Case Allison M
Department of Obstetrics, Gynecology and Reproductive Sciences, Royal University Hospital, University of Saskatchewan, Saskatoon.
Can Fam Physician. 2003 Nov;49:1465-72.
To review family physicians' role in investigation and management of infertile couples.
MEDLINE and PubMed were searched using the MeSH headings infertility, advanced maternal age, polycystic ovarian syndrome, clomiphene citrate, and insulin sensitizers. Bibliographies of review articles and textbooks were also searched. Review articles, randomized trials, observational studies, and case series are cited.
Approximately 8% of Canadian couples have difficulty conceiving. Mother's age significantly affects ability to conceive. Infertility assessment focuses on ovulatory dysfunction, tubal factors, sexual factors, and male factors. Women older than 35 years more than 12 months infertile; women younger than 35 more than 18 months infertile; women likely to have such problems as anovulation, tubal disease, or endometriosis; women whose partners' semen tests abnormal; and women who request referral should be referred. Patients treated with clomiphene citrate should be aware of its potential side effects.
Family physicians have an important role in preconception counseling. Detailed and focused assessment facilitates initial investigations and treatment and can identify couples who could benefit from referral for further assessment.
综述家庭医生在不孕夫妇检查与管理中的作用。
使用医学主题词“不孕症”“高龄产妇”“多囊卵巢综合征”“枸橼酸氯米芬”和“胰岛素增敏剂”检索MEDLINE和PubMed。还检索了综述文章和教科书的参考文献。引用了综述文章、随机试验、观察性研究和病例系列。
约8%的加拿大夫妇存在受孕困难。母亲年龄显著影响受孕能力。不孕症评估聚焦于排卵功能障碍、输卵管因素、性因素和男性因素。35岁以上不孕超过12个月的女性；35岁以下不孕超过18个月的女性；可能存在无排卵、输卵管疾病或子宫内膜异位症等问题的女性；伴侣精液检查异常的女性；以及要求转诊的女性均应转诊。接受枸橼酸氯米芬治疗的患者应了解其潜在副作用。
家庭医生在孕前咨询中发挥着重要作用。详细且有针对性的评估有助于初步检查和治疗，并可识别出可从转诊接受进一步评估中获益的夫妇。
