A Survey And Analysis On The Etiology Of Infertility

Introduction According to the WHO, there exist nearly 60 - 80 million patients with infertility worldwide, consisting of 10-20% of population at reproductive-age. In the USA, 15% of women at reproductive-age (around 9.3 million) received the treatment for infertility in 1995. Besides major diseases, a variety of factors play roles in the etiology of infertility, such as age, occupation, obesity, overweight, living condition, unhealthy living habits, religion, folk-custom, and the developments of society economy, culture, sanitation. It was necessary to carry out surveys on its etiology and correlation factors, and accurate understandings of the prevalence of infertility among Chinese population are needed to provide scientific rationale for the prevention and treatment of infertility.Objective This study is to investigate and premiliary evaluate the distributions of sex, age, etiology and the risk factors among patients with infertility, and expect to give a scientific basis to reduce the incidence of infertility and improve the clinical management.Methods (1) Retrospective data were collected by questionnaires between May and October of 2006 in the Reproductive and Genetic Hospital of Citic-Xiang Ya. Questionnaires were delivered to a total of 4,234 couples with infertility at their first visit to the hospital. Information collected included their ages, the duration of infertility, sexual life, pregnancy and parturition history, menstrual cycle, infection history, surgery history, and infertility-specific examinations as well. All the data were input into Excel files. SPSS 13.0 and Excel software were used for all analyses. Student t-test and chi-square tests were performed. The significance level was set at 0.05.Result (1)Age distribution: The age (mean±SD) was 32.1±4.9 and 29.6±4.5 years old for males and females, respectively. Age was normally distributed for both males and females, most cases were in 25-45 years old of males (94.6%) and 20-40 years old of females (97.3%). 92.4% of males were＜40 years old, whereas 13.9% of females were＞=35 years old, only 2.6% of females were＞=40 years old; (2) Sex distribution: A preliminary diagnosis showed that, among 4,234 couples with infertility, 2,149 (50.8%) was related to the wife, 1,018 (24.0%) related to the husband, 994 (23.5%) related to both the husband and wife, and this left 73 (1.7%) for unknown reasons. There was a statistically significant difference in the sex distribution between primary and secondary infertilities (p＜0.05); (3) Rank of causes related to infertility: tubal defect and pelvic disease (41.4%), male factors including azoospermia, oligospermia,asthenospermia,teratospermia, necrospermia and ejaculation dysfunction(36.4%), ovulatory dysfunction (12.2%), and other rare or unexplained factors (10%); (4) Rank of majior causes related to female infertility: Among female patients with infertility, tubal defect and pelvic disease were the most common risk factors (2,284, 65.1%), the rest of factors were ranked as: ovulatory dysfunction (673, 19.2%), endometriosis or adenomyosis (254, 7.2%), rare diseases (165, 4.7%), and unexplained reasons (134, 3.8%). tubal defect and pelvic disease and ovulatory dysfunction accounted for the majority of female infertility, as high as 84.3%. There were more secondary infertilities among patients with tubal defect and pelvic disease (57.2%), while more primary infertilities among patients with ovulatory dysfunction (70.6%); (5) Rank of major causes related to male infertility: Among 2,012 male patients with infertility, there were 1,364 (67.8%) azoospermia, 575 (28.6%) oligospermia,asthenospermia,teratospermia, 53(2.6%) ejaculation dysfunction, and 20(1.0%) necrospermia.Tubal defect and pelvic disease was the most important reason for female infertility, which emphasizes the prevention in this group. Popularizing the information of reproductive health, reducing the incidence of sexually transmitted disease and abortion were belived to decrease the incidence of infertility rerulted from tubal defect and pelvic diseaseThe most important reason for male infertility was spermatogenic failure, which indicates the importance of further studies on mechanisms of spermatogeny, and for a efficient measures for the prevention and treatment of infertility.