International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
BMC Womens Health. 2011 Jun 24;11:32. doi: 10.1186/1472-6874-11-32.
Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.
Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).
Risk factors in the obstetric history for secondary infertility were lack of prenatal care in the last pregnancy, the first pregnancy before the age of 21 years, a history of unwanted pregnancy, a pregnancy with other than current partner, an adverse pregnancy outcome, stillbirth, postpartum infection and curettage. Presence of HIV, herpes simplex virus type 2 (HSV-2), or Treponema pallidum antibodies, and bacterial vaginosis (BV), were significantly more common in women in secondary infertile relationships than those in fertile relationships. The population attributable fractions (PAF%) for obstetric events, HIV, other (STIs), and BV were 25%, 30%, 27%, and 14% respectively.
The main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.
继发不孕是资源匮乏国家常见的、可预防但被忽视的生殖健康问题。本研究旨在探讨过去的性传播感染（STIs）包括艾滋病毒、细菌性阴道病（BV）和产科病史中的因素与继发不孕的关系，以及它们对继发不孕的相对贡献。
2007 年 11 月至 2009 年 5 月，在卢旺达基加利大学教学医院设立了一个研究不孕不育诊所。将有继发性不孕的 21-45 岁性活跃女性定义为病例（n=177），将同期多产且最近分娩的女性定义为对照（n=219）。采用结构式问卷对参与者进行社会人口学特征和产科史访谈，并对其进行艾滋病毒和生殖道感染（RTIs）检测。
与继发性不孕相关的产科病史危险因素为上次妊娠无产前保健、21 岁前首次妊娠、意外妊娠、与现伴侣以外的人妊娠、不良妊娠结局、死产、产后感染和刮宫。与生育能力正常的女性相比，继发性不孕女性中 HIV、单纯疱疹病毒 2 型（HSV-2）或梅毒螺旋体抗体以及细菌性阴道病（BV）更为常见。产科事件、HIV、其他（STIs）和 BV 的人群归因分数（PAF%）分别为 25%、30%、27%和 14%。
本研究的主要发现是，产科事件、HIV 和其他 STIs 对卢旺达继发不孕的影响大致相同。扩大 HIV/STI 预防、增加计划生育服务的获取、改善产前和产科保健以及降低死产和婴儿死亡率，都有可能降低撒哈拉以南非洲的继发不孕率。
