Abstract
Background: With the implementation of the two-child policy in China, more couples expressed their desire to have a child. We conducted this study to evaluate the incidence and risk factors of infertility in couples intending to have a first child and second child.Methods: Couples who presented to the pre-pregnancy clinical centers were enrolled from 2013 to 2017. Participants were categorized into “first child intention” and “second child intention” groups based on the number of children they already had. Couples were followed up every three months until pregnancy or 12 months. Data regarding the sociodemographic characteristics, history of reproduction and gynecology, history of male disease, and laboratory and imaging examination results were collected. Odds ratios (ORs) and their 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). The study showed great differences in infertility risk factors between two groups. Risk factors for “first child intention” infertility included advanced age (>35 years), abnormal body mass index (BMI), longer menstrual durations, endometrial polyps, polycystic ovarian syndrome (PCOS), salpingostomy, and history of mycoplasma. However, in “second child intention” group, clinical risk factor was slightly different, such as leiomyoma, higher age (>40 years).Conclusion: The incidence and risk factors of infertility are significantly different between “first child intention” group and “second child intention” group. Early and targeted intervention for couples in different groups at high risk can help reduce infertility and social burden.