Etiological Analysis Of Secondary Infertility In The Era Of Second Birth

Objective Through detailed medical history and comprehensive auxiliary examination,the causes and related risk factors of secondary infertility are clarified,which provides a clear basis for the diagnosis and treatment of secondary infertility in the second child pregnancy.Methods 548 cases of infertility diagnosed at Qinghai University Affiliated Hospital from January 2016 to June 2018 were collected,including 212 cases of primary infertility and 336 cases of secondary infertility.Only patients with secondary infertility were selected as the case group,and 157 cases of pregnant women during the same period of natural pregnancy were selected as the control group.By collecting the general condition of the patient(age,ethnicity,weight,cultural level,history of bad tobacco and alcohol),medical history(contraceptive methods,sexual partner status,menstrual history,abortion history,etc.),related auxiliary examination results(sex hormones,Immunological kit,thyroid function,gynecological color Doppler ultrasound,vaginal discharge smear,gynecological color Doppler ultrasound,colposcopy,tubal fluid and angiography,hysteroscopy,laparoscopic examination if necessary,etc.),detailed records of the causes of secondary infertility and analysis the results.Results The cause of secondary infertility after the opening of the "second child policy" and the composition ratio were ovarian causes(31.25%),fallopian tube causes(29.46%),uterus and cervical causes(19.64%),vaginal causes(11.62%),Immunization reasons(5.36%),unknown reasons(2.68%);The main cause of ovarian disease leading to secondary infertility is polycystic ovary syndrome.The remaining pathogenic factors include premature ovarian failure,hyperprolactinemia,and ovarian endometriosis;Among the causes of fallopian tubes,inflammation ranks first,accounting for 45.46%.Others are endometriosis adhesions,fallopian tube tuberculosis,and surgical injury;At the age of 5 years,the number of patients with secondary infertility is the highest in 31-35 years old,accounting for 30.95%;There were significant differences in age,weight,menstrual history,and abortion history between the two groups(P<0.05);The causes of secondary infertility in different age groups are different: 20 to 25 years old,36 years old and above are mainly ovarian causes,and 26 to 36 years old are causes of fallopian tubes.Conclusion The etiology of secondary infertility is complex and diverse.After the opening of the "second child policy",the cause of ovarian disease is prominent.Strengthening the early detection of ovarian function has great clinical significance for the preservation of female second characteristics and fertility;Adequate and individualized advice should be given to elderly patients with a second child’s willingness to assist reproductive technology as soon as possible;Inflammation of the cause of fallopian tubes can not be ignored,strengthening sexual health education,publicity of contraception,etc.is conducive to reducing its incidence;Age 35 years old,obesity,low level of culture,menstrual disorders,multiple sexual partners,history of induced abortion and secondary infertility.