Incidence and risk factors of infertility among couples who desire a first and second child in Shanghai, China: a facility-based prospective cohort study

Abstract

Background With the implementation of the two-child policy in China, more couples have expressed the desire to have another child. We conducted this study to evaluate the incidence of infertility and risk factors in couples intending to have a first and second child. Methods From 2013 to 2017, a prospective cohort study was conducted at the pre-pregnancy center of the International Peace Maternal and Child Health Hospital. The participants were selected by screening and random sampling couples who came to the pre-pregnancy center. Data regarding patient sociodemographic characteristics, reproductive and gynecological history, male disease history, and laboratory and imaging examination results were collected. Couples were followed up every 3 months until pregnancy or for 12 months, whichever came first. Multi-factor logistic regression was used to analyze risk factors for infertility. Adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors. Results The overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338), respectively. This study found great differences in both infertility rate (P < 0.001) and risk factors between the two groups. Risk factors for “first child intention” infertility included advanced age (> 35 years) (aOR = 1.70, 95% CI 1.27–2.28), abnormal body mass index (BMI) (aOR = 1.58, 95% CI 1.31–6.26), longer menstrual periods (aOR = 4.47, 95% CI 2.25–8.88), endometrial polyps (aOR = 2.52, 95% CI 1.28–4.97), polycystic ovarian syndrome (PCOS) (aOR = 6.72, 95% CI 1.79–7.39), salpingostomy (aOR = 3.44, 95% CI 1.68–7.07), and history of mycoplasma (aOR = 1.54, 95% CI 1.09–2.40). However, in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma (aOR = 5.60, 95% CI 1.06–29.76), and higher age (> 40 years) (aOR = 7.36, 95% CI 1.01–53.84). Conclusion The overall infertility rate in Shanghai is similar to that of other large cities in China. Marriage at advanced ages has become increasingly common. As such, the government must consider subsidies to encourage childbirth at childbearing ages, which can improve fertility levels.

Predictors and incidence of depression and anxiety in women undergoing infertility treatment: A cross-sectional study

“…The age of infertile woman (>35 years) was another independent risk factor for depressive symptoms (P<0.05). These finding was similar to many previous study conducted in other provinces of China [ 13 , 14 ]. And the possible reason might be that with the increase of age, the probability of successful conception of infertile patients will gradually decrease [ 33 ].…”

“…In Japan, about 67% of unmarried women believe that couples should have at least one child after marriage, while about 25% of married women believe that a couple is socially acceptable only after they have children, according to the study [ 12 ]. In China, people attach great importance to fertility [ 13 , 14 ]. Even though women have relatively high family decision-making power than in the past, there still exist a tendency in society to think that "it is always women’s fault to have no children” [ 5 , 15 ].…”

“…In recent years, with the increasing incidence of infertility, more and more researchers have begun to pay attention to the psychological stress, such as anxiety and depression, of infertile women [ 5 , 9 , 17 ]. However, many of the current studies only focused on the relationship between stigma and psychological distress [ 4 , 5 , 12 , 18 ], only few studies [ 13 , 14 ] investigated the risk factors for psychological stress in infertile women. Besides, the sample size included in these studies were not large enough, and they only investigated the influence of demographic characteristics on psychological stress of infertile women.…”

Critical windows of greenness exposure during preconception and gestational periods in association with birthweight outcomes

“…Additionally, we experienced a loss to follow-up for 15 992 women who lacked birth records. Possible reasons for these missing records include infertility (16.95%, n = 2177 in Shanghai) as reported by Zhu et al (2022), and pregnancy loss (ranging between 10% and 24%) as indicated by Jiang et al (2023). The impact of this loss to follow-up on greenness effects remains uncertain.…”

Rising trend of childlessness in China: analysis of social and regional disparities with 2010 and 2020 census data

“…For decades, the percentage of childlessness among women remained low, with a rate of 1.46% for women aged 40–49 in the 1982 population census,10 1.69% for women aged 49 in the 1987 1% population sample survey,11 1.25% for women aged 49 in the 1990 population census,12 less than 2% for women aged 49 in the 2017 National Fertility Survey13 and 4.16% for women aged 49 in the 2015 1% population sample survey 14. However, over the past few decades, there has been a gradual increase in the prevalence of childlessness, specifically as a result of infertility 15–18. The National Health Commission of China indicated that the incidence of infertility was between 7% and 10% in 2021 19.…”