Alopecia areata is associated with increased risk of infertility in a retrospective cohort study using TriNetX

Introduction Alopecia areata (AA) has been associated with adverse pregnancy outcomes, but its relationship with infertility remains poorly characterized. Given the prevalence and psychosocial impact of infertility and the reproductive implications of systemic AA therapies, we examined for potential associations between AA and infertility. Methods A retrospective cohort study was conducted using the TriNetX research network, querying for female patients aged 18-45 years with AA and matched controls. Reproductive outcomes <10-years of diagnosis were compared between cohorts, excluding patients with pre-existing outcomes. AA patients were additionally compared with matched infertile controls. Sex hormone levels were analyzed using t-tests. Results A total of 31,404 AA patients and 31,404 matched controls were included. AA was associated with increased risk of infertility (RR=1.21, 95%CI:1.09-1.35) and decreased likelihood of pregnancy (RR=0.78, 95%CI:0.73-0.82) and IVF utilization (RR=0.71, 95%CI:0.52-0.99). Compared with infertile controls, AA patients had significantly lower IVF use (0.17% vs. 5.04%) and pregnancy rates (6.50% vs. 19.45%) (both p<0.0001). AA patients had lower testosterone and DHEAS levels (both p<0.0001), though within reference ranges. Conclusion AA was associated with increased infertility risk and reduced reproductive outcomes, suggesting broader reproductive implications beyond infertility alone. Multidisciplinary counseling and prospective studies incorporating reproductive intentions are warranted.