Stan C, Prêtre M, Boulvain M, Campana A
Département de gynécologie et d'obstétrique, Hôpitaux universitaires de Genève.
Schweiz Med Wochenschr. 1999 Sep 18;129(37):1321-7.
The management of infertile couples at regional hospital level is rarely reported and is generally less known, whereas the activity of university infertility clinics is usually the reference. We evaluate the diagnostic approach to infertile couples at the Regional Hospital of Sierre.
The medical charts of 389 couples presenting with infertility between 1989 and 1996 were reviewed. The investigations and interpretation of results were always performed by the same investigator.
A lower pregnancy rate was observed in the case of a pathological postcoital test and when proximal tubal occlusion or phimosis were diagnosed by hysterosalpingography or laparoscopy. In our population, age of the female partner > 40 years, duration of infertility of more than 36 months and multifactorial, male and female, aetiology of infertility were significantly associated with a poor prognosis (p < 0.001). For the assessment of tubal patency, hysterosalpingography and laparoscopy with chromopertubation showed an acceptable level of agreement (kappa coefficient = 0.58). Hysterosalpingography does not provide a precise diagnosis in peritoneal and ovarian pathology (72.9% sensitivity, 55.7% specificity). A third of pregnancies were obtained without treatment during the diagnostic study of the menstrual cycle, or after hysterosalpingography and laparoscopy with chromopertubation.
Most diagnostic procedures for infertility can be performed in a regional hospital by an infertility specialist collaborating closely with a university centre. When infertile couples are transferred to a university centre their evaluation is simplified, as they have already completed an initial systematic investigation and treatment plan at the regional hospital. This two-step approach may be beneficial in selecting couples who need specific treatment not available in a regional hospital.
关于地区医院层面不孕夫妇的管理鲜有报道，且普遍鲜为人知，而大学不孕诊所的活动通常是参考标准。我们评估了锡永地区医院对不孕夫妇的诊断方法。
回顾了1989年至1996年间389对不孕夫妇的病历。检查及结果解读均由同一名研究者完成。
性交后试验异常、子宫输卵管造影或腹腔镜检查诊断为近端输卵管阻塞或包茎时，妊娠率较低。在我们的研究人群中，女性伴侣年龄>40岁、不孕持续时间超过36个月以及不孕病因是多因素的（包括男性和女性因素）与预后不良显著相关（p<0.001）。对于输卵管通畅性的评估，子宫输卵管造影和输卵管通液腹腔镜检查显示出可接受的一致性水平（kappa系数=0.58）。子宫输卵管造影对腹膜和卵巢病变无法提供精确诊断（敏感性为72.9%，特异性为55.7%）。在月经周期诊断性检查期间，或在子宫输卵管造影和输卵管通液腹腔镜检查后，三分之一的妊娠是未经治疗而获得的。
大多数不孕诊断程序可由地区医院的不孕专科医生与大学中心密切合作完成。当不孕夫妇转至大学中心时，他们的评估得以简化，因为他们已在地区医院完成了初步的系统检查和治疗计划。这种两步法可能有助于筛选出需要地区医院无法提供的特定治疗的夫妇。
