Boivin J, Schmidt L
School of Psychology, Cardiff University, Tower Building, Park Place, Cardiff, Wales CF10 3AT, UK.
Hum Reprod. 2009 Jul;24(7):1626-31. doi: 10.1093/humrep/dep077. Epub 2009 Apr 9.
There seems to be little discussion between patient and physician about the use of complementary and alternative medicines (CAMs), perhaps because they are not perceived to have adverse effects on fertility. We therefore compared ongoing pregnancy and live birth rate in spontaneous users and non-users of CAM during a 12-month period of assisted reproduction technique (ART) treatment. Consent was by questionnaire return.
This was a prospective observational cohort study with a 12-month follow-up period, sampling consecutive patients attending five ART clinics in Denmark. N = 728 women about to have ART for the first time completed self-report assessments prior to treatment (Time 1, T1) and at 12-month follow-up (Time 2, T2). Data from treatment records were also available for n = 590.
About 30.6% (n = 223) of women used CAMs during the observation period. At T2 the ongoing pregnancy and live birth rate was 31.3% lower in CAM users (42.2%) compared with non-users (61.4%). Adjusted odds of pregnancy/live birth remained lower in CAM users versus non-users, odds ratio = 0.467 (95% confidence interval 0.306-0.711) after controlling for prognostic indicators (age, parity, years infertile).
Concurrent use of CAM during treatment with ART was associated with a 30% lower pregnancy rate that could not be explained by poor prognosis or life style factors. The mechanisms that could account for this association were discussed. Concurrent CAM use should be monitored during ART. A main limitation was that we could not ascertain which type of CAM was most associated with lower pregnancy rates.
患者与医生之间似乎很少讨论补充和替代医学(CAMs)的使用情况,这可能是因为人们认为这些方法对生育能力没有不良影响。因此,我们比较了在辅助生殖技术(ART)治疗的12个月期间,自行使用和未使用CAMs的患者的持续妊娠率和活产率。通过问卷回复获得同意。
这是一项前瞻性观察队列研究,随访期为12个月,对丹麦五家ART诊所的连续就诊患者进行抽样。N = 728名首次接受ART治疗的女性在治疗前(时间1,T1)和12个月随访时(时间2,T2)完成了自我报告评估。n = 590名患者的治疗记录数据也可用。
在观察期内,约30.6%(n = 223)的女性使用了CAMs。在T2时,使用CAMs的患者(42.2%)的持续妊娠率和活产率比未使用者(61.4%)低31.3%。在控制了预后指标(年龄、产次、不孕年限)后,使用CAMs的患者与未使用者相比,妊娠/活产的调整比值仍然较低,比值比 = 0.467(95%置信区间0.306 - 0.711)。
在ART治疗期间同时使用CAMs与妊娠率降低30%相关,这无法用预后不良或生活方式因素来解释。讨论了可能导致这种关联的机制。在ART治疗期间应监测CAMs的同时使用情况。一个主要局限性是我们无法确定哪种类型的CAMs与较低的妊娠率最相关。