女性不孕症影响因素分析及应对策略  

Analysis of Risk Factors Related to Female Infertility and Countermeasures

作　　者：姚颖杰[1] 秦茂华[1] 陈云雁[1] 黄荣芳[1] 杨蕴洁 路娜娜 王海清 YAO Yingjie;QIN Maohua;CHEN Yunyan;HUANG Rongfang;YANG Yunjie;LU Nana;WANG Haiqing(Dept.of Reproductive Health and Infertility,Kunming City Maternal and Child Health Hospital,Kunming Yunnan 650032,China;Grassroots Guidance Section,Kunming City Maternal and Child Health Hospital,Kunming Yunnan 650032,China)

机构地区：[1]昆明市妇幼保健院生殖健康与不孕不育科,云南昆明650032 [2]昆明市妇幼保健院基层指导科,云南昆明650032

出　　处：《昆明医科大学学报》2024年第9期103-109,共7页Journal of Kunming Medical University

基　　金：昆明市卫生健康委“百工程”人才培养基金资助项目(2021-百工程-28)。

摘　　要：目的探讨女性不孕症及生育力影响因素。方法对2021年7月至2023年6月到昆明市妇幼保健院就诊的776例符合纳入条件的不孕女性进行一般情况、既往病史、辅助检查结果等相关数据采集,采用多因素Logistic回归模型探讨不孕症的影响因素。结果女性不孕症患病率较高年龄段集中在26~35岁,病因复杂、相互影响,其中输卵管因素、排卵障碍、卵巢储备功能低下为主要原因,分别占不孕患者的48.32%、19.20%、10.57%,原发性和继发性不孕患者上述3类病因占比P值分别为<0.001,<0.001,0.42。多因素Logistic回归模型结果提示,年龄(95%CI:1.14~1.21)、孕前体质指数(95%CI:0.74~10.83,1.28~2.30)、吸烟史(95%CI:1.27~17.66)、月经紊乱(95%CI:3.52~8.68)、人工流产史(95%CI:1.08~2.19,5.52~15.22)、泌尿/生殖道感染史(95%CI:3.74~6.42)和宫腹腔手术史(95%CI:3.99~7.40)是女性生育力的主要影响因素。女性不孕的首要影响原因是输卵管阻塞,其与不洁性生活史、流产及盆腔手术操作等有关;次要原因包括排卵障碍,其与卵巢储备功能低下、内分泌紊乱、生育延迟等有关。结论女性不孕症的主要影响因素包括输卵管因素、排卵障碍及卵巢储备功能低下,同时,年龄、孕前体质指数、居住地、吸烟史、月经周期、人工流产次数、泌尿生殖道感染史、宫腹腔手术史和全身疾病史均是生育力的影响因素,需针对病因及影响因素,积极预防、治疗。Objective To investigate the etiology and influencing factors of female infertility.Methods A total of 776 infertile women who visited Kunming Maternal and Child Health Hospital from July 2021 to June 2023 were collected.Multiple Logistic regression model was used to explore the etiology of infertility.Results The prevalence of female infertility is higher in the age group of 26~35 years old,and the etiology is complex and mutually influential,among which fallopian tube factors,ovulation disorders,and low ovarian reserve are the main reasons,accounting for 48.32%,19.20%,and 10.57%of infertility patients respectively.For primary and secondary infertility patients,the P-values for the above three causes are<0.001,<0.001,and 0.42 respectively.Results from a multivariate logistic regression model suggest that age(95%CI:1.14~1.21),pre-pregnancy body mass index(BMI)(95%CI:0.74~10.83,1.28~2.30),smoking history(95%CI:1.27~17.66),menstrual irregularities(95%CI:3.52~8.68),history of induced abortion(95%CI:1.08-2.19,5.52~15.22),history of genitourinary tract infections(95%CI:3.74~6.42),and history of gynecological surgeries(95%CI:3.99~7.40)are major influencing factors on female fertility.The primary cause of female infertility is tubal obstruction,which is associated with a history of unsafe sexual practices,abortions,and pelvic surgeries;secondary causes include ovulatory disorders,which are linked to diminished ovarian reserve,endocrine disorders,and delayed childbearing.Conclusion The main influencing factors of female infertility include tubal factors,ovulatory disorders,and decreased ovarian reserve function.Additionally,factors such as age,pre-pregnancy body mass index(BMI),place of residence,smoking history,menstrual cycle regularity,number of induced abortions,history of genitourinary infections,history of gynecological surgeries,and systemic disease history all impact fertility.It is necessary to target the causes and influencing factors for proactive prevention and treatment.

关 键 词：生育力 不孕症 影响因素 防治 

分 类 号：R711.6[医药卫生—妇产科学]