我国三省不孕症的流行病学研究
摘要
[研究背景]：
不孕症是涉及全球各个地区或国家育龄夫妇的问题,它已受到全世界的广泛关注。70年代末到80年代出,各国开始重视不孕症的问题,陆续开展不孕症的发生率和病因学的研究。80年代中末期WHO在25个国家的33个研究中心组织了一次采用标准化诊断的不孕症夫妇调查,结果表现发达国家约有5%～8%的夫妇受到不孕的影响,发展中国家一些地区不孕症的发生率可高达30%。
在70～80年代,我国有关不孕症的发生率见于几份零星的调查,90年代后也少见相关的报道。近年来由于社会竞争、就业压力的增大以及环境的恶化不孕症的病人确实增多。我国的计划生育政策是生育一个孩子以后夫妻必须采取避孕措施,因此在我国研究不孕症发生率最好是新婚人群。
国内有关不孕症发生率的研究单一研究较多,并各地报道的不孕症发生率差异很大,可能与不同研究的调查对象为整个育龄期妇女而未采取各年龄段进行分层抽样调查有关；另外,其发生率尚有地域、种属不同的差异。
不孕症是一个非常复杂的生理过程,是一种特殊的生殖健康缺陷,它不同于临床上其他的疾病,由于其生理、心理因素并存,故常常给家庭、社会造成严重的影响,大多数不孕症患者迫切渴望得到医疗帮助,早日摆脱不孕症的困扰。因此我们有必要对不孕症的病因及影响因素及诊治情况进行研究,为提高我国的人口质量提供依据。我们的研究首先通过育龄妇女信息系统WIS系统现有资料来粗略的分析一下10年来新婚妇女的生育情况,并且通过现场调查分析不孕症的发生率及影响因素,此外还通过调查不孕症门诊患者来了解不孕症患者的病因情况。总的来说本研究包括不孕症发生率的调查、不孕症影响因素的调查以及不孕症病因调查。
[研究目的]：
1.研究总目的：从多个来源,多个视角,多个层面来研究中国三个省份6个县市新婚人群生育能力及不孕症因的发生率、影响因素及病因的流行病学现状。
2.具体目的：
2.1中国三省育龄妇女信息系统(WIS)现有资料研究目的：
1)了解3省初婚妇女结婚后生育情况；
2)了解3省初婚妇女婚后生育时间随年代变化趋势；
3)了解3省初婚妇女结婚年龄与婚后生育时间的关系。
2.2中国三省新婚人群不孕症发生率研究目的：
1)了解中国三省新婚夫妇不孕症发生率；
2)探讨三省不孕症发生与女性结婚年龄的关系；
3)比较三省新婚夫妇不孕症发生率的差异；
4)了解不孕人群的求医情况。
2.3蚌埠市新婚人群不孕症发生率及影响因素研究目的：
1)了解蚌埠新婚人群不孕症发生率的影响因索。
2.4中国三省不孕症门诊现场调查目的：
1)不孕患者不孕病因总体分布情况；
2)不孕症病因女性因索分析；
3)不孕症病因男性因素分析。
[研究对象与方法]：
本研究资料来源有两种,一是对育龄妇女信息系统(WIS)现有资料分析,一种是现场调查,其中现场调查包括对新婚人群的现场调查和不孕症门诊病人的现场调查两种。
1.研究对象
本研究为意向性抽样。研究现场包括安徽省的蒙城县、蚌埠市,四川省的射洪县、乐至县,以及河南省的南乐和泌阳县,共三省6个县(市)。
1.1研究对象的选择
1.1.1中国三省WIS系统现有资料的研究对象选择标准
6个县(市)1995年到2004年这10年间结婚的人员。
1.1.2中国三省份新婚人群不孕症发生率研究对象选择标准
6个县(市)所有2005年和2006年结婚的妇女,具体研究对象的纳入标准如下1)女方达到合法结婚年龄并且在生育期,即结婚年龄≥20岁,且<49岁；2)男方达到合法结婚年龄并且在生育期,即结婚年龄≥22岁,且男方结婚年龄<55岁；3)男女双方都是初婚；4)当地常驻人口。蚌埠市新婚人群的研究对象纳入标准与此相同。
1.1.3不孕症门诊现场调查研究对象纳入标准
从2009年11月到2010年5月,6个县(市)寻求不孕症诊疗的不孕症患者。
2.调查方法
本研究的调查发方法属于横断面研究。
3.研究内容
3.1 WIS系统现有资料：研究内容包括：1)基本人口学特征：出生日期、结婚日期、户籍；2)生育情况。
3.2三省及蚌埠不孕症发生率研究：研究内容包括：1)基本人口学特征；2)生育情况；3)避孕情况；4)不孕症的就诊情况。
3.2.不孕症门诊调查：研究内容包括：1)基本人口学特征；2)月经史、妊娠史、性生活史等；3)女方相关的疾病史、体格检查、妇科检查和有关的特殊检查；4)女方治疗不孕症的用药史；5)男方调查：年龄、精液检查、生殖器疾病史等。
4.分析方法
用Epidata软件录入数据,采用双录入方法,然后将所有数据导入SPSS,利用SPSS15.0软件进行逻辑检查,从而获得清洁数据。
对于连续性变量,如果是正态分布进行基本统计学描述时用均值和标准差来描述,否则用四分位数来描述。另外在比较不同组之间的差异时候,按照实际情况,我们对连续性变量进行分组转换成分类变量处理。对于分类变量我们采用卡方检验来比较不同组之间的差异。对于混杂因素,我们采用分层分析和标准化法。为了了解蚌埠市新婚人群不孕症的影响因素,我们做了Logistic回归分析。
[研究结果]
1.育龄妇女信息系统(WIS)现有资料分析结果
1.1女方结婚后生育情况
初婚女性结婚后1年累计未怀孕的比例呈上升趋势,从1995年的22.3%,上升到2004年的28.3%。我们将这10年分为1995-1998,1999-2001和2002-2004年三个年代组。95-98年结婚的人,婚后1年累计未怀孕率是22.8%；99-01年结婚的人,婚后1年累计未怀孕率是25.9%；02-04年结婚的人婚后1年累计未怀孕率上升到27.7%。
1.2女方婚后生育情况与年代的关系
考虑到不同年代,女性结婚年龄构成比有所不同,采用按照年龄分层分析不同年代妇女结婚后生育情况。研究结果如下图显示：从图可以看出来每一个年龄组的人结婚后1年内未怀孕率都是随年代呈现上升趋势的。例如20～岁结婚的95-98年婚后1年内未怀孕率是22.4%,99-01年结婚年龄是20～岁的人婚后1年内未怀孕率上升到25.1%,02-04年结婚年龄在20～岁的人婚后1年内未怀孕率上升到25.7%。结婚年龄在25～岁的人婚后1年内未怀孕率在95-98年是24%,但是到02-04年上升到32%。尤其是≥30岁结婚的人婚后1年内未怀孕率在95-98年是25.4%,但是到02-04年的时候婚后1年内未怀孕率上升到35.9%。
1.3女方结婚年龄与生育情况的关系
分层分析结果显示：95-98年结婚,20-岁结婚的人至今有3%的人尚未生育,25～岁结婚的人至今有3.6%的人尚未生育,≥30岁结婚的人至今有7.3%的人尚未生育。与此同时这三个年龄组的人在结婚后1年未怀孕比例也呈上升趋势,分别是22.4%,24%和25.4%。
99-01年结婚,20～岁结婚的人至今有5.2%的人尚未生育,25～岁结婚的人至今有6.3%的人尚未生育,≥30岁结婚的人至今有13.3%的人尚未生育。与此同时这20～岁组,25～岁和结婚年龄≥30岁这三个年龄组的人在结婚后1年未怀孕比例也呈上升趋势,分别是25.1%,28%和32.6%。具体结果如下图。
02-04年结婚,20～岁结婚的人至今有9%的人尚未生育,25～岁结婚的人至今有12.4%的人尚未生育,≥30岁结婚的人至今有30.3%的人尚未生育。与此同时这20～岁组,25～岁和结婚年龄≥30岁这三个年龄组的人在结婚后1年未怀孕比例也呈上升趋势,分别是25.7%,32%和44.2%。结果如下图。
2.中国三省份新婚人群不孕症发生率分析结果
2.1三省不孕症发生率
本研究共调查了安徽省、河南省和四川省6个县市的55984人。研究结果显示真正不孕症患者有3920人是真正的不孕症患者,不孕症发生率是7.4%。
2.2不孕症发生率与女性结婚年龄的关系
结婚年龄在20～岁结婚的人不孕症发生率是7.0%,25～岁结婚的人不孕症的发生率是8.6%,大于等于30岁结婚的人不孕症的发生率是12.5%,差别有统计学意义。
2.3三省新婚夫妇不孕症发生率比较
研究结果显示：不同省份之间不孕症发生率粗率不同,四川省不孕症发生率最高为10.9%,其次是河南为6.0%,安徽省不孕症发生率为5.9%,差别有统计学意义。标准化法比较这三个省的不孕症发生率后发现四川省不孕症发生率校正率为10.86%,河南省为6.08%,安徽省为5.89%。
2.4不孕人群的求医情况
我们共调查得到3920名不孕症患者,仅有33.1%人就诊过不孕症。有11.0%的人去过省级以及上级别的医院；有27.6%的人就诊过市级医院；有69%的人就诊过县级医院；有15.4%的人是在县级以下医院就诊的。有1225人接受过不孕症治疗,仅占不孕人数的31.25%。
3.蚌埠市新婚人群不孕症发生率及影响因素研究
本研究共调查了蚌埠市6个区共8390名新婚夫妇。研究结果显示：不孕症发生率为10.5%。单因素分析结果显示：20～岁结婚的人中不孕症发生率为8.7%,≥25岁结婚的人不孕症的发生率为13%,差异有统计学意义。非农业户口的女性不孕症发生率为12.5%,而农业户口的女性不孕症的发生率仅为65%。妇女文化程度为小学及以下的组,不孕症的发生率为83%；文化程度为初中以及下组不孕症的发生率为76%,高中或中专学历的组人不孕症的发生率为9.5%；文化程度为大专或以上学历的组不孕症的发生率为16.9%。蓝领不孕症的发生率为7.9%；白领不孕症的发生率为14%。多因素Logistic回归分析结果显示：结婚年龄≥25岁的人不孕症发生率是20-岁结婚的1.27倍；妻子文化程度是大专或以上学历的不孕症大发生率是学历为初中及以下的214倍,非农业户籍不孕症发生率是农业户籍的1.31倍。
4.不孕症门诊现场调查结果
4.1不孕症病因总的分析
本研究共调查了1449对来不孕门诊寻求诊疗的夫妇。至病例资料收集截止时,有1179例己查到病因,占81.4%。根据不孕症的病因可以分为单纯女性因素,单纯男性因素和男女共同因素三大类。不孕原因为单纯女性因素的占49.5%；单纯男性因素占11.9%；双方共同因素的有占18.6%。根据WHO提出了以病因诊断为依据的分类方法,不孕症病因中占首位的是输卵管问题,占51.5%；第二位是男性因素,占31.9%,第三位是宫颈因素,占26.1%；第四位是排卵问题,占18%；第五位是子宫因素,占14.4%。
4.2不孕症病因女性因素分析
我们的研究发现这1449对不孕症夫妇中,女性因素有1007人。原发性不孕症占56.1%；继发性不孕症占43.9%。女性继发不孕症患者病因占首位的是输卵管问题(78.3%),其次是宫颈因素(42.5%),占第三位的是排卵问题(16.5%),最后是子宫因素(14.3%)。而原发性不孕症患者不孕症病因占首位的是宫颈因素(35.7%),占第二位的是子宫因素(25.8%),其次是排卵问题(25.5%),最后是输卵管问题(10.8%)。
4.3不孕症病因男性因素分析
研究结果表明共有462名男性存在不育问题。不孕症男性因素中最主要的原因是精液质量问题,占男性不育原因的87.2%；其次是早泄,约占22.5%,排在第三位的是前列腺炎史,占17.5%,第四位是阳萎占8.9%,第五位是性交困难,占6.3%。男性不育其中精液有问题的最多,高达403人。有37.4%的人存在精液液化不良；有47.6%的人精子计数少；有68.8%的人精子活率低；有66.2%的人精子活力差。另外我们进行深一步分析发现在本研究中不孕原因不明(非女性因素)的269例中有191例男性没有做精液检查,也就是说有71%(191/269)的原因不明的不孕症不能确定是否是男性的原因。
[结论]
1.育龄妇女信息系统(WIS)现有资料分析结论
1.1 1995-2004年这10年间妇女婚后1年累计未怀孕率上升降趋势。
1.2按照年龄分层,随着年代的推进,妇女婚后1年累计未怀孕率和至今未怀孕率都呈上升趋势。
1.3随着女性初婚年龄的增加,生育能力有下降趋势。
2.中国三省份新婚人群不孕症发生率分析结论
2.1新婚人群不孕症发生率高；
2.2结婚年龄越晚,发生不孕症的可能性越大；
2.3不孕症的发生存在地区差异,四川省新婚人群不孕症发生率最高；
2.4不孕症患者就诊率低,不能及时就诊。
3.蚌埠市新婚人群不孕症发生率及影响因素研究结论
3.1妻子结婚年龄晚、学历高、非农业户籍的人是不孕症的危险因素。
4.不孕症门诊调查结论
4.1不孕症的病因单纯女性因素居多,其次是双方因素,最后是单纯男性因素；
4.2根据WHO提出了病因分类方法,不孕症病因中占首位的是输卵管问题,第二位是男性因素,第三位是宫颈因素,第四位是排卵问题,第五位是子宫因素；
4.3女性继发不孕症患者病因输卵管问题占首位,其次是宫颈因素,占第三位的是排卵问题,最后是子宫因素。而原发性不孕症患者不孕症病因占首位的是宫颈因素,占第二位的是子宫因素,其次是排卵问题,最后是输卵管问题；
4.4不孕症男性因素中最主要的原因是精液问题,男性患者存在不就诊问题。
Backgrounds: Infertility has now become a global medical and social problem. It has received widespread attention for relating to couple of childbearing age. Since the later 1970s to the early 1980s, many counties has paid attention to infertility and carried out some studies on the incidence of infertility and its etiology. A study conducted by WHO in 33 research centers in 25 countries indicated that the incidence of infertility was 5% to 8% in developed countries; while the rate was as high as 30% in developing counties.
Only a few of small-scale investigation data were reported in our country between1970s to 1980s. And the related research was also scarce. The number of patients with infertility has increased year by year in recent years due to competition, employment pressures and the devastation of the natural environment. Our government is carrying out "one couple, one child" policy. In general, urban couples are restricted to one while rural couples are allowed up to two if their first child is a girl. So we should investigate the infertility rate among newly married people.
Much research on the infertility was oneness of research not several sources study. And the results of incidence of infertility were with a wide range in different research. One reason was the difference of respondents'age for stratified cluster sampling in different studies. In addition, the infertility was different in different region and race.
Infertility is a very complex physiological process, and it is also a special reproductive health defects. It is different from other clinical diseases. It affects family and community severely for physiological and psychological reasons. Most patients with infertility want get rid of the infertility and get assistance from health facility. So we need to study the etiology and influencing factors of infertility. In that case, we can prove the evidence to improve the human quality in our country. First, our research will use pre-existing data based on "women with reproductive age in family planning system (WIS) to fertility status of after marriage among newly married women in the past 10 years. In addition, we will use field survey to investigate infertility rate and its influencing factors among newly married population. Third, we will investigate infertility clinic patients to understand the reason of infertility. Generally speaking, our research include threes parts:the infertility rate study, infertility influencing factors and its reason' study.
General objectives:From several sources, more than one perspective, a number of levels to study the infertility, its influencing factors and reasons among newly married women in six counties in three provinces in China.
Specific objective:
1. Specific objective of pre-existing data based on "women with reproductive age in family planning system (WIS)"
1) To understand the fertility status of after marriage among newly married women in three provinces;
2) To understand the tendency of newly married women's birth timing in different ages in three provinces;
3) To compare the relationship between women's age at marriage and their birth timing.
2. Specific objective of infertility rate among newly married population in three provinces:
1) To understand the infertility rate among newly married population in three provinces,
2) To explore the relationship between infertility rate and women's age at marriage;
3) To compare the incidence of infertility in three provinces;
4) To understand the health seeking behavior among infertile patients.
3. Specific objective of infertility rate and influencing factors in Bengbu city:
1) To understand the infertility rate and influencing factors among newly married people in Bengbu city.
4. Specific objective of infertility clinic investigation:
1) To understand the general reason of infertility;
2) To understand the reason of female infertility;
3) To understand the reason of male infertility.
Objective and Method
There are two sources of this study. One of source was based on the pre-existing data based on "women with reproductive age in family planning system (WIS)", the other came from field survey. The field survey included the investigation of newly married people and investigation of infertile patients.
1. Objective
We used purposive sampling method to collect the data of the newlywed people from six counties in 3 provinces. The site measured date came from Mengchen and Bengbu counties in Anhui provinces, Shehong and Yuezhi counties in Sichuan provinces, Nanle and Biyang counties in Henan provinces.
1.1 Criteria for the selection
1.1.1 Criteria for the selection of pre-existing data (WIS):Newly married people who got married between 1995 and 2004 in six counties.
1.1.2 Criteria for the selection of newly married people in three provinces:Newly married people who got married between 2005 and 2006 in six counties. The detail Criteria for the selection of respondents were as following:1) women's age at marriage was legal and in their reproductive lives, the other word:wife's age at marriage≥20 and <49 years; 2) men's age at marriage was legal and in their reproductive lives, the other word:husband's age at marriage≥22 and<49 years; 3) Both spouse were first marriage; 4) permanent population in this county.
1.1.3 Criteria for the selection of infertile patients from clinic:infertile patients who seeking therapy from November 2009 to March 2010 in six counties.
2. Investigated methods
The study of pre-existing data (WIS), the investigation among newly married people and infertile patients from clinic belong to Cross-sectional Study.
3. Content of the study
3.1 Content of the re-existing data (WIS):The contents of survey include:1) the demographic characteristics, such as birthday, marriage day, census register; 2) fertility circumstance.
3.2 Content of newly married people in three provinces and Bengbu city:The contents of survey include:1) the demographic characteristic; 2) fertility circumstance; 3) contraceptive history; 4) health seeking behavior.
3.3 Content of infertile patients from clinic:1) the demographic characteristic; 2) menstrual history, child-bearing history and sexual history, ea al; 2) women's disease history, physical examination and examination of department of gynaecology; 4) medication history for infertility therapy; 5) investigation for men:age, semen examination, Genital disease history, et al.
4 Analyze methods:
After questionnaires filled, the researcher of each study site checked all the questionnaires. Use Epidata 3.0 to establish a database; all the questionnaire were inputted for two times. Use the SPSS 15.0 statistical software package to discover the logic problems.
Means and standard deviation were used to describe the continuous variable if it is normal distribution, otherwise, the quartile were used. In addition, we changed the continuous variable into categorical variable andχ2 Test was used to compare difference in different groups. Stratified analyses were used to control the Confounding factor. Logistic regression was used to analyze the influencing factors of infertility.
Results
1 results of re-existing data (WIS):
1.1 Analysis of the fertility among newly married women after marriage
The results indicated that the proportion of women who didn't get pregnancy inl year after marriage has increased in the past 10 years. The proportion of women who didn't get pregnancy in1 year after marriage increased from22.3% in 1995 to 28.3% in 2004. We divided 10 years into three different parts,1995-1998,1999-2001, and 2002-2004. The Cumulative p proportion of women who didn't get pregnancy inl year after marriage was 22.8% for women who got married in 1995-1998; this rate was 25.9% for women who got married in 1999-2001; the rate increased to 27.7% for women who got married in 2002-2004.
1.2The tendency of newly married women's fertility condition in different ages
Because women's age at marriage was different in different ages, stratified analysis was used to analyze the women's fertility condition. The results showed that the proportion of women who didn't get pregnancy in1 year after marriage of 1995-1998 was 22.4% in 20～years old group; the rate the rate increased to 25.1% of 1999-2001 in the same group at first marriage. The proportion of women who didn't get pregnancy in1 year after marriage of 1995-1998 was 24% in 25-years old group; The rate the rate increased to 32% of 2002-2004 in the same group. The proportion of women who didn't get pregnancy inl year after marriage of 1995-1998 was 25.4% in 30 years old or above group, but the rate sharply increased to 35.9% of 2002-2004 in the same group women at first marriage. See the following figure.
1.3 The relationship between women's age at marriage and their fertility condition
The results of stratified analysis indicated that 3% women were no pregnancy till now after marriage of 1995-1998 in 20～years old group; the rate were3.6%,7.3% for women got marriage in 1995-1998 with 25～years old group and more than 30 years group, respectively. At the same time the proportion of women who didn't get pregnancy in1 year after marriage were 22.4%,24% and 25.4%, respectively. See the following figure.
For those women who got marriage in 1999-2001,5.2% women were no pregnancy till now after marriage; the rate were 6.3%,13.3% for women got marriage with 25～years old group and more than 30 years group, respectively. At the same time the proportion of women who didn't get pregnancy in1 year after marriage were 25.1%,28% and 32.6%, respectively. See the following figure.
For those women who got marriage in 2002-2004,9% women were no pregnancy till now after marriage; the rate were 12.4%,30.3% for women got marriage with 25～years old group and more than 30 years group, respectively. At the same time the proportion of women who didn't get pregnancy in1 year after marriage were 25.7%,32% and 44.2%, respectively. See the following figure.
2. Results of newly married people in three provinces:
2.1 The infertility rate of three provinces
We totally investigated 55984 newly married women in Anhui province, Henan province and Sichuan province. The results indicated that there were 3920 infertility women, and the infertility rate was 7.4% in those provinces.
2.2 The relationship between infertility and women's age at marriage
The infertility rate was 7.0% for women who got marriage with 20-years old, the infertility rate was 8.6% for those women who got marriage with 25-years old, and the rate was as high as 12.5% for those women who got marriage 30 years or above. There was a statistically significant difference.
2.3 The compare the incidence of infertility in three provinces
The results showed that the infertility rate was different between three provinces. The infertility rate was 10.9% for Sichuan provinces,6.0% for Henan provinces, and 5.9% for Anhui provinces. There was a statistically significant difference. The results from standardization indicated that adjustment infertility rate was 10.86% for Sichuan provinces, 6.08% for Anhui provinces, and 5.89% for Henan provinces.
2.4 Heath seeking behavior
The results indicated that the number of infertility was 3920 in our survey. But only 33.1% of them went to hospital for treatment. Among those infertility women, only 1225 accepted related therapy.
3. Results of infertility rate and influencing factors among newly married women in Bengbu city
We totally investigated 8390 newly married women in six distracts in Bengbu city. The results indicated that the infertility rate was 10.5% among newly married women in Bengbu city. The single factor analysis indicated that the infertility rate was 8.7% for women who had married at age 20～years, while the rate was 13% for those who had married at age 25 year old or above. There was a statistically significant difference. 12.5% of non-agricultural census register population was infertility, while 6.5% agricultural census register population was infertility. The infertility rate was 8.3 for women with Primary school,7.6% for women with middle school,9.5% for women with high schools,16.9% for women with college or above. The infertility rate was 7.9% for women with blue-collar,14% for women with white-collar. The results of logistic regression indicated that in comparison with women who had married at ages 20～, the multivariate odds ratios (OR) was 1.27 for women who had married at ages 25 years or older. Compared with wife's education level was middle school or lower, the OR of infertility was 2.14 for women with education level was college or above. The OR of infertility was 1.31 for non-agricultural census register population versus those agricultural census register.
4. Results of infertility clinic investigation
4.1 The reason of infertility
We totally investigated 1449 infertile patients when they went to hospital. At the end of data collection, there were 1179 cases have found the cause of the infertility. The reason of infertility simplex ascribed to women factors was 717, accounting for 49.5%; the reason of infertility simplex ascribed to men factors was 172, accounting for 11.9%; reason of infertility ascribed to both couples factors was 994, accounting for 18.6%. According to WHO classify of infertility, the main reason of infertility was tubal disease, followed by male factor, the third reason was cervical factors, ovulatory disorders were the fourth reason of infertility, the last one was uterus factors.
4.2 The analysis of female infertility
We totally investigated 1449 infertile patients, and 1007 women have infertility reason. The primary infertility was 56.1% and secondary infertility was 43.9%. The main reason of secondary infertility was tubal disease (78.3%), followed by cervical factors (42.5%), the third reason was ovulatory disorders (16.5%), and the fourth reason was uterus factors (14.3%). Among those primary infertility patients, the main reason was cervical factors (35.7%), followed by uterus factors (25.8%), the third reason was ovulatory disorders (25.5%), and the fourth reason was tubal disease (10.8%).
4.3 The analysis of male infertility
The results indicated that 462 male had infertility problem. Among the main reasons of male infertility, the seminal quality had the highest proportion, accounting for 87.2%, followed by Ejaculation Dysfunction, accounting for 22.5%, the third reason was prostatitis history, accounting for 17.5%, the fourth reason was impotence, accounting for 8.9%, the fifth reason was dyspareunia, accounting for 6.3%. The main reason of male infertility was sperm problem. As high as 403 men has perm problem. Among of them,37.4% were semen unliquefaction,47.6% were Spermacrasia,68.8% sperm motility of sperm was low, and 66.2% sperm activity rate was low. In addition, in the deep further analysis we found that among 269 unexplained infertility patients,191 of them didn't examine the male problem. That means, among 71% unexplained infertility patients we don't know whether the infertility reason ascribed to men.
Conclusion:
1. Conclusion of re-existing data (WIS)
1.1 The proportion of women who didn't get pregnancy inl year after marriage has increased in the past 10 years;
1.2 stratified analysis indicated that women who didn't get pregnancy in1 year after marriage was on the rise with women increasing age at marriage;
1.3 With the age increasing at marriage, the fertility ability declined.
2. Conclusion of newly married women in three provinces
2.1 The infertility rate was high among newly married women;
2.2 Women at older age at marriage were risk factor of infertility;
2.3 The infertility rate was different in different region; the Sichuan province has the high infertility rate;
2.4 Most infertility patients didn't go to health institution for therapy.
3. Conclusion of newly married women in Bengbu city
3.1 Women with older age at marriage, the higher the level of schooling, and non-agricultural census register population was risk factor of infertility.
4. Conclusion of infertility clinic investigation
4.1 The main reasons of infertility was simplex women factor, followed by both factor and simplex men factors;
4.2 According to WHO classify of infertility, the main reason of infertility was tubal disease, followed by male factor, the third reason was cervical factors, ovulatory disorders were the fourth reason of infertility, the last one was uterus factors;
4.3 The main reason of secondary infertility was tubal disease, followed by cervical factors, the third reason was ovulatory disorders, and the fourth reason was uterus factors. Among those primary infertility patients, the main reason was cervical factors followed by uterus factors, the third reason was ovulatory disorders, and the fourth reason was tubal disease;
4.4 The main reasons of male infertility were seminal quality problem, and male infertile patients didn't seek treatment.
不孕症是涉及全球各个地区或国家育龄夫妇的问题,它已受到全世界的广泛关注。70年代末到80年代出,各国开始重视不孕症的问题,陆续开展不孕症的发生率和病因学的研究。80年代中末期WHO在25个国家的33个研究中心组织了一次采用标准化诊断的不孕症夫妇调查,结果表现发达国家约有5%～8%的夫妇受到不孕的影响,发展中国家一些地区不孕症的发生率可高达30%。
在70～80年代,我国有关不孕症的发生率见于几份零星的调查,90年代后也少见相关的报道。近年来由于社会竞争、就业压力的增大以及环境的恶化不孕症的病人确实增多。我国的计划生育政策是生育一个孩子以后夫妻必须采取避孕措施,因此在我国研究不孕症发生率最好是新婚人群。
国内有关不孕症发生率的研究单一研究较多,并各地报道的不孕症发生率差异很大,可能与不同研究的调查对象为整个育龄期妇女而未采取各年龄段进行分层抽样调查有关；另外,其发生率尚有地域、种属不同的差异。
不孕症是一个非常复杂的生理过程,是一种特殊的生殖健康缺陷,它不同于临床上其他的疾病,由于其生理、心理因素并存,故常常给家庭、社会造成严重的影响,大多数不孕症患者迫切渴望得到医疗帮助,早日摆脱不孕症的困扰。因此我们有必要对不孕症的病因及影响因素及诊治情况进行研究,为提高我国的人口质量提供依据。我们的研究首先通过育龄妇女信息系统WIS系统现有资料来粗略的分析一下10年来新婚妇女的生育情况,并且通过现场调查分析不孕症的发生率及影响因素,此外还通过调查不孕症门诊患者来了解不孕症患者的病因情况。总的来说本研究包括不孕症发生率的调查、不孕症影响因素的调查以及不孕症病因调查。
[研究目的]：
1.研究总目的：从多个来源,多个视角,多个层面来研究中国三个省份6个县市新婚人群生育能力及不孕症因的发生率、影响因素及病因的流行病学现状。
2.具体目的：
2.1中国三省育龄妇女信息系统(WIS)现有资料研究目的：
1)了解3省初婚妇女结婚后生育情况；
2)了解3省初婚妇女婚后生育时间随年代变化趋势；
3)了解3省初婚妇女结婚年龄与婚后生育时间的关系。
2.2中国三省新婚人群不孕症发生率研究目的：
1)了解中国三省新婚夫妇不孕症发生率；
2)探讨三省不孕症发生与女性结婚年龄的关系；
3)比较三省新婚夫妇不孕症发生率的差异；
4)了解不孕人群的求医情况。
2.3蚌埠市新婚人群不孕症发生率及影响因素研究目的：
1)了解蚌埠新婚人群不孕症发生率的影响因索。
2.4中国三省不孕症门诊现场调查目的：
1)不孕患者不孕病因总体分布情况；
2)不孕症病因女性因索分析；
3)不孕症病因男性因素分析。
[研究对象与方法]：
本研究资料来源有两种,一是对育龄妇女信息系统(WIS)现有资料分析,一种是现场调查,其中现场调查包括对新婚人群的现场调查和不孕症门诊病人的现场调查两种。
1.研究对象
本研究为意向性抽样。研究现场包括安徽省的蒙城县、蚌埠市,四川省的射洪县、乐至县,以及河南省的南乐和泌阳县,共三省6个县(市)。
1.1研究对象的选择
1.1.1中国三省WIS系统现有资料的研究对象选择标准
6个县(市)1995年到2004年这10年间结婚的人员。
1.1.2中国三省份新婚人群不孕症发生率研究对象选择标准
6个县(市)所有2005年和2006年结婚的妇女,具体研究对象的纳入标准如下1)女方达到合法结婚年龄并且在生育期,即结婚年龄≥20岁,且<49岁；2)男方达到合法结婚年龄并且在生育期,即结婚年龄≥22岁,且男方结婚年龄<55岁；3)男女双方都是初婚；4)当地常驻人口。蚌埠市新婚人群的研究对象纳入标准与此相同。
1.1.3不孕症门诊现场调查研究对象纳入标准
从2009年11月到2010年5月,6个县(市)寻求不孕症诊疗的不孕症患者。
2.调查方法
本研究的调查发方法属于横断面研究。
3.研究内容
3.1 WIS系统现有资料：研究内容包括：1)基本人口学特征：出生日期、结婚日期、户籍；2)生育情况。
3.2三省及蚌埠不孕症发生率研究：研究内容包括：1)基本人口学特征；2)生育情况；3)避孕情况；4)不孕症的就诊情况。
3.2.不孕症门诊调查：研究内容包括：1)基本人口学特征；2)月经史、妊娠史、性生活史等；3)女方相关的疾病史、体格检查、妇科检查和有关的特殊检查；4)女方治疗不孕症的用药史；5)男方调查：年龄、精液检查、生殖器疾病史等。
4.分析方法
用Epidata软件录入数据,采用双录入方法,然后将所有数据导入SPSS,利用SPSS15.0软件进行逻辑检查,从而获得清洁数据。
对于连续性变量,如果是正态分布进行基本统计学描述时用均值和标准差来描述,否则用四分位数来描述。另外在比较不同组之间的差异时候,按照实际情况,我们对连续性变量进行分组转换成分类变量处理。对于分类变量我们采用卡方检验来比较不同组之间的差异。对于混杂因素,我们采用分层分析和标准化法。为了了解蚌埠市新婚人群不孕症的影响因素,我们做了Logistic回归分析。
[研究结果]
1.育龄妇女信息系统(WIS)现有资料分析结果
1.1女方结婚后生育情况
初婚女性结婚后1年累计未怀孕的比例呈上升趋势,从1995年的22.3%,上升到2004年的28.3%。我们将这10年分为1995-1998,1999-2001和2002-2004年三个年代组。95-98年结婚的人,婚后1年累计未怀孕率是22.8%；99-01年结婚的人,婚后1年累计未怀孕率是25.9%；02-04年结婚的人婚后1年累计未怀孕率上升到27.7%。
1.2女方婚后生育情况与年代的关系
考虑到不同年代,女性结婚年龄构成比有所不同,采用按照年龄分层分析不同年代妇女结婚后生育情况。研究结果如下图显示：从图可以看出来每一个年龄组的人结婚后1年内未怀孕率都是随年代呈现上升趋势的。例如20～岁结婚的95-98年婚后1年内未怀孕率是22.4%,99-01年结婚年龄是20～岁的人婚后1年内未怀孕率上升到25.1%,02-04年结婚年龄在20～岁的人婚后1年内未怀孕率上升到25.7%。结婚年龄在25～岁的人婚后1年内未怀孕率在95-98年是24%,但是到02-04年上升到32%。尤其是≥30岁结婚的人婚后1年内未怀孕率在95-98年是25.4%,但是到02-04年的时候婚后1年内未怀孕率上升到35.9%。
1.3女方结婚年龄与生育情况的关系
分层分析结果显示：95-98年结婚,20-岁结婚的人至今有3%的人尚未生育,25～岁结婚的人至今有3.6%的人尚未生育,≥30岁结婚的人至今有7.3%的人尚未生育。与此同时这三个年龄组的人在结婚后1年未怀孕比例也呈上升趋势,分别是22.4%,24%和25.4%。
99-01年结婚,20～岁结婚的人至今有5.2%的人尚未生育,25～岁结婚的人至今有6.3%的人尚未生育,≥30岁结婚的人至今有13.3%的人尚未生育。与此同时这20～岁组,25～岁和结婚年龄≥30岁这三个年龄组的人在结婚后1年未怀孕比例也呈上升趋势,分别是25.1%,28%和32.6%。具体结果如下图。
02-04年结婚,20～岁结婚的人至今有9%的人尚未生育,25～岁结婚的人至今有12.4%的人尚未生育,≥30岁结婚的人至今有30.3%的人尚未生育。与此同时这20～岁组,25～岁和结婚年龄≥30岁这三个年龄组的人在结婚后1年未怀孕比例也呈上升趋势,分别是25.7%,32%和44.2%。结果如下图。
2.中国三省份新婚人群不孕症发生率分析结果
2.1三省不孕症发生率
本研究共调查了安徽省、河南省和四川省6个县市的55984人。研究结果显示真正不孕症患者有3920人是真正的不孕症患者,不孕症发生率是7.4%。
2.2不孕症发生率与女性结婚年龄的关系
结婚年龄在20～岁结婚的人不孕症发生率是7.0%,25～岁结婚的人不孕症的发生率是8.6%,大于等于30岁结婚的人不孕症的发生率是12.5%,差别有统计学意义。
2.3三省新婚夫妇不孕症发生率比较
研究结果显示：不同省份之间不孕症发生率粗率不同,四川省不孕症发生率最高为10.9%,其次是河南为6.0%,安徽省不孕症发生率为5.9%,差别有统计学意义。标准化法比较这三个省的不孕症发生率后发现四川省不孕症发生率校正率为10.86%,河南省为6.08%,安徽省为5.89%。
2.4不孕人群的求医情况
我们共调查得到3920名不孕症患者,仅有33.1%人就诊过不孕症。有11.0%的人去过省级以及上级别的医院；有27.6%的人就诊过市级医院；有69%的人就诊过县级医院；有15.4%的人是在县级以下医院就诊的。有1225人接受过不孕症治疗,仅占不孕人数的31.25%。
3.蚌埠市新婚人群不孕症发生率及影响因素研究
本研究共调查了蚌埠市6个区共8390名新婚夫妇。研究结果显示：不孕症发生率为10.5%。单因素分析结果显示：20～岁结婚的人中不孕症发生率为8.7%,≥25岁结婚的人不孕症的发生率为13%,差异有统计学意义。非农业户口的女性不孕症发生率为12.5%,而农业户口的女性不孕症的发生率仅为65%。妇女文化程度为小学及以下的组,不孕症的发生率为83%；文化程度为初中以及下组不孕症的发生率为76%,高中或中专学历的组人不孕症的发生率为9.5%；文化程度为大专或以上学历的组不孕症的发生率为16.9%。蓝领不孕症的发生率为7.9%；白领不孕症的发生率为14%。多因素Logistic回归分析结果显示：结婚年龄≥25岁的人不孕症发生率是20-岁结婚的1.27倍；妻子文化程度是大专或以上学历的不孕症大发生率是学历为初中及以下的214倍,非农业户籍不孕症发生率是农业户籍的1.31倍。
4.不孕症门诊现场调查结果
4.1不孕症病因总的分析
本研究共调查了1449对来不孕门诊寻求诊疗的夫妇。至病例资料收集截止时,有1179例己查到病因,占81.4%。根据不孕症的病因可以分为单纯女性因素,单纯男性因素和男女共同因素三大类。不孕原因为单纯女性因素的占49.5%；单纯男性因素占11.9%；双方共同因素的有占18.6%。根据WHO提出了以病因诊断为依据的分类方法,不孕症病因中占首位的是输卵管问题,占51.5%；第二位是男性因素,占31.9%,第三位是宫颈因素,占26.1%；第四位是排卵问题,占18%；第五位是子宫因素,占14.4%。
4.2不孕症病因女性因素分析
我们的研究发现这1449对不孕症夫妇中,女性因素有1007人。原发性不孕症占56.1%；继发性不孕症占43.9%。女性继发不孕症患者病因占首位的是输卵管问题(78.3%),其次是宫颈因素(42.5%),占第三位的是排卵问题(16.5%),最后是子宫因素(14.3%)。而原发性不孕症患者不孕症病因占首位的是宫颈因素(35.7%),占第二位的是子宫因素(25.8%),其次是排卵问题(25.5%),最后是输卵管问题(10.8%)。
4.3不孕症病因男性因素分析
研究结果表明共有462名男性存在不育问题。不孕症男性因素中最主要的原因是精液质量问题,占男性不育原因的87.2%；其次是早泄,约占22.5%,排在第三位的是前列腺炎史,占17.5%,第四位是阳萎占8.9%,第五位是性交困难,占6.3%。男性不育其中精液有问题的最多,高达403人。有37.4%的人存在精液液化不良；有47.6%的人精子计数少；有68.8%的人精子活率低；有66.2%的人精子活力差。另外我们进行深一步分析发现在本研究中不孕原因不明(非女性因素)的269例中有191例男性没有做精液检查,也就是说有71%(191/269)的原因不明的不孕症不能确定是否是男性的原因。
[结论]
1.育龄妇女信息系统(WIS)现有资料分析结论
1.1 1995-2004年这10年间妇女婚后1年累计未怀孕率上升降趋势。
1.2按照年龄分层,随着年代的推进,妇女婚后1年累计未怀孕率和至今未怀孕率都呈上升趋势。
1.3随着女性初婚年龄的增加,生育能力有下降趋势。
2.中国三省份新婚人群不孕症发生率分析结论
2.1新婚人群不孕症发生率高；
2.2结婚年龄越晚,发生不孕症的可能性越大；
2.3不孕症的发生存在地区差异,四川省新婚人群不孕症发生率最高；
2.4不孕症患者就诊率低,不能及时就诊。
3.蚌埠市新婚人群不孕症发生率及影响因素研究结论
3.1妻子结婚年龄晚、学历高、非农业户籍的人是不孕症的危险因素。
4.不孕症门诊调查结论
4.1不孕症的病因单纯女性因素居多,其次是双方因素,最后是单纯男性因素；
4.2根据WHO提出了病因分类方法,不孕症病因中占首位的是输卵管问题,第二位是男性因素,第三位是宫颈因素,第四位是排卵问题,第五位是子宫因素；
4.3女性继发不孕症患者病因输卵管问题占首位,其次是宫颈因素,占第三位的是排卵问题,最后是子宫因素。而原发性不孕症患者不孕症病因占首位的是宫颈因素,占第二位的是子宫因素,其次是排卵问题,最后是输卵管问题；
4.4不孕症男性因素中最主要的原因是精液问题,男性患者存在不就诊问题。
Backgrounds: Infertility has now become a global medical and social problem. It has received widespread attention for relating to couple of childbearing age. Since the later 1970s to the early 1980s, many counties has paid attention to infertility and carried out some studies on the incidence of infertility and its etiology. A study conducted by WHO in 33 research centers in 25 countries indicated that the incidence of infertility was 5% to 8% in developed countries; while the rate was as high as 30% in developing counties.
Only a few of small-scale investigation data were reported in our country between1970s to 1980s. And the related research was also scarce. The number of patients with infertility has increased year by year in recent years due to competition, employment pressures and the devastation of the natural environment. Our government is carrying out "one couple, one child" policy. In general, urban couples are restricted to one while rural couples are allowed up to two if their first child is a girl. So we should investigate the infertility rate among newly married people.
Much research on the infertility was oneness of research not several sources study. And the results of incidence of infertility were with a wide range in different research. One reason was the difference of respondents'age for stratified cluster sampling in different studies. In addition, the infertility was different in different region and race.
Infertility is a very complex physiological process, and it is also a special reproductive health defects. It is different from other clinical diseases. It affects family and community severely for physiological and psychological reasons. Most patients with infertility want get rid of the infertility and get assistance from health facility. So we need to study the etiology and influencing factors of infertility. In that case, we can prove the evidence to improve the human quality in our country. First, our research will use pre-existing data based on "women with reproductive age in family planning system (WIS) to fertility status of after marriage among newly married women in the past 10 years. In addition, we will use field survey to investigate infertility rate and its influencing factors among newly married population. Third, we will investigate infertility clinic patients to understand the reason of infertility. Generally speaking, our research include threes parts:the infertility rate study, infertility influencing factors and its reason' study.
General objectives:From several sources, more than one perspective, a number of levels to study the infertility, its influencing factors and reasons among newly married women in six counties in three provinces in China.
Specific objective:
1. Specific objective of pre-existing data based on "women with reproductive age in family planning system (WIS)"
1) To understand the fertility status of after marriage among newly married women in three provinces;
2) To understand the tendency of newly married women's birth timing in different ages in three provinces;
3) To compare the relationship between women's age at marriage and their birth timing.
2. Specific objective of infertility rate among newly married population in three provinces:
1) To understand the infertility rate among newly married population in three provinces,
2) To explore the relationship between infertility rate and women's age at marriage;
3) To compare the incidence of infertility in three provinces;
4) To understand the health seeking behavior among infertile patients.
3. Specific objective of infertility rate and influencing factors in Bengbu city:
1) To understand the infertility rate and influencing factors among newly married people in Bengbu city.
4. Specific objective of infertility clinic investigation:
1) To understand the general reason of infertility;
2) To understand the reason of female infertility;
3) To understand the reason of male infertility.
Objective and Method
There are two sources of this study. One of source was based on the pre-existing data based on "women with reproductive age in family planning system (WIS)", the other came from field survey. The field survey included the investigation of newly married people and investigation of infertile patients.
1. Objective
We used purposive sampling method to collect the data of the newlywed people from six counties in 3 provinces. The site measured date came from Mengchen and Bengbu counties in Anhui provinces, Shehong and Yuezhi counties in Sichuan provinces, Nanle and Biyang counties in Henan provinces.
1.1 Criteria for the selection
1.1.1 Criteria for the selection of pre-existing data (WIS):Newly married people who got married between 1995 and 2004 in six counties.
1.1.2 Criteria for the selection of newly married people in three provinces:Newly married people who got married between 2005 and 2006 in six counties. The detail Criteria for the selection of respondents were as following:1) women's age at marriage was legal and in their reproductive lives, the other word:wife's age at marriage≥20 and <49 years; 2) men's age at marriage was legal and in their reproductive lives, the other word:husband's age at marriage≥22 and<49 years; 3) Both spouse were first marriage; 4) permanent population in this county.
1.1.3 Criteria for the selection of infertile patients from clinic:infertile patients who seeking therapy from November 2009 to March 2010 in six counties.
2. Investigated methods
The study of pre-existing data (WIS), the investigation among newly married people and infertile patients from clinic belong to Cross-sectional Study.
3. Content of the study
3.1 Content of the re-existing data (WIS):The contents of survey include:1) the demographic characteristics, such as birthday, marriage day, census register; 2) fertility circumstance.
3.2 Content of newly married people in three provinces and Bengbu city:The contents of survey include:1) the demographic characteristic; 2) fertility circumstance; 3) contraceptive history; 4) health seeking behavior.
3.3 Content of infertile patients from clinic:1) the demographic characteristic; 2) menstrual history, child-bearing history and sexual history, ea al; 2) women's disease history, physical examination and examination of department of gynaecology; 4) medication history for infertility therapy; 5) investigation for men:age, semen examination, Genital disease history, et al.
4 Analyze methods:
After questionnaires filled, the researcher of each study site checked all the questionnaires. Use Epidata 3.0 to establish a database; all the questionnaire were inputted for two times. Use the SPSS 15.0 statistical software package to discover the logic problems.
Means and standard deviation were used to describe the continuous variable if it is normal distribution, otherwise, the quartile were used. In addition, we changed the continuous variable into categorical variable andχ2 Test was used to compare difference in different groups. Stratified analyses were used to control the Confounding factor. Logistic regression was used to analyze the influencing factors of infertility.
Results
1 results of re-existing data (WIS):
1.1 Analysis of the fertility among newly married women after marriage
The results indicated that the proportion of women who didn't get pregnancy inl year after marriage has increased in the past 10 years. The proportion of women who didn't get pregnancy in1 year after marriage increased from22.3% in 1995 to 28.3% in 2004. We divided 10 years into three different parts,1995-1998,1999-2001, and 2002-2004. The Cumulative p proportion of women who didn't get pregnancy inl year after marriage was 22.8% for women who got married in 1995-1998; this rate was 25.9% for women who got married in 1999-2001; the rate increased to 27.7% for women who got married in 2002-2004.
1.2The tendency of newly married women's fertility condition in different ages
Because women's age at marriage was different in different ages, stratified analysis was used to analyze the women's fertility condition. The results showed that the proportion of women who didn't get pregnancy in1 year after marriage of 1995-1998 was 22.4% in 20～years old group; the rate the rate increased to 25.1% of 1999-2001 in the same group at first marriage. The proportion of women who didn't get pregnancy in1 year after marriage of 1995-1998 was 24% in 25-years old group; The rate the rate increased to 32% of 2002-2004 in the same group. The proportion of women who didn't get pregnancy inl year after marriage of 1995-1998 was 25.4% in 30 years old or above group, but the rate sharply increased to 35.9% of 2002-2004 in the same group women at first marriage. See the following figure.
1.3 The relationship between women's age at marriage and their fertility condition
The results of stratified analysis indicated that 3% women were no pregnancy till now after marriage of 1995-1998 in 20～years old group; the rate were3.6%,7.3% for women got marriage in 1995-1998 with 25～years old group and more than 30 years group, respectively. At the same time the proportion of women who didn't get pregnancy in1 year after marriage were 22.4%,24% and 25.4%, respectively. See the following figure.
For those women who got marriage in 1999-2001,5.2% women were no pregnancy till now after marriage; the rate were 6.3%,13.3% for women got marriage with 25～years old group and more than 30 years group, respectively. At the same time the proportion of women who didn't get pregnancy in1 year after marriage were 25.1%,28% and 32.6%, respectively. See the following figure.
For those women who got marriage in 2002-2004,9% women were no pregnancy till now after marriage; the rate were 12.4%,30.3% for women got marriage with 25～years old group and more than 30 years group, respectively. At the same time the proportion of women who didn't get pregnancy in1 year after marriage were 25.7%,32% and 44.2%, respectively. See the following figure.
2. Results of newly married people in three provinces:
2.1 The infertility rate of three provinces
We totally investigated 55984 newly married women in Anhui province, Henan province and Sichuan province. The results indicated that there were 3920 infertility women, and the infertility rate was 7.4% in those provinces.
2.2 The relationship between infertility and women's age at marriage
The infertility rate was 7.0% for women who got marriage with 20-years old, the infertility rate was 8.6% for those women who got marriage with 25-years old, and the rate was as high as 12.5% for those women who got marriage 30 years or above. There was a statistically significant difference.
2.3 The compare the incidence of infertility in three provinces
The results showed that the infertility rate was different between three provinces. The infertility rate was 10.9% for Sichuan provinces,6.0% for Henan provinces, and 5.9% for Anhui provinces. There was a statistically significant difference. The results from standardization indicated that adjustment infertility rate was 10.86% for Sichuan provinces, 6.08% for Anhui provinces, and 5.89% for Henan provinces.
2.4 Heath seeking behavior
The results indicated that the number of infertility was 3920 in our survey. But only 33.1% of them went to hospital for treatment. Among those infertility women, only 1225 accepted related therapy.
3. Results of infertility rate and influencing factors among newly married women in Bengbu city
We totally investigated 8390 newly married women in six distracts in Bengbu city. The results indicated that the infertility rate was 10.5% among newly married women in Bengbu city. The single factor analysis indicated that the infertility rate was 8.7% for women who had married at age 20～years, while the rate was 13% for those who had married at age 25 year old or above. There was a statistically significant difference. 12.5% of non-agricultural census register population was infertility, while 6.5% agricultural census register population was infertility. The infertility rate was 8.3 for women with Primary school,7.6% for women with middle school,9.5% for women with high schools,16.9% for women with college or above. The infertility rate was 7.9% for women with blue-collar,14% for women with white-collar. The results of logistic regression indicated that in comparison with women who had married at ages 20～, the multivariate odds ratios (OR) was 1.27 for women who had married at ages 25 years or older. Compared with wife's education level was middle school or lower, the OR of infertility was 2.14 for women with education level was college or above. The OR of infertility was 1.31 for non-agricultural census register population versus those agricultural census register.
4. Results of infertility clinic investigation
4.1 The reason of infertility
We totally investigated 1449 infertile patients when they went to hospital. At the end of data collection, there were 1179 cases have found the cause of the infertility. The reason of infertility simplex ascribed to women factors was 717, accounting for 49.5%; the reason of infertility simplex ascribed to men factors was 172, accounting for 11.9%; reason of infertility ascribed to both couples factors was 994, accounting for 18.6%. According to WHO classify of infertility, the main reason of infertility was tubal disease, followed by male factor, the third reason was cervical factors, ovulatory disorders were the fourth reason of infertility, the last one was uterus factors.
4.2 The analysis of female infertility
We totally investigated 1449 infertile patients, and 1007 women have infertility reason. The primary infertility was 56.1% and secondary infertility was 43.9%. The main reason of secondary infertility was tubal disease (78.3%), followed by cervical factors (42.5%), the third reason was ovulatory disorders (16.5%), and the fourth reason was uterus factors (14.3%). Among those primary infertility patients, the main reason was cervical factors (35.7%), followed by uterus factors (25.8%), the third reason was ovulatory disorders (25.5%), and the fourth reason was tubal disease (10.8%).
4.3 The analysis of male infertility
The results indicated that 462 male had infertility problem. Among the main reasons of male infertility, the seminal quality had the highest proportion, accounting for 87.2%, followed by Ejaculation Dysfunction, accounting for 22.5%, the third reason was prostatitis history, accounting for 17.5%, the fourth reason was impotence, accounting for 8.9%, the fifth reason was dyspareunia, accounting for 6.3%. The main reason of male infertility was sperm problem. As high as 403 men has perm problem. Among of them,37.4% were semen unliquefaction,47.6% were Spermacrasia,68.8% sperm motility of sperm was low, and 66.2% sperm activity rate was low. In addition, in the deep further analysis we found that among 269 unexplained infertility patients,191 of them didn't examine the male problem. That means, among 71% unexplained infertility patients we don't know whether the infertility reason ascribed to men.
Conclusion:
1. Conclusion of re-existing data (WIS)
1.1 The proportion of women who didn't get pregnancy inl year after marriage has increased in the past 10 years;
1.2 stratified analysis indicated that women who didn't get pregnancy in1 year after marriage was on the rise with women increasing age at marriage;
1.3 With the age increasing at marriage, the fertility ability declined.
2. Conclusion of newly married women in three provinces
2.1 The infertility rate was high among newly married women;
2.2 Women at older age at marriage were risk factor of infertility;
2.3 The infertility rate was different in different region; the Sichuan province has the high infertility rate;
2.4 Most infertility patients didn't go to health institution for therapy.
3. Conclusion of newly married women in Bengbu city
3.1 Women with older age at marriage, the higher the level of schooling, and non-agricultural census register population was risk factor of infertility.
4. Conclusion of infertility clinic investigation
4.1 The main reasons of infertility was simplex women factor, followed by both factor and simplex men factors;
4.2 According to WHO classify of infertility, the main reason of infertility was tubal disease, followed by male factor, the third reason was cervical factors, ovulatory disorders were the fourth reason of infertility, the last one was uterus factors;
4.3 The main reason of secondary infertility was tubal disease, followed by cervical factors, the third reason was ovulatory disorders, and the fourth reason was uterus factors. Among those primary infertility patients, the main reason was cervical factors followed by uterus factors, the third reason was ovulatory disorders, and the fourth reason was tubal disease;
4.4 The main reasons of male infertility were seminal quality problem, and male infertile patients didn't seek treatment.
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