Cramer D W, Goldman M B, Schiff I, Belisle S, Albrecht B, Stadel B, Gibson M, Wilson E, Stillman R, Thompson I
JAMA. 1987 May 8;257(18):2446-50.
We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.
我们研究了283名诊断为输卵管粘连或阻塞的未生育不育女性以及1981年至1983年在7家合作医院住院分娩的3833名女性过去的避孕使用情况。使用多变量逻辑回归计算与屏障避孕法或口服避孕药使用相关的输卵管性不孕的相对风险，以控制地区、年龄、宗教、教育程度、吸烟、性伴侣数量、初潮后时间以及其他避孕方法使用等混杂因素。曾经使用过屏障避孕法的女性患输卵管性不孕的风险显著降低（相对风险 = 0.6；95%置信区间，0.5和0.8）。当评估使用时间最长的屏障避孕法类型时，使用子宫托或避孕套加杀精剂的女性比仅使用避孕套或杀精剂的女性风险更低。总体而言，过去使用口服避孕药既未增加也未降低女性患输卵管性不孕的风险，但有证据表明口服避孕药与输卵管性不孕之间的关联可能因所用口服避孕药中的雌激素含量和孕激素类型而异。我们得出结论，使用机械和化学屏障相结合的屏障避孕法（如子宫托、宫颈帽以及避孕套加杀精剂）的避孕使用者对输卵管损伤具有最明确的保护作用。
