Ho Jacqueline R, Hoffman Jacquelyn R, Aghajanova Lusine, Smith James F, Cardenas Marisela, Herndon Christopher N
Obstetrics & Gynecology, University of Southern California, 2020 Zonal Ave, Los Angeles, CA 90033 USA.
Obstetrics, Gynecology, & Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA.
Contracept Reprod Med. 2017 May 3;2:17. doi: 10.1186/s40834-017-0044-7. eCollection 2017.
Infertility is a prevalent disease of reproductive health that exerts an impact on an estimated 80 million people worldwide. For many, involuntary childlessness becomes a central and preoccupying issue in their lives, the impact of which is exacerbated by lack of access to basic care and treatment. These effects maybe further magnified among immigrant communities, a growing but highly marginalized population that has been shown in other areas of reproductive health to experience worse health outcomes and delays in access to care. To date, few studies have examined the unique medical and sociocultural considerations of infertility among immigrant populations in the United States.
Our study is a cross-sectional analysis of women presenting for infertility evaluation at a county hospital serving a low resource, socioculturally diverse largely immigrant communities in comparison to infertile women from a largely affluent population presenting to a high resource, comprehensive fertility center. We employed surveys to evaluate demographics and socioeconomic parameters as well as abstracted data from medical records to obtain infertility diagnoses. Multivariate regression analysis was applied to examine impact of sociocultural factors as predictors of duration of untreated infertility disease burden experienced by patients.
Eighty-seven women were included in our analysis. In the county hospital/low resource clinic (LR), the mean age was 32.9 ± 4.9 vs 36.4 ± 6.3 years in the fee-for-service/high resource clinic (HR). The mean reported duration of infertility in LR and HR patients was 3.4 ± 3.0 vs 2.3 ± 1.5 years. 70% of LR patients were monolingual non-English speakers vs 5.4% of HR patients. 59% of LR patients reported an annual household income of less than $25,000 and 70% did not have a college degree. 81.1% of HR patients reported an income of higher than $100,000, and 81.1% had completed college or graduate school. The most common infertility diagnosis in the LR was anovulation (38%) and tubal factor (28%) compared to diminished ovarian reserve (37.8%) and male factor (51.4%) in the HR. After controlling for age at the initiation of pregnancy attempt, lower education level, lower income, and immigrant status were significantly correlated with a longer duration of infertility.
Women presenting for infertility care to a low resource county medical center represent immigrant communities and are generally of younger age, but with a longer duration of infertility. This study identifies lower educational level, income, and immigrant status as barriers in access to care.
不孕症是一种常见的生殖健康疾病，全球约有8000万人受其影响。对许多人来说，非自愿不育成为他们生活中的核心和困扰问题，而缺乏基本护理和治疗则加剧了这种影响。在移民社区中，这些影响可能会进一步放大，移民社区人口不断增加，但高度边缘化，在其他生殖健康领域，他们的健康状况更差，获得护理的时间也更晚。迄今为止，很少有研究探讨美国移民人口不孕症的独特医学和社会文化因素。
我们的研究是一项横断面分析，比较了在一家服务于资源匮乏、社会文化多样的大型移民社区的县医院接受不孕症评估的女性，与在一家资源丰富的综合生育中心就诊的来自富裕人群的不孕女性。我们采用调查问卷评估人口统计学和社会经济参数，并从病历中提取数据以获得不孕症诊断。应用多变量回归分析来检验社会文化因素作为患者未治疗不孕症疾病负担持续时间预测因素的影响。
我们的分析纳入了87名女性。在县医院/资源匮乏诊所（LR），平均年龄为32.9±4.9岁，而在收费服务/资源丰富诊所（HR）为36.4±6.3岁。LR组和HR组患者报告的平均不孕持续时间分别为3.4±3.0年和2.3±1.5年。70%的LR组患者只会说一种语言且非英语，而HR组患者中这一比例为5.4%。59%的LR组患者报告家庭年收入低于25000美元，70%没有大学学历。81.1%的HR组患者报告收入高于100000美元，81.1%完成了大学或研究生学业。LR组最常见的不孕症诊断是无排卵（38%）和输卵管因素（28%），而HR组是卵巢储备功能减退（37.8%）和男性因素（51.4%）。在控制了开始尝试怀孕时的年龄后，较低的教育水平、较低的收入和移民身份与较长的不孕持续时间显著相关。
在资源匮乏的县医疗中心寻求不孕症护理的女性代表移民社区，她们通常年龄较小，但不孕持续时间较长。本研究确定较低的教育水平、收入和移民身份是获得护理的障碍。
