不孕（育）症夫妻二元应对异质性研究及相关因素分析

doi:10.3969/j.issn.1674-8115.2024.06.010

摘要/Abstract

摘要：

目的·采用潜在剖面分析法探索辅助生殖技术（assisted reproductive technology，ART）治疗前不孕（育）症夫妻二元应对水平的潜在剖面，并探讨不同剖面间的差异及相关因素。方法·招募2023年9月至11月在上海交通大学医学院附属仁济医院生殖医学中心接受ART治疗的不孕（育）症初诊夫妇，应用一般资料问卷、生育压力量表（Fertility Problem Inventory，FPI）、二元应对评估工具（Dyadic Coping Inventory，DCI）、生育生活质量量表（Fertility Quality of Life Tool，FertiQoL量表）进行评估。采用潜在剖面分析探索不孕（育）症夫妻治疗前二元应对的剖面类型，比较不同剖面之间的一般特征，及FPI和FertiQoL量表得分；采用多元Logistic回归分析不同二元应对剖面的相关因素。结果·共纳入257对不孕（育）症夫妻，女性平均年龄（30.15±3.07）岁，男性平均年龄（31.82±3.82）岁，平均婚龄（3.75±2.16）年，平均不孕（2.90±1.92）年；男方导致不孕118对、女方导致不孕109对、男女共患不孕（育）症30对；男性DCI平均得分（128.25±19.15）分，女性（129.91±18.32）分。根据二元应对水平，257对夫妻可分为4个潜在剖面：共同积极组（153对，59.5%）、共同消极组（85对，33.1%）、男方积极组（12对，4.7%）及男方消极组（7对，2.7%）；不同剖面不孕（育）症夫妻的年龄、FPI得分、FertiQoL量表得分、再婚比例间差异均具有统计学意义（均P<0.05）。多元Logistic回归分析结果显示，以共同积极组为参照，共同消极组的男方年龄更大（OR=1.122，95%CI 1.004~1.254，P=0.036）、男女双方FPI得分更高（男：OR=1.019，95%CI 1.003~1.035，P=0.018；女：OR=1.020，95%CI 1.004~1.036，P=0.015）、男方FertiQoL量表得分更低（OR=0.966，95%CI 0.937~0.996，P=0.029）。结论·接受ART治疗前不孕（育）症夫妻的二元应对水平可分为4个剖面类型；与共同积极应对夫妻相比，男性生育压力大、年龄大、感知的生育生活质量低，以及女性生育压力大均是夫妻共同消极应对的危险因素。

关键词: 二元应对, 不孕（育）症, 潜在剖面分析, 生育压力量表, 生育生活质量量表

Abstract:

Objective ·To analyze infertility couples, dyadic coping level by using latent profile analysis (LPA), and explore the heterogeneity and related factors of different profiles. Methods ·From September to November 2023, 257 newly diagnosed infertility couples in pre-infertility treatment with assisted reproductive technology (ART) were recruited from Reproductive Medicine Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine. All couples were evaluated by using general information questionnaire, Fertility Problem Inventory (FPI), Dyadic Coping Inventory (DCI), and Fertility Quality of Life (FertiQoL) Tool. LPA was used to explore the dyadic coping profiles of the couples before ART treatment, and general information, FPI scores and FertiQoL scores were compared among the profiles. Multinomial Logistic regression analysis was used to explore the related factors of different profiles. Results ·A total of 257 couples with infertility were included, with an average age of (30.15±3.07) years for females, (31.82±3.82) years for males, (3.75±2.16) years for marriage, and (2.90±1.92) years for infertility; there were 118 couples caused by male infertility, 109 couples caused by female infertility, and 30 couples caused by both infertility; the average DCI score for males was (128.25±19.15) points, while for females it was (129.91±18.32) points. According to the dyadic coping levels, the infertile couples were divided into four profiles: common positive coping group (153 couples, 59.5%), common negative coping group (85 couples, 33.1%), male positive coping group (12 couples, 4.7%), and male negative coping group (7 couples, 2.7%). There were statistically significant differences in the infertile couples' age, FPI score, FertiQoL score, and remarriage rate among the four profiles (P<0.05). Multinomial Logistic regression analysis results showed that, with the common positive coping group as the reference, the common negative coping group had older men (OR=1.122, 95%CI 1.004?1.254, P=0.036), higher FPI scores for both males and females (male: OR=1.019, 95%CI 1.003?1.035, P=0.018; female: OR=1.020, 95%CI 1.004?1.036, P=0.015), and lower FertiQol scores for males (OR=0.966, 95%CI 0.937?0.996, P=0.029). Conclusion ·There are four types of dyadic coping profiles in infertile couples before ART treatment. Compared with the common positive coping couples, higher reproductive pressure, elder age, and lower perceived fertility quality of life of males, and higher reproductive pressure of females are all risk factors for common negative coping couples.

Key words: dyadic coping, infertility, latent profile analysis (LPA), Fertility Problem Inventory (FPI), Fertility Quality of Life (FertiQoL) Tool

中图分类号:

R473.71

奚慧琴, 田梅梅, 谢雷, 徐于睿, 黄欣, 徐颖, 章雅青. 不孕（育）症夫妻二元应对异质性研究及相关因素分析[J]. 上海交通大学学报（医学版）, 2024, 44(6): 746-754.

XI Huiqin, TIAN Meimei, XIE Lei, XU Yurui, HUANG Xin, XU Ying, ZHANG Yaqing. Heterogeneity and related factors of dyadic coping in infertility couples[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(6): 746-754.

图/表 6

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Variable	x±s	P₅	P₂₅	P₅₀	P₇₅	P₉₀
Female DCI score/point	129.91±18.32	100.90	118.00	131.00	142.00	152.00
Male DCI score/point	128.25±19.15	99.90	113.50	131.00	141.00	149.20

Variable	x±s	P₅	P₂₅	P₅₀	P₇₅	P₉₀
Female DCI score/point	129.91±18.32	100.90	118.00	131.00	142.00	152.00
Male DCI score/point	128.25±19.15	99.90	113.50	131.00	141.00	149.20

Number of profiles	AIC	BIC	aBIC	Entropy	P value		Profile probability
Number of profiles	AIC	BIC	aBIC	Entropy	LMRT	BLRT	Profile probability
1	4 476.72	4 490.92	4 478.24	1	‒	‒	‒
2	4 429.10	5 553.95	4 431.75	0.571 2	0.000	0.010	0.420/0.580
3	4 429.78	4 465.28	4 433.57	0.488 3	0.000	0.158	0.534/0.228/0.238
4	4 413.71	4 459.85	4 418.64	0.815 1	0.000	0.010	0.595/0.331/0.047/0.027
5	4 419.51	4 476.29	4 425.57	0.605 7	0.000	0.020	0.368/0.323/0.053/0.036/0.219

Number of profiles	AIC	BIC	aBIC	Entropy	P value		Profile probability
Number of profiles	AIC	BIC	aBIC	Entropy	LMRT	BLRT	Profile probability
1	4 476.72	4 490.92	4 478.24	1	‒	‒	‒
2	4 429.10	5 553.95	4 431.75	0.571 2	0.000	0.010	0.420/0.580
3	4 429.78	4 465.28	4 433.57	0.488 3	0.000	0.158	0.534/0.228/0.238
4	4 413.71	4 459.85	4 418.64	0.815 1	0.000	0.010	0.595/0.331/0.047/0.027
5	4 419.51	4 476.29	4 425.57	0.605 7	0.000	0.020	0.368/0.323/0.053/0.036/0.219

Item	Cluster				χ²/F value	P value
Item	Common positive coping group (153 couples)	Common negative coping group (85 couples)	Male positive coping group (12 couples)	Male negative coping group (7 couples)	χ²/F value	P value
Female age/year	29.78±3.13	30.82±2.94^①	29.42±2.97	31.29±1.89	2.722	0.045
Male age/year	31.20±3.45	32.91±4.07^②	31.58±5.47	32.57±2.30	3.888	0.010
Marriage time/year	3.79±2.16	3.93±2.24	2.75±1.54	2.36±1.11	2.072	0.104
Infertility time/year	2.92±1.96	3.09±1.92	1.92±1.31	1.57±0.79	2.516	0.059
Female education level/n(%)					11.544	0.073
Below university degree	33 (21.57)	22 (25.88)	0 (0)	1 (14.28)
University degree	102 (66.67)	55 (64.71)	11 (91.67)	3 (42.86)
Above university degree	18 (11.76)	8 (9.41)	1 (8.33)	3 (42.86)
Male education level/n(%)					7.374	0.288
Below university degree	37 (24.18)	21 (24.71)	2 (16.67)	1 (14.29)
University degree	97 (63.40)	59 (69.41)	10 (83.33)	4 (57.14)
Above university degree	19 (12.42)	5 (5.88)	0 (0)	2 (28.57)
Female income/n(%)					8.855	0.182
<5 000 yuan/month	50 (32.68)	31 (36.47)	1 (8.33)	2 (28.57)
5 000‒10 000 yuan/month	66 (43.14)	36 (42.35)	6 (50.00)	1 (14.29)
>10 000 yuan/month	37 (24.18)	18 (21.18)	5 (41.67)	4 (57.14)
Male income/n(%)					5.962	0.427
<5 000 yuan/month	16 (10.46)	12 (14.12)	0 (0)	0 (0)
5 000‒10 000 yuan/month	73 (47.71)	34 (40.00)	7 (58.33)	2 (28.57)
>10 000 yuan/month	64 (41.83)	39 (45.88)	5 (41.67)	5 (71.43)
Female with jobs/n(%)	130 (84.97)	75 (88.24)	11 (91.67)	6 (85.71)	0.796	0.850
Male with jobs/n(%)	149 (97.39)	84 (98.82)	11 (91.67)	7 (100.00)	2.614	0.455
Remarriage/couple(%)	1 (0.65)	3 (3.53)	1 (8.33)	1 (14.29)	8.707	0.033
Cause of infertility/n(%)					6.935	0.327
Male	72 (47.06)	36 (42.35)	6 (50.00)	4 (57.14)
Female	66 (43.14)	39 (45.88)	3 (25.00)	1 (14.29)
Both spouses	15 (9.80)	10 (11.76)	3 (25.00)	2 (28.57)
Treatment/n(%)					3.922	0.687
IVF	84 (54.90)	49 (57.65)	8 (66.67)	2 (28.57)
ICSI	45 (29.41)	26 (30.59)	2 (16.67)	3 (42.86)
PGT	24 (15.69)	10 (11.76)	2 (16.67)	2 (28.57)