Inducedabortions, miscarriages, and tobacco smoking asriskfactors forsecondary infertility

Study objective-The aim was to determine whetherinducedabortions could increase theriskofsecondary infertility. Design-This wasa case-control study; caseswerewomen withsecondary infertility,individually matchedtotwocontrols who werecurrently pregnant. Eachparticipant was interviewed by one oftwo medicaldoctors usingaquestionnaire that soughtinformation ontheirdemographic, socioeconomic, medical, andreproductive status. Thedatawereanalysedby conditional logistic regression. Setting-The studytookplacein the AlexandraMaternityHospital inAthens, Greece, in1987-88. Participants-84 women consecutively admitted withsecondary infertility and168 pregnantcontrols tookpart. Mainresults-Eight cases andnocontrols reported aprevious ectopic pregnancy, confirming thattheoccurrence ofapregnancy ofthistypedramatically increases therisk ofsecondary infertility. Furthermore, the occurrenceofeither inducedabortions or spontaneous abortions independently and significantly increasedtheriskof subsequentdevelopment ofsecondary infertility. Thelogistic regression adjusted relativerisks (and95%confidence intervals) for secondary infertility were2-1(11-40)when therewas one previous inducedabortion and2-3(1-0-5-3) whentherewere twopreviousinduced abortions. Tobaccosmoking significantly increased theriskofsecondary infertility, theadjusted relative riskbeing 30(1-3-6-8). Conclusions-Legalised inducedabor