better evaluate the impact of AD management in the setting of infertility and vice versa.
“Our study demonstrated a subtle, yet significant higher risk of infertility in the AD population; however, this observation has imperative and meaningful clinical applications from a public health perspective. Information regarding improvement in symptoms or recovery of patients with AD and the possible effect on infertility could not be drawn, and further prospective studies are warranted to address this issue,” the study authors wrote.
1. Horev A, Shalom G, Weintraub AY, Freud T, Cohen AD. Atopic dermatitis and infertility: a nationwide retrospective cohort study. Dermatology.2022;238(2):313-319. doi: 10.1159/000515600. Epub 2021 Apr 21.
2. Bláfoss J, Hansen AV, Malchau Lauesegaard SS, Ali Z, Ulrik CS. Female asthma and atopy – impact on fertility: a systematic review. J Asthma Allergy. 2019 Jul;12(12):205–11.