中国育龄夫妇不孕率系统综述

Infertility rate in married couples of reproductive age in China： a systematic review and Meta-analysis

目的运用循证分析方法估计中国育龄夫妇不孕率及其在不同地区和人群间的差别。方法检索1980—2012年万方、维普、CNKI、PubMed数据库关于不孕率调查的文献，通过Meta分析合并不孕率，并通过Meta回归分析发现不孕率变异的来源。结果纳入文献27篇。中国各地区总合并不孕率为5．7％（95％CI：5．3％～6．1％），新婚人群1年和2年合并不孕率分别为12．5％（95％CI：9．5％～15．4％）和6．6％（95％CI：4．9％～8．4％）；非新婚人群的1年和2年合并不孕率分别为6．4％（95％CI：4．2％～8．6％）和3．0％（95％CI：2．6％～3．3％）。Meta回归分析发现各地区2年不孕率低于1年不孕率，经济水平低的地区不孕率高，文献的研究方法中历史性队列研究和前瞻性研究的不孕率较高。结论由于各研究对于不孕率的界定不一致，导致各研究间不具有绝对的可比性。应重视各不孕率调查的可比性问题。

Objective To estimate the infertility rates and to examine factors that contribute to the variations in infertility rates among studies. Methods Wanfang, CQVIP, CNKI, and PubMed Database were searched for infertility relevant population-based prevalence studies between 1980 and 2012. Meta-analysis and meta-regression were used to calculate the pooled size of effect and to identify the sources of variation. Results A total of 27 articles using data from regional surveys were included in the review. Results showed that the combined prevalence was 5.7%（95%CI： 5.3%-6.1% ）. Combined prevalence rates of 1-year and 2-year infertility in newly married couples were 12.5% （95%CI： 9.5%-15.4% ） and 6.6% （95%CI： 4.9%-8.4% ）, respectively, while were respectively 6.4% （95%CI： 4.2%-8.6% ） and 3.0% （95%CI： 2.6%-3.3% ）, in women of reproductive age. Results from Meta-regression showed that the prevalence of 2-year infertility was lower than that of 1-year while infertility in regions was seen higher under the poor socioeconomic condition than in the better regions. Infertility in studies using cohort or prospective studies was seen to be higher than in other studies. Conclusion Owing to the inconsistency in determining the numerator and denominator that were used to calculate the prevalence of infertility as well as the inconsistency in criteria used to define the infertility, an agreed definition on infertility needs to be followed, in order to facilitate the comparison among studies.