Association of perforation of the appendix with female tubal infertility

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 wome n with documented primary tubal infertility attending in vitro fertilizatio n clinics in Toronto, Canada, from July to December 1998 and 490 controls w ho were pregnant during the same time period. Self-administered questionnai res and review of medical records were used to assess exposures. The author s found that neither history of acute appendicitis nor perforation of the a ppendix was a statistically significant risk factor for tubal infertility. The crude odds ratio for perforated appendicitis was 3.4 (95% confidence in terval (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 (od ds 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, 9 5% CI: 2.8, 12.8) were significantly associated with tubal infertility in m ultivariate analysis. These data do not provide substantial evidence that p erforation of the appendix is an important risk factor for female tubal inf ertility.