Association of cannabis use with female infertility based on NHANES

With the gradual legalisation of recreational cannabis, associated health effects have received widespread attention, but their association with female infertility remains unclear. The aim of this study was to explore the association between cannabis use and infertility among females of childbearing age in the United States. Data were obtained from the National Health and Nutrition Examination Survey 2013–2018; 1694 female participants aged 18–45 years were included. The association between cannabis use and female infertility was analysed by logistic regression analysis. All data were weighted before analysis. After adjusting for all covariates, former cannabis users demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.04, 95% confidence interval: 1.21–3.43, <i>P</i> = 0.012), whereas current cannabis users exhibited no significant difference in infertility odds relative to never-users. In subgroup analysis, former users aged 18–35 years exhibited higher odds of infertility than never-users (odds ratio: 2.37, 95% confidence interval: 1.11–5.04, <i>P</i> = 0.027); but former cannabis users aged 36–45 years demonstrated no significant difference in infertility odds compared with never-users. Among former cannabis users aged 18–35 years, those with sustained abstinence exceeding 3 years demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.94, 95% confidence interval: 1.29–6.71, <i>P</i> = 0.005). In contrast, individuals with shorter abstinence durations (&lt;3 years) showed no significant difference in infertility odds relative to never-users. Among females of childbearing age, the odds of infertility was not elevated among current cannabis users compared with never-users, while the odds of infertility was elevated among former users. This relationship between cannabis use and female fertility is more often reflected in the distant term (&gt;3 years of cessation), and this adverse association is more pronounced among females in the most active reproductive years (18–35). As the legalisation of recreational cannabis use expands in multiple states of the United States and several other countries, its health impact receiving increasing attention. Currently, there is limited clinical research on the association between cannabis use and infertility in women. Our research showed that women of childbearing age who currently use cannabis do not have higher odds of infertility than those who have never used it. However, women who stopped using cannabis, particularly those who had ceased for &gt;3 years, were more likely to experience infertility. The link between former cannabis use and infertility had become stronger over time and was most noticeable in women at their peak fertility age (18–35 years old). This study can help researchers further explore the effects of cannabis on female fertility and its mechanisms, as well as aid public health policymakers in developing more informed public health policies.