Epidemiological study of infertility

  Infertility is a problem involving couples of reproductive age in all regions or countries around the world, and is one of the common gynecological diseases. The occurrence of infertility often brings many physical and psychological pains to patients and their families, which seriously affects the reproductive health and family happiness of patients. According to statistics, the divorce rate of infertile couples is 2.2 times higher than that of the normal population. In the late 1980s, WHO organized a survey of infertile couples using standardized diagnosis in 33 research centers in 25 countries, and the results showed that about 5%-8% of couples in developed countries were affected by infertility, and the prevalence of infertility in some areas of developing countries could be as high as 30%. The WHO reported in the late 1990s that the incidence of infertility worldwide had reached 10%-20%. In the United States, one out of every seven couples has difficulty conceiving at some point during their reproductive years. According to some information, the incidence of infertility in recent years is about 15%-20% in foreign countries, and the incidence in China is about 5%. Wang Jianzhong of the Department of Obstetrics and Gynecology of Ganzhou City People’s Hospital has calculated that the prevalence of infertility in Ganzhou City is 5.17%, of which the primary infertility rate is 3.91% and the secondary infertility rate is 1.26%. In Qinghai province, the prevalence of infertility was 10.08%, 11.14% in urban areas, 10.31% in rural areas, and 8.19% in pastoral areas after a survey of 5000 cases of women of childbearing age. Through a questionnaire survey of 19595 married families of reproductive age in a representative sample of the natural population of Guangdong Province, Tang Lixin et al. calculated that the prevalence of infertility in Guangdong Province was as high as 14.7%. Overall, the prevalence of female infertility in China is higher in the western mountainous and poor regions than in the economically developed eastern provinces and cities. As people’s medical health awareness and quality of life improve, the importance of reproductive health is gradually increasing, and the number of people seeking consultation and treatment for infertility is on a very clear upward trend. This has led medical practitioners around the world to pay more attention to infertility and to increase their research on this disease.  Infertility is associated with many factors, such as age, age at first intercourse, number of sexual partners, and even region, environment, diet, and work. It goes without saying that fertility declines with age, with 33% of women no longer having children after the age of 40 and 87% after the age of 45. Larsen reported that 15% of infertility patients aged 20-40 years had their first sexual intercourse at an age younger than 13 years, and only 4% had their first sexual intercourse after the age of 19. In 1988, China’s Population Planning Commission analyzed a sample of 2,000 married women nationwide and found that: the infertility rate declined as the age of marriage advanced; the incidence of infertility was lowest among women aged 20-29; the infertility rate among illiterate women was 10.8%, 5.04% among junior high school educated women and 8.37% among university educated women, i.e., university and illiterate women were close to each other and higher than those in secondary schools; the incidence of infertility was lower in urban than in rural areas; and the first menstrual period was lower than that in rural areas. It is lower than that in rural areas; the older the age of menarche, the higher the incidence of infertility; the incidence is higher in northwest than in southeast coastal areas; the Han population is lower than that of ethnic minorities. It is worth noting that in recent years, as people’s awareness of health has increased, more people have noticed the importance of mental health, and therefore, the influence of psychological factors on infertility has gradually become a subject of concern. Research shows that about 5% of infertility is caused by psychological factors. With the development of society, people’s life is getting faster and faster, and work pressure is gradually increasing, making many people live in a busy and stressful atmosphere. Mental tension inevitably stimulates the release of adrenaline and norepinephrine, which in turn increases the synthesis and release of catecholamines, endorphins and prolactin, and finally interferes with the secretion of ovarian hormones, making female endocrine disorders and leading to infertility. In turn, infertility patients are subjected to greater mental stress from themselves and the outside world, and so on in a vicious circle. Li Shaoqin et al. used the 90-item symptom self-assessment scale to evaluate and test 27 patients with infertility and 29 married, fertile, normal, healthy individuals. The Hillary Klonoff-Cohen study found that most women under stress were 93% less likely to become pregnant at the end of treatment within 5 years than women who were completely relaxed. Therefore, while treating patients with infertility for their native disease, attention should be paid to observing changes in their psychological status and providing psychotherapy accordingly.  Infertility clinically involves a wide range of etiologies and often multiple diseases coexist. Some studies have shown that the most important cause of infertility is genital inflammation. The tubal adhesions, obstruction, and fluid accumulation due to pelvic inflammation, tuberculosis, and endometriosis, as well as the adhesion of pelvic tissues to form septa, cause the tubal to lose its function of capturing and absorbing eggs, and thus infertility. The rate of tubal infertility is significantly higher in patients with early age of first sexual intercourse, early age of first pregnancy, premarital sex, premarital pregnancy, multiple sexual partners, previous vaginitis, untreated chronic abdominal pain of unknown origin and history of tuberculosis. Several epidemiological surveys have shown that tubal infertility accounts for about 40% or more of female infertility, ovulatory factors for about 40%, unexplained for about 10%, and other uncommon factors for about 10%. Ovulation disorders are the second cause of female infertility, and such are often associated with female endocrine disorders. Ovarian dysplasia, follicular maturation disorders, luteal insufficiency, polycystic ovary syndrome, premature ovarian failure, hyperprolactinemia, ovarian tumors, etc., can all lead to ovulation disorders and affect conception. The most common one is polycystic ovary syndrome, followed by hyperprolactinemia, while 25% or more of PCOS patients have elevated PRL at the same time. With the progress of medical science, the pregnancy rate of infertile couples can be more than 30 to 50.