Epidemiological and clinical aspects of fertility and diseases associated with infertility among Swedish-born and foreign-born women

Sammanfattning: Objective To examine the association between sociodemographic factors and first birth country of birth and hospitalization for pelvic inflammatory disease (PID), ectopic pregnancy (EP), enfertility trends in Sweden during the 90s (study 1). To examine the association between dometriosis (EM) and infertility (study 2). To examine the long-term effects of alcohol consumption on female fertility (study 3). To describe the clinical symptoms and signs in women diagnosed with PID in a Swedish hospital setting in comparison with the diagnostic criteria from the CDC 2002 Guidelines (study 4). Methods In study 1, the impact of socioeconomic factors and years in Sweden on first birth fertility was examined in 1991 92 (N = 452,000) and 1997 98 (N = 495,756) among Swedish-born and 19 subgroups of foreign-born women aged 20 41 years. Poisson regression was used in the analysis. Study 2 followed 2,170,177 women living in Sweden at some point between 1990 and 2004 for hospitalization for PID, EP, EM or infertility. In study 3, selfestimated alcohol consumption was obtained from postal questionnaires to 7,393 women in the age-range 18 28 years in 1969. Data on deliveries, miscarriages, legal abortions, EP, PID, EM and infertility examinations, in relation to the intake of alcohol, were analysed until 1987. Study 4 included 189 out-patients diagnosed as having PID at the obstetric and gynaecological emergency department of a Swedish university hospital in 2001. Data on symptoms, signs, pelvic examination and laboratory tests were extracted from the electronic medical records. Results First birth rates decreased and mean age at first birth increased between the two periods among the Swedish-born and most foreign-born women. Non-employment and low income were associated with decreased first birth fertility, and low educational status was associated with slightly increased first birth fertility. Several groups of foreign-born women increased their first birth fertility even if they were non-employed or had a low income. Among foreign-born women fewer years in Sweden was significantly associated with increased first birth fertility (study 1). For PID and infertility, all groups of foreign-born women exhibited significantly increased risks compared to Swedish-born women whereas country of birth was associated with EM and EP to a smaller extent (study 2). High consumers of alcohol had an increased risk for infertility examinations, as compared with moderate consumers, relative risk ratio (RR) = 1.59 (95% confidence interval (CI): 1.09 2.31) and low consumers had a decreased risk (RR= 0.64; CI: 0.46 0.90). For both high and low consumers a significantly lower number of first and second partus were observed (study 3). Most symptoms associated with the PID diagnosis are mentioned in the CDC 2002 Guidelines. Detected rates of Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (NG) were 5% and 0%, respectively, among the tested patients (CT = 52% and NG = 12%). The women presented clinical symptoms and signs that largely were in accordance with guidelines. Only half of the patients were tested for CT (study 4). Conclusions Public health information should emphasize that postponement of first birth could lead to involuntary childlessness. Even in a country like Sweden, which offers publicly financed treatment for infertility, differences based on country of birth exist. Additionally, to limit alcohol intake may be of importance for women who intend to have children. The clinical basis for the diagnostics of PID was largely in accordance with the criteria in the CDC 2002. The testing rate for CT should be improved in clinical praxis.