臺灣博碩士論文加值系統

近二十年來隨著社會的變遷造成環境的改變，生殖醫學相關科技的日益進步，國際上對環境職業性危害因子可能造成生殖上的問題廣為關注，其中以年齡二十五至三十四歲的高生育群婦女成長最多。在評估生殖能力方面又以受孕前所需時間（time to pregnancy）為其新興工具，但是臺灣至今尚無此相關參考標準。
本調查係繼臺灣省家庭計畫研究所於1997年「臺灣地區不孕盛行狀況調查研究報告」之後續研究，為建立全臺灣地區婦女生育力之平均標準曲線，以全臺地區婦女為對象進行抽樣，排除外島及山地鄉地區，蒐集婦女相關生育資料、影響生殖之疾病史，俾建立臺灣地區婦女之生育力參考標準，並應用於相關職業性生殖危害的比較依據，以及其他相關計畫工作執行之參考。
經由全臺9143個案中抽樣取601名婦女進行訪視,實際訪察408人，完訪241名, 完訪率約59.1%。未完訪者多因遷移緣故，拒訪者佔24名(5.9%)，共取得681孕次，其中全部有效孕次計608次，近十四年來之孕次則計有588次。經多變項分析及Cox Model分析，整體而言各可能影響因子與隨時間受孕累積比例並無顯著相關。在三個月內累積受孕比為6.0%，至六個月為75.9%，至九個月為81.8%，至一年為89.8%，一年以內未懷孕者達10.2%。
第二次以上懷孕者較初次懷孕之受孕能力比為低0.9178 (95% CI=0.77~1.09)，與泰國地區情況相似。而整體受孕累積比則與國際各國接近，尤其是英國一般族群為對象之研究結果。

Object： To construct the reference curve of fecundibility in term of waiting time to pregnancy in the general population of Taiwan.
Methods：This study was a retrospective study. We used data from a marriage cohort of the infertility of Taiwan conducted by Institute of Taiwan family planning in 1996. The population included 9143 couples spread in Taiwan and married in April,1990. We sampled 601 couples and interviewed them using a structured questionnaire . We visited 408 couples from 1998 to 1999. 241 women (59%) completed interviews and 588 pregnancies were analysed with Cox regression model . Women were categorized and analysed according to their waiting time to pregnancy which was defined at least one month and above. The analysis excluded the pregnancies delivered more than 14 years ago to reduce recall bias, and those without the information of time to pregnancy.
Result: Compared with the waiting time which women tried to conceived before each pregnancy, the cumulative percent was 56% in 3 months, 75.9% in 6 months, 81.8% in 9 months, and 89.8 % in one year. 10.2% pregnancies in total were not conceived before one year, and the waiting time to conception before each pregnancy of the women in Taiwan was similar with the published data in Asian and European countries.
Conclusions: The fecundibilty curve of time to pregnancy in Taiwan general population can be used to estimate the risk of subfecundibility of specific occupational exposures. And it can also be used to compare the fecundibility with other races or countries.

摘要3
英文摘要4
目錄5
表目錄7
圖目錄8
壹、緒論9
一、研究背景9
二、研究動機10
三、研究目的10
貳、文獻探討12
一、受孕所需時間及年齡的關係12
二、種族及性別的影響13
三、生活型態及習性與受孕時間的影響13
四、工作負荷及受孕時間的關係14
五、職業方面暴露因素對受孕所需時間的影響14
六、妊娠結果與受孕時間的關係15
七、問卷調查研究方式16
參、材料與方法17
一、研究架構17
二、研究對象17
三、取樣方式17
四、問卷設計及變項收集18
五、訪視員訓練20
六、族群調查研究20
七、資料處理及統計分析20
伍、結果22
一、研究對象基本資料描素22
二、分析結果22
陸、討論26
一、研究方法討論26
1、測量工具及單位26
2、方法限制性27
3、計畫性懷孕27
4、性生活頻率27
5、選擇性誤差28
6、回憶性偏差28
二、研究結果討論28
三、國際生育力比較31
柒、結論與建議32
捌、參考文獻33
附錄52

1. Sallmen M, Lindbohm ML, Kyyronen P, Nykyri E, Anttila A, Taskinen H, Hemminki K. Reduced fertility among women exposed to organic solvents. American Journal of Industrial Medicine 1995;27(5):699-713.
2. Bonde JP, Kolstad H. Fertility of Danish battery workers exposed to lead. International Journal of Epidemiology 1997;26(6):1281-8.
3. Brandt LP, Nielsen CV. Fecundity and the use of video display terminals. Scandinavian Journal of Work, Environment & Health 1992;18(5):298-301.
4. Joffe M. Time to pregnancy: a measure of reproductive function in either sex. Asclepios Project.Occupational & Environmental Medicine 1997;54(5):289-95.
5. Bisanti L, Olsen J, Basso O, Thonneau P, Karmaus W. Shift work and subfecundity: a European multicenter study. European Study Group on Infertility and Subfecundity. Journal of Occupational & Environmental Medicine 1996;38(4):352-8.
6. Tuntiseranee P, Olsen J, Chongsuvivatwong V, Limbutara S. Fecundity in Thai and European regions: results based on waiting time to pregnancy. Human Reproduction 1998;13(2):471-7.
7. Joffe M. Advantages of a standard method for research on reproductive effects of occupation. Journal of Epidemiology & Community Health 1988;42(3):209-12.
8. Olsen J. Subfecundity according to the age of the mother and the father. Danish Medical Bulletin 1990;37(3):281-2.
9. Joffe M. Decreased fertility in Britain compared with Finland. Lancet 1996;347(9014):1519-22.
10. Zhou H, Weinberg CR. Re: "Smoking reduces fecundity: a European multicenter study on infertility and subfecundity". American Journal of Epidemiology 1997;145(1):81-2.
11. Wilcox AJ, Baird DD, Weinberg CR. Do women with childhood exposure to cigarette smoking have increased fecundability? American Journal of Epidemiology 1989;129(5):1079-83.
12. Weinberg CR, Wilcox AJ, Baird DD. Reduced fecundability in women with prenatal exposure to cigarette smoking. American Journal of Epidemiology 1989;129(5):1072-8.
13. Bolumar F, Olsen J, Boldsen J. Smoking reduces fecundity: a European multicenter study on infertility and subfecundity. The European Study Group on Infertility and Subfecundity. American Journal of Epidemiology 1996;143(6):578-87.
14. Jensen TK, Hjollund NH, Henriksen TB, Scheike T, Kolstad H, Giwercman A, Ernst E, Bonde JP, Skakkebaek NE, Olsen J. Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy. BMJ 1998;317(7157):505-10.
15. Hatch EE, Bracken MB. Association of delayed conception with caffeine consumption. American Journal of Epidemiology 1993;138(12):1082-92.
16. Bolumar F, Olsen J, Rebagliato M, Bisanti L. Caffeine intake and delayed conception: a European multicenter study on infertility and subfecundity. European Study Group on Infertility Subfecundity. American Journal of Epidemiology 1997;145(4):324-34
17. Joesoef MR, Beral V, Rolfs RT, Aral SO, Cramer DW. Are caffeinated beverages risk factors for delayed conception?. Lancet 1990;335(8682):136-7.
18. Buckett W, Bentick B. The epidemiology of infertility in a rural population. Acta Obstetricia et Gynecologica Scandinavica 1997;76(3):233-7.
19. Niels Henrik, Job strain and time to pregnancy . Scand J Work Environ Health 1998.
20. Bisanti L, Olsen J, Basso O, Thonneau P, Karmaus W. Shift work and subfecundity: a European multicenter study. European Study Group on Infertility and Subfecundity. Journal of Occupational & Environmental Medicine 1996;38(4):352-8.
21. Tuntiseranee P, Olsen J, Geater A, Kor-anantakul O. Are long working hours and shiftwork risk factors for subfecundity? A study among couples from southern Thailand. Occupational & Environmental Medicine 1998;55(2):99-105.
22. Smith EM. Journal of Environmental Medicine, vol 39, 1997.
23. Bonde JP.Reversible reduction of semen quality during occupational exposure to radiating heat.. Ugeskrift for Laeger 1993;155(14):1021-4.
24. Sallmen M, Lindbohm ML, Anttila A, Kyyronen P, Taskinen H, Nykyri E, Hemminki K. Time to pregnancy among the wives of men exposed to organic solvents. Occupational & Environmental Medicine 1998;55(1):24-30.
25. Sallmen M, Lindbohm ML, Kyyronen P, Nykyri E, Anttila A, Taskinen H, Hemminki K. Reduced fertility among women exposed to organic solvents. American Journal of Industrial Medicine 1995;27(5):699-713.
26. Correa A, Gray RH, Cohen R, Rothman N, Shah F, Seacat H, Corn M. Ethylene glycol ethers and risks of spontaneous abortion and subfertility. American Journal of Epidemiology 1996;143(7):707-17.
27. Bonde JP, Kolstad H. Fertility of Danish battery workers exposed to lead. International Journal of Epidemiology 1997;26(6):1281-8.
28. Bonde JP. Subfertility in relation to welding. A case referent study among male welders. Danish Medical Bulletin 1990;37(1):105-8.
29. de Cock J, Westveer K, Heederik D, te V, van Kooij R. Time to pregnancy and occupational exposure to pesticides in fruit growers in The Netherlands . Occupational & Environmental Medicine 1994;51(10):693-9.
30. Henriksen TB, Baird DD, Olsen J, Hedegaard M, Secher NJ, Wilcox AJ. Time to pregnancy and preterm delivery. Obstetrics & Gynecology 1997;89(4):594-9.
31. Joffe M, Li Z. Association of time to pregnancy and the outcome of pregnancy. Fertility & Sterility 1994;62(1):71-5.
32. Joffe M. Male- and female-mediated reproductive effects of occupation: the use of questionnaire methods. Journal of Occupational Medicine 1989;31(12):974-9.
33. 張明正、林惠生、蔡益堅等。台灣地區不孕盛行狀況調查研究報告。台中：台灣省家庭計畫研究所，1997。
34. Norušis MJ/SPSS Inc. SPSSR for Windows: Base system user’s guide, Release 6.0. Chicago, IL: SPSS, Inc., 1993. 828 pp.
35. Norušis MJ/SPSS Inc. SPSSR for Windows: Advanced Statistics, Release 6.0. Chicago, IL: SPSS, Inc., 1993. 580 pp.
36. Joffe M, Villard L, Li Z, Plowman R, Vessey M. A time to pregnancy questionnaire designed for long term recall: validity in Oxford, England. Journal of Epidemiology & Community Health 1995;49(3):314-9.