美国波士顿大学公共卫生学院Jennifer J Yland团队研究了不同避孕方式对女性生育能力的影响。2020年11月11日，该研究发表在《英国医学杂志》上。

为了评估妊娠前使用各种避孕方法与随后生育能力之间的相关性，2007-2019年，研究组在丹麦和北美进行了一项前瞻性队列研究，招募了17954名备孕超过6个月经周期的女性，均报告她们的避孕史、个人医疗和生活方式的特点。主要结局为怀孕，由双月随访问卷确定，长达12个月。

大约38％（6735名）的参与者最近使用了口服避孕药，13％（2398名）使用了长效可逆避孕方法，而31％（5497名）使用了避孕套。与使用避孕套的女性相比，最近停止口服避孕药、使用避孕环和一些长效可逆避孕方法的女性经历了短期的生育能力恢复延迟。

与使用避孕套相比，使用可注射避孕药造成生育能力下降，比率为0.65。注射避孕药的女性恢复正常生育能力的延迟时间最长（5-8个月经周期），其次是使用贴片避孕药的女性（4个月经周期），口服避孕药和使用阴道环的女性（3个周期），以及激素、宫内节育器和植入避孕药的女性（2个周期）。终身使用激素避孕方法的时间与生育能力无关。

研究结果表明，某些激素避孕方法的使用与生育能力恢复延迟有关，注射避孕药的延迟时间最长。但长期使用这些避孕方法对生育能力几乎没有持久影响。

附：英文原文

Title: Pregravid contraceptive use and fecundability: prospective cohort study

Author: Jennifer J Yland, Kathryn A Bresnick, Elizabeth E Hatch, Amelia K Wesselink, Ellen M Mikkelsen, Kenneth J Rothman, Henrik T Srensen, Krista F Huybrechts, Lauren A Wise

Issue&Volume: 2020/11/11

Abstract:

Objective To evaluate the association between pregravid use of a variety of contraceptive methods and subsequent fecundability.

Design Prospective cohort study.

Setting Denmark and North America, 2007-19.

Participants 17954 women who had tried to conceive for up to six menstrual cycles at study entry. At baseline, participants reported their contraceptive histories, and personal, medical, and lifestyle characteristics.

Main outcome measures Pregnancy, determined by bimonthly follow-up questionnaires for up to 12 months.

Results Approximately 38% (n=6735) of participants had recently used oral contraceptives, 13% (n=2398) had used long acting reversible contraceptive methods, and 31% (n=5497) had used barrier methods. Women who had recently stopped using oral contraceptives, the contraceptive ring, and some long acting reversible contraceptive methods experienced short term delays in return of fertility compared with users of barrier methods. Use of injectable contraceptives was associated with decreased fecundability compared with use of barrier methods (fecundability ratio 0.65; 95% confidence interval 0.47 to 0.89). Users of injectable contraceptives had the longest delay in return of normal fertility (five to eight menstrual cycles), followed by users of patch contraceptives (four cycles), users of oral and ring contraceptives (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles). Lifetime length of use of hormonal contraceptive methods was not associated with fecundability.

Conclusions Use of some hormonal contraceptive methods was associated with delays in return of fertility, with injectable contraceptives showing the longest delay. The findings indicated little or no lasting effect of long term use of these methods on fecundability.

DOI: 10.1136/bmj.m3966

Source: https://www.bmj.com/content/371/bmj.m3966