Despite the fact that generations of obstetricians and gynecologists have painstakingly taught young girls the importance of contraception and timely childbirth, to this day, a large number of patients still steadfastly opt for medical and abortion and, a few years later, are forced to go to reproductive centers and embark on the long road to pregnancy. This is really a phenomenon that makes us deeply helpless. As the saying goes, “A clever woman cannot cook without rice”. In the treatment of infertility, the woman’s eggs are the most valuable and critical resource. In other words, the quantity and quality of the woman’s eggs determines the success or failure of almost all fertility treatments. Once a woman’s ovarian reserve decreases, her chances of conception drop almost linearly. In our center, more than 1/3 of our infertility patients suffer from ovarian failure, so that they have no available eggs or embryos even after receiving a full course of ovulation treatment; for this reason, they repeatedly undergo various options of fertility treatment, get up the courage to start over again, repeatedly go to follow-up appointments, undergo ultrasound examinations and various medications worth a lot of money, and then They have to go back to the clinic again and again, repeatedly undergoing ultrasound examinations and expensive medications, and then return to the clinic again and again, exhausted physically and emotionally, spending a lot of money and posing a major challenge to the stability of their marriage and family. Why is egglessness so scary? On the face of it, the embryo comes from both parents, so both should get equal credit, but this is not the case. A mature egg is millions of times larger than a sperm, so the egg not only provides the genetic material for the embryo and nutrition for its early development, but also contains additional genetic material such as mitochondrial genes in the egg’s cytoplasm. So it can be said that the egg definitely plays an even more important role in terms of the quality of the offspring. The same is true for the saying, “A high father makes a high child; a high mother makes a high child”. Moreover, physiologically, only one to two eggs are finally matured and expelled during each ovulation cycle of a woman, while a normal male ejaculates hundreds of millions of sperms per ejaculation. This also shows how valuable the mother’s eggs are compared to the father’s sperm. Not only are women’s eggs a scarce resource, but they are also an asset that cannot be reinvested or regenerated. The eggs in the ovaries are like apples on a tree waiting to ripen, packed in spherical vacuoles that form a structure called a “follicle”. During the 20th week of gestation, while the daughters are still in their mother’s womb receiving the gentle caress of the warm amniotic fluid over and over again, the number of follicles in their ovaries reaches a lifetime high, reaching a total of 6-7 million at this stage. Thereafter, the follicles gradually atrophy and wither away, and by the time of birth, there are still about 1 million follicles in the ovaries. When the baby girl grows into a healthy and cute girl, the follicles in the ovaries do not return to the growth path, but continue to be atretic, and when the girls reach the threshold of puberty, only 300,000-500,000 follicles remain in the ovaries. After menstruation, girls gradually establish their regular ovulation cycle, but the process of ovulation is like the examination for the Imperial examination in feudal times, where more than 1000 follicles start to develop at the same time, but in the end only one follicle matures and expels the egg, while the rest of the follicles all go into atresia. Therefore, every time you have a period, you must lose some of your ovarian assets. After menopause, only a few thousand follicles remain in your ovaries, but after years and years, the quality of these follicles and eggs is so poor that they cannot cause normal ovulation, let alone conception. Just as there is a difference between rich and poor in society, the rich and poor of a woman’s ovarian reserve is also very different, and can even be disparate. Therefore, the time of menarche may vary from person to person, and the time of menopause may vary from early to late. women who start menstruating after the age of 15-16 or who have menstrual periods every 20-23 days should be aware of whether their ovarian reserve is normal and identify any possible problems in time. If menopause occurs before the age of 40, the woman is likely to have “premature ovarian failure”. However, regardless of ovarian assets, the best quality eggs are always the first to develop and ovulate. Moreover, as women age, various environmental pollution, oxidative stress, heavy metal accumulation and other exposure factors may act on the eggs in the ovaries, causing a significant decline in their quality. For example, there are many jewelry factory workshops, furniture factories, renovation sites, chemical plants and other units that are accustomed to using large amounts of chemical materials containing formaldehyde and other VOCs, and women who work here without good protection are bound to have their ovaries damaged. Just as Qin Shi Huang sent Xu Fu to lead a team of 3,000 people to find the elixir of immortality and was ultimately unsuccessful, at present, humans still do not have the practical and reliable technology to make their ovaries immortal. As the saying goes, “after this village, there is no such store”, the only remedy for physiological aging of the ovaries is to have children at the right time. The function of the ovaries is nothing more than fertility and providing women with the hormones to maintain a beautiful body and skin, hormones that can be replaced artificially, but eggs cannot be created by human force. Women who are determined to have a baby or who are working hard for their career should first think about whether they have any signs of “congenital deficiency” and should first go to an assisted reproduction specialist for a menstrual ultrasound, sinus follicle count and sex hormone test, and based on the doctor’s assessment, decide whether their ovarian resources will allow them to put aside the important task of having children. Otherwise, the consequences may be irreversible. If the “congenital deficiency” is remedied in time, the problem may not become serious. However, if the problem is not correct, the consequences will be unimaginable. The incidence of premature ovarian failure is reported to be about 1 in 1,000 women aged 30 or older, 1 in 10,000 women between 20 and 30, and 1 in 100,000 women under 20 years of age. Gynecologic endocrine disease specialists should be consulted early to find the cause. Another cause of ovarian damage is radiation therapy and chemotherapy for tumor patients. As their hair starts to fall out one by one, the follicles in their ovaries are dying and atrophying in large numbers. For all diseases, the key is early detection and aggressive response. In addition to early conception once ovarian function is detected, cryopreservation of ovarian tissue can also be resorted to. Whether you are a tumor patient about to undergo radiotherapy/chemotherapy or a woman with prematurely declining ovarian function, you can remove the only remaining ovarian cortex through a minimally invasive laparoscopic procedure, freeze and preserve it, and then graft the ovarian tissue back onto the remaining ovarian medulla later with a mini-incision; if the blood vessels can be well sutured and the blood supply can be quickly restored, the follicles can gradually grow If the blood vessels are well sutured and the blood supply is rapidly restored, the follicles can gradually grow, develop, secrete sex hormones and resume the ovulatory cycle. The incision of this type of surgery is similar in appearance to the incision of tubal ligation, so it does not leave obvious scars on the abdominal wall and the patient usually recovers very quickly after the surgery. On the other hand, if the pelvic cavity, fallopian tubes or male sperm have significant lesions, the chances of conceiving naturally are very slim and can be obtained with the help of IVF technology. In short, as long as the egg and the uterus are still alive, the hope of conceiving the next generation will not be dashed. Moreover, since the ovarian tissue is preserved in thin slices, some of the slices can be transplanted each time, and when the follicles in the first transplanted ovarian tissue are depleted several years later, the abdominal cavity can be opened again along the original abdominal scar, and the remaining ovarian tissue can be transplanted again, and the natural ovarian function can be continued. What if a patient with premature ovarian failure has not yet given birth, but her ovaries are already “barren”? Theoretically, patients with early onset premature ovarian failure still have a certain number of follicles in their ovaries, just as a post-menopausal woman may still have thousands of follicles in her ovaries. However, the quality of these follicles is so poor that even if they can be removed for in vitro fertilization, the chances of success are very low because there are a lot of uncertainties during fertilization, embryo formation and development, embryo implantation and the 40-week gestation period, and the chances of bringing the baby home are slim. For this reason, in such cases, doctors abroad recommend donor IVF treatment. In the UK, government regulations state that the donor will not be informed of the destination of the donated eggs, but that the individual resulting from IVF has the right to know his or her biological mother after reaching the age of 18; in Spain, the government specifies that each donor’s eggs can only be given to a maximum of 10 couples. These regulated, strict regulations help to avoid the problem of inbreeding between IVF offspring from the same egg donor. The current requirements for egg donation in China are very demanding, requiring not only that the donor and recipient be double-blind, but also that the donor herself be an infertile patient receiving IVF. However, these patients themselves do not know whether they can successfully conceive, and because the relevant laws and regulations are not yet perfect, few are willing to donate their eggs. This has led to a shortage of eggs in regular centers in China and the sale of eggs at high prices in underground centers. However, it would be a great gift from God if a person with premature ovarian failure had identical twin sisters with approximately normal ovarian reserve. Because they are almost identical genotypically, the donation and transplantation of ovarian tissue does not trigger a rejection reaction in the recipient, so the sister’s donated ovarian tissue grows well in the recipient’s body. Usually, the recipient can gradually resume a regular menstrual cycle about six months after the procedure, and many of them can conceive naturally in about one year if there are no other factors causing infertility. The procedure is similar to the one described above. Therefore, “egglessness” is still the most difficult dilemma for doctors specializing in reproductive medicine in China, and there is no safer and more effective treatment method than egg donation. However, in order to protect the safety of the patient and her offspring, the patient should still be sensible and choose to receive treatment at a regular center approved by the state.