京津冀地区辅助生殖机构不孕不育首诊育龄夫妇现况分析

Current situation of the first-visit infertile couples in assisted reproductive institutions in Beijing, Tianjin and Hebei Province in China: a cross-sectional study

目的分析我国京津冀地区辅助生殖机构首次就诊的不孕夫妇现况,为辅助生殖医疗资源优化配置提供依据和线索。方法本研究为横断面研究,依托全国生育力低下夫妇监控平台,提取平台中北京市、天津市、河北省石家庄市的辅助生殖中心10159对首诊不孕夫妇的信息,分析三地患者构成差异及夫妇实验室指标随年龄的变化趋势。结果不孕人群就诊时无子女率均达到80%以上。北京的外地来源患者[66.5%(1285/1934)]、初婚[91.7%(3326/3626)]、高龄女性的比例[3.3%(142/4331)]高于天津[11.9%(276/2381)、90.8%(2191/2412)、2.5%(101/4045)]和石家庄[4.7%(77/1628)、86.0%(1533/1783)、1.5%(27/1783)],差异均具有统计学意义(均P<0.001)。北京就诊患者卵泡刺激素(follicle-stimulating hormone,FSH)水平>10 U/L人数占比[8.9%(361/4077)]和抗苗勒管激素(anti-Müllerian hormone,AMH)水平<1.1μg/L人数占比[26.8%(602/2249)]均高于天津[5.3%(202/3828)、25.8%(455/1763)]和河北石家庄地区[6.9%(115/1666)、15.7%(269/1712)],三组间比较和两两比较差异均具有统计学意义(均P<0.05)。随年龄增长,FSH水平明显上升(FSH>10.0 U/L由20岁时占0%到49岁时占67.7%),AMH水平及窦卵泡计数明显下降(AMH<1.1μg/L由20岁时0%上升至49岁时100%;窦卵泡计数<5由20岁时11%上升至49岁时的100%)。结论我国京津冀地区首诊不孕患者构成情况存在差异,年龄对于患者卵巢储备功能影响显著。因此,在辅助生殖资源配置过程中,应充分考虑社会需求和当地条件,落实分级诊疗制度,更有针对性地合理配置辅助生殖医疗资源。

Objective To analyze the current situation of infertile couples in reproductive institutions in Beijing,Tianjin,and Hebei Province in China,thus providing clues for the optimal allocation of assisted reproductive medical resources.Methods Based on a cross-sectional design,the information of 10159 first-visit infertile couples from representative assisted reproductive centers in Beijing,Tianjin,and Shijiazhuang in Hebei Province was extracted from the national monitoring platform for couples with low fertility.The basic characteristics,lifestyle information,assisted reproductive technology(ART)treatment information,and biological indicators of couples were investigated.Both of the regional and age distributions of those characteristics were analyzed.Results The childless rate of the infertility population reached more than 80%.In Beijing,the rates of provincial patients[66.5%(1285/1934)],first marriage[91.7%(3326/3626)],and age≥43 years[3.3%(142/4331)]were significantly higher than those in Tianjin[11.9%(276/2381),90.8%(2191/2412),2.5%(101/4045)]and Shijiazhuang city[4.7%(77/1628),86.0%(1533/1783),1.5%(27/1783),all P<0.001].The patients in Beijing had higher follicle-stimulating hormone(FSH)level and lower anti-Müllerian hormone(AMH)level[the rate of FSH>10 U/L:8.9%(361/4077)and the rate of AMH<1.1μg/L:26.8%(602/2249)]than those in Tianjin[5.3%(202/3828),25.8%(455/1763)]and Shijiazhuang in Hebei Province[6.9%(115/1666),15.7%(269/1712),all P<0.05].With the increasing of age,FSH level increased(the rates of FSH>10 U/L increased from 0%at 20 years old to 67.7%at 49 years old,AMH and AFC decreased(the rate of AMH<1.1μg/L increased from 0%at 20 years old to 100%at 49 years old;and the rate of AFC<5 increased from 11%at 20 years old to 100%at 49 years old).Conclusion The composition of first-visit infertility patients in Beijing,Tianjin,and Hebei Province are different.In the process of assisted reproductive resource allocation,the social needs,local conditions,the reasonably hierarchical diagnosis and treatment system should be fully considered.