在德国的生育诊所中，谁是治疗的把关人？——一项前瞻性队列研究（PinK 研究）的基线结果。
Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study).
机构信息
Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany.
Institute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany.
出版信息
BMC Pregnancy Childbirth. 2018 Mar 5;18(1):62. doi: 10.1186/s12884-018-1690-8.
BACKGROUND
It is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany.
METHODS
The baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men.
RESULTS
92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain.
CONCLUSION
While almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect.
背景
据估计，工业化国家中所有夫妇的 5-15%患有不孕症。对孩子的渴望或自我认定的不孕可能导致心理压力和社会孤立。2014 年，德国约有 53000 名女性接受了辅助生殖治疗。在德国的生育诊所进行第一次就诊之前，关于夫妇接受生育治疗的第一次医疗咨询和患者需求知之甚少。德国正在进行的夫妇生育治疗前瞻性队列研究（PinK 研究）的基线调查为此提供了德国的初步结果。
方法
基线调查于 2012 年至 2013 年进行。诊所工作人员在治疗开始时向六家生育诊所的患者发放了自我管理问卷。参与率为 31.0%，我们能够分析 323 名女性和 242 名男性的数据。
结果
92.6%的女性首先向妇科医生咨询未满足的生育愿望。泌尿科医生（44.2%）之后，全科医生（12.0%）是男性最常接触的初始联系人。在就诊生育诊所之前，36.4%的男性没有就未满足的生育愿望进行任何医疗咨询。所有男性中有 46.9%表示希望由医生发起关于不孕不育的对话。在首次就诊生育诊所之前，11.2%的男性和 24.8%的女性被医生告知生育治疗可能会引起情绪压力。
结论
虽然几乎所有女性在就诊生育中心之前都会咨询妇科医生，但三分之一的男性在该阶段不会咨询任何医生。对于其余男性群体，泌尿科医生和全科医生是最重要的联系人。明显存在性别特定的医疗保健需求。为了缩小德国男性的医疗保健差距，应提供更多机会以便于咨询。由于其门槛低且以家庭为导向，普通实践可以为此做出重要贡献。
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