患者告知书：医生怎么评估女性不孕症

患者告知书：医生怎么评估女性不孕症 （美国 2008）
 

资料来源：http://www.asrm.org/patients/factsheets/infertilityinwomen.pdf

 岳阳市第一人民医院妇产科李诚

if you've been trying to get pregnant and haven't been successful, when should you think about seeing your doctor to find out if you have a problem with fertility? most women wait a year before going to see the doctor. but if you are older than 35, have irregular periods, or have any medical problems that could make it difficult for you to get pregnant, you should go sooner.

如果你想受孕而没有成功，你认为应该什么时候找医生看看有没有生育的问题？大部分女人等一年才看医生。但如果你超过35岁，或有难以受孕的医学问题，应该早点看医生。

 

your doctor will perform several tests to help figure out the problem. your partner also should have tests because he could have a fertility problem.

医生会做一些检查以帮助指出问题。因为你的伴侣可能有生育问题，也应该做些检查。

 

diagnosis: what is the basic problem?  诊断：有什么基本的问题？

first, your doctor will ask you about your medical history and may give you a physical exam. then, your doctor may perform one or more of the following tests to see if you are producing an egg and if that egg can travel to your womb:

首先，医生会询问病史和体格检查，然后做一个或多个以下检查，看你能不能产生卵子，卵子能不能进入子宫。

 

ovulation testing  排卵试验

ovulation occurs when your ovary releases an egg (oocyte) from a follicle (fluid filled cyst) in the ovary.  after that, the egg will be picked up by the fimbria (fingers of the fallopian tubes), then travel through the tube to your uterus (womb). when you ovulate, your body goes through changes. these changes include:

当卵巢的卵泡释放卵子的时候就是排卵了。排出的卵子被输卵管伞检拾。然后通过输卵管进入子宫。排卵时你的身体变化包括：

* your body temperature rises after ovulation. a special thermometer can be used to take your temperature, then daily measurements can be recorded on a basal body temperature chart.

排卵后体温升高。可以用特别的体温计测量体温，然后每天记录在基础体温表上。

* your body makes more of an important hormone called progesterone after you ovulate. an over the counter urine test kit or a blood test can measure lh (luteinizing hormone) levels, which is the trigger for ovulation and the cause of the subsequent rise in progesterone.

排卵后身体分泌一种重要的激素即孕激素。药店的排卵试纸或血液检查可测量黄体生成素水平，那是导致排卵及随后黄体酮升高的触发因素。

 

* your follicles increase in size prior to ovulation. this change in follicle growth can be measured by an ultrasound and help predict the time of ovulation

排卵前卵泡逐渐增大，b超可以测量卵泡发育的变化，帮助预测排卵的时间。

 

how frequently you get your period and how long it lasts (recorded on a menstrual calendar) will also help identify when ovulation occurs.

记录月经周期和月经持续时间对监测排卵有帮助。

 

fallopian tube testing  输卵管的检查

after you ovulate, an egg travels from the ovary to the uterus through one of your fallopian tubes.    for the egg to make the trip, the tubes need to be clear of any blockages. to make sure that one or both tubes are not blocked, your doctor can perform one of two different procedures:

排卵后，卵子要从卵巢通过一侧输卵管进入子宫。卵子的旅行需要清楚输卵管的任何障碍。要确定一侧或两侧输卵管没有堵塞，医生要做一个或多个不同的程序：

 

* hysterosalpingogram (hsg).  子宫输卵管造影

during this x-ray procedure, a speculum is used to open the vagina then a catheter or device is used to place (inject) liquid into your cervix (opening into the uterus) so that it flows into the uterus. if the liquid comes out the ends of one or both of your tubes, then you can determine if one or both of the tubes are open. if the liquid does not enter or does not flow completely through one or both of your tubes, then the affected tube or tubes should be considered blocked. a blockage may or may not be corrected by surgery.

做子宫输卵管造影时，用窥器撑开阴道，然后用一条导管或设施向子宫颈口注射液体进入子宫。如果液体从一侧或双侧输卵管末端流出，就知道是不是一侧或双侧输卵管通畅。如果液体完全不能进入一侧或双侧输卵管，应该考虑是受累的一侧或双侧输卵管堵塞。一侧或双侧输卵管堵塞可能手术能纠正，也可能手术不能纠正。

 

* laparoscopy.   腹腔镜

in this minimally invasive procedure, a surgical instrument called a laparoscope is inserted through a very small incision below your belly button. the surgeon can look through the laparoscope to see if one or both of your tubes are open. the laparoscope can also be used to look for other problems that may affect fertility, such as adhesions (scar tissue) or endometriosis (tissue from the lining of the uterus that grows in the wrong place and can cause irritation or scarring).

做这种微创手术用的手术器械叫腹腔镜，腹腔镜插入肚脐下的一个很小的切口，医生就能通过腹腔镜看见一侧或双侧输卵管是不是通畅，还能看见其它影响受孕的问题。例如粘连（疤痕组织）或子宫内膜异位症（子宫内膜在错误的地方生长并激惹出血）。

 

uterine testing  子宫检查

your doctor may perform other procedures to look for other problems, such as:

医生还要做别的检查找别的其他问题，例如：

 

* fibroids (noncancerous growths in the uterus) 子宫肌瘤（良性，长在子宫）

* polyps (noncancerous growths in the uterine lining) 息肉（良性，长在子宫内膜）

* scarring 粘连

* an abnormally shaped uterus 子宫发育不良

 

several procedures may be used:

可能用一些特殊的方法：

* hsg (described above) 子宫输卵管造影（参见上述）

* hysteroscopy is a surgical procedure in which a telescope-like instrument is placed through the cervix and to look at the inside of your uterus

宫腔镜是用类似放大镜的器械通过子宫颈检查子宫腔的手术。

* sonohysterogram is an office procedure using ultrasound where a thin catheter is inserted through the opening of the cervix into the uterus, then sterile liquid is injected into the uterus. while the fluid is in the uterus, a vaginal ultrasound is used to obtain a good view of the uterine cavity. this procedure also provides important information about the muscle wall of the uterus (myometrium).

子宫超声造影在超声波室做，将很小的导管通过子宫颈口插入子宫，然后将无菌的液体注入子宫。子宫有液体的时候，超声阴道探头就能看清楚子宫腔。这种方法也能提供子宫肌层的重要信息。

 

hormone testing 激素检查       

too much or not enough of important chemicals called hormones can cause ovulation problems. blood tests reveal the hormone levels in your body. your doctor may check some of these hormones, as they can affect your fertility. testing may include checking for thyroid function or for a hormone (prolactin) that increases milk production in the breasts.

有太多或不足够的重要化学物称为激素能够引起排卵问题。血液检验可以显示你身体的激素水平。医生可能检查一些影响受孕的激素。这些检验可能包括甲状腺功能或一种增加乳房分泌乳汁的催乳素。

 

ovarian reserve tests  卵巢储备试验                     

these blood tests measure hormone levels and give us an estimate of how many eggs you have in your body and how good they are. the tests are performed during the first days of your menstrual cycle and sometimes before and after you take a fertility drug. your doctor may perform these tests if:

这些检测血液激素水平的检验让我们评估你身体的卵子数量和质量，这些检验在月经周期第一天做，有时候在你服促排卵药之前或之后做。医生可能在以下情况做这些检验：

* you are more than 35 years old  35岁以上                                              

* you have one ovary  只有一个卵巢

* you have had ovarian surgery  卵巢做过手术

* you have had a poor response to fertility treatments 对不孕治疗反应差

* you have irregular menstrual cycles  月经周期不规则

 

other tests 其它检查                                                      

your doctor may also recommend pre-pregnancy tests for:

医生也可能推荐妊娠前做以下检查：

* infections (chicken pox, rubella, hiv, hepatitis, syphilis or other sexually transmitted infections)

感染（水痘，风疹，爱滋病，肝炎，梅毒或其它性传播疾病） 

               

* genetic testing (cystic fibrosis, sickle cell, tay-sachs or other genetic disorders)

遗传检查（囊性纤维化，镰状细胞，家族性白痴病或其它的遗传病）

 

 

the american society for reproductive medicine grants permission to photocopy this fact sheet and distribute it to patients.       created 2008  

美国生殖医学会批准这告知书复印件派发给患者  2008制订     （斑竹翻译，欢迎指正）