Department of Obstetrics and Gynecology, Indiana University School of Medicine; Indianapolis, IN; Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO.
Department of Obstetrics and Gynecology, Indiana University School of Medicine; Indianapolis, IN; Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO.
Am J Obstet Gynecol. 2021 Aug;225(2):157.e1-157.e9. doi: 10.1016/j.ajog.2021.03.011. Epub 2021 Mar 11.
In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device led to a perception that all intrauterine devices cause upper genital tract infection and infertility.
This study aimed to assess the association between intrauterine device use and time to conception.
The Fertility After Contraceptive Termination Study is a multicenter, prospective cohort study of women stopping their contraceptive method to attempt conception. We recruited participants between 2011 and 2017. Participants were a convenience sample of women recruited from academic centers in Philadelphia, PA; Los Angeles, CA; St. Louis, MO; Indianapolis, IN; Aurora, CO; and Salt Lake City, UT. Women were eligible if they stopped their contraceptive method within the past 120 days before enrollment, were between 18 and 35 years of age, had no history of infertility or sterilization, and had at least 6 months of follow-up. Baseline data included demographic and reproductive characteristics, past contraceptive use, nucleic acid amplification testing for sexually transmitted infections, and serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. The primary exposure was intrauterine device use (ever); the primary outcome was time to conception. All participants were observed longitudinally for up to 24 months. We used piecewise exponential proportional hazards models with multiple imputation to provide hazard ratios and their respective 95% confidence intervals.
Of the 461 participants, mean age was 28.2 years, 178 (38.7%) were Black, 157 (34.1%) were considered as low socioeconomic status, and 275 (59.7%) had a history of intrauterine device use. Without adjusting for any covariates, the median time to conception was shorter for participants who had a history of intrauterine device use (5.1 months) than participants who never used an intrauterine device (7.5 months). After controlling for potential confounders, the association of past intrauterine device use with time to conception was not statistically significant (adjusted hazard ratio, 1.25; 95% confidence interval, 0.99-1.58). In our multivariable model, age, nulligravidity, Black race, low socioeconomic status, and past Mycoplasma genitalium infection were associated with longer times to conception (hazard ratio, 0.76; 95% confidence interval, 0.58-0.99). Conception by 12 months was lower in participants with past Mycoplasma genitalium infection (68% vs 80% without past infection; P=.019).
We found no impairment of fertility with ever use of an intrauterine device. Serologic evidence of past Mycoplasma genitalium infection was associated with longer times to conception and higher rates of infertility. Mycoplasma genitalium infection is a potential modifiable cause of infertility.
20 世纪 70 年代，大量有关 Dalkon 盾宫内节育器的医学报告、媒体报道和诉讼导致人们认为所有宫内节育器都会引起上生殖道感染和不孕。
本研究旨在评估宫内节育器使用与受孕时间之间的关系。
《避孕措施终止后的生育力研究》是一项多中心、前瞻性队列研究，纳入了试图怀孕而停止避孕措施的女性。我们于 2011 年至 2017 年期间招募参与者。参与者为从宾夕法尼亚州费城、加利福尼亚州洛杉矶、密苏里州圣路易斯、印第安纳州印第安纳波利斯、科罗拉多州奥罗拉和犹他州盐湖城的学术中心招募的便利样本女性。符合条件的参与者为在入组前 120 天内停止避孕措施、年龄在 18 至 35 岁之间、无不孕或绝育史、且随访时间至少 6 个月的女性。基线数据包括人口统计学和生殖特征、既往避孕方法使用情况、性传播感染的核酸扩增检测以及沙眼衣原体、阴道毛滴虫和生殖支原体既往感染的血清学检测。主要暴露因素为宫内节育器使用（曾用）；主要结局为受孕时间。所有参与者均接受长达 24 个月的纵向观察。我们使用分段指数比例风险模型和多重插补法提供风险比及其相应的 95%置信区间。
在 461 名参与者中，平均年龄为 28.2 岁，178 名（38.7%）为黑人，157 名（34.1%）被认为处于低社会经济地位，275 名（59.7%）有宫内节育器使用史。在未调整任何协变量的情况下，有宫内节育器使用史的参与者的中位受孕时间（5.1 个月）短于从未使用过宫内节育器的参与者（7.5 个月）。在控制潜在混杂因素后，过去宫内节育器使用与受孕时间之间的关联无统计学意义（调整后的风险比，1.25；95%置信区间，0.99-1.58）。在我们的多变量模型中，年龄、初产妇、黑人、低社会经济地位和既往生殖支原体感染与受孕时间延长有关（风险比，0.76；95%置信区间，0.58-0.99）。有既往生殖支原体感染的参与者在 12 个月内怀孕的比例较低（68% vs. 80%无既往感染；P=.019）。
我们发现宫内节育器的曾用史不会损害生育能力。生殖支原体既往感染的血清学证据与受孕时间延长和更高的不孕率有关。生殖支原体感染是一种潜在可改变的不孕原因。
