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改善计划妊娠夫妇的自然生育力

Authors
Mark D Hornstein, MD
William E Gibbons, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

引言

医务人员经常会接受那些担心自身生育能力的夫妇的咨询。有些夫妇甚至在尝试妊娠之前或未达到低生育力标准时就来寻求此类信息。这些夫妇们会尤其积极地听从关于生活方式因素对生育力以及对整体健康的影响的建议。

一些生活方式因素似乎对达到妊娠前的时间长短有影响；这些影响往往较小并且是累积性的[1]。流行病学研究表明改变生活方式可以提高生育力，不过这些干预措施并未在随机试验中得到可靠的验证[2,3]。

本文将总结关于吸烟、体质指数(body mass index, BMI)、酒精与咖啡因摄入、运动和应激对生育力的影响，以及这些因素对计划妊娠夫妇的影响的数据。对低生育力夫妇的评估和治疗将单独讨论。 (参见“不孕概述”和“男性不育的治疗”和“女性不孕症的病因”和“女性不孕症的评估”)

定义

  • 生育力(也称为繁殖力)是指受孕并繁衍后代的能力。
  • 不孕是即使频繁性交也无能力受孕。不孕是指生育能力减弱的状态，但未必没有生育能力。因此，常用低生育力这个术语来代替不孕症。35岁以下的女性在尝试受孕12个月后不成功则应评估是否存在不孕症，年龄在35岁或以上的女性则应在6个月后就进行评估。
  • 不育症是无能力繁衍后代。
  • 生育能力是在单个月经周期内怀孕的概率。
  • 生育能力不足是指生育能力降低。
  • 怀孕所需时间(time to pregnancy)是指一对夫妇受孕所花费的时间长度，通常以月计。该参数通常被用于流行病学研究作为生育能力不足的衡量标准[4,5]。

正常生育力

应该向夫妇提供关于正常生育力的信息。如图所示(图 1)，大多数的受孕发生在尝试怀孕的前6个月经周期[5,6]。随着妊娠失败的持续月份数量的增加，生育能力逐渐而下降。总体而言，经过12个月无保护性交，约85%的夫妇会受孕。在未孕的那些夫妇中，约50%将在接下来的36个月内自然受孕[7]。在尝试怀孕48个月后依然没有受孕的夫妇中，有5%-7%的夫妇仅偶尔会自然受孕。开始进行不孕症评估的标准因个人特征(如年龄)而不同，这将单独讨论。 (参见“女性不孕症的评估”和“男性不育的评估”)  

                             

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-17.
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