1. How is infertility defined? Is infertility very serious nowadays? According to the World Health Organization’s diagnostic criteria: a couple with a normal sex life, without contraception, can be diagnosed as infertile after one year of not getting pregnant. The concept of infertility, on the other hand, refers to the inability of the male partner to conceive for male reasons, and usually refers to a pathological pregnancy state in which the woman is able to conceive but the embryonic development is hindered, manifested by spontaneous miscarriage, embryonic arrest, premature birth, stillbirth, etc., which does not result in a healthy live birth of a newborn child. The globalized infertility rate has increased significantly due to the delayed age of marriage and childbirth, widespread adoption of contraceptives, proliferation of various abortion methods, deterioration of environmental and ecological problems, increased medical costs that are difficult to afford, lack of knowledge about infertility and reproductive health, and over-treatment and unregulated treatment by profit-oriented medical institutions. Chongqing city alone had an infertility incidence rate of 8.6% of the total local population! Statistics worldwide show that the number of couples requiring human assisted reproductive technologies such as artificial insemination and IVF accounts for 5% of the infertility population, and it can be said that infertility has become a serious problem that endangers the continuation of human race health, family happiness and social stability. 2. What are the reasons for so many infertility problems? In the past, when it comes to infertility, it seems to be a woman’s problem, but should men also be checked? Of course, once the problem of infertility arises, both husband and wife must be examined together, regardless of whether they have a history of pregnancy or childbirth in the past. Because fertility is a matter for both men and women, it is important to distinguish between male and female factors. Male factors account for about 1/3 of the cases, mainly including: oligospermia, weak, deformed sperm and azoospermia and abnormal semen liquefaction and sexual function. Female factors account for 2/3, and can be divided into four categories: ovulation, pelvic causes, immune causes and unknown causes, of which pelvic factors, which are often referred to as tubal incompetence, fluid retention or obstruction, uterine fibroids, uterine malformations, endometriosis and pelvic adhesions, account for about 1/2; ovulation factors include premature ovarian failure, persistent non-ovulation and polycystic ovary syndrome, follicular luteinization without rupture The remaining 1/6 are immune infertility, which includes autoimmune antibody positivity and closed antibody deficiency as the main manifestation, and unexplained infertility, the cause of which cannot be determined by current diagnostic methods, but the ability to conceive is really low. 3. It sounds very complicated, so how should we examine and treat infertility problems if we encounter them? This is not a simple question. In the past 30 years, the infertility treatment technology has made rapid development and brilliant achievements, such as artificial insemination of husband sperm, establishment of human sperm bank, cryopreservation of embryos and oocytes, in vitro culture of immature eggs for artificial insemination, single sperm intracytoplasmic microinjection, pre-implantation genetic diagnosis technology, etc., which have made many imaginations that could only be read in science fiction become real stories happening around us. We have a lot of stories around us. For example, it used to be big news to say that someone’s child was a test-tube baby, but now IVF is joining the ranks of new humans with nearly 200,000 births per year worldwide; and through pre-implantation genetic diagnosis, embryos with matching leukocyte compatibility antigens are found and then transferred to the mother to grow and develop a “life-saving compatriot “It has also become a major breakthrough in disease therapeutics to save their terminally ill brothers or sisters who can only be reborn by fully mated stem cell transplantation. Thus, the hope of solving infertility is growing, but this in no way means that people can, like shopping online, tap their keyboards and type in the subject word, search on the INTERNET, and randomly choose so-and-so method to treat infertility, or that any medical institution or lay doctor can see such diseases. Infertility treatment must be carried out in specialized infertility medical institutions by medical personnel qualified by national professional training in strict accordance with the standardized standards for various diseases, which not only ensures the effectiveness of treatment, but also effectively upholds the ethics of reproductive medicine and family planning requirements. Otherwise, it will not only increase a lot of unnecessary medical expenses and risks, but also make the patient spend money to cure the disease, but also delay the valuable treatment time. 4.What are the commonly used infertility tests? What is the significance? Are there any points to note when performing these tests? First of all, there are four basic tests: the first one is male semen analysis. The first is the male semen analysis, which must be done with the appropriate sperm analyzer, counting plate, staining and other laboratory conditions, to achieve the following standards are considered basically normal, namely, sperm density > 20 * 106 / L, sperm motility rate > 50%, a level > 25%, a + b level > 50%, malformation rate < 35-40%. The second item is female gynecological examination. This is the most basic necessary content, women should not refuse because of shyness, fear of trouble or feel uncomfortable, because the doctor can visually understand through this examination whether the woman has no vulva, vagina, cervical infection, injury, deformity and other problems that are not conducive to pregnancy, but also through double diagnosis to check the size, position, texture, mobility of the uterus, thickening and pulling pain in the adnexal area, triple diagnosis to determine the uterine sacrum The triple examination can determine whether there is tenderness and nodules at the root of the ligament, etc. Accordingly, pelvic infertility factors such as fibroids, endometriosis, adnexal masses and uterine malformations can be detected or excluded. The third item is ovulation monitoring. This includes basal body temperature measurement, ultrasound follicle monitoring, six gonadal items, thyroid or adrenal hormone level measurement, endometrial histology diagnosis, etc. It is mainly to understand whether there are ovarian infertility factors such as ovulation disorders, polycystic ovary syndrome, premature ovarian failure, follicular luteinization unruptured syndrome, etc. This type of examination requires strict timing and repeated examination for comprehensive consideration, for example, basic gonadal endocrine function requires For example, the basal glandular endocrine function requires fasting blood to be drawn before 9:00 am on 2-4 days after menstruation, while ultrasound monitoring of ovulation often requires 3-5 times of continuous monitoring from 2-3 days after menstruation to dynamically observe the actual follicular development and discharge. In order to achieve more objective results, it is necessary to perform it early after menstruation to avoid the result of "false positive tubal obstruction" due to thickening of the endometrium and increased secretion blocking the tubal lumen after a long time. In addition, infertility-related immune antibody monitoring, karyotyping of both couples and embryonic chorionic villi, monitoring of rare blood types and hemolysis factors, tuberculin testing, hysteroscopy and laparoscopy are often used to assist in the diagnosis of infertility. 5.Once the diagnosis is clear, the next step is treatment. (1) Infertility treatment requires a profound foundation in gynecological endocrinology, which is the most difficult combination of internal science and surgical operation in obstetrics and gynecology, and only common knowledge and skills in obstetrics and gynecology are not enough. In 2006, when I went to Shandong University Reproductive Hospital and Nanjing Medical University Hospital Reproductive Medicine Center to receive professional training, I felt that I was learning a new specialty! All the concepts, procedures and requirements were completely different from those in the field of obstetrics and gynecology, and we were indeed "new comers" in this field. We had to learn and enrich our new knowledge system, otherwise we would not be able to meet the requirements of patients and clinical work. (2) All treatments for infertility are double-edged swords and must be individualized, taking into full consideration the patient's comprehensive conditions and the specific clinical treatment wishes. For example, in polycystic ovary syndrome, which is the most common cause of ovarian infertility, the patient is often eager to request ovulatory treatment, but if her obesity, hyperandrogenemia, insulin resistance, etc. are not well "pre-treated", she may easily develop ovarian dysplasia or hyperstimulation syndrome after the use of ovulatory drugs, which may affect the pregnancy rate and may also lead to hypogonadism. The rate of pregnancy can also be affected by hypoproteinemia, disturbance of water-electrolyte balance and even coagulation disorders, multi-organ failure and other serious consequences. Therefore, every day in the face of patients' expectation and anxious desire, we must have a kind and calm heart, "like walking on thin ice, like facing the abyss" meticulous analysis of each detail, through adequate communication to reach in-depth informed consent, so as not to "do a bad thing with good intentions", let the patient disappointed and regret. The patient is disappointed and regrets himself. (3) Assisted reproductive technologies can only solve fertility problems to a certain extent, and they should never be deified or misused. Reproduction is the instinct of human reproduction, which is gradually improved and strengthened in the process of human evolution, otherwise we would not be facing the threat of "population explosion". Therefore, I believe that there are only limited means of treatment and there is no absolute infertility. As my predecessors said, all doctors can do is to "always comfort, often help, and occasionally cure". As an infertility specialist, in addition to drugs, surgery and assisted reproductive technology, we must make efforts to rekindle hope and confidence in patients, let go of the heavy mental burden, and stimulate the great potential from both body and mind, in order to obtain a satisfactory pregnancy outcome.