Prevalence of infertility treatment in patients with vulvodynia

There is a paucity of data on the fertility desires of patients with vulvodynia, and if pain associated with vaginal intercourse limits these patients’ reproductive goals. Thus, the objective of this study was to determine the prevalence of infertility treatment in patients with vulvodynia. We hypothesized that patients with vulvodynia would have higher rates of infertility treatment compared to the general public and that, of those seeking infertility treatment, uptake of intrauterine insemination (IUI) would be higher compared to uptake of oral or gonadotropin cycles requiring vaginal intercourse, given the potential barrier of painful intercourse. Retrospective chart review. Self-administered questionnaires detailing symptom history, vulvar pain characteristics, pregnancy desires, and history of infertility treatment, were completed by patients seeking evaluation at an ambulatory vulvar disorders clinic from 1996 to 2018. Patients with diagnoses other than vulvodynia were excluded. Primary outcome was prevalence of infertility treatment, defined as use of oral induction agents, gonadotropins, IUI, in-vitro fertilization (IVF), or surgical procedures for tubal factor infertility. Secondary outcomes included desire for pregnancy and frequency of vaginal intercourse. Descriptive statistics were used to characterize these distributions. Approval of this study was granted by the Institutional Review Board. 379 patients diagnosed with generalized or localized vulvodynia were included in this study. Mean age of patients was 40.3 years (SD 14.9). 30.3% (N=115) patients reported desiring pregnancy, and 81.7% (N=94) of their partners were in agreement with this desire. 7.65% (N=29) patients had sought or were seeking infertility treatment, compared to 12.5% reported in population prevalence studies. 35.6% (N=135) patients reported having vaginal intercourse at least once weekly, while 0.53% (N=20) patients reported never having vaginal intercourse. Of the patients who sought infertility treatment, 10 (32.0%) received oral induction agents, 3 (9.6%) utilized gonadotropins, 5 (16.0%) employed IUI, 4 (12.9%) underwent surgical procedures for tubal factor infertility, 3 (9.6%) received IVF, and 6 (19.3%) were unaware of treatment modality. Prevalence of infertility treatment in patients with vulvodynia is similar to that of the general public. A large proportion of patients with vulvodynia desire pregnancy; these patients do not refrain from vaginal intercourse and do not have higher rates of IUI uptake compared to other treatment modalities.