Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781.
Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781.
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DOI：
10.1097/aog.0000000000003271
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发表时间：
2019-06-01
影响因子：
7.2
通讯作者：
中科院分区：
文献类型：
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不孕症的定义是，年龄小于35岁的女性在无保护性交或治疗性供体授精后12个月内或年龄大于35岁的女性在6个月内未能怀孕，影响高达15%的夫妇。不孕症评估可以提供给任何根据定义患有不孕症或处于不孕症高风险的患者。35岁以上的女性应接受快速评估，并在尝试怀孕失败6个月后或更早（如有临床指征）接受治疗。对于40岁以上的女性，需要更及时的评估和治疗。如果一个女人有一个已知的条件，导致不孕不育，妇产科医生应该提供立即评估。初步检查的基本组成部分包括回顾病史、体格检查和其他检查。对于女性伴侣，检查将集中在卵巢储备，排卵功能和结构异常。生殖器官的成像提供了有关影响生育能力的条件的有价值的信息。影像学检查可以检测输卵管通畅性和盆腔病理，并评估卵巢储备功能。男性因素是40-50%夫妇不孕的原因。鉴于男性因素在不育异性夫妇中的高患病率，从一开始就有必要对男性伴侣进行基本病史和评估。女性健康专家可以合理地获取男性伴侣的病史并进行精液分析。将所有男性不育患者转诊给具有男性生殖医学专业知识的专家也是合理的。不明原因的不孕症可能在多达30%的不孕夫妇中被诊断出来。至少，这些患者应该有排卵，输卵管通畅和正常精液分析的证据。
Infertility, defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years, affects up to 15% of couples. An infertility evaluation may be offered to any patient who by definition has infertility or is at high risk of infertility. Women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to become pregnant or earlier, if clinically indicated. In women older than 40 years, more immediate evaluation and treatment are warranted. If a woman has a condition known to cause infertility, the obstetrician-gynecologist should offer immediate evaluation. Essential components of an initial workup include a review of the medical history, physical examination, and additional tests as indicated. For the female partner, tests will focus on ovarian reserve, ovulatory function, and structural abnormalities. Imaging of the reproductive organs provides valuable information on conditions that affect fertility. Imaging modalities can detect tubal patency and pelvic pathology and assess ovarian reserve. Male factor is a cause of infertility in 40-50% of couples. Given the high prevalence of male factor in infertile heterosexual couples, a basic medical history and evaluation of the male partner are warranted from the outset. A women's health specialist may reasonably obtain the male partner's medical history and order the semen analysis. It is also reasonable to refer all male infertility patients to a specialist with expertise in male reproductive medicine. Unexplained infertility may be diagnosed in as many as 30% of infertile couples. At a minimum, these patients should have evidence of ovulation, tubal patency, and a normal semen analysis.