我国辅助生殖机构女性不孕症患者基本特征、就医情况和地区差异研究

Basic characteristics,treatment seeking behavior and regional differences of female infertility patients in assisted reproductive institutions in China

目的描述我国辅助生殖机构女性不孕症患者的基本特征和就医情况,并比较东、中、西部之间的差异。方法本研究使用中国疾病预防控制中心妇幼保健中心辅助生殖技术管理部自2018年起参与的国家重点研发计划“生殖健康及重大出生缺陷防控研究”中单元六——育龄人群生殖健康及医疗保健服务匹配情况现状分析和诊疗示范推广研究子课题的数据。选取我国东、中、西部不同地区的8个省会城市中2018年体外受精技术取卵周期数在1000以上和1000以下的辅助生殖机构各1家,对16家机构门诊首次就诊的20~49岁不孕症女性患者的问卷数据进行分析。采用频率描述、χ^(2)检验、Kruskal-Wallis H检验等方法对患者年龄、文化程度、个人年收入、试孕时长、单程交通时间等指标进行分析。结果最终纳入3673例女性患者作为研究对象。患者的年龄为(31.0±4.6)岁,59.0%(2156/3660)为本科/大专以上学历,中位试孕时长2.0(1.3,3.5)年。人口学特征方面,东部和西部地区35岁以上患者在小机构中占比更大,分别为22.8%(216/948)和26.4%(148/561),中部地区高中及以下学历患者的比例更高,在大机构中为49.1%(216/440),小机构中为47.0%(275/585)。经济方面,30.5%(521/1708)的东部患者达到10万元以上的个人年收入,而只有2.8%(26/939)愿意接受10万元以上的治疗费用,中、西部地区患者无论从个人年收入方面,还是可接受的治疗费用方面,均低于东部地区(P<0.001)。交通方面,西部地区患者所耗费的单程交通时间最长,30.9%(117/379)的大机构患者和29.8%(167/561)的小机构患者需要花费3 h以上;东部地区的大机构内异地就医的患者比例最高,为21.6%(164/758)。结论我国辅助生殖机构的不孕症患者年龄普遍超过女性最佳生育年龄,受教育程度较高,因此在年轻人和受教育程度较低的人群中,应加强生育知识的宣传,鼓励有生育意愿的夫妻尽早开始准备;另外,西部地区大龄患者更多,经济和交通条件更加不利,需要政策层面的更多关注。

ObjectiveTo describe the characteristics and medical seeking behaviors of female infertility patients in assisted reproductive institutions in China overall and geographical regions,and compare the differences among the eastern,the middle and the western regions.MethodsThis study used the data from Unit 6-Analysis on the matching status of reproductive health and health care services among reproductive age population and demonstration and promotion study of diagnosis and treatment in National Key R&D Program"Reproductive Health and Major Birth Defects Prevention and Control Study"participated by the Assisted Reproductive Technology Management Department of Maternal and Child Health Care Center,Chinese Center for Disease Control and Prevention.One assisted reproductive institution with more than 1000 and less than 1000 oocyte retrieval cycles by in vitro fertilization techniques in 2018 was selected from 8 provincial capital cities in different regions of eastern and western China,and the questionnaire data of infertile female patients aged 20-49 years who first visited the outpatient clinics of 16 institutions were analyzed.The patient's age,degree of culture,annual personal income,try-to-conceived time,and one-way transportation time were analyzed using the frequency description,χ^(2) test,Kruskal-Wallis H test and other methods.ResultsA total of 3673 female patients were finally included as study subjects.The patient's age was(31.0±4.6)years old,and 59.0%(2156/3660)was an undergraduate/college degree or above,with a median pregnancy test duration of 2.0(1.3,3.5)years.In terms of demographic characteristics,the proportion of patients over 35 years old in the eastern and western regions was greater in small institutions,22.8%(216/948)and 26.4%(148/561),respectively.The proportion of patients with academic degrees in high school and below in the central region was higher,49.1%(216/440)in large institutions and 47.0%(275/585)in small institutions.In terms of economics,30.5%(521/1708)of eastern patients reached an annual income of more than RMB 100000,while only 2.8%(26/939)were willing to accept more than RMB 100000 in treatment costs,and patients in the central and western regions were lower than those in the eastern region in terms of their annual income and acceptable treatment costs(P<0.001).In terms of transportation,patients in the western region spent the longest amount of one-way transportation time,with large institutions of 30.9%(117/379)and small institutions of 29.8%(167/561)needing to spend more than 3 h;the proportion of patients in the eastern region who seek medical treatment from overseas was the highest,with 21.6%(164/758).ConclusionThe age of infertility patients in assisted reproductive institutions in China generally exceeds the optimal reproductive age of women and has a higher degree of education.Therefore,in young and people with a lower degree of education,the publicity of reproductive knowledge should be strengthened to encourage couples with fertility willingness to start preparation as early as possible.ln addition,there are more older patients in the western region,as well as the economic and transportation conditions are more unfavorable,and more attention needs to be paid at the policy level.