甘肃省不孕症患病率及其影响因素分析

目的:了解甘肃省育龄夫妇不孕症(infertility)患病率现状及其可能的影响因素。方法:运用分层整群抽样法抽取自然人群中具有代表性的2 621个已婚育龄家庭为研究对象,采用问卷调查方式,对甘肃省育龄夫妇不孕症患病情况进行横断面调查,同时调查其有关的流行病学因素。采用EpiData软件建立数据库,双人录入法进行数据录入,数据采用SPSS 15.0软件进行统计学分析。结果:甘肃省原发不孕的患病率为13.08%,继发不孕的患病率为35.25%;调查结果显示,育龄妇女年龄、月经周期及男方的体质量指数(BMI)和吸烟情况均是原发不孕的危险因素;继发不孕除以上因素外,育龄夫妇的活产次数、死胎次数、自然流产数、人工流产数及药物流产史也是其危险因素。结论:甘肃省原发不孕患病率为13.08%,促进和帮助欠发达地区的经济发展、加大教育及医疗卫生的投入、加强宣传,消除生殖健康隐患将有助于降低不孕率。     

昆山市城区已婚育龄妇女生殖道感染现况及影响因素研究

目的:了解昆山市城区已婚育龄妇女生殖道感染(RTI)流行情况及影响因素。方法:采用整群抽样方法抽取昆山市城区3465例已婚育龄妇女为研究对象进行调查问卷、妇科检查及相关实验室检查,分析RTI的影响因素。结果:针对检测念珠菌阴道炎、细菌性阴道炎、滴虫阴道炎和宫颈炎4种目标疾病,昆山市城区已婚育龄妇女RTI总患病率为48.57%。多因素Logistic逐步回归分析表明:RTI的发病与年龄、职业、婚育史及不良生活习惯等因素密切相关。结论:昆山市城区已婚育龄妇女RTI患病率较高,应积极采取措施;进一步加大生殖健康知识宣传力度,针对与其发病有关的多种影响因素,开展有效的干预。     

助孕技术在输卵管性不孕的应用和评价

不孕症是一种特殊的生殖健康缺陷,近年全世界范围内不孕症发病率呈上升趋势,占已婚育龄夫妇的10%～15%,我国育龄妇女的不孕症人数日益增多,发病率约为7%～10%。据世界卫生组织属下的人类生殖特别规划署统计,不孕症与心血管疾病及肿瘤并列为当今影响人类生活和健康的三大主要疾病。而     

城区已婚育龄妇女生殖道感染情况分析

目的：了解城区已婚育龄妇女生殖道感染（RTI）现状及相关因素,为保障妇女生殖健康提供干预措施。方法：对来本院进行妇女病普查的4259例城区已婚育龄妇女进行询问病史、妇科检查、实验室及影像检查;进行调查问卷500份了解妇女病普查及相应的治疗和卫生保健指导情况。结果：城区已婚育龄妇女生殖道感染患病率为56.96%,其中慢性宫颈炎发病比率为78.03%,居首位;经济状况差、文化素质低、流产及分娩次数多,避孕措施不当、不良的卫生习惯等是RTI的高发因素。结论：城区已婚育龄妇女生殖道感染患病率较高,慢性宫颈炎的发病应引起高度关注;开展健康教育,普及保健知识,动员社会力量参与,积极进行妇女病普查普治是提高妇女生殖健康的重要措施。     

84例不孕症患者临床分析

对84例不孕症患者进行了临床分析,包括原发性不孕症73例(86.90%),继发不孕症11例(13.10)。不孕妇女的初诊年龄为23～38岁,27～28岁呈一峰值。不孕原因以机能性和卵巢性不孕多见。84例中妊娠19例,妊娠率为22.62%,其中以卵巢性因素不孕症妊娠率最高(7/22人,31.82%)。随着晚婚政策的落实,不孕症有提前就诊趋势。     

不孕症妇女的危险因素研究

目的研究不孕症妇女引起不孕的危险因素,为进一步改善不孕症妇女健康状况,降低不孕症的发病率提供参考依据。方法本研究为病例对照研究。采用系统抽样方法每间隔2例抽取232例不孕症妇女,根据匹配原则抽取229例已生育妇女,使用自编调查问卷进行"一对一"访谈调查。结果造成不孕的危险因素有:不孕家族史(OR=18.025)、异位妊娠史(OR=3.738)、药流史(OR=3.066)。结论不孕妇女的主要危险因素是不孕家族史、异位妊娠史、药流史。     

关于不孕夫妇生育态度和对辅助生殖技术接受性的调查

目的:了解接受辅助生殖技术(ART)的不孕不育夫妇对生育以及对ART的看法。方法:以问卷调查的形式对接受ART的夫妇双方进行调查。问卷内容涉及夫妇双方基本情况、不孕情况、对生育以及ART的看法等。结果:共发放问卷866份,回收问卷866份,有效问卷837份。涉及不孕夫妇410对。平均不孕时间4.5±2.9年,其中57.7%来自城市,42.3%来自农村。城市居民就诊年龄大于农村居民。18.3%的被调查者有避孕史,城市居民避孕的比例高于农村居民(30.4%vs 6.7%),避孕目的以工作因素为主。希望生育的主要原因是喜欢孩子(51.4%),仅6.8%的患者认为是由于家庭和社会的压力。当得知患有不孕症时,仅有15.9%的被调查者首选ART;城市居民对ART的担忧比农村居民多(31.9%vs 17.8%,P<0.05);女方较男方对可能造成的自身影响更担心(P<0.05)。而超过半数的被调查者认为不会告知周围的人自己接受ART,接近50%的人在是否告知子代为ART儿问题上持不确定态度。同一对夫妇在选择解决不孕手段和对周围人告知上的一致性超过50%,而在对子代的告知方面一致性不高。结论:不孕夫妇生育的目的主要是出于对孩子的喜爱,然而对ART仍持谨慎态度。     

正确对待不孕与再孕的重要意义

不孕是妇产科临床常见病症之一。由于各个国家、各个地区对不孕症的定义、统计方法及资料来源等的标准不一,其发生率也有差异。国外发生率一般为育龄夫妇的10～20%,国内报道为1～10%。不孕症与不育症的定义有所不同,不可混淆。不孕症(steritity)是指育龄夫妇性生活正常(未避孕),在一定期限内从未妊娠。而不育症(infertility)则指女方有过妊娠,但均以流产、早产、死胎或死产而结束(包括反复自发性或称习惯性流产),无孩子存活。不孕症的期限,国内外以往都以三年为限,近年来都趋于缩短,如世界卫生组织1986年采用以一年为限,国内有用一年、两年或三年者。鉴于已婚夫妇40～90%在一年内自然妊娠,95%二年内妊娠,故1988年8月中华医学会和中华妇产科杂志编辑部召开的全国不孕症研讨会上,推荐不孕症期限以两年为妥,但不孕症的治疗则可根据夫妇本人、病因及病情轻重等具体情况,适当提前或推后。     

关于两地生活探亲夫妇不孕症诊断标准的探讨

本文对探亲夫妇首次受孕和不孕的有关情况进行了调查 ,试图探索两地生活夫妇自然受孕力及其影响因素 ,为建立两地生活探亲夫妇不孕症诊断标准提供依据。1　资料与方法　　于 1997年 10月至 1998年 2月用整群抽样的方法调查了沈阳军区所属部队 5个月内来队探亲的已婚育龄夫妇共计 32 93对。调查对象均符合以下标准之一 :①婚后未采用任何避孕措施已妊娠或正在妊娠的探亲夫妇。②婚后两地生活正常探亲≥ 3年未妊娠夫妇。③两地生活间隔至少3个月以上探亲夫妇。调查内容包括 :探亲夫妇人口学特征、两地生活探亲情况、婚后首次受孕及不孕情况。…     

不孕症妇女的心理和心理卫生(附137例临床分析)

目的探讨心理因素与不孕症之间的关系.方法137例不孕症妇女按汉密顿焦虑量表(HAS)和抑郁量表(HDS)评定心理状态,同时选择正常育龄妇女150例作对照.按既往是否有过妊娠史分原发不孕组与继发不孕组,按不孕病程长短分A组(不孕2年)、B组(不孕3年)、C组(不孕4年)、D组(不孕5年)、E组(不孕5年以上),比较分析心理因素与不孕症之间的关系.结果137例不孕妇女抑郁发生率46.8%,焦虑发生率78.1%,焦虑伴抑郁发生率27.7%.不孕症妇女的焦虑与抑郁评分明显高于正常育龄妇女,原发不孕组的焦虑与抑郁评分明显高于继发不孕组,随着不孕病程的延长,焦虑与抑郁评分亦增高.结论心理状态可能是引起不孕症的原因之一,其在减轻或加剧不孕症的病程方面有很重要的意义.     

Infertility in rural Ghana.

OBJECTIVES: This study measured the prevalence of self-reported infertility, as well as the level of knowledge of causes of infertility. Infertility was defined as failure to achieve conception after a minimum of 12 months of exposure. METHODS: Prevalence and knowledge of infertility were assessed in a representative community-based survey using a structured questionnaire in a rural district in Ghana among a random sample of 2,179 men and women from 15 to 49 years. RESULTS: The prevalence of infertility was 11.8% among women and 15.8% among men. The knowledge of causes of infertility was limited; only 46.5% of the respondents reported any cause. Most respondents failed to identify reproductive tract infections as causes of infertility. CONCLUSIONS: Infertility in Ghana and other sub-Saharan countries deserves more recognition as a public health problem. Prevention and treatment of infertility should be incorporated in reproductive health programs, while male participation in reproductive health programs and research needs to be encouraged. Public education about the causes of infertility is recommended.     

Laparoscopy should be strongly considered for women with unexplained infertility

AIM: Women with unexplained infertility frequently become pregnant after diagnostic laparoscopy. In this study the effect of laparoscopic surgery on such women was evaluated by the pregnancy rate after laparoscopic surgery. METHODS: A total of 47 unexplained infertile women underwent laparoscopic evaluation during the period August 2002 to January 2005 in our center. The percentage of positive laparoscopic findings and the pregnancy rate after laparoscopy were calculated. The patients were divided into 5 subgroups according to maternal age, pregnancy rates were calculated for each group, and compared with the outcome of assisted reproductive technology (ART) treatment for the same age groups. RESULTS: In 87.2% of the women, laparoscopy revealed abnormal findings; endometriosis lesions, peritubal adhesions and tubal obstructions were found in 21, 17 and 3 cases, respectively. After laparoscopy 23 achieved pregnancy (pregnancy rate: 48.9%). The pregnancy rates of the groups at the age of 25 years old or less, 26-30, 31-35, 36-40 and over 41 years old were 100%, 75.0%, 45.5%, 27.2% and 0%, respectively. In the case of the 26-30 years old group, the pregnancy rate after laparoscopy was significantly higher than that in the ART treatment group (33.3%, P < 0.05). CONCLUSIONS: Laparoscopy should be strongly considered for examining women with unexplained infertility.     

Laparoscopy for the treatment of unexplained infertility

Aim:  To determine the best treatment for unexplained infertility.
Methods:  A retrospective study was used to examine Japanese women with unexplained infertility that had undergone laparoscopy. The main outcome measure of the study was the rate of pregnancy after laparoscopy.
Results:  One hundred and thirty-eight women diagnosed with unexplained infertility received laparoscopy and as a result 55 women had their diagnosis of unexplained infertility confirmed. There were no statistically significant differences between the women who became pregnant after laparoscopy in terms of duration of infertility, duration of treatment or age. The pregnancy rate of women with unexplained infertility was 56.4%, with 90% of these pregnancies achieved within the first 6 months. There were 64 women with minor endometriosis considered to be suffering from unexplained infertility before laparoscopy. The characteristics of the patients in the unexplained infertility group and in the minor endometriosis group were similar, but patients with minor endometriosis were found to have a lower pregnancy rate compared to those with unexplained infertility (35.9% vs 56.4%; P  = 0.02).
Conclusions:  The effective period after laparoscopy appears to be 6 months. Assisted reproductive technology should be considered after that time. Pregnancy rates were low in women with minor endometriosis compared with unexplained infertility. It is important to clarify the cause of infertility using laparoscopy. (Reprod Med Biol 2006; 5 : 59–64)     

A study of second-look laparoscopy after acute salpingitis

Acute salpingitis (AS) has a major impact on the reproductive health of women. In this study second-look laparoscopy was assessed for its ability to predict reproductive function after AS. We questioned 158 women who had had a second-look laparoscopy with tubal dye insufflation after laparoscopically proven AS between September 1984 and August 1989. The answers of 69 women with at least two years of involuntary infertility were analyzed. The mean follow-up period was 76 months (range 53–108 months). Second-look laparoscopy revealed bilateral tubal occlusion in 21.7% (15/69). Bilateral tubal occlusion was found in 9.5% (2/21) after mild stage, 20% (4/20) after moderate stage and 32.1% (9/28) after severe stage AS. The rate of infertility during follow-up was 9.5% (stage I), 35% (stage II) and 39.9% (stage III). Eighty per cent (12/15) of women with proven bilateral tubal occlusion after treated AS had involuntary infertility, and 14.8% (8/54; P=0.000001) of women with one or both tubes patent also had infertility. Specificity, sensitivity and positive predictive value for subsequent infertility were 85.2%, 80% and 84.1%, respectively. Pelvic adhesions (21/69) were strongly correlated with bilateral tubal occlusion (8/21; 38.1%; P=0.029), a history of chronic pelvic pain (14/21; 66.7%; P=0.00024), as well as failure to achieve an intrauterine pregnancy (10/21; 47.6%; P=0.024). Recurrent pelvic infections occurred in 16% (12/69) and ectopic pregnancies in 7.3% (5/69). Operations for infertility and pelvic pain (excluding ectopic pregnancy), were carried out in 11.6% (8/69). We conclude that second-look laparoscopy after treated AS have accurate evaluation of reproductive function. Received: 10 January 1996 / Accepted: 29 April 1996     

The pattern of infertility diagnoses in women of advanced reproductive age.

OBJECTIVE: Our intention was to determine whether there is a unique pattern of infertility diagnoses in older infertile couples. STUDY DESIGN: The design of this study was a retrospective chart review study. It was performed in a tertiary referral reproductive medicine unit. There were 2 groups of patients-couples: group 1, female partner aged 20-29 (n = 105) at presentation; group 2, female partner aged 40-45 (n = 112) at presentation. All women underwent infertility evaluations between 1989 and 1994. There were no interventions. The prevalence of standard infertility diagnoses was the main outcome measure. RESULTS: The prevalence of 8 major infertility diagnoses in the younger and older groups (each couple could have >/=1 diagnosis) was as follows: (1) ovulatory factor-younger group, 56%; older group, 30%; (2) tubal factor-younger group, 34%; older group, 29%; (3) endometriosis-younger group, 13%; older group, 17%; (4) uterine factor-younger group, 1%; older group, 5%; (5) cervical factor-younger group, 4%; older group, 1%; (6) luteal deficiency-younger group, 4%; older group, 10%; (7) male factor-younger group, 32%; older group, 45%; (8) unexplained-younger group, 5%; older group, 10%. The only significant difference was an increase in ovulatory factor in the younger group. CONCLUSIONS: There is no unique pattern of infertility diagnoses in women of advanced reproductive age as seen at a tertiary referral center. We speculate that a high false-positive rate associated with standard infertility tests and a different referral pattern for older couples obscures any real differences in the etiology of infertility in older couples.     

Alcohol use as predictor for infertility in a representative population of Danish women

BACKGROUND: Our aim was to examine the association between use of alcohol and subsequent incidence of primary infertility. METHODS: The study subjects were chosen from a population-based cohort of Danish women aged 20-29 years. Eligible women were nulliparous and not pregnant (n = 7760). Information on alcohol intake and potential confounders (age, education, marital status, diseases in the reproductive organs, and cigarette smoking) was assessed at enrollment. The incidence of fertility problems during follow-up was obtained by record linkage with the Danish Hospital Discharge Register and the Danish Infertility Cohort Register. Main outcome measures were hazard ratios of infertility according to alcohol intake at baseline estimated in a multivariate Cox proportional hazards model. RESULTS: During a mean follow-up of 4.9 years, 368 women had experienced infertility. Alcohol intake at baseline was unassociated with infertility among younger women, but was a significant predictor for infertility among women above age 30. In this age group, the adjusted hazard ratio for consuming seven or more drinks per week was 2.26 (95% confidence interval: 1.19-4.32) compared with women consuming less than one drink per week. CONCLUSIONS: These findings suggest that alcohol intake is a predictor for infertility problems among women in the later reproductive age group.     

Determinants of reproductive outcome after abdominal myomectomy for infertility.

OBJECTIVE: To determine the effect of myomectomy as a therapy for infertility and to define the factors that influence reproductive outcome. DESIGN: Retrospective study of a case series. SETTING: An academic department specializing in conservative surgery. PATIENT(S): A total of 138 infertile women who underwent first-line conservative surgical treatment at laparotomy for uterine leiomyomas over an 8-year period. INTERVENTION(S): Data were collected on baseline clinical characteristics, surgical details, and subsequent reproductive history. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rates at 24 months according to selected clinical and fibroid characteristics. RESULT(S): Pregnancy occurred in 76 women. The 24-month cumulative probability of conception according to the Kaplan-Meier method was 87% in patients <30 years of age, 66% in patients 30-35 years of age, and 47% in patients >35 years of age. The pregnancy rates in women with and without minor infertility factors in addition to myomas were 56% and 71%, respectively, and those in women with <2 years versus > or =2 years of infertility were 84% and 51%, respectively. The size and site of the largest myoma and the total number of tumors removed did not influence the outcome. CONCLUSION(S): Our results suggest a benefit of myomectomy in infertile patients. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.     

Type 1 diabetes mellitus associated or not with primary hypothyroidism and women’s fertility

Abstract

The aim of this study is to evaluate the prevalence of infertility and other reproductive parameters in women with type 1 diabetes mellitus (DM1) with and without primary hypothyroidism (PH). This is a cross-sectional study conducted at Division of Endocrinology. We evaluated 110 female, aged over 18 years, 79 had DM1 and 31 had DM1 plus PH. They were interviewed to obtain data on their gynecological and obstetric history; medical charts were reviewed to determine the characteristics of the diseases and to assess clinical/laboratory data. Infertility was defined as 12 months of unprotected sexual intercourse without conception. We used the chi-square and Mann–Whitney’s tests, and logistic regression analysis. The prevalence of infertility in the total sample was 24.5%, no differences were found between groups regarding obstetric outcomes and gynecologic variables. Factors associated with infertility were microvascular complication (OR: 11.36; 95% CI: 2.488–52.632; p?=?.029), polycystic ovary syndrome (OR: 9.80; 95% CI: 2.247–43.478; p?=?.016), PH (OR: 3.38; 95% CI: 1.078–10.638; p?=?.047), and older age at onset of DM1 (OR: 1.12; 95% CI: 1.029–1.215; p?=?.019). The presence of PH in women with DM1 was a predictive factor for infertility. Women with DM1 showed poorer reproductive outcomes compared to the general population.