Influencing factors of different contraceptive methods on female fertility

doi:10.3877/cma.j.issn.1673-5250.2023.01.015

Objective

To investigate influencing factors of subsequent pregnancy ability of childbearing-aged women after the discontinuation of intrauterine device (IUD).

Methods

A retrospective analysis was conducted by extracting 15 031 pregnant women from the Lianyungang Maternal Health Care System who gave birth in hospitals at all levels in Lianyungang area from January 2016 to December 2018. They were divided into IUD group (discontinuation of IUD, n=7 452) and condom group (discontinuation of condom, n=7 579) according to the different discontinuation of contraceptive measures. From January 30, 2019 to November 30, 2020, the baseline survey, first follow-up visit after the birth of second child were completed and subsequent pregnancy ability of childbearing-aged women after the discontinuation of IUD were summarized. This study was approved by the Ethics Committee of Lianyungang Maternal and Child Health Hospital, Jiangsu Province (Approve No. LYG-MEP202101).

Results

① There were no statistically significant differences between two groups of age, occupation, body mass index (BMI), and number of miscarriages (P>0.05). ② There were statistically significant differences in the subsequent pregnancy time of childbearing women at different ages, abortion frequency, delivery mode of the first child and contraceptive time between the two groups (P<0.05). ③There was no significant difference in the cumulative pregnancy rate in 6, 12, 18 and 24 months after the cessation of contraception between the two groups (P>0.05). ④ The results of COX multivariate regression analysis on the influencing factors of fertility in women of childbearing age showed that age ≥35 years old (HR=1.063, 95%CI: 1.027-1.101, P<0.05), body mass index < 18.5 kg/m² (HR=0.867, 95%CI: 0.802-0.938, P<0.001), body mass index ≥24.0 kg/m²(HR=1.265, 95%CI: 1.054-1.519, P<0.05), the number of abortions was 1-2 (HR=1.439, 95%CI: 1.349-1.534, P<0.001), the number of abortion ≥3 (HR=1.352, 95%CI: 1.268-1.441, P<0.001), were independent risk factors affecting fertility in women of childbearing age.

Conclusions

Childbearing-aged women should avoid advanced pregnancy, control their weight reasonably and reduce the number of artificial termination of pregnancy. Proper use of the IUD has no effect on the fertility of women of childbearing age after removal of the IUD.

Key words: Intrauterine devices, Condoms, Number of pregnancies, Cesarean section, Risk factors, Retrospective studies, Pregnant women

表1 2组停用避孕措施后生育二胎育龄妇女的一般临床资料比较[例数(%)]

组别	例数	年龄(岁)		职业		BMI(kg/m²)
组别	例数	<35	≥35	有正式工作	无正式工作	<18.5	18.5~23.9	≥24.0
IUD组	7 452	2 615(35.1)	4 837(64.9)	1 383(18.6)	6 069(81.4)	56(0.8)	7 198(96.5)	198(2.7)
避孕套组	7 579	2 679(35.4)	4 900(64.6)	1 448(19.1)	6 131(80.9)	86(1.1)	7 287(96.2)	206(2.7)
χ²值		0.108		0.734		5.971
P值		0.378		0.202		0.051
组别	例数	流产次数			第1胎分娩方式		第1胎异常分娩结局
组别	例数	0次	1~2次	≥3次	剖宫产术	阴道分娩	出生缺陷	死胎
IUD组	7 452	4 065(54.6)	3 030(40.6)	357(4.8)	2 243(30.1)	5 209(69.9)	16(0.2)	19(0.2)
避孕套组	7 579	4 202(55.4)	3 022(39.9)	355(4.7)	2 391(31.6)	5 188(68.4)	18(0.2)	19(0.2)
χ²值		1.214			3.696		0.062
P值		0.545			0.055		0.803

表1 2组停用避孕措施后生育二胎育龄妇女的一般临床资料比较[例数(%)]

组别	例数	年龄(岁)		职业		BMI(kg/m²)
组别	例数	<35	≥35	有正式工作	无正式工作	<18.5	18.5~23.9	≥24.0
IUD组	7 452	2 615(35.1)	4 837(64.9)	1 383(18.6)	6 069(81.4)	56(0.8)	7 198(96.5)	198(2.7)
避孕套组	7 579	2 679(35.4)	4 900(64.6)	1 448(19.1)	6 131(80.9)	86(1.1)	7 287(96.2)	206(2.7)
χ²值		0.108		0.734		5.971
P值		0.378		0.202		0.051
组别	例数	流产次数			第1胎分娩方式		第1胎异常分娩结局
组别	例数	0次	1~2次	≥3次	剖宫产术	阴道分娩	出生缺陷	死胎
IUD组	7 452	4 065(54.6)	3 030(40.6)	357(4.8)	2 243(30.1)	5 209(69.9)	16(0.2)	19(0.2)
避孕套组	7 579	4 202(55.4)	3 022(39.9)	355(4.7)	2 391(31.6)	5 188(68.4)	18(0.2)	19(0.2)
χ²值		1.214			3.696		0.062
P值		0.545			0.055		0.803

表2 2组停用避孕措施后生育二胎育龄妇女的再次受孕时间比较

组别	例数	年龄<35岁		年龄≥35岁		流产次数为0次		流产次数为1~2次		流产次数≥3次
组别	例数	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)
IUD组	7 452	2 615	4(3，6)	4 837	6(3，7)	4 065	4(3，6)	3 030	5(3，6)	357	4(1，9)
避孕套组	7 579	2 679	4(1，9)	4 900	3(1，8)	4 202	3(1，8)	3 022	3(1，9)	355	6(4，8)
Z值		－10.84		－15.75		－12.14		－12.25		－4.49
P值		<0.001		<0.001		<0.001		<0.001		<0.001
组别	例数	第1胎为剖宫产术分娩		第1胎为自然分娩		避孕时间≤5年		避孕时间为5~10年		避孕时间≥10年
组别	例数	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)
IUD组	7 452	2 243	5(1，6)	5 209	5(3，6)	3 368	5(3，6)	3 853	4(3，6)	231	5(3，6)
避孕套组	7 579	2 391	3(1，6)	5 188	4(1，9)	5 256	3(1，9)	2 051	4(1，8)	272	3(1，6)
Z值		－13.29		－11.86		－14.47		－9.71		－2.63
P值		<0.001		<0.001		<0.001		<0.001		0.009

表2 2组停用避孕措施后生育二胎育龄妇女的再次受孕时间比较

组别	例数	年龄<35岁		年龄≥35岁		流产次数为0次		流产次数为1~2次		流产次数≥3次
组别	例数	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)
IUD组	7 452	2 615	4(3，6)	4 837	6(3，7)	4 065	4(3，6)	3 030	5(3，6)	357	4(1，9)
避孕套组	7 579	2 679	4(1，9)	4 900	3(1，8)	4 202	3(1，8)	3 022	3(1，9)	355	6(4，8)
Z值		－10.84		－15.75		－12.14		－12.25		－4.49
P值		<0.001		<0.001		<0.001		<0.001		<0.001
组别	例数	第1胎为剖宫产术分娩		第1胎为自然分娩		避孕时间≤5年		避孕时间为5~10年		避孕时间≥10年
组别	例数	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)	例数	M(Q₁, Q₃)
IUD组	7 452	2 243	5(1，6)	5 209	5(3，6)	3 368	5(3，6)	3 853	4(3，6)	231	5(3，6)
避孕套组	7 579	2 391	3(1，6)	5 188	4(1，9)	5 256	3(1，9)	2 051	4(1，8)	272	3(1，6)
Z值		－13.29		－11.86		－14.47		－9.71		－2.63
P值		<0.001		<0.001		<0.001		<0.001		0.009

表3 2组停用避孕措施后生育二胎育龄妇女不同时间累计妊娠率比较[例数(%)]

组别	例数	<6个月	<12个月	<18个月	<24个月
IUD组	7 452	4 828(64.8)	7 293(97.9)	7 364(98.8)	7 421(99.6)
避孕套组	7 579	4 957(65.4)	7 409(97.8)	7 510(99.1)	7 556(99.7)
χ²值		0.63	0.66	0.11	0.28
P值		0.428	0.344	0.061	0.155

表3 2组停用避孕措施后生育二胎育龄妇女不同时间累计妊娠率比较[例数(%)]

组别	例数	<6个月	<12个月	<18个月	<24个月
IUD组	7 452	4 828(64.8)	7 293(97.9)	7 364(98.8)	7 421(99.6)
避孕套组	7 579	4 957(65.4)	7 409(97.8)	7 510(99.1)	7 556(99.7)
χ²值		0.63	0.66	0.11	0.28
P值		0.428	0.344	0.061	0.155

表4 停用避孕措施1年内影响育龄妇女再次受孕危险因素的多因素COX回归分析

变量	B	SE	Wald值	HR值	HR值95%CI	P值
年龄≥35岁(vs<35岁者)	0.061	0.018	11.954	1.063	1.027~1.101	0.001
有正式工作(vs无正式工作者)	0.006	0.021	0.086	1.006	0.965~1.049	0.771
BMI(vs BMI为18.5~23.9 kg/m²者)
<18.5 kg/m²	－0.143	0.04	12.678	0.867	0.802~0.938	<0.001
≥24.0 kg/m²	0.235	0.093	6.373	1.265	1.054~1.519	0.012
流产次数(vs流产次数为0次者)
1~2次	0.364	0.033	122.415	1.439	1.349~1.534	<0.001
≥3次	0.301	0.033	85.001	1.352	1.268~1.441	<0.001
第1胎为阴道分娩(vs剖宫产术分娩者)	－0.022	0.018	1.477	0.979	0.945~1.013	0.224
使用IUD(vs使用避孕套者)	－0.005	0.018	0.094	0.995	0.961~1.029	0.759
避孕时长(vs避孕时长为≤5年者)
5~10年	－0.050	0.047	1.133	0.951	0.868~1.043	0.287
≥10年	－0.022	0.047	0.209	0.979	0.892~1.074	0.648

表4 停用避孕措施1年内影响育龄妇女再次受孕危险因素的多因素COX回归分析

变量	B	SE	Wald值	HR值	HR值95%CI	P值
年龄≥35岁(vs<35岁者)	0.061	0.018	11.954	1.063	1.027~1.101	0.001
有正式工作(vs无正式工作者)	0.006	0.021	0.086	1.006	0.965~1.049	0.771
BMI(vs BMI为18.5~23.9 kg/m²者)
<18.5 kg/m²	－0.143	0.04	12.678	0.867	0.802~0.938	<0.001
≥24.0 kg/m²	0.235	0.093	6.373	1.265	1.054~1.519	0.012
流产次数(vs流产次数为0次者)
1~2次	0.364	0.033	122.415	1.439	1.349~1.534	<0.001
≥3次	0.301	0.033	85.001	1.352	1.268~1.441	<0.001
第1胎为阴道分娩(vs剖宫产术分娩者)	－0.022	0.018	1.477	0.979	0.945~1.013	0.224
使用IUD(vs使用避孕套者)	－0.005	0.018	0.094	0.995	0.961~1.029	0.759
避孕时长(vs避孕时长为≤5年者)
5~10年	－0.050	0.047	1.133	0.951	0.868~1.043	0.287
≥10年	－0.022	0.047	0.209	0.979	0.892~1.074	0.648

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