女性不孕常做的检查 Examination of female infertility

陈凤林教授指出：导致不孕症的原因有150多种，不孕经检查确诊了才可以得到有效的治疗!女性不孕的检查和目的如下：

Professor Chen Fenglin pointed out that there are more than 150 reasons leading to infertility, which can be effectively treated only after the diagnosis of infertility has been examined. The purpose of female infertility examination is as follows:

1. 妇科检查：看有阴道、宫颈发育是否正常、有无阴道炎、宫颈炎;子宫位置、大小、活动度、有无炎症;附件(输卵管和卵巢统称附件，即子宫的附件)有无增厚、压痛。

1. Gynecological examination: to see whether there is normal vaginal and cervical development, vaginitis and cervicitis; uterine position, size, activity, inflammation; appendix (tubal and ovarian appendix, that is, uterine appendix) whether there is thickening, tenderness.

2. 四维彩超检查：有两个目的：一是看子宫发育情况、有无畸形及肌瘤、腺肌症、子宫内膜异位症、有无卵巢囊肿等;二是查有无排卵子宫内膜是否和卵泡同步。查排卵在月经来潮的第10-12天开始，在医生的指导下连续检测才能看到卵泡由小到大、由成熟到排出的过程。

2. Four-dimensional color Doppler ultrasonography has two purposes: one is to see the development of uterus, whether there are deformities and myoma, adenomyosis, endometriosis, ovarian cyst, etc. The other is to check whether there is ovulation endometrium and follicle synchronization. Ovulation begins on the 10th to 12th day of menstruation and can be detected continuously under the guidance of a doctor before the follicles are seen from small to large and from mature to discharged.

3. 抽血：查内分泌及有无抗体

(1)检查性激素六项。有两个时间：一是在月经来的第5-5天抽血查卵巢的储备功能、有无卵巢功能减退或衰退、泌乳素增高、有无多囊卵巢综合征等不正常激素表现;二是针对月经不调或闭经的患者，可在任何时间检查。

(2)甲状腺功能，甲亢或甲减均影响怀孕需孕前治疗。

(3)查抗体(即看有无免疫性不孕)：无时间限制，任何一天空腹抽血即可。

3. Blood sampling: check endocrine and antibody

(1) Six items of sex hormones were examined. There are two times: one is to take blood on the 5th to 5th day of menstruation to check ovarian reserve function, whether ovarian function is declining or declining, prolactin is increasing, whether polycystic ovary syndrome and other abnormal hormone manifestations; the other is to check at any time for patients with irregular menstruation or amenorrhea.

(2) Thyroid function, hyperthyroidism or hypothyroidism all affect the need for pregnant treatment.

(3) Check antibodies (that is, to see if there is immune infertility): no time limit, fasting blood can be drawn on any day.

4.动态数字化子宫输卵管碘油造影：最佳检查时间是月经干净的3-7天内，如果不在最佳时间，需要先检查血HCG、B超确定不是怀孕，患者签字要求检查才可行检查。检查之前要查白带常规。

4. Dynamic digital hysterosalpingography: The best time for examination is within 3-7 days after menstruation is clean. If it is not in the best time, blood HCG and B-mode ultrasonography are needed to confirm that it is not pregnant. The patient's signature requires examination before examination. Check leucorrhea routine before examination.

5. 宫腔镜检查：特别是有月经量少、月经量多、经期延长、多次排卵期出血、不规则阴道出血、B超提示子宫内膜较厚或较薄、有流产或胎停育者一定要查宫腔镜，看有无子宫内膜炎、子宫内膜息肉、粘膜下子宫肌瘤、子宫腔粘连、子宫畸形等情况。同时，还可顺便做宫腔镜下插管通液，较一般的通液要确。

5. Hysteroscopy: Especially those who have less menstruation, more menstruation, prolonged menstruation, multiple ovulation bleeding, irregular vaginal bleeding, B-mode ultrasonography suggest that endometrium is thicker or thinner, miscarriage or miscarriage should be examined by hysteroscopy to see if there are endometritis, endometrial polyps, submucosal uterine myoma, uterine cavity adhesion, uterine deformity and so on. At the same time, hysteroscopy intubation can also be done incidentally, more accurate than the general fluid.

6. 腹腔镜检查：如不明原因的不孕证或不孕病史超过3年需要做腹腔镜检查。腹腔镜能直接观察子宫、输卵管、卵巢有无病变或粘连，并可以随时在直视下通液看输卵管到底是否通畅，同时又可随时治疗如分离粘连、治疗积水、输卵管整形、治疗子宫内膜异位症等。

6. Laparoscopy: Laparoscopy is necessary if the unknown cause of infertility or the history of infertility exceeds 3 years. Laparoscopy can directly observe the uterus, fallopian tube, ovary lesions or adhesions, and can at any time under direct vision to see whether the fallopian tube is unobstructed, at the same time, it can also be treated at any time, such as separation of adhesions, treatment of hydrosalpinx, tubal plastic, treatment of endometriosis and so on.

7.交媾实验，主要针对不明原因不孕的患者，是为观察精子在阴道内和宫颈口的数量、活动力，以及是否有性功能障碍或宫颈粘液与精子有不相容性而导致的不孕所做的一种检查。又称房事后试验。

Sexual intercourse test, mainly for patients with unexplained infertility, is to observe the number and motility of sperm in the vagina and cervical orifice, as well as whether there is sexual dysfunction or incompatibility between cervical mucus and sperm resulting in infertility. Also known as after-the-fact housing test.

交媾后试验异常原因主要有以下几种情况。①宫颈炎症。②宫颈粘液块状。③性行为障碍，在阴道、宫颈均无精子，男方查精正常，女方宫颈粘液正常，表明性交方式不当，精液未射入阴道内，特别是女方特胖时可有上述情况。④免疫因素。当宫颈管反复无精子或为死精时，可考虑做精子宫颈粘液接触试验。

The main reasons for abnormal postpartum test are as follows. Cervical inflammation. (2) Cervical mucus mass. (3) Sexual behavior disorders, in the vagina, cervix are azoospermia, men normal sperm, women normal cervical mucus, indicating inappropriate sexual intercourse, semen is not injected into the vagina, especially when the woman is very fat. (4) Immune factors. When the cervical canal is azoospermia or dead sperm repeatedly, the mucus contact test of cervix and sperm can be considered.

宫腔镜、腹腔镜检查和治疗是现代妇产科的一场革命，它们的运用是不孕不育患者的福音，带来了意想不到的效果，具有微创、住院天数短、疗效好等优势。

Hysteroscopy, laparoscopic examination and treatment is a revolution in modern obstetrics and gynecology. Their application is the gospel of infertility patients, which brings unexpected results. They have the advantages of minimally invasive, short hospitalization days and good curative effect.