Understanding assisted reproductive technology

  Due to environmental pollution, delayed childbearing age, high life pressure and other reasons, the number of infertile couples in the society is gradually increasing. At the same time, because our country is affected by the concept of inheritance, most families are eager to have children, which puts infertile couples under great psychological pressure, and even causes family and social problems such as divorce, extramarital affairs and so on. The assisted reproductive technology, commonly referred to as test-tube baby, can enable an infertile couple to realize the desire of pregnancy and childbirth, and has received widespread attention in recent years.
  What is assisted reproductive technology
  Assisted reproductive technology is a human assisted reproductive technology (ART) for short, refers to the use of medical technical aids make infertile couples pregnancy, including artificial insemination (AI) and in vitro fertilization – embryo transfer (IVF-ET) and There are two types of derivative technologies. Through assisted reproductive technology, create a shortcut that facilitates the rendezvous of sperm and egg, or establish a superior environment that is conducive to the combination of sperm and egg, so as to achieve the purpose of assisting pregnancy.
  In 1945, Chinese American scientist Zhang Mingjue began to do in vitro fertilization experiments on rabbits. After in-depth research, Zhang Mingjue used experiments to confirm that the sperm fertilized in the body completes a certain physiological change that activates itself while waiting for the egg in the fallopian tube, so it can fertilize the egg. In the same year, Australian scholar Austis also discovered the same phenomenon in an experiment, which he called sperm capacitation. The international biological community named the two people’s research results as the “Zhang Austin” principle. In 1959, Zhang Mingjue and scientist Pincus collaborated on research and successfully achieved in vitro fertilization and embryo transfer of rabbits, laying the foundation for the establishment of human IVF-ET. On July 25, 1978, Lesley, who was infertile due to fallopian tube factors, gave birth to the world’s first test-tube baby Louise Brown. So far, the human IVF-ET technology was officially established, and its inventor, Dr. Robert Edwards, also won the 2010 Nobel Prize for Physiology. Or medical awards. Subsequently, assisted reproductive technology has flourished worldwide.
  While the development of assisted reproductive technology abroad, Chinese medical workers are also actively developing assisted reproductive technology. In April 1985 and December 1986, the first test-tube babies were born in Taiwan and Hong Kong. In March 1988, with the efforts of Professor Zhang Lizhu’s team, the third hospital of Beijing Medical University gave birth to the first test-tube baby in Mainland China. The first embryo-donated test-tube baby was born in Xiangya Medical College of Central South University (formerly Hunan Medical University) in June 1988. In February 1995, China’s first frozen-thawed embryo test-tube baby was born. In April 1996, China’s first ICSI test-tube baby was born in the First Affiliated Hospital of Sun Yat-sen University. The first case of PGD in China was completed in the same hospital in 1999. With the success of fluorescence in situ hybridization (FISH) in the preimplantation diagnosis of chromosome aneuploidy and embryo sex, multiplex PCR, fluorescence PCR and multicolor FISH, especially the interphase nuclear conversion carried out since 1999 , Whole genome amplification and comparative genome hybridization have been successively used in PGD, which has promoted the application of PGD. The application and development of freezing technology in the field of reproductive medicine in China began in the 1980s. In 1981, China’s first human sperm bank was established in Xiangya School of Medicine, Central South University, and self-preserved sperm services were opened to the society in 2004. In January 2006, my country’s first case and the second international case of “three-frozen (frozen eggs, frozen sperm, frozen embryos, then thawed and transplanted into the mother’s womb)” IVF was born in Peking University Third Hospital.
  In 2010, with the approval of the Ministry of Education, Peking University Third Hospital, Shandong University Provincial Hospital, and Zhejiang University School of Medicine Affiliated Obstetrics and Gynecology Hospital established three key laboratories of the Ministry of Education for assisted reproduction, reproductive endocrinology, and reproductive genetics. A particularly important event in the history of reproductive medicine research and development.
  At present, there are more than 500 reproductive medicine centers in mainland China that can carry out conventional in vitro fertilization-embryo transfer (IVF-ET) technology, and can maintain a stable success rate. The application scope and technical level of China’s assisted reproductive technology-derived technologies have approached the international advanced level.
  The pros and cons of assisted reproductive technology
  Assisted reproductive technology is like a double-edged sword. It uses medical aids to enable infertile couples to obtain pregnancy, thereby realizing the desire to have children. At the same time, it also brings some disadvantages, such as multiple pregnancy, excessive use of ovulation drugs, and ovaries. Hyperstimulation syndrome, mother/offspring safety, gynecological tumors and offspring growth and development, occurrence of genetic diseases, etc. In addition, the ethical norms and legal systems in the clinical application of gamete donation are not sound enough, leading to profit-driven, some institutions illegally implement assisted reproductive technology, such as surrogacy, gamete trading, and the provision of assisted reproductive technology without access. These all need to be formulated by the state. More complete rules and regulations to regulate the implementation of assisted reproductive technology.
  Different types of assisted reproductive technology indications
  assisted reproductive technology can be divided into artificial insemination, in vitro fertilization, intracytoplasmic sperm injection, preimplantation genetic diagnosis, embryo transfer technology. The following briefly introduces the different technologies and their indications.
  1. Artificial insemination (AI) is
  a method in which sperm is placed in the female reproductive tract in a non-sexual manner, so that the sperm and the egg are naturally combined to achieve conception. The earliest successful AI treatment in humans was the artificial insemination between spouses performed by John Hunter in 1790 for the wife of a severe hypospadias patient. Although it has been more than 200 years, it is still a commonly used effective fertility technique. Depending on the source of semen, AI divides the husband’s sperm artificial insemination (AIH) and donor (non-spouse) artificial insemination (AID). The two indications are different.
  AIH indications: ①a certain degree of male deficiency, weakness, abnormal semen liquefaction, retrograde ejaculation, etc.; ②male sexual dysfunction, such as impotence, premature ejaculation, non-ejaculation, etc.; ③male and female genital tract malformations, such as male hypospadias, female vagina And cervical stenosis, severe cervical erosion, etc.; ④The woman’s cervical mucus is abnormal; ⑤The inability to intercourse caused by psychological factors; ⑥Immune infertility; ⑦Unexplained infertility.
  AID indications: ①irreversible azoospermia, severe oligospermia, asthenospermia, and teratospermia; ②failure of vas deferens recanalization; ③ejaculatory disorder; ④the man and (or) family have serious genetic diseases that are not suitable for childbearing ; ⑤ Maternal and child blood group incompatibility cannot get a surviving newborn.
  It must be emphasized that in the indications ①②③, except for testicular azoospermia, other patients who intend to undergo artificial insemination with donor sperm must be clearly explained to them by medical personnel. Intracytoplasmic sperm injection technology can also be used. He has descendants of his own blood relationship. If the patient himself still insists on giving up the right to assist in pregnancy through intracytoplasmic sperm injection, he must sign an informed consent form before using artificial insemination with sperm.
  2. In vitro fertilization-embryo transfer (IVF-ET) is
  also known as the first generation of IVF. The egg taken from the mother is placed in a petri dish, and the sperm that has been optimally induced and capacitated is added, so that the sperm and egg are combined in vitro and developed into a pre-embryo before being transplanted back into the mother’s uterus, and the baby is delivered after pregnancy.
  Indications: ① Gamete transport disorder caused by various factors of the woman; ② Ovulation disorder; ③ Endometriosis; ④ Few and asthenospermia of the man; ⑤ Unexplained infertility; ⑥ Immune infertility.
  3. Intracytoplasmic sperm injection