Menopause earlier than 40 years of age is known as premature ovarian failure. There is no effective way to increase ovarian function or reverse the decline in fertility, and the use of complementary medicine may only improve egg quality. Therefore, it is important for women to detect early warning signs of ovarian “premature aging”. It is important to make early life plans, balance career development and family life, and if you wish to become a mother, it is best to have children early. The end of ovarian life expectancy is menopause. The ovarian reserve is related to the life expectancy of the ovaries and the duration of fertility, which varies from one individual to another, and is commonly referred to as “different lives for the same person”. Many people believe that a woman’s fertility begins with menstruation and ends with menopause, but in fact, a woman’s natural fertility begins to decline rapidly 10 years before menopause, and menopause occurs when eggs are depleted. Predicting ovarian lifespan has important implications, including anticipating fertility endpoints, anticipating the risk of developing related diseases, and taking possible steps to reduce life loss or deficits. “If you want to become a mother, but wish to study abroad for a PhD, workplace hustle or enjoy ‘the world of two” before having children, why not test your ovarian lifespan to see how long your window of time is.” Yang Dongzhi said that fertility decline is irreversible and people need to grasp the best age to have children. It is common to see women who have not planned their fertility well, and when they want to have children, they have very little ovarian life left, and some of them regretfully turn out to be the best of their “generation”. When a mother’s ovaries age prematurely, her daughters may suffer the same fate. Menopause before the age of 40 means an early end to ovarian life. It not only affects fertility, but also has a negative impact on women’s psychological, neurological and cardiovascular health. “Premature ovarian hypofunction”, also known as “premature ovarian insufficiency”, or POI for short, has been on the rise in recent years. Women at risk of premature ovarian insufficiency (POI) have a chance of natural pregnancy until 10 years before menopause, and need contraception if they do not have a child. Regarding the genetic pathology of premature end of ovarian life, there are many factors that affect premature ovarian failure, the most common of which are as follows: 1. Genetic factors: including low reserve at birth, such as women with Turner/other genetic factors who are born with poorer ovarian reserve than others and are more prone to premature failure; 2. Overconsumption: women with FMR1 mutations/single or double allele expression subtypes associated with POA/ Women with AMHR2/AIRE are prone to premature ovarian failure; 3, other genetic factors: BRCA1 mutation. 4, Medically induced damage and ovarian lesions: ovarian surgery, radiation, chemotherapy or bone marrow transplantation received by tumor patients can cause damage to ovarian function; 5, Other medical factors: ovarian lesions such as endometriosis, ovarian masses. 6, autoimmune: thyroid, adrenal, polyglandular diseases, and any other autoimmune diseases, or women with a family history of autoimmunity or recurrent miscarriages are at higher risk of premature ovarian failure than the average woman. 7. Family history: early menopause in mother or sister. Yang Dongzi said that if a mother goes through menopause early, her daughter may also go through menopause earlier. There is no way to reverse the age of the ovaries, but when the ovarian reserve is declining and not yet terminal, there are auxiliary drugs that may improve the quality of the eggs, “and perhaps a chance of fertility”. For women who have gone through menopause, there are a number of supportive drugs that may improve egg quality and “may be able to grab a glimpse of fertility. For women who have gone through menopause, the only way to have children is through volunteer egg donation, as they have no eggs. Because of this, early detection of premature ovarian decompensation is very important. Young women with high risk factors can be dynamically monitored for anti-Mullerian hormone (AMH). “Doctors use this indicator to assess the age of the test woman’s ovaries,” AMH hormone is positively correlated with a woman’s ovarian reserve, meaning that the lower the level of AMH values, the worse the ovarian reserve function. A continuous deviation from the warning line of the normal female AMH variation range (low 95 percent) indicates early ovarian aging. After the age of 35, the AMH level decreases significantly. Therefore, it is important to know your ovarian life expectancy early. Four suggestions: 1) Plan your life well and try to have children early; 2) Minimize environmental factors, such as avoiding smoking or second-hand smoke, staying away from drugs, and being cautious about ovarian surgery; 3) Get enough sleep and be optimistic and open-minded; 4) Have annual medical check-ups, especially gynecological check-ups, and consult a specialist if there are any abnormalities. Q&A Q：I have been pregnant twice, but both pregnancies stopped after less than three months, and the test showed that there is a problem with the closed antibody, is it possible to cure the “closed antibody” before the next pregnancy? A: Clinically, we often encounter two or more early terminations of spontaneous pregnancy, i.e. “recurrent spontaneous abortion”. The first thing a patient should do is to see a doctor to screen for the cause. The patient learns through the test that she is negative for closed antibodies, but in fact there is much more to find than just “closed antibodies”. There are several possible causes: 1) genetic factors such as chromosomal checks to see if genetic factors cause the embryo to fail to survive; 2) anatomical reasons, such as whether there are abnormalities in the reproductive tract that cause the embryo to fail to stay; 3) endocrine diseases; 4) immune factors, closed antibodies are only one type of immune antibody; and infection factors. It is recommended that you go to the hospital for a comprehensive screening. Q: Is it true that polymorphism of chromosome 9 causes easy miscarriage? Is it true that it is fine after the first trimester of early pregnancy? A: Generally speaking, chromosomal polymorphism does lead to an increased chance of miscarriage in some cases. Our fertility center has genetic counseling every afternoon with professional geneticists to analyze the possibility of this pregnancy outcome. Termination of development of embryos with chromosomal polymorphisms is mostly seen in the early stages of pregnancy and into the middle trimester. From the chromosomal point of view, there are relatively fewer problems after the middle trimester, but it is not completely guaranteed that the embryo is normal. Therefore, follow-up prenatal checkups are very important and should not be neglected. Q: What should I do in terms of diet to prepare or regulate pregnancy? Is there any truth to some folk sayings, such as not eating cold foods like crabs and eating more apples to protect the pregnancy? A: It is true that there are many folk sayings, but from the scientific point of view, it is necessary to have a balanced diet and a variety of diets, not just to eat whatever is good. For example, the high fat content of certain foods can easily cause indigestion, the gastrointestinal tract function during pregnancy is adjusted, if the gastrointestinal function is fragile and increase the burden on the stomach and intestines, will affect the health of pregnant women. From this perspective, some folk sayings have their validity, but it is important to have a balanced diet, and pregnant women should also be alert to foods that can easily cause their allergies. Q: Is polycystic ovary syndrome hereditary? A: There is a certain genetic predisposition, but it is not very precise, for example, there is a fixed genetic mutation like in thalassemia. Polycystic ovary is a polygenic, acquired genetic predisposition and may have a good spontaneity. If a mother has polycystic ovaries, her daughter will have a higher risk of inheriting the disease, which is a tendency. Then again, if the father is bald and there are family members with high blood pressure and diabetes, the probability of polycystic in women will also be higher than in the general population. Therefore, if there is a family history of polycystic ovaries and the girl is experiencing irregular periods, consider seeking early screening with a doctor to detect the disease early. Q: Is it true that the child’s lungs will be weaker after birth if fertility preservation treatment is performed? Is there any strict medical standard for fetal preservation? A: Yes, medically birth control is mainly for patients with pre-eclampsia. There are also clear diagnostic criteria for pre-eclampsia, where problems occur after pregnancy, such as stomach pain and bleeding, and these conditions require birth control. Many women tend to be nervous after pregnancy and even ask to be hospitalized to keep the baby safe, but in fact, there is no need to be too nervous, and the progesterone that is commonly used to keep the baby is not necessarily needed by everyone. If the doctor diagnoses a preterm miscarriage, it is necessary to keep the fetus. In addition, for patients with recurrent spontaneous miscarriages, if the factors causing the recurrent spontaneous miscarriages require special medication to cope with them, this is also part of the fetal preservation, but according to the doctor’s prescription. From the medical point of view, different methods are used to maintain the pregnancy for different reasons, and the most important thing is to “listen to the doctor”. Q: Not long ago, the media exposed the case of underground clinics illegally taking eggs for assisted reproduction, can you tell us what qualifications a regular assisted reproduction clinic/center should have? A: Nowadays, there are 53 hospitals in Guangdong Province with assisted reproduction qualifications. The technologies that different reproductive centers can do vary, for example, some can only do artificial insemination, some can do normal IVF, and some can do third-generation IVF, which can be found on the provincial health planning commission’s website, including the name of the hospital and the assisted reproduction programs that can be carried out. Some patients go to Taiwan, Hong Kong and other places to do assisted reproduction, their qualification certificate is required to be listed in the clinic, patients can pay attention to check. The current problem of underground black clinics is mainly because some patients need to do egg donation and egg donation. China’s law stipulates that such egg donation is legal only if the person doing IVF has extra eggs and is willing to donate them voluntarily. Therefore, there are very few legal egg sources in China and underground clinics have emerged. It is important to note that assisted reproduction is a highly demanding medical technology, and such strict national approval is conducive to better management of this market, as unqualified medical technology is not guaranteed. Q: Can I undergo IVF with high insulin? A: If the diagnosis says high insulin, this may be a case of insulin resistance, mostly seen in patients with polycystic ovary syndrome, where insulin resistance is a relatively major lesion. If ovulation is done before insulin resistance is corrected, the response to ovulation drugs is very low. Even if one happens to ovulate, the endometrium is not well tolerated, as if there is a seed and the land is faulty, so the chances of conception are still low. If the patient is very lucky to be successful, the use of insulin sensitizer is continued. Q: Will the high number and failure of ovarian egg retrieval cause overstimulation of the ovaries? How can it be treated? A: Hyperstimulation has nothing to do with multiple ovulation retrievals, it is mainly related to the response of individual ovaries to ovulation medication. Some individuals are very sensitive to the medication and have a strong response to low doses, resulting in many eggs developing and growing at the same time. Hyperstimulation syndrome is not a long-term disease, it is a one-time event that only overreacts to one ovulation, and then slowly disappears after ovulation has passed. If the embryo is not released, the disease may last for a week or so. If the embryo is released and pregnancy occurs, the disease cycle will be longer, and some patients may have to be hospitalized for ascites pumping and fluid replacement, but the hyperstimulation will not last forever. However, the next time ovulation is performed, the likelihood of stimulation recurrence will increase. Q: Are patients with polycystic ovaries prone to ovarian aging? Do they still need treatment if they have no need for fertility? A: This is actually a common disease in recent years. In terms of ovarian life expectancy, it does not cause a decrease in life expectancy, but it does cause frequent ovulation, which has an impact on fertility. Therefore, it can be said that this disease is not a problem for ovarian life expectancy, but it is a problem for fertility. For the group without fertility requirements, we have been scientifically advised that this disease is chronic and will always be present and has to be regulated. For women who have finished having children, if fertility is no longer considered, then other problems should be considered because non-ovulation and menstrual disorders can cause female health problems such as endometrial cancer, polycystic ovaries patients have 10 times higher chance of endometrial cancer than the general population, in addition to other problems such as metabolic syndrome, diabetes, cardiovascular disease, hyperlipidemia, coronary heart disease, etc. This condition requires continued doctor visits and long-term health management. If you want a second generation, I still recommend having children at the right age. It is more difficult to have a child at an older age, so it is important to take advantage of it before it is too late. Q: What should I do if I was born in ’96 and haven’t had my first period? A：This is primary amenorrhea, you must go to the hospital for examination to find out the cause of primary amenorrhea. 20 years old is too late to go to the hospital, this patient should go to the hospital for examination as soon as possible. Q: How can young urbanites maintain their ovaries? A: The main reserve of the ovaries is the eggs, and this reserve has been declining since the formation of the embryo, and this decline cannot be stopped by medical means. Some beauty salons say that they can maintain the ovaries, but in fact lack of scientific basis, as maintenance, stay away from staying up late, mental tension, anxiety, smoking, drinking, alcohol, exposure to harmful substances and other factors, is the best maintenance. Q: What kind of tests do senior couples need to undergo to have a baby? Is it only for women? A: Human fertility decreases after the age of 35, and it is the same for both men and women. But not everyone is the same, there are individual differences. I think the earlier the better for individual cases. Both couples should go to a fertility center for fertility assessment, and women should have their ovarian reserve assessed, and they should consult fully with their doctor if they need assisted reproduction. I suggest that the sooner you consult your doctor the better, and that you see a specialist for the few opportunities left. Q: How much does gynecological inflammation affect pregnancy preparation? A: Gynecological inflammation has an effect on fertility actually on the reproductive tract. This is actually not difficult to deal with and requires a clear diagnosis, such as mycosis fungoides which requires adherence to treatment and listening to the doctor. Cervicitis is actually a vague concept, whether there is cervical lesion or not can be diagnosed by doing cervical discharge and exfoliative cell examination. Q: What are the requirements for the third generation (PGD/PGS) in vitro fertilization technology? Is the success rate high? A: First, IVF technology is not more efficient than one generation, different technologies are suitable for different people. PGD is for the diagnosis of possible fetal hereditary diseases, to clearly detect whether the embryo has a certain disease, such as for detecting several embryos of a thalassemia couple, to see which one is free of thalassemia, to see whether it is possible to have a healthy child, PGS is genetic sequencing, which is for a specific category of people, such as recurrent miscarriage. PGS is genetic sequencing, which is aimed at a specific group of people, such as recurrent miscarriages, to see if this has a genetic mutation abnormality. So IVF technology is not a matter of being advanced or not, the decision to do it or not is actually up to the doctor, especially the geneticist, and it’s hard to summarize in one sentence whether or not you can have a successful pregnancy after doing it. When you go for it at the age of 20, your fertility is good and the success rate of pregnancy is high, but when you are 40, even though you don’t have any disease, your fertility has decreased and the success rate will be lower. Q: Ovulation promotion, who is it for? A: Ovulation promotion is first used for people who are not ovulating, such as those with polycystic ovary syndrome, or those who are detected to be ovulating and are always infertile, such people need assisted conception or artificial insemination. Ovulation promotion will ensure that the woman has an egg in the cycle. In addition, even if there is ovulation, not everyone can ovulate regularly. Ovulation promotion has some significance for women over 35 years old, for example, if a woman has only one ovulation per month, but after ovulation promotion she may have 2 ovulations this month, which increases the possibility of fertility. So ovulation promotion is based on medical needs. If you detect ovulation on time, have intercourse on time and do not get pregnant, you can go for testing if there is any problem with the fallopian tubes or if your husband’s semen is normal. Q: Can I still conceive naturally if my left fallopian tube is incompetent and the right one is open but not smooth? A: The fallopian tubes are an important part of natural conception. If the test results show that there is a problem and an ectopic pregnancy has occurred, then this is highly suggestive that the woman’s fallopian tubes have been affected by diseases, such as inflammation and infection. In fact, the pelvis is very small and often when one side is affected, the other side is inevitably affected as well. In this case, the chances of natural pregnancy will be reduced. If you still want to know whether the other fallopian tube is available, you can go for an imaging or laparoscopic surgery, as this will allow you to see the condition of the fallopian tubes directly. If pregnancy preparation fails repeatedly, you need to consult your doctor about IVF for assisted reproduction.