Making IVF is not an easy task

The world’s first test-tube baby was born in the United Kingdom in 1978. Ten years later, China’s first test-tube baby was born, which opened the prelude to the development of assisted reproductive technology in China. On April 15, 2019, China’s first test-tube baby was upgraded to become a mother, ushering in “the second generation of test-tube babies.” Assisted reproductive technology has enabled more and more infertile couples to “get a new life.” While full of hope, many people still have misunderstandings about it, blindly running around on the hard and tortuous road to seeking children.

Three mountains overwhelm infertile couples

“This is the third time we have come to Beijing!” Zhang Lin (pseudonym) and her husband took the train from their home for one night and came to the Peking Union Medical College Hospital Gynecological Endocrinology and Reproduction Center early for waiting. There were many people. Zhang Lin was wearing a mask and sitting in the corner, raising her eyes from time to time to see the happy couple passing by after the successful pregnancy. From 2016 to the present, Zhang Lin has always wanted children but no results. She is 33 years old this year under great pressure. “He (husband) is an only child and can’t lift his head without a child in his hometown. He has visited six or seven hospitals in recent years. Here is the last hope.”

The Zhang Lin couple are just the epitome of many “infertile” families. The data shows that China has more than 40 million infertility patients, accounting for 15% of the population of childbearing age, that is, every eight couples have one infertility.

Yu Qi, director of the Gynecological Endocrinology and Reproduction Center of Peking Union Medical College Hospital, said that at present, Chinese people are facing three major problems in fertility, that is, they can’t afford it, can’t keep it, and can’t get well. In recent years, people generally blame environmental pollution, agricultural residue pollution, mental stress, etc. for “not getting pregnant”. In fact, although these factors have an impact, they are extremely limited. The main reason is the delay of childbearing age, especially after the age of 30, the probability of natural pregnancy will become lower and lower every time the age increases by one year. After 40 years old, not only ovarian function declines, but also various gynecological diseases will reduce the possibility of conception again and again. If you have done abortion again, the incidence of infertility will be higher. The higher the age, the higher the miscarriage rate, so “unable” can happen from time to time. Yu Qi said that according to statistics, only one of the 20 eggs in women over 40 years old is normal. If you choose a test-tube baby, the chance of getting 20 eggs at one time is very small, so you need to take it multiple times, and the embryo has only a 50% success rate of transplantation. In addition, there have been more birth defects in recent years, which is mainly related to technological progress. Prenatal diagnosis is becoming more and more advanced, and the birth defect registration system is becoming more and more perfect. Many small defects such as minor congenital heart disease and accessory ear are also registered, so people feel that there are more birth defects. However, as female childbearing age continues to rise, the incidence of birth defects will indeed increase.

The road of test tube needs to pass

In ancient times, there was “Send Son Avalokitesvara”, and today there is “Assisted Reproductive Technology”, which many people regard as “life-saving straw.” Moreover, it is not easy to do IVF. Whichever link is interrupted will directly affect the success rate of IVF. Once it fails, it will have to come back again.

Assisted reproduction should be consistent with the diagnosis of infertility. The World Health Organization defines infertility as the failure to achieve pregnancy after 12 months or more of regular sexual life without contraception. Women over 35 years of age should seek medical treatment after 6 months of failure.

IVF should meet the indication. The test-tube infant indication population usually includes: the female’s gamete transport disorder, ovulation disorder, endometriosis due to various reasons, the male’s sperm quality is poor or weak, and the immune system is infertile.

Relevant tests should be carried out before assisted childbirth is carried out, and the results can only be carried out normally. Carry out laboratory tests to exclude infections, infectious diseases, basic diseases and other conditions that are not conducive to test-tube babies. For example, in recent years, it has been clinically found that the problem of hydrosalpinx has a great impact on the success rate of test-tube babies, so it is necessary to check and treat in advance before implementing assisted reproductive technology.

Promote the removal of eggs. After entering the reproductive center, ovulation is promoted by drugs, and then 10 to 15 oocytes are removed from the ovary by the egg retrieval device. At this stage, it is not necessary to get enough eggs every time, and some need to take many times.

Screen oocyte quality. Not all oocytes are of acceptable quality, and even 100% are unqualified. If there is no usable oocyte, it is naturally impossible to go to the next step. This is the main reason why older IVF babies are unsuccessful.

In vitro fertilization. In a laboratory environment, allow qualified oocytes to be combined with sperm. But in this process, not all oocytes will be fertilized, and some embryos will stop developing in these few days, and it is impossible to grow into babies.

Genetic testing. For patients in need, genetic testing before embryo transfer will eliminate embryos with genetic disease information and genetic problems of their parents, and reduce the birth rate of children with defects.

Embryo Transfer. After 3 to 5 days of incubation, the embryo is transplanted back into the uterine cavity to implant it successfully in the uterus and continue to grow and develop. The remaining embryos continue to be cultured, and embryos that are not used temporarily are frozen.

Determine if you are pregnant successfully. After a successful pregnancy, corpus luteum support is needed to provide progesterone to the pregnant woman. After pregnancy, there are risks of pregnancy and birth, so test-tube babies are not so easy.

Don’t drag your baby for too long

Yu Qi said that assisted reproductive technology is not a panacea, but a “remedy”. It is recommended that couples with birth plans have early births and good births, and do n’t drag them until they are too old. Even as a test-tube baby, the younger the higher the success rate. Before the age of 25, you should start thinking about asking for a child, make a birth plan, do not delay too late, try to complete the birth before the age of 35. If you have no children after the age of 35, you have to be very active in preparing for pregnancy, giving birth to the first priority of work and life. After the age of 40, let it take its course, if you can’t have children, don’t toss your body too much.

For assisted reproductive technology, Yu Qi believes that it should be treated rationally and selected in a targeted manner.

Test tube babies have not been said for generations. In vitro fertilization-embryo transfer (IVF-ET), intracytoplasmic sperm injection technique (ICSI), pre-embryo transfer genetic testing (PGT), these three are generally considered to be three generations of IVF. Yu Qi explained that the three technologies are suitable for different groups of people, and there is no one that is better than which.

The domestic success rate is not lower than abroad. Although the Department of Assisted Reproduction started late in China, after more than 30 years of unremitting efforts, it has now reached the world’s advanced level. In recent years, many people have gone to the United States to be test-tube babies and believe that their transplantation success rate is high. In fact, it is because the United States carries out PGT on all patients, screens all the embryos obtained, picks out completely normal embryos for transplantation, and of course has a high success rate. Take the Peking Union Medical College Hospital as an example. The success rate of IVF is over 40%. There are many domestic ovulation promotion programs. These are different programs developed by doctors according to different conditions of the Chinese people.

The gap between domestic hospitals is not large. At present, many infertility patients flock to Beijing, Shanghai and other places to seek medical treatment, but the IVF technology is already mature, and the public hospitals that have approved assisted reproductive technology in China are not far behind. Mainly, many patients think that some provincial hospitals cannot carry out genetic testing before embryo transfer. In fact, the current value of this technology is not worth adopting for everyone, and it is still controversial. Because this technology is still not 100% correct, it is likely that some normal embryos will be screened out, and embryo biopsies will also cause the loss of some embryos. Therefore, all hospitals are not encouraged to carry out this technology.

With the 540 billion euros bailout package, the EU has taken a key step in the issue of uniting the fight against epidemics. While observing the EU’s anti-epidemic measures, we have to see that the EU has indeed had an early response to the chaos, as well as today’s adjustments and efforts.

First of all, the understanding of the EU’s anti-epidemic measures should be based on an accurate determination of the EU’s status. Some people think that one of the reasons why the EU looks in crisis before the impact of the epidemic is due to the lack of ethnic identity and national identity among EU member states.

You have to know that European countries have a long journey to a consortium like the EU today. This is by far the most successful example of regional integration practice in the world. As the ASEAN celebrates its 50th anniversary, the demonstration effect of the EU model has been discussed. But neither ASEAN nor the European Union is a substitute for sovereign states. In recent years, in the face of the deep reorganization of the international order and international pattern, the European Union upholds the concept of “European sovereignty” and begins to strengthen the internal construction of the European Union and reshape the European external strategy. , Not to seek further sovereignty transfers from member states, but to try to improve their position in the game of great powers. After Brexit, the EU still has 27 member states. At the end of March this year, the EU had initially agreed to start negotiations on accession to Albania and Northern Macedonia.

As an important regional integration organization in the world, the EU is not a “United States of Europe” or “Federal Europe”. It cannot achieve national recognition like a specific country. In fact, the chaos in the early days of the European epidemic was precisely due to the fact that member countries were too concerned about their national identity.

Second, we must objectively understand the EU’s anti-epidemic efforts. Some people in the country believe that in front of the epidemic situation, the EU behaved as a group of heads, contradictions, and weak anti-epidemic. But that was mainly a month ago. The new crown epidemic has fully demonstrated the power and destructive power of non-traditional security issues. Whether it is foreseeable or sudden response, it is beyond the past, and the EU is no exception. As European countries have recently upgraded their prevention and control measures, since late March, the European Union has carried out a series of major adjustments to the European country ’s anti-epidemic strategy in response to the previous member countries ’self-righteousness, insufficient overall coordination, and new challenges for European integration The anti-epidemic package strengthened timely coordination and emphasized unified action, seeking unity and cooperation both internally and externally. The European Commission recently announced that it will actively promote a more flexible state aid system. The president of the European Commission also specifically publicly apologized to Italy and promised to unite against the epidemic. The European Union ’s High Representative for Foreign Affairs and Security Policy called on April 7 that “responding to the global epidemic requires unprecedented general mobilization at all levels”, “Europe is achieving unity to fight the epidemic, which should be known to the world”

As for the EU’s “allied help reached hope in crisis”, this is used to describe the failure of the US-Europe cooperation mechanism and the downfall attitude of the United States towards European anti-epidemic.

Of course, the epidemic situation in Europe continues. How to do a better job of uniting and cooperating in the fight against the epidemic is still a serious test being accepted by the EU and its member states.

Third, rationally judge the prospects of the EU. It is a fact that the EU ’s own frame design is not perfect. However, in the context of the continuous questioning of the ability and effectiveness of the EU ’s solidarity and cooperation to fight the epidemic, there are domestic concerns that the epidemic will break the EU in the future, and others believe that the epidemic has exposed a series of problems such as insufficient EU leadership and crisis management capabilities , Will bring about a crisis of public trust, which in turn leads to a crisis of legitimacy, and is not optimistic about its prospects.

The global new crown epidemic will undoubtedly accelerate the reshaping of civilization and the reconstruction of the world order, so it will also bring a series of serious challenges for the EU. European political observers pointed out that the new crown epidemic is a new test of EU cohesion and credibility. This requires that the EU, like other countries and international organizations, dare and be good at meeting challenges in new emergencies, realize self-adjustment and mechanism updates as soon as possible, and gradually improve its own structure.

The European Union ’s High Representative for Foreign Affairs and Security Policy recently pointed out that the fight against the epidemic will take place on multiple fronts. Within Europe, the significance of the EU as a coalition to be protected must be highlighted. Unity is not an empty talk. Therefore, it is not necessary to be pessimistic about the EU tomorrow. The epidemic is not over. How the EU will develop in the future will depend not only on the subsequent control of the epidemic but also on the EU ’s subsequent efforts.