An Epidemiological Study On The Infertility In Three Provinces In China

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 MethodThere 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. ObjectiveWe 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 selection1.1.1 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 methodsThe 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 study3.1 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.Results1 results of re-existing data (WIS):1.1 Analysis of the fertility among newly married women after marriageThe 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 agesBecause 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 conditionThe 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 provincesWe 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 marriageThe 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 provincesThe 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 behaviorThe 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 cityWe 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 investigation4.1 The reason of infertilityWe 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 infertilityWe 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 infertilityThe 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 provinces2.1 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 city3.1 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 investigation4.1 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.