Smith Lindsay F P
Royal College of General Practitioners, 14 Princes Gate, Hyde Park, London SW7 1PU, UK.
Hum Fertil (Camb). 2003 May;6 Suppl 1:S9-12. doi: 10.1080/1464770312331369173.
Women frequently present to their general practitioner (GP) stating they have been trying for some time to get pregnant and failed. All GPs must be able to deal with the range of initial presentations in terms of history taking, examination and routine investigation. Treatment may be initiated in primary care, although at present most GPs are likely to refer to secondary care. In the future more GPs will undertake treatment themselves or refer to a GP with a special interest at Primary Care Trust (PCT) level. Both clomiphene and metformin either separately or together can be used in appropriate cases in primary care and are likely to lead to a high success rate and the prevention of unnecessary referrals to secondary care. GPs need to provide ongoing care throughout investigation and treatment for infertility and deal with subsequent outcomes both positive and negative. GPs as well as women themselves must be involved in the development of local guidelines from the outset together with secondary care specialists and those working on behalf of the PCT. It has yet to be shown that any guideline reduces NHS costs or improves patient outcomes.
女性经常向她们的全科医生（GP）表示，她们已经尝试怀孕一段时间但未成功。所有全科医生都必须能够在病史采集、检查和常规检查方面处理一系列初始症状。虽然目前大多数全科医生可能会将患者转诊至二级医疗，但在初级医疗中也可以开始治疗。未来，更多的全科医生将自行进行治疗，或者转诊至初级医疗信托基金（PCT）层面有特殊兴趣的全科医生处。克罗米芬和二甲双胍单独使用或联合使用，在适当的初级医疗病例中都可以使用，并且可能会带来高成功率，并防止不必要地转诊至二级医疗。全科医生需要在不孕症的整个检查和治疗过程中提供持续护理，并处理后续的积极和消极结果。从一开始，全科医生以及女性自身就必须与二级医疗专家和代表初级医疗信托基金工作的人员一起参与制定当地指南。目前尚未证明任何指南能降低国民保健制度（NHS）的成本或改善患者预后。
