Introduction: Chronic opioid use reduces fertility by suppressing the hypothalamic pituitary axis. The effect of medication to treat opioid use disorder (MOUD) on women’s fertility is understudied. Using national administrative claims, we identify the impact of MOUD on odds of conception in women with OUD.
Methods: We conducted a retrospective case-crossover study using Merative™ MarketScan® Commercial and Multi-State Medicaid Databases from 2006 – 2016. Dates of conception were derived from delivery codes and used as “case” days compared to all other (“control”) days of insurance enrollment. We examined 8,105 births among 6,936 women with OUD to model odds of conception on a given day as a function of MOUD exposure (buprenorphine, methadone, extended-release depot naltrexone, or oral naltrexone) using conditional logistic regression. Hormonal contraception was used as an active comparator group.
Results: In the sample, 2,391 women received buprenorphine, 783 methadone, 208 extended-release depot naltrexone and 320 oral naltrexone. Mean age is 26.1 years (range: 13-45) with 60.5% having Medicaid and 39.5% commercial insurance. Days on which women used methadone (OR 0.56, 95% CI 0.47-0.68) or oral contraceptives (OR 0.42, 95% CI 0.35-0.50) compared to no medication were associated with lower odds of conception. Treatment with extended-release depot naltrexone compared to no medication was associated with higher odds of conception (OR 1.87, 95% CI 1.23-2.83). There was no difference in conception with buprenorphine (OR 0.99, 95% CI 0.89-1.11) or oral naltrexone (OR 0.85, 95% CI 0.55-1.31).
Impact: The majority of treatment-seeking people with OUD who experienced pregnancy during the observation period did not receive MOUD. Those who received extended-release depot naltrexone had higher odds of conceiving compared to no treatment. Treatment with methadone was associated with lower odds of conception, whereas buprenorphine and oral naltrexone had no association. More research is needed to understand the impact of MOUD on fertility to inform prescriber counseling.
Organization: Saint Louis University
Bello Kottenstette JR, Xu K, Grucza R