Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina.
Am J Epidemiol. 2018 Feb 1;187(2):337-346. doi: 10.1093/aje/kwx240.
In a 1989 paper, Marchbanks et al. (Am J Epidemiol. 1989;130(2):259-267) noted inconsistent definitions of infertility across research and clinical practice and examined differences in prevalence estimates across definitions. Since their study, there have been substantial changes in society, technology, and clinical practice related to female reproductive health. In response, we revisited the original paper using data from a recent study among reproductive-aged women. Internal comparisons across various definitions of infertility were made by assessing how many and which women were classified as infertile, their age at infertility, and the probability of spontaneous pregnancy after infertility. Results were also compared with Marchbanks et al. Black women were more likely to be classified as infertile than white women based on the definition "12 months of unprotected intercourse" (40.1% vs. 33.7%) but less likely by "12 months of attempting pregnancy" (14.3% vs. 21.8%) and "visiting a doctor for help getting pregnant" (8.4% vs. 19.7%). After unprotected intercourse for 12 months, 36.1% of women who were attempting pregnancy spontaneously conceived by 6 months compared with 13.5% of women who were not attempting pregnancy. While our results for most infertility definitions were similar to those of Marchbanks et al., prevalence estimates continued to differ across demographic groups by definition.
在 1989 年的一篇论文中，Marchbanks 等人（Am J Epidemiol. 1989;130(2):259-267）指出，在研究和临床实践中，不孕的定义不一致，并研究了不同定义下的患病率估计值的差异。自他们的研究以来，社会、技术和与女性生殖健康相关的临床实践发生了重大变化。有鉴于此，我们使用最近一项针对育龄妇女的研究数据重新审视了原始论文。通过评估有多少和哪些女性被归类为不孕、她们的不孕年龄以及不孕后自然怀孕的概率，对各种不孕定义进行了内部比较。结果还与 Marchbanks 等人进行了比较。根据“12 个月无保护性交”的定义，黑人女性比白人女性更有可能被归类为不孕（40.1%比 33.7%），但根据“12 个月尝试怀孕”和“因怀孕问题就诊”的定义，她们的可能性较低（14.3%比 21.8%和 8.4%比 19.7%）。在无保护性交 12 个月后，尝试怀孕的女性中有 36.1%在 6 个月内自然怀孕，而未尝试怀孕的女性中只有 13.5%。虽然我们大多数不孕定义的结果与 Marchbanks 等人的结果相似，但按定义，患病率估计值在不同人群中仍存在差异。
