辅助生殖夫妇婚姻状况的影响因素及其对妊娠结局的影响

程静娴; 王春艳; 王婕妤; 袁兰兰; 吴炫烨; 王吟霜; 罗桂英

doi:10.16766/j.cnki.issn.1674-4152.002973

辅助生殖夫妇婚姻状况的影响因素及其对妊娠结局的影响

doi: 10.16766/j.cnki.issn.1674-4152.002973

安徽医科大学第一附属医院生殖中心，安徽合肥 230000

基金项目:

安徽省高校自然科学研究项目 KJ2020A0203

安徽省高校人文社会科学研究项目 SK2020A0146

详细信息

通讯作者:
罗桂英，E-mail：luogyhsz@126.com

中图分类号: R711.6
计量
- 文章访问数: 251
- HTML全文浏览量: 115
- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2022-08-08

Factors influencing marital status in assisted reproduction couples and its impact on pregnancy outcomes

The Reproductive Center of the First Affiliated Hospital of Anhui Medical University, Heifei, Anhui 230000, China

摘要

摘要: 目的探讨辅助生殖夫妇婚姻状况的影响因素，分析其对妊娠结局的影响，为提高辅助生殖技术(ART)的成功率提供参考。方法选择安徽医科大学第一附属医院生殖中心2020年3—8月进入试管周期的402对夫妻为研究对象，采用一般资料调查法、Locke-Wollance婚姻调适问卷(MAT)、社会支持评定量表(SSRS)进行调查，分析婚姻状况的影响因素，并随访妊娠结局，探讨辅助生殖夫妇婚姻对妊娠的影响。结果 402对夫妻中，男性的婚姻得分为(117.34±20.40)分，高于女性的(109.80±21.90)分(P＜0.01)。单因素分析显示，女方的月收入、在职状态、不孕年限、不孕原因、ART压力源以及与长辈同住差异有统计学意义(均P＜0.05)；男方的年龄、文化程度、在职状态、月收入、不孕年限和不孕原因差异有统计学意义(均P＜0.05)。双方的婚姻状况与社会支持均呈正相关关系(r=0.290、0.250，均P＜0.01)，多元回归分析显示，不孕年限、不孕原因，ART压力源、与长辈同住及社会支持得分是女性婚姻状况的影响因素(均P < 0.05)，年龄、文化程度、不孕年限及社会支持得分是男性婚姻状况的影响因素(均P＜0.05)，女性婚姻失调组的临床妊娠率(57.5%)低于婚姻良好组(68.4%)，差异有统计学意义(P＜0.05)。结论 ART夫妇婚姻状况的影响因素不同，女性婚姻状况低于男性且对临床妊娠有影响，临床工作中需根据这些危险因素将夫妻作为一体进行心理疏导，提高辅助生殖的成功率。
- 辅助生殖 /
- 婚姻状况 /
- 影响因素 /
- 妊娠结局
Abstract: Objective To study the factors influencing the marital status of assisted reproductive technology (ART) couples and its impact on pregnancy outcomes, in order to provide a reference for improving the success rate of ART. Methods A total of 402 couples who entered the in vitro fertilization (IVF)cycle from March 2020 to August 2020 at the Reproductive Center of the First Affiliated Hospital of Anhui Medical University were selected as the research objects. General data, Locke Wollance marriage adjustment test (MAT) and social support rating scale (SSRS) were used to analyze the influencing factors of marital status and subsequent pregnancy outcomes, and to explore the influence of marriage on pregnancy in ART couples. Results Among the 402 couples, men ' s marriage score (117.34±20.40) was significantly higher than women ' s (109.80±21.90, P < 0.01). Univariate analysis showed that there were significant differences in women ' s monthly income, working status during ART, infertility duration, causes of infertility, ART stressors and living with elders (all P < 0.05). There were statistically significant differences in the male partner ' s age, education level, employment status, monthly income, infertility duration and causes of infertility (all P < 0.05). There were positive correlation between both marital status and social support (r=0.290, 0.250, both P < 0.01). The results of multiple regression analysis showed that infertility duration, cause of infertility, ART stressors, living with elders, and social support are risk factors for women ' s marital status (all P < 0.05). Age, culture level, duration of infertility and social support are risk factors for male marital status (all P < 0.05). The clinical pregnancy rate of the female marriage disorder group (57.5%) was lower than that of the good marriage group (68.4%), and the difference was statistically significant (P < 0.05). Conclusion The marital status of ART couples is affected by different factors, and the marital status of women is lower than that of men and has an impact on clinical pregnancy. In clinical work, couples should be treated as a whole for psychological counseling according to these risk factors in order to improve the success rate of assisted reproduction.
- Assisted reproduction /
- Marital status /
- Influencing factor /
- Pregnancy outcomes
利益冲突 无

HTML全文

表 1 ART夫妇婚姻状况

Table 1. Marital status of ART couples

性别	例数	婚姻状况得分(x±s，分)	婚姻状况[例(%)]
性别	例数	婚姻状况得分(x±s，分)	失调	良好
男性	402	117.34±20.40	79(19.65)	323(80.35)
女性	402	109.80±21.90	127(31.59)	275(68.41)
统计量		5.053^a	15.037^b
P值		< 0.001	< 0.001
注：^a为t值, ^b为χ²值。

下载: 导出CSV

表 2 ART夫妇婚姻状况的单因素分析

Table 2. Univariate analysis of marital status of ART couples

项目	女方		统计量	P值	男方		统计量	P值
项目	例数	婚姻状况得分	统计量	P值	例数	婚姻状况得分	统计量	P值
年龄(岁)
＜30	147	110.67±23.18	0.280^a	0.756	108	120.83±20.62	4.045^a	0.018
30~34	188	108.94±21.03			179	117.88±18.96
≥35	67	110.33±23.63			115	113.23±21.82
文化程度
小学及以下	16	103.88±18.76	1.545^a	0.188	7	120.14±13.95	4.750^a	0.001
初中至高中	191	108.32±20.36			185	112.83±21.48
大专	88	108.97±22.99			92	119.71±21.09
本科	89	113.85±23.84			95	121.71±16.47
硕士及以上	18	114.78±23.45			23	125.35±18.19
在职状态
在职	163	112.82±22.87	3.266^a	0.039	329	118.16±19.85	2.683^a	0.070
离职	109	106.02±20.99			28	118.32±22.50
未就业	130	109.80±21.90			45	110.73±22.25
月收入(元)
＜5 000	295	108.87±21.36	3.173^a	0.043	133	113.64±20.32	4.106^a	0.017
5 000~10 000	88	110.33±23.12			201	118.28±20.97
＞10 000	19	121.79±21.47			68	121.82±17.77
居住地
本市	170	110.12±21.98	0.035^a	0.966	164	119.32±19.98	1.328^a	0.266
本省外市	211	109.53±22.12			219	116.06±20.41
外省	21	109.90±19.80			19	115.05±23.47
婚姻史
初婚	338	109.60±22.37	-0.421^b	0.674	360	117.05±20.19	-0.852^b	0.395
再婚	64	110.86±19.32			42	119.88±22.45
不孕年限(年)
1~3	233	112.24±21.98	3.595^a	0.028	237	120.86±19.69	9.265^a	<0.001
4~5	100	107.05±23.07			103	113.27±20.98
≥6	69	105.54±18.82			62	110.66±19.46
有无子女
有	88	111.08±19.77	0.619^b	0.536	78	114.29±22.44	-1.472^b	0.142
无	314	109.44±22.47			324	118.08±19.85
不孕原因
男方原因	65	114.05±22.49	3.650^a	0.013	85	121.88±17.32	2.175^a	0.090
女方原因	192	106.08±21.91			156	116.24±19.98
双方原因	72	112.90±20.66			66	113.97±21.87
不明原因	73	112.74±21.35			95	117.43±22.14
治疗时间(年)
≤1	134	110.10±22.70	1.053^a	0.369	120	117.56±20.05	0.423^a	0.736
2~3	215	110.79±21.94			231	117.78±20.44
4~5	35	104.14±19.30			30	116.33±21.85
≥6	18	106.72±19.63			21	112.71±20.73
治疗费用(万)
≤3	28	109.14±25.80	1.634^a	0.196	30	119.03±18.59	1.762^a	0.173
4~5	208	111.67±21.64			198	119.01±19.90
≥6	166	107.57±21.43			174	115.16±21.15
ART压力源
自身	243	110.72±21.54	2.642^a	0.049	226	118.20±19.85	0.827^a	0.480
配偶	36	100.08±21.65			38	112.58±17.11
父母	31	111.52±21.85			35	117.49±23.60
其他	92	110.61±22.35			103	117.17±21.57
与长辈同住
否	201	112.32±21.24	2.322^b	0.021	220	117.61±20.22	0.287^b	0.774
是	201	107.28±22.31			182	117.02±20.67
注：^a为F值，^b为t值。

下载: 导出CSV

表 3 女方变量赋值方法

Table 3. Female variable assignment method

变量	赋值方法
因变量	婚姻状况得分，以实际值赋值
自变量
在职状态	在职=(1, 0, 0), 离职=(0, 1, 0), 未就业=(0, 0, 1)
月收入	＜5 000元=1, 5 000~10 000元=2, ＞10 000元=3
不孕年限	1~3年=1, 4~5年=2, ≥6年=3
不孕原因	男方原因=(1, 0, 0, 0)，女方原因=(0, 1, 0, 0), 双方原因=(0, 0, 1, 0), 不明原因=(0, 0, 0, 1)
ART压力源	自身=(1, 0, 0, 0), 配偶=(0, 1, 0, 0), 父母=(0, 0, 1, 0), 其他=(0, 0, 0, 1)
与长辈同住	否=1, 是=2
社会支持	以实际值赋值

下载: 导出CSV

表 4 男方变量赋值方法

Table 4. Male variable assignment method

变量	赋值方法
因变量	婚姻状况得分，以实际值赋值
自变量
年龄	＜30岁=1, 30~34岁=2, ≥35岁=3
文化程度	小学及以下=1, 初中至高中=2, 大专=3, 本科=4, 硕士及以上=5
月收入	＜5 000元=1, 5 000~10 000元=2, ＞10 000元=3
不孕年限	1~3年=1, 4~5年=2, ≥6年=3
社会支持得分	以实际值赋值

下载: 导出CSV

表 5 女方婚姻状况的多元线性回归分析

Table 5. Multiple linear regression analysis of female marital status

变量	B	SE	β	t值	P值
不孕年限	-3.680	1.361	-0.129	-2.703	0.007
不孕原因(双方原因)	8.429	2.826	0.148	2.983	0.003
ART压力源(配偶)	-9.611	3.682	-0.125	-2.610	0.009
与长辈同住	-5.403	2.057	-0.124	-2.627	0.009
社会支持得分	1.076	0.172	0.298	6.259	＜0.001

下载: 导出CSV

表 6 男方婚姻状况的多元线性回归分析

Table 6. Multiple linear regression analysis of male marital status

变量	B	SE	β	t值	P值
年龄	-4.371	1.363	-0.160	-3.206	0.001
文化程度	3.517	1.053	0.170	3.340	0.001
不孕年限	-2.999	1.393	-0.110	-2.154	0.032
社会支持得分	0.738	0.153	0.226	4.813	＜0.001

下载: 导出CSV

表 7 女方婚姻状况对妊娠结局的影响[例(%)]

Table 7. Effects of female marital status on pregnancy outcomes

婚姻状况	例数	生化妊娠	临床妊娠	活产
婚姻失调	127	82(64.6)	73(57.5)	62(48.8)
婚姻良好	275	203(73.8)	188(68.4)	149(54.2)
χ²值		3.604	4.519	1.002
P值		0.058	0.034	0.317

下载: 导出CSV

表 8 男方婚姻状况对妊娠结局的影响[例(%)]

Table 8. Effects of male marital status on pregnancy outcomes

婚姻状况	例数	生化妊娠	临床妊娠	活产
婚姻失调	79	57(72.2)	55(69.6)	39(49.4)
婚姻良好	323	228(70.6)	206(63.8)	172(53.3)
χ²值		0.075	0.952	0.384
P值		0.784	0.329	0.536

下载: 导出CSV

参考文献(21)

[1]	翟振武, 刘雯莉. 中国妇女终身不孕水平究竟有多高?——基于人口调查数据的分析[J]. 人口研究, 2020, 44(2): 3-17. https://www.cnki.com.cn/Article/CJFDTOTAL-RKYZ202002001.htm ZHAI Z W, LIU W L. Estimating the prevalence of infertility in china using census data[J]. Population Research, 2020, 44(2): 3-17. https://www.cnki.com.cn/Article/CJFDTOTAL-RKYZ202002001.htm
[2]	赵丰华, 谢君文. 浅析我国离婚率逐年攀升现象[J]. 法制与社会, 2020(7): 149-150. https://www.cnki.com.cn/Article/CJFDTOTAL-FZSL202007071.htm ZHAO F H, XIE J H. Brief analysis of our country divorce rate climbs year by year phenomenon[J]. Legal System and Society, 2020(7): 149-150. https://www.cnki.com.cn/Article/CJFDTOTAL-FZSL202007071.htm
[3]	胡素文, 鲍祎敏, 唐诗, 等. 行体外受精-胚胎移植的不孕症患者挫败感现状及影响因素分析[J]. 中国护理管理, 2021, 21(5): 692-696. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202105013.htm HU S W, BAO Y M, TANG S, et al. Current status of defeat and influencing factors in female infertility patients with in vitro fertilization-embryo transfer[J]. Chinese Nursing Management, 2021, 21(5): 692-696. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202105013.htm
[4]	范芳晋, 冯灵, 涂双燕, 等. 神经内科监护室过渡期病人家属需求现状及影响因素分析[J]. 护理研究, 2022, 36(14): 2503-2506. doi: 10.12102/j.issn.1009-6493.2022.14.011 FAN F J, FENG L, TU S Y, et al. Analysis of status quo and influencing factors of family members needs of patients during transitionperiod in neurology monitoring intensive care unit[J]. Chinese Nursing Research, 2022, 36(14): 2503-2506. doi: 10.12102/j.issn.1009-6493.2022.14.011
[5]	胡颖, 李再元, 方浴娟, 等. 辅助生殖技术助孕患者伴侣亲密关系与产前抑郁的相关性研究[J]. 中华全科医学, 2019, 17(3): 419-422. doi: 10.16766/j.cnki.issn.1674-4152.000697 HU Y, LI Z Y, FANG Y J, et al. Analysis of correlation among intimate relationship with spousal and prenatal depression among patients undergoing assisted reproductive technology[J]. Chinese Journal of General Practice, 2019, 17(3): 419-422. doi: 10.16766/j.cnki.issn.1674-4152.000697
[6]	王婕妤, 唐王琴, 吴景梅, 等. 首次行试管婴儿助孕夫妻的婚姻调适和抑郁的关系[J]. 中华疾病控制杂志, 2022, 26(9): 1108-1112. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202209020.htm WANG J Y, TANG W Q, WU J M, et al. Relationship between marital adjustment and depressionin infertile couples undergoing in vitro fertilization treatment for the first time based on the actor-partner interdependence model[J]. Chin J Dis Control Prev, 2022, 26(9): 1108-1112. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202209020.htm
[7]	SAMAM M, MOSTAFA H, ABBAS R, et al. The relationship between perceived stress and marital satisfaction in couples with infertility: actor-partner interdependence model[J]. Int J Fertil Steril, 2019, 13(1): 66-71.
[8]	PASHA H, BASIRAT Z, ESMAILZADEH S, et al. Marital intimacy and predictive factors among infertile womenin Northern Iran[J]. J Clin Diagn Res, 2017, 11(5): QC13-QC17.
[9]	NI Y, HUANG L M, TONG C Y, et al. Analysis of the levels of hope and influencing factors in infertile women with first-time and repeated IVF-ET cycles[J]. Reprod Health, 2021, 18(1): 200.
[10]	SWARNALI B, BHARATI R, SHREEKANTIAH U. Marital duration, and fertility-related stress as predictors of quality of life: gender differences among primary infertile couples[J]. J Hum Reprod Sci, 2021, 14(2): 184-190.
[11]	DIANA A, CORINA G, ELENA O, et al. Emotional disorders, marital adaptation and the moderating role of social support for couples under treatment for infertility[J]. Ginekol Pol, 2021, 92(2): 98-104.
[12]	高辉. 多次行夫精宫腔内人工授精妇女焦虑、心理弹性与婚姻调适的相关性研究[D]. 大连: 大连医科大学, 2020. GAO H. Correlation between anxiety, resilience and marital adjustment inwomen undergoing intrauterine insemination repeatedly[D]. DaLian: DaLian Medical university, 2020.
[13]	LEI A J, YOU H X, LUO B R, et al. The associations between infertility-related stress, family adaptability and family cohesion in infertile couples[J]. Sci Rep, 2021, 11(1): 24220. DOI: 10.1038/s41598-021-03715-9.
[14]	RAZHAN C, GITI O, KHADIJEH A, et al. Child-Free lifestyle and the need for parenthood and relationship with marital satisfaction among infertile couples[J]. Iran J Psychiatry, 2021, 16(3): 243-249.
[15]	戴晴, 李伦兰, 廖晨霞, 等. 脊髓损伤患者及其配偶二元应对体验的质性研究[J]. 中华护理杂志, 2021, 56(8): 1180-1186. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202108013.htm DAI Q, LI L L, MIAO C L, et al. A qualitative research on the dual coping experience of patients with spinal cord injury and their spouses[J]. Chin J Nurs, 2021, 56(8): 1180-1186. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202108013.htm
[16]	FARNAZ S, SEYEDEH B, HASANPOOR A, et al. Psychological well-being of infertile women and its relationship with demographic factors and fertility history: a cross-sectional study[J]. BMC Women ' s Health, 2021, 21: 22.
[17]	时梦醒, 王康霞, 鲁智敏, 等. 辅助生殖夫妇术前抑郁情绪的影响因素及其对活产率的影响[J]. 安徽医科大学学报, 2020, 55(2): 272-276. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202002023.htm SHI M X, WANG K X, LU Z M, et al. Factors associated with the depression of couples preparing for assisted reproductive and their effect on live birth rate[J]. Acta Universitatis Medicinalis Anhui, 2020, 55(2): 272-276. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202002023.htm
[18]	GAURI B, GULZHANZT A, AIPAMYS I, et al. The effect of stress, anxiety and depression on in vitro fertilization outcome in kazakhstani public clinical setting: a cross-sectional study[J]. J Clin Med, 2021, 10(5): 937.
[19]	史新宇, 孙一鑫, 刘鹏辉, 等. 以夫妻为中心的护理干预在实施体外受精-胚胎移植患者中的应用及效果观察[J]. 护士进修杂志, 2021, 36(8): 725-729. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202108013.htm SHI X Y, SUN Y X, LIU P H, et al. Application and effect of couple-centered nursing intervent-ion in patients undergoing in vitro fertilization-embryo transfer[J]. Journal of Nurses Training, 2021, 36(8): 725-729. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202108013.htm
[20]	LOVENESS D, KATHERINE B, HAYDEN K, et al. Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis[J]. Hum Reprod Update, 2022, 9(3): 34.
[21]	WU X L, WU Y D, XIA M, et al. Case management improves satisfaction, anxiety, and depression of patients with pregnancy loss after in vitro fertilization and embryo transfer[J]. Comput Math Methods Med, 2022: 1968313. DOI: 10.1155/2022/1968313.