Estimates of human fertility and pregnancy loss
Estimates of human fertility and pregnancy loss
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DOI：
10.1016/s0015-0282(16)58144-8
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发表时间：
1996-03-01
影响因子：
6.7
通讯作者：
Selevan, SG
中科院分区：
文献类型：
--
作者：
Zinaman, MJ;Clegg, ED;Selevan, SG
目的：检查一组可能具有生育能力的夫妇的生育力和妊娠浪费率。设计：对 200 对希望在 12 个月经周期内怀孕的夫妇进行前瞻性观察研究，并跟踪妊娠结果。地点：一所大学妇产科中心。患者：通过个人访谈和问卷调查来筛选参加研究的夫妇。建议夫妻在预计排卵日进行性交。第一阶段包括前三个周期，其中女性每天收集晨尿样本，接受周期中期性交后测试，如果月经推迟，则进行血清 hCG 测试。第二阶段包括接下来的九个周期，每月通过电话联系女性，并在月经推迟时接受血清 hCG 检测。对未发生临床（血清 hCG）妊娠的周期的尿液样本进行敏感的 hCG 检测，以检测隐匿妊娠。对怀孕进行跟踪直至分娩以确定结果。结果：在整个研究期间跟踪的 200 对夫妇中，82% 的人怀孕了。在前两个周期中，每个周期的最大生育率约为 30%。在研究的其余部分中，这一比率迅速下降。第一阶段的流产占检测到的妊娠的 31%。其中 41% (15/36) 仅通过尿液 hCG 检测发现，并被归类为隐匿性损失。其中 11 名患者后来在研究过程中实现了临床认可的受孕。结论：这些结果支持这样的概念：人类生殖效率在每个周期约 30% 时达到最大。其中相当多的妊娠以自然流产告终。此外，很大比例的女性会在月经错过之前流产。
Objective: To examine the fertility and pregnancy wastage rates in a group of presumably fertile couples.Design: Prospective observational study of 200 couples desiring to achieve pregnancy over 12 menstrual cycles coupled with pregnancy outcome follow-up.Setting: A university-based obstetrics and gynecological center.Patients: Personal interviews and questionnaires were used to screen couples for entry into the study. Couples were counseled to have intercourse centered on predicted day of ovulation. Phase 1 included the first three cycles in which women collected daily morning urine samples, underwent midcycle postcoital tests, and, if late for their menses, presented for serum hCG testing. Phase 2 encompassed the next nine cycles in which women were contacted monthly by phone and underwent serum hCG testing if menses was delayed. Urine samples from cycles in which clinical (serum hCG) pregnancy did not occur underwent sensitive hCG testing to detect occult pregnancies. Pregnancies were followed until delivery to ascertain outcome.Results: Eighty-two percent of the 200 couples followed for the entire study period conceived. The maximal fertility rate was approximately 30% per cycle in the first two cycles. This rate quickly tapered over the remainder of the study. Pregnancy wastage during phase 1 accounted for 31% of the pregnancies detected. Forty-one percent (15/36) of these losses were seen only by urine hCG testing and were categorized as occult. Eleven of these same patients later achieved clinically recognized conceptions during the study.Conclusions: These results support the concept that the efficiency of human reproduction is maximum at approximately 30% per cycle. A very significant number of these pregnancies end in spontaneous abortion. In addition, pregnancy loss before missed menses occurs in a significant proportion of women.