去除长效避孕措施后育龄妇女妊娠率的变化

Changes in pregnancy rate of women of childbearing age after removing long-acting contraceptive measures

目的分析去除宫内节育器(带铜IUDs)、皮下避孕埋植剂(简称皮埋,非生物降解型)、曼月乐(Mirena?)及输卵管再通术后育龄妇女生育力的恢复情况。方法选择2016年3月1日至2019年3月31日在西北民族大学附属医院、甘肃省第三人民医院、甘肃省计划生育科学技术服务中心就诊,且两年中有生育二孩意愿的育龄妇女411例为研究对象,按不同避孕法将其分为五组:无避孕措施组、IUDs组、皮埋组、曼月乐组和输卵管再通组,观察并对比各组在1年内的妊娠情况。结果无避孕措施组、IUDs组、皮埋组、曼月乐组和输卵管再通组6个月后再次妊娠率分别为66.92%(89/133)、64.04%(73/114)、55.36%(31/56)、53.66%(44/82)、30.77%(8/26),12个月后再次妊娠率分别为96.99%(129/133)、92.98%(106/114)、87.50%(49/56)、89.02%(73/82)、57.69%(15/26)。在去除避孕措施后,五组在6个月、12个月时的妊娠率比较差异均有统计学意义(χ^(2)值分别为14.486、40.724,P<0.05)。经Logistic回归分析显示,6个月[Exp(B)95%CI分别为0.782(0.6150.995)、0.604(0.4450.818)]和12个月[Exp(B)95%CI分别为0.676(0.4800.951)、0.392(0.2540.605)]的再次妊娠率均与节育器类型及放置时间有关(P<0.05)。结论使用IUDs、皮埋法、曼月乐避孕5年内并不损害育龄妇女的生育能力,但输卵管再通术后生育力恢复较弱,使用不同宫内节育器超过5年都可能不同程度地影响生育力。

Objective To analyze the recovery of fertility in women of childbearing age after removal of copper intrauterine devices(with copper IUDs),subcutaneous contraceptive implants(abbreviated as skin implants,non-biodegradable),Mirena,and fallopian tube recanalization.Methods 411 women hospitalized in the Affiliated Hospital to Northwest Minzu University,the Third People′s Hospital of Gansu and Gansu Family Planning Science and Technology Service Center during the period from March 1,2016 to March 30,2019,and who were willing to have a second child within two years were selected as subjects of the study.According to the contraceptive methods employed,they were divided into five groups:group without any contraceptive device,group with IUDs,group with implants,group with Mirena,and group with fallopian tube recanalization.Observed and compared the pregnancy rates of each group within 1 year.Results The rate of re-pregnancy after 6 months in the group without any contraceptive device,group of women with the IUDs,implants group,Mirena group and fallopian tube recanalization group were 66.92%(89/133),64.04%(73/114),55.36%(31/56),53.66%(44/82) and 30.77%(8/26),respectively.The rates of re-pregnancy after 12 months in the group without any contraceptive device,group of women with the IUDs,implants group,Mirena group and fallopian tube recanalization group were 96.99%(129/133),92.98%(106/114),87.50%(49/56),89.02%(73/82),57.69%(15/26),respectively.After removing the contraceptive measures,there were statistically significant differences in pregnancy rates at 6 months and 12 months among the five groups(χ^(2)=14.486 and 40.724,respectively,both P<0.05).Logistic regression analysis showed that the 6-month [Exp(B)95%CI=0.782(0.615~0.995) and 0.604(0.445~0.818)] and 12-month [Exp(B)95%CI=0.676(0.480~0.951) and 0.392(0.254~0.605)] re-pregnancy rates were both related to the type and placement time of the IUDs(P<0.05).Conclusion The use of IUDs,skin burying method and Mirena will not damage the fertility of women of childbearing age within 5 years,but the recovery of fertility after fallopian tube recanalization is weak,and the use of different contraceptive devices over 5 years may affect the fertility in various degrees.