小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 盆腔手术既往史
- 月经周期不规律
- 多毛症
- 痤疮
- 可触及的子宫异常
- 附件异常
- 溢乳
其他诊断因素
- 性交疼痛
- 陷凹异常
危险因素
- 年龄 > 35 岁
- 性传播疾病史
- 极高体脂
- 极低体脂
- 吸烟
- 自身免疫性疾病
- 阑尾炎病史
- 精神病
- 物质滥用
- 饮酒
- 咖啡因摄入
- 压力
诊断性检查
首要检查
- 精液分析
- 黄体期孕酮
- 尿黄体生成素（Luteinising Hormone, LH
- 经阴道超声扫描
- 子宫输卵管造影片
- 子宫输卵管造影超声检查 (HyCosY)
需考虑的检查
- 基础卵泡刺激素（Follicle-stimulating Hormone, FSH
- 血清 LH
- 血清雌二醇
- 游离血清睾酮
- 血清 TSH
- 血清催乳素
- 氯米芬激发试验
- 盐水注射超声波图
- 三维超声
- 盆腔 MRI
- 腹腔镜和宫腔镜检查
- 染色体核型分析
新兴检查
- 血清抑制素
- 囊状卵泡计数
- 血清抗苗勒管激素 (AMH)
治疗流程
有基础的或相关的疾病
无排卵性
输卵管
与子宫内膜异位症有关
年龄相关
不明原因
子宫受损/缺失
撰稿人
作者
Jane A. Stewart, MD, BSc, MBChB, FRCOG
Consultant Gynaecologist
Subspecialist in Reproductive Medicine
Newcastle Fertility Centre
Newcastle upon Tyne
UK
利益声明
JAS is an honorary secretary of the British Fertility Society; she is also the head of a large NHS fertility service.
鸣谢
Dr Jane A. Stewart would like to gratefully acknowledge Dr Jared C. Robins, a previous contributor to this topic. JCR declares that he has no competing interests.
同行评议者
Daniel Williams, MD
Professor of Clinical Obstetrics and Gynecology
University of Cincinnati College of Medicine
Cincinnati
OH
利益声明
DW declares that he has no competing interests.
Mira Aubuchon, MD
Assistant Clinical Professor
Division of Reproductive Endocrinology
University College of Medicine
Cincinnati
OH
利益声明
MA declares that she has no competing interests.
Stephanie Dahl, MD
Assistant Clinical Professor
Department of Obstetrics and Gynecology
University of North Dakota School of Medicine
Fargo
ND
利益声明
SD declares that she has no competing interests.
Andrew Drakeley, MBChB, MD, MRCOG, CCST
Consultant Gynaecologist
Subspecialist in Reproductive Medicine
Liverpool Women's NHS Foundation Trust
School of Reproductive and Developmental Medicine
Liverpool
UK
利益声明
AD declares that he has no competing interests.
鉴别诊断
- 男性不育症
更多 鉴别诊断指南
- 不孕与反复性妊娠丢失的定义：委员会意见
- 不明原因不孕不育夫妇的循证治疗
更多 指南患者教育信息
Fertility problems: some reasons
Fertility problems: what treatments work?
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明