Tsevat Danielle G, Wiesenfeld Harold C, Parks Caitlin, Peipert Jeffrey F
Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO.
Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Am J Obstet Gynecol. 2017 Jan;216(1):1-9. doi: 10.1016/j.ajog.2016.08.008.
Female infertility, including tubal factor infertility, is a major public health concern worldwide. Most cases of tubal factor infertility are attributable to untreated sexually transmitted diseases that ascend along the reproductive tract and are capable of causing tubal inflammation, damage, and scarring. Evidence has consistently demonstrated the effects of Chlamydia trachomatis and Neisseria gonorrhoeae as pathogenic bacteria involved in reproductive tract morbidities including tubal factor infertility and pelvic inflammatory disease. There is limited evidence in the medical literature that other sexually transmitted organisms, including Mycoplasma genitalium, Trichomonas vaginalis, and other microorganisms within the vaginal microbiome, may be important factors involved in the pathology of infertility. Further investigation into the vaginal microbiome and other potential pathogens is necessary to identify preventable causes of tubal factor infertility. Improved clinical screening and prevention of ascending infection may provide a solution to the persistent burden of infertility.
女性不孕症，包括输卵管因素导致的不孕，是全球主要的公共卫生问题。大多数输卵管因素导致的不孕病例可归因于未经治疗的性传播疾病，这些疾病沿生殖道上行，能够引起输卵管炎症、损伤和瘢痕形成。证据一直表明沙眼衣原体和淋病奈瑟菌作为致病细菌，与包括输卵管因素不孕和盆腔炎在内的生殖道疾病有关。医学文献中关于其他性传播微生物（包括生殖支原体、阴道毛滴虫和阴道微生物群中的其他微生物）可能是不孕症病理过程中重要因素的证据有限。有必要对阴道微生物群和其他潜在病原体进行进一步研究，以确定输卵管因素不孕的可预防原因。改善临床筛查和预防上行感染可能为持续存在的不孕负担提供解决方案。
