Effective from March 1, 2016, the policy of second child has been relaxed and the wave of second child has come. For post-90s couples, they may still be worrying about their first child; for post-80s couples, it’s the right time to have a second child; and for post-70s couples, they need to hurry up and try to catch the last train. Is age really so important for having a second child? Age affects fertility in several ways: fertility, eugenics and maternal health management. 1, fertility Previous studies have shown that the reserve function of the ovaries begins to decline after a woman is older than 35 years old, and a significant decline can be found after the age of 40. The decline in fertility is mainly manifested in 2 aspects: first, the decline in the number of follicles, and second, the decline in the quality of eggs. 2, changes in the number of eggs When a female fetus is 4 months to 5 months old, 6-7 million germ cells are formed. The number of follicles in the body of a baby girl at birth decreases to 1-2 million. More than ten years later, at the time of female puberty, about 300,000-500,000 germ cells remain. The reproductive life of a woman is about 30-35 years, during which 400 dominant follicles can be formed if she ovulates once a month, which means that each mature egg is formed from more than 10,000 germ cells. In other words, all other germ cells are eliminated in this “marathon race”, which we call “atresia”. This means that the fertility of women of childbearing age continues to decline with age, and most current research evidence suggests that this process is irreversible. 3. Decline in egg quality Eggs appear to be immature – unable to be fertilized or over-mature. The fertilization rate of mature eggs also declines. 4. Indicators for Assessing the Ovaries Age and ovarian decline show a correlation, but not a one-to-one correspondence. Are there any more reliable objective indicators of fertility? There are several indicators for assessing the ovaries: sinus follicle count, follicle stimulating hormone in the blood, etc. One of the indicators in the blood test is called “anti-Müllerian hormone”, or AMH for short, which is a hormone secreted by primary oocytes in the dormant stage of a woman’s body, and the more primary oocytes there are, the higher the level of the hormone will be. With the increase of age, the success rate of assisted reproduction techniques in assisted conception, under 35 years old, the success rate of 60%-70%, 35-40 years old success rate of 40%; greater than 40 years of age, the success rate of 20%. 5, eugenics Due to the problem of the rising age of having a second child, it is more important to pay attention to prenatal screening for birth defects. On the one hand, it is the screening of the genetic aspects of the fetus, and on the other hand, it is the screening of the body structure. There are 23 pairs of human beings with a total of 46 chromosomes. When forming an egg or a sperm, the chromosomes split in two and become 23, which may lead to an imbalance and abnormalities in the number and structure of chromosomes in the process of splitting. For example, if 24+23, it becomes 47 chromosomes, and chromosomal aneuploidy occurs, such as trisomy 21 and trisomy 18, etc. As the age of the parents preparing for a second child increases, the probability of such abnormalities will increase. Parents preparing for their second child are often aware of this when they are pregnant with their first child. It is important to note that due to the increased risk when preparing for a second pregnancy, screening needs to be doubly emphasized. In addition, the latest non-invasive testing technology can use a very small number of fetal nucleated red blood cells in the “mother’s peripheral blood” to test for chromosome abnormalities by amplifying the gene sequences on the target chromosomes, with an accuracy rate of 99.9999%. Body structure screening, mainly pregnancy 18 weeks -24 weeks ultrasound, the development of technology, now three-dimensional, four-dimensional ultrasound in the major hospitals have been equipped with, can provide a higher precision and intuitive images for screening. 6, advanced maternal age After the age of 35 years old with the increase in age, the advanced maternal age of miscarriage, gestational hypertension, placenta praevia, preterm delivery, premature rupture of membranes, gestational diabetes, postpartum hemorrhage and other complications are significantly higher than the age of the mother. Miscarriage: chromosomal abnormalities of the embryo (trisomy 21 and trisomy 18, mentioned earlier, both increase miscarriage), uterine fibroids, cervical damage, endocrine abnormalities (progesterone deficiency). We mentioned earlier that the success rate of assisted conception at age 40 is 20%, do you know what the miscarriage rate is after successful assisted conception over the age of 40? 20%! In the end, only 70%-80% of deliveries are successful. Hypertension in pregnancy: Being older than 35 years is one of the risk factors for hypertension in pregnancy. The basis of the pathology is spasm of small arteries, manifested by increased blood pressure, edema, proteinuria, blood concentration, affecting the brain, heart, lungs, liver, kidneys and many other important organs. Some couples whose first child was delivered by cesarean section need to pay attention to what when preparing for their second child? 1, cesarean section is what we often call a cesarean section, China is the world’s highest rate of cesarean section, this is due to a variety of factors, one of the possible factors, when the couple’s family planning, did not take into account the possibility of the future of the second child, chose the cesarean section delivery. So how does a C-section for the first child affect the preparation of the second child? Modern cesarean sections are generally performed using a “lower uterine segment cesarean section”, where the scar on the uterus is located on the lower part of the anterior wall of the uterus. The wall of the uterus in this location is relatively thin, and there are no large blood vessels, so there is less tension on the uterus during the pregnancy, so that even after a cesarean section, the effect of scarring on the birth of a second child is reduced to a very low level. A very low level. It is important not to get pregnant too early in order to prevent the risk of rupture of the uterine scar when the scar has not fully healed and the tension on the uterine wall increases with pregnancy. Therefore, the cesarean section more than 2 years after the operation before pregnancy. 2.Is it possible to have a cesarean section with my first child and have a normal delivery with my second child? This depends on the reason for the first cesarean section and the timing of the cesarean section. If the reasons for choosing cesarean section for the first time still exist during the second pregnancy, for example, the condition of the pelvis is not ideal and will not be changed during the second pregnancy, then the second baby will also need a cesarean section. While some factors, such as fetal hypoxia in the first pregnancy that led to an emergency cesarean section, are not manifested by hypoxia in the second pregnancy, and the reason for the cesarean section no longer exists, there is a possibility of natural delivery. The next factor to consider is the timing of the last cesarean section. Some mothers have had their first baby during their own normal labor, when the uterine opening was already open (the door to labor was already open), and they were unable to have a normal delivery and changed to a cesarean section due to abnormal fetal position and other reasons. In the case of a second pregnancy, the birth canal has already been “exercised” during the first labor, so the chances of a successful delivery are greater. Some mothers, on the other hand, do not have contractions during the first time, never have pain in the stomach, and deliver their babies directly by cesarean section, in which case the decision to go through with the delivery of the second child will require more preparation and courage. In short, it’s a case-by-case situation, and you need to plan your labor and delivery with your obstetrician. After all the “troubles” of preparing for a second child, what are the benefits of having a second child that make it worthwhile for mothers to try and make the effort? In the family planning, the second child is indeed a major decision, especially the mother, again to conceive the baby, in the baby’s small time also put more energy to take care of them. But, to a certain extent, it’s worth it, even if it’s just from a medical perspective. Medical research over the past few decades has made it clear that having a baby and breastfeeding significantly reduces the risk of developing some malignant pathologies in the mother. For example, the incidence of endometrial, ovarian and breast cancer. After pregnancy, due to the cessation of menstruation, the lining of the uterus no longer sheds blood regularly every month, and this state of affairs lasts for at least 9 months, and may be prolonged for another 3 to 12 months if breastfeeding is practiced. This process reduces the chance of malignant changes in the proliferation and repair of the endometrial cells, thus reducing the risk of endometrial cancer. For similar reasons, endometriosis, commonly known as “chocolate cysts,” is a condition that resolves or even cures due to the cessation of menstruation after pregnancy. In the same way, the ovaries stop ovulating after pregnancy, avoiding the repair of ovulation wounds, which can reduce the incidence of ovarian cancer. Life details To have a second child, it is recommended that both men and women go to the hospital for a pre-pregnancy checkup before getting pregnant and stop taking contraceptive pills, antibiotics and other medications, and practice eugenics under the guidance of a doctor. Do a good job of eating a light, nutritious diet, eat more fresh vegetables, fruits, coarse grains, beans, cereals and other foods, comprehensive to supplement the nutrition needed during pregnancy. In addition, also pay special attention to daily folic acid, pre-pregnancy for folic acid intake is also very important, can be very good to avoid fetal malformation. Many mothers are aware of the need to take folic acid supplements in preparation for pregnancy, but in order to maintain folic acid at a certain level in a woman’s body, doctors recommend starting to take it after marriage to ensure that the early embryo has a better nutritional state of folic acid. According to research, it takes 4 weeks after a woman has consistently taken folic acid every day for the state of folic acid deficiency in her body to improve in a tangible way. In this way, in the sensitive period of fetal neural tube formation in early pregnancy, enough folic acid to meet the needs of the nervous system development, and to insist on taking it in the sensitive period of the first trimester of pregnancy in order to play the best preventive effect. When preparing for a second pregnancy, it is also important to take folic acid as early as possible, one capsule daily. Physiological dose is 0.4 mg, and often folic acid preparation is 0.8 mg, no relationship, folic acid is a water-soluble vitamin, more than taken can be excreted through the urine, will not accumulate toxicity. The adverse effects of tobacco and alcohol should be quit or reduced – on both sides. The best time to give birth to a second child Several studies have shown that waiting 18 to 23 months after having a baby before conceiving a second child is best for the health of the next baby. If the first baby is a normal birth, then the recovery period is relatively short. Generally, after only 1 year, the woman’s physiological functions are basically restored after delivery, and after checkups, she can consider conceiving a second baby.