Since January 1, 2016, China has started to fully implement the two-child policy, and the era of “two-child era” is coming. From the age calculation, the first batch of the main force of the second child is the post-80s. Some of the post-80s women have already passed 35 years old and are of advanced maternal age, with a general decline in fertility, significantly lower chances of pregnancy and higher risks of childbirth. Therefore, before having a second child, it is advisable for the couple to go to the hospital for a fertility assessment, and after a successful pregnancy to strengthen pregnancy management and prevent various pregnancy complications. What factors can affect your fertility Many mothers who have already had one child think that as long as they are not menopausal, they should have no problem having children. In this regard, Professor Yang Dongzhi said that many factors in life can damage a mother’s fertility, and even women who have already had a history of childbirth may not be able to conceive a second child. These factors include: 1. Age The quality of eggs is relatively high in women between the ages of 25 and 28, and the level of hormone secretion is at its most stable, so it is the best time to have children. Women generally have only 400-500 follicles to mature and ovulate in their lifetime, eggs cannot be regenerated and once the egg reserve is depleted, the decline of ovarian function will be irreversible. Studies have shown that after the age of 35, women’s fertility decreases in a waterfall pattern, and after the age of 38, the number of follicles and the quality of eggs decreases, and fertilization ability is poor, so it is not easy to fertilize and get pregnant. With the change of sexual concept, the incidence of unclean sex, early age of sex and too frequent sex has increased, and the incidence of gonorrhea, non-gonorrhea and other sexually transmitted diseases has also increased, and women have more chances to suffer from vaginitis, cervicitis, adnexitis and pelvic inflammatory disease, which can easily lead to obstruction of the fallopian tubes, adhesions and restricted function of the umbilical end, and if there is one or more abortions and induced abortions, it is more likely to cause secondary infertility. The same time, male reproductive organs inflammation (testicular inflammation, epididymitis, prostatitis, etc.) can also lead to azoospermia, oligospermia, weak sperm, etc., thus affecting fertility. 3, social environment Increased pressure and faster pace of life can easily lead to low libido, sexual dysfunction and reduced fertility in men; women show endocrine disorders, ovulation disorders, menstrual disorders, which can also make it difficult for mothers to get pregnant. 4, other factors Environmental pollution, improper diet (such as excessive dieting and weight loss, smoking and drinking), bad habits (staying up late), etc., may affect the function of the female ovaries, egg quality or male semen quality, which in turn can cause fertility difficulties. Fertility assessment to see your ovarian reserve function Before deciding to have a second child, it is best to have a fertility assessment to see if you can get pregnant and then arrange a reasonable time to prepare for pregnancy if it is suitable. According to Prof. Yang Dongzhi, the fertility assessment is divided into three steps: first is the consultation, including age, menstrual history (status of menstruation), family history (such as how fertile your mother is, how many children she had, whether it is easy to have children, how old her mother was when she went through menopause, history of diseases, etc.). The second step is a physical examination, including a gynecological examination, which is usually tailored to the woman’s past medical history, for example, if she has had an infectious disease, she will need to check for signs of infection at present. The third step is an ancillary examination to understand ovarian reserve function, which simply means assessing how many follicles are left in the ovaries to be expelled and the quality of the follicles (i.e. ability to fertilize and develop into an embryo), etc. This can be a direct indication of one’s fertility. Medical advances have provided increasingly accurate means of assessing ovarian reserve function, which can now be referenced to include, in addition to age: (1) menstrual changes, such as shortened menstrual cycles, decreased menstrual flow, and menstrual disorders; (2) basal hormone levels, including FSH, LH, E2, inhibin B, and mullerian duct inhibitory factor (AMH); (3) ovarian imaging, including AFC, ovarian volume (3) Ovarian imaging, including AFC, ovarian volume, ovarian stromal blood flow; (4) Ovarian stimulation test, etc. In addition to the female fertility assessment, the male partner should also be examined: first, a semen test. If the semen test result is azoospermia, the next step is to investigate the cause of the azoospermia, and finally, a testicular puncture to determine if there is sperm production. If the semen test results are low sperm, weak sperm, deformed sperm, etc., the male partner can be judged to have low fertility, and chromosomal testing and endocrine function tests need to be performed on the male partner to further investigate the cause and give treatment. When you are pregnant with your second child, it is important that you do not take it lightly. There can be significant risks during pregnancy for older women. Pregnancy over 35 years old is a high-risk pregnancy, and the chances of miscarriage, premature birth, gestational hypertension, gestational diabetes and other pregnancy complications are greatly increased; the risk of fetal chromosomal disorders and fetal malformations is also increased accordingly. But these risks are not uncontrollable, provided that pregnant mothers have regular pregnancy checkups to screen for diabetes, hypertension, hyperthyroidism, premature birth and other high-risk factors, and to monitor fetal “movements”. The first thing you need to do is to pay attention to a balanced intake of nutrients, and it is best to visit a nutrition clinic to monitor your nutritional status. In addition to diet control, exercise is also a good way to control weight. In addition, for women whose first child was delivered by cesarean section, doctors generally recommend contraception for more than two years when the uterus recovers before conceiving the second child, because the uterus that has undergone a cesarean section is a scarred uterus, and the possibility of placenta praevia is greater, and part of it is an aggressive placenta praevia, said Professor Yang Dongzi, the most worried situation is cesarean scar pregnancy, that is, the embryo grows on the scar left by the cesarean section, the first child was delivered by cesarean section. The rate of scar pregnancy in the second child is as high as 15.2 percent. The obstetrics and gynecology department classifies “cesarean scar pregnancy” as a critical condition, with the risk of uterine rupture and uncontrolled vaginal hemorrhage, endangering the mother’s life.