目的 探讨在开展"国家免费孕前优生健康检查项目(下简称"免费孕前检查")"过程中常规开展精液检查的必要性及可行性.方法 (1)整理分析广州市近年来参加免费孕前检查人群的年龄结构变化特征;(2)对广州市免费孕前检查定点医疗机构开展精液检查需求及能力问卷调查;(3)对相关专家进行访谈.结果 (1)随着全面二孩政策的调整,高龄高危再生育家庭比例折线式上升;(2)全市35家孕前定点服务机构均正常开展精液常规技术,但以手工法为主(54.29%);大部分未开展实验室质控(71.43%);其中采用WHO5实验室标准的仅有9家(25.71%),以采用全国临床检验操作规程等其他标准的为主流17家(48.57%);(3)专家访谈普遍认为有必要在免费孕前检查中增加精液常规检查.结论 在"免费孕前检查项目"中增加精液常规检查具有必要性和一定的可行性,尤其是针对特殊人群,比如高龄、有不孕不育家族史等情况,进一步完善孕前保健体系,但同时要重视基层精液检查实验室标准化的建设.%Objective To explore the necessity and feasibility of semen examination in carrying out Free Pre Pregnancy Health Examination Project (FPPHEP). Methods 1. The characteristics of the age structure changes in FPPHEP in Guangzhou from 2013 to 2016 was analyzed. 2. Total 35 designated medical institutions of FPPHEP in Guangzhou were surveyed for their present situation of semen examination service. 3. Relevant andrology experts were interviewed. Results With the launch of the two-child policy, the proportion of elderly high-risk pre pregnancy of the family plan sharply increased. 2. All 35 pre pregnancy designated medical institutions performed routine semen examination, 19 (54.29%) of them used the manual methods, 10 (28.57%) of them had internal quality control, 25 (71.43%) had not the quality control; 9 (25.71%) of them referenced WHO5 standard, 9 (25.71) referenced the WHO4 standard, 17 (48.57%) referenced the national clinical laboratory procedures and other standard. 3, Andrology experts generally believed that it was necessary to supplement the routine semen examination in FPPHEP. Conclusion The supplement of semen examination in "FPPHEP is necessary and feasible, especially for special populations such as age, family history of infertility. It should be strengthened to further improve FPPHEP and standardize the operating procedure of semen examination in MCH community health service.
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