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Among U.S. military veterans, experiences of sexual violence may be tied to infertility later on in life, according to a retrospective cohort study.

In women, 15.5% of those experiencing a sexual assault throughout their life had an infertility diagnosis for themselves or their partner, compared to 11.3% for those who did not experience a sexual assault (P=0.02), reported Ginny Ryan, MD, MA, of the University of Washington School of Medicine.

An experience of sexual assault that occurred during military service was also associated with an infertility diagnosis among women (16% vs 12.3% in those without a sexual assault, P=0.05), Ryan said in a virtual presentation at the American Society for Reproductive Medicine annual meeting.

An increase in infertility diagnoses was observed among men who experienced sexual assaults, but the relationship was not statistically significant.

"Alarmingly, more than half of women veterans have experienced one attempted or completed sexual assault, and most of these had an assault in the military," Ryan said. She also said one in nine male veterans have experienced a lifetime event of sexual assault, which has been underreported.

"What we are starting to see, is that the negative repercussions of such a trauma may include infertility, at least as diagnosed by a medical professional," Ryan said. Future research, she added, will allow us to clarify the time course of infertility and sexual assault, identify other factors of infertility, and drill down on causation.

In this study, Ryan and colleagues assessed the prevalence of sexual assault and its association with infertility among 3,000 U.S. military veterans ages 19 to 45. Around 1,388 female and 1,590 male veterans answered questions about sexual assault. The researchers conducted phone interviews that lasted an average of 90 minutes, gathering information about experiences of sexual assault that occurred during military service and across the life course, as well as whether participants or their partners had been diagnosed with infertility.

Overall, 13.6% of women and 12.1% of men reported a lifetime infertility diagnosis for them or their partner. Approximately 56% of female veterans experienced at least one attempted or completed sexual assault during their lifetime, with around 36% of all women experiencing sexual assault during their time in the military. Among male veterans, 12% had an experience of sexual assault in their lifetime, with around 3.5% undergoing an assault during military service.

In male veterans, an infertility diagnosis was reported in 14.7% of those with a lifetime event of sexual assault versus 10.2% of those without a sexual assault (P=0.07). And an infertility diagnosis was reported in 17.8% of men with a sexual assault occurring while in the military versus 10.5% for those without such a history (P=0.08). Data in the male population trended toward an association, but because the numbers of assault were smaller, it did not reach statistical significance, said Ryan.

Ryan stated that this study was limited by its self-reported nature and cross-sectional approach, as researchers were unable to assess a causal relationship between sexual assault and infertility. Additionally, because this is a sensitive topic, study participants may have been discouraged from fully disclosing their history, she said.

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