| 1. ObjectivesThis study was intended to describe the previous history of spontaneous miscarriage among infertility patients with spontaneous miscarriage and the causes of infertility, and identify risk factors of recurrence spontaneous miscarriage so as to propose suggestions for preventing recurrence of miscarriage.2. MethodsThrough stratified random sampling, one reproductive center per general hospital and maternity hospital affiliated was selected in Beijing Shanghai and Guangzhou.751 infertility patients with history of spontaneous miscarriage who complied with the inclusion and exclusion criteria were recruited. Related information was collected through case report forms in this cross-sectional investigation. Risk factors of recurrent spontaneous miscarriage were assessed using simple and multivariate logistic regression analyses.3. ResultsAmong the 751 patients, there were 200 infertility patients with recurrent spontaneous miscarriage, accounting for 26.63%(95% CI:23.50%,29.95%); there were 551 infertility patients with single miscarriage, accounting for 73.37%. Among 200 infertility patients with recurrent spontaneous miscarriage,155 cases (77.5%),34 cases (17.0%) and 11 cases (5.5%) experienced twice,3 times and at least 4 times spontaneous miscarriages.Among total of the 1019 spontaneous miscarriages in 751 patients,857 spontaneous miscarriages (84.1%) occurred within 12 weeks of pregnancy. Among all the 751 patients,141 patients (18.8%) experienced at least once 12-20 weeks" miscarriage, and other 610 patients (81.2%) experienced their spontaneous miscarriage within 12 weeks of pregnancy. Among 200 patients with recurrent spontaneous miscarriage,63 patients (31.5%) experienced at least one miscarriage between 12-20 weeks of pregnancy.Infertility causes among 751 cases,462 cases (61.52%) were only from female partner, 105 cases (13.98%) from male partner,119 cases (15.85%) from both partner and 65 cases (8.66%) from unexplained causes. In general hospitals, male infertility accounted for 17.06% and female infertility accounted for 56.17%. In maternity hospital, male infertility accounted for 10.81% and female infertility accounted for 67.03%.From simple logistic regression, statistically difference was found in terms of infertility causes between recurrent spontaneous miscarriage and single miscarriage group (P=0.008). The proportion of unexplained causes in the recurrent spontaneous miscarriage group (14.00%) was higher than in the single miscarriage group (6.72%) (P=0.002). The difference of infertility causes between general hospitals and maternity hospitals was statistically significant (P=0.006). The proportion of male infertility was higher in general hospitals (17.06%) than in maternity hospitals (10.81%) (P=0.014). Multivariate logistic regression indicated that low educational background, concomitant endocrinological (P=0.037, OR=2.55) and immunological (P=0.001, OR=3.24) disorder were risk factors of recurrent spontaneous miscarriage.4. ConclusionsThe proportion of infertility patients with recurrent spontaneous miscarriage is high. Most of patients have twice previous spontaneous miscarriages, so the diagnostic criteria for recurrent spontaneous miscarriage changes to two and more previous spontaneous miscarriages can avoid missing high-risk patients and facilitate early medical intervention. Most of miscarriages occurred within 12 weeks of pregnancy; the proportion of patient experience at least one 12-20 weeks’ spontaneous miscarriage was higher than in the general population. Low educational levels, immunological and endocrinological disorder are risk factors for infertility with recurrent spontaneous miscarriage.5. SuggestionsWe suggest that reproductive centers establish psychological health archives for infertility patients with spontaneous miscarriage. Pay attention to patients’ psychological health so that they can face conception and fail pregnancy rationally. Attention should be paid to populations with high risks for recurrent miscarriage, and endocrinological and immunological disorder should be proactively corrected prior to embryo transplantation to prevent repeated miscarriage after artificial reproductive techniques, meanwhile, prevention and treatment of miscarriage of 12-20 weeks should be seriously taken. Reproductive centers in maternity hospitals could enhance promotion of male infertility treatment then attract male infertility patients. |
