全面放开二孩政策后生殖医学在全科医疗中的意义和应用

人口问题是我国发展的关键问题。随着全面二孩政策的实施，有再生育需求的妇女不断增多，但随着社会压力等多种因素的影响，有再生育需求的妇女不断高龄化，而女性不孕的比例随年龄增长而上升，因此高龄不育女性成为不孕女性中最重要的组成部分。如何落实全面二孩政策，帮助不孕夫妇(尤其是高龄不孕夫妇)实现再生育愿望成为一个新的挑战。专科医院由于地域及数量限制，已然无法满足不孕症患者的咨询及诊疗需求。而全科医生立足社区，是为个人、家庭与社区提供全面服务的医生，在维护社区人民健康中起到举足轻重的作用。但目前有关不孕及辅助生殖技术(assisted reproductive technology，ART)的知识及技术还局限于专科医院，服务社区的全科医生所掌握的该方向的知识及技术不足，不能满足不孕患者需求。如果全科医生能了解有关不孕及辅助生殖技术知识，及时对患者状况进行有效监测，提供相关咨询服务，同时疏导患者心理，并将患者推荐至专业的生殖医学机构接受更有效的治疗，便可以在全面二孩政策的执行中充当重要角色，为全面二孩政策的推广及实施打下坚实的基础。本综述系统性地探讨了临床实用的不孕及辅助生殖技术，并梳理出相关知识，目的是使全科医生重视并了解生殖医学，满足社区中不孕患者诊疗及咨询需求。 

An exploration of the significance and application of reproductive medicine in general practice after comprehensive second child policy

The population problem is the key problem of the development of our country. With the release of a comprehensive second child policy, there is an increase in the number of women who want to have a second child. The age of women who have the need to reproduce is increasing with the influence of multiple factors such as social pressure. Older women with infertility become the most important component of infertile women, for the rate of female infertility increases with age. How to implement comprehensive second child policy and help the infertile couples, especially the older infertile couples, becomes a new challenge. Due to regional and quantitative limitations, specialized hospitals have been unable to meet the consultation and treatment needs of infertile patients. A general practitioner, as a physician who is based on the community and provides comprehensive services for individuals, families and communities, plays an important role in maintaining the health of the community. However, the knowledge and technology of infertility and assisted reproductive technology (ART) are still limited to specialized hospitals. Also, the knowledge and technology in this field mastered by general practitioners serving the community cannot meet the needs of infertile patients. If the general practitioner is able to understand the relevant knowledge of infertility and assisted reproductive technology, monitor the conditions of patients in time, provide consulting services and counsel patient psychology, also recommend patients to the professional institutions of reproductive medicine for more effective treatments. After that, they can play important roles in the second child policy and lay a solid foundation for the policy promotion. The purpose of this review is to systematically explore the clinical application of infertility and assisted reproductive technology, and to sort out relevant knowledge, so as to make general practitioners pay attention to and understand reproductive medicine, and to meet the needs of diagnosis, treatment and consultation for infertile patients in the community.