Incidence
It seems that overnight, fertility clinics have become overcrowded. Is this because the incidence of infertility is increasing? Is it because the incidence of infertility is increasing? This is not the main reason, Peng Xian Dong answered. Peng is a doctor at the Ji’ai Genetic and Infertility Center and was one of the first doctors in China to enter the field of assisted reproduction. He told me: I think there are especially many infertility patients in the hospital now, probably because they come to the hospital now. “Once upon a time such people usually didn’t go to the hospital; they either saw a Chinese doctor or adopted a child and were done.”
However, doctors are not denying that the decline in fertility is a problem that all of humanity is facing because of pollution, obesity, work stress, etc., brought about by modernization. In 1980, the World Health Organization (WHO) introduced the first edition of semen analysis standards, the normal value of sperm count per milliliter of semen is 60 million; in 2000, the fourth edition of semen analysis standards, only 20 million per milliliter of concentration, can be considered normal; another 10 years, in 2010, the fifth edition of semen In the fifth edition of semen analysis in 2010, the normal standard was lowered again to 15 million.
Another important factor contributing to this decline is the age at which women are having children; in 2013, the Lancet featured a feature on “fertility” in which it was noted that for the first time in England, the average age at first birth exceeded 30 years. In China, this trend is also evident: in the 1960s, the average age of first birth was 22.02 years when our grandparents were young; by the time our parents were young, the average age of first birth was 24.44 years, and by the time we were due to have children, according to a 2012 survey, Chinese women’s first pregnancies and first births were mainly in the 25-29 age range. As a footnote, the average age of first birth for women in Beijing was 26.67 years in 1999, 27.9 weeks in Shanghai in the same year, and 29.8 weeks in Hong Kong.
In the last century, the World Health Organization predicted that infertility would become the third leading disease of the 21st century, after tumors and cardiovascular disease – in fact, in countries like Japan, where infertility is a major problem, almost one in six babies are born using artificially assisted reproduction; and in the United States, one in eight couples In the United States, one in eight couples have problems conceiving or maintaining a pregnancy. Approximately 7.4 million women in the United States have received infertility services in their lifetime, however, less than 3 percent of infertility cases in the United States receive assisted reproductive technologies such as IVF, and approximately 85-90 percent of infertility cases are treated with surgery or medications.
The World Health Organization’s focus on infertility began at almost the same time as its focus on “contraception”. Officially, the WHO has two definitions of infertility: clinically, “a couple who has had regular unprotected sex for one year without pregnancy” is diagnosed as infertile; demographically, no contraception, non-breastfeeding, and no pregnancy for five years is defined as infertility. survey reported that “in 2010, globally, about 48.5 million couples of childbearing age who wanted a child were unable to have their wish within five years, with 19.2 million couples unable to have their first child and 29.3 million couples unable to have another child (the latter figure does not include China).”
What about the incidence of infertility in China?In 1988, the National Family Planning Commission published a national sample survey on fertility and birth control that showed an overall national infertility rate of 6.89% from 1976-1985. In 2010, an epidemiological survey showed that the infertility rate in Shanghai was around 9.3%, and in a 2011 doctoral dissertation at the Union Medical College, the medical doctor concluded that the average infertility rate was 7.4% in a sample of six counties and cities in three provinces, Anhui, Henan and Sichuan, and 12.5% among people older than 30 years of age who married. 12.5 percent. a 2012 Xinhua report similarly mentioned 12.5 percent, although that report only vaguely stated that “survey results released by the Chinese Population Association show that infertility in China now exceeds 40 million, accounting for 12.5 percent of the population of childbearing age.” For the national picture, most of the doctors we interviewed thought the number would be around 10 percent.
There is speculation that China’s infertility rate should not be significantly higher or lower than most of this world, but no one knows its exact value.In 2010, the Center for International Exchange and Cooperation of the Ministry of Health, the Reproductive Medicine Branch of the Chinese Medical Association, and Merck Serono of Switzerland launched a China-wide infertility epidemiology survey. However, the results of the survey remain a mystery, and Merck Serono has declined the invitation to interview us.
Chances
Under normal circumstances, a couple with regular sex has an 87% chance of getting pregnant in one year; in two consecutive years, the chance rises to 94%; and in three consecutive years, the chance hardly changes much.
Staff at the Human Sperm Bank remove the containers of sperm from the sperm storage tanks. Semen donated by volunteers is stored in liquid nitrogen at -196 degrees Celsius. In recent years, the number of infertility patients has gradually increased and the number of qualified sperm donors has decreased
In the U.S., in 2002, best-selling author Sylvia B. K. Hoffman, who is also a member of the Spermatozoa Foundation, published a book on the subject. Ann Hewlett Hewlett wrote a book called “Making a Man”. In the book, she suggested that women should have children early while they are young or risk infertility – one-third to half of American female executives do not have children. In 2013, another best-selling author, Jane Tucci, was featured in The Atlantic Monthly. In 2013, another best-selling author, Jane Tucci, published an article in The Atlantic Monthly about her experience of having three children one after the other since she was 35. Tuzi, who was 40 when her last child was born, argued that things are not that scary and that we are overly fearful of infertility at an advanced age.
Most of the data for Tucci’s article comes from a chapter in one of her books, The Impatient Woman’s Guide to Pregnancy. It’s a book that teaches women how to master the best time to conceive and increase their chances of getting pregnant – in other words, it’s a “living person’s guide” to dealing with infertility, and it’s become a bestseller. In the book, Tucci asks: Your mother didn’t know about basal body temperature and ovulation test strips, she didn’t know what ovulation meant, and she didn’t know how a fertilized egg develops, but you were born anyway, so why is it so hard for you to have a baby? “You are an impatient woman, and unfortunately, most modern women are.” They plan their studies, their families, they want to take everything under control …… and pregnancy, something that is full of odds and full of uncertainty.
The hypothalamus sends impulse signals to the pituitary gland, which receives the signals and secretes luteinizing hormone (LH) and follicle stimulating hormone (FSH), and transmits these hormones to the ovaries to promote the growth of follicles in the ovaries, the growing follicles secrete estrogen, and estrogen promotes the secretion of LH and FSH, and in promoting each other, finally, FSH and LH reach a peak, and the follicles are stimulated by this peak Under the stimulation of this peak, the follicle collapses and the follicular fluid and egg flow out, the latter is picked up by the umbrella end of the fallopian tube, and just like that, you ovulate. The egg is the largest cell in the body, it is 0.1 mm in diameter and has a lifespan of 12-24 hours. If it fails to meet the sperm during this time, the ovum will die and the cycle will be a failure.
To improve your chances of getting pregnant, you need to catch the moment of ovulation, perhaps by keeping a thermometer by your pillow and taking your basal body temperature every morning when you open your eyes – a woman’s basal body temperature is lowest on the day of ovulation and rises 0.3-0.6 degrees after ovulation, resulting in a nice sawtooth shape on the temperature curve. Perhaps you can also buy test strips to “play with urine”. Most ovulation test strips rely on the concentration of luteinizing hormone (LH) to predict ovulation, which in most women occurs 14-28 hours after the LH peak. But even so, you need to accept the odds as well. A study in the American Journal of Fertility and Sterility showed that intercourse two days before ovulation was associated with a 29% chance of pregnancy for women aged 35 to 39 and 42% for those between 27 and 29 years old.
In terms of a strict medical definition, assisted reproductive technology refers to assisted reproductive means of manipulating gametes, i.e. artificial insemination, or IVF. Clinically, assisted reproductive technology is necessary for about 20% of couples with infertility, and if the incidence of infertility is 10%, about 2% of couples of childbearing age will need to resort to assisted reproductive technology. Again, this is a technique that relies on odds. One senior fertility doctor told his students, “All we can do is increase the chances that the person we see will get pregnant over time.”
Of the two assisted reproductive technologies, the odds of getting pregnant with IUI are about twice as high as the natural pregnancy rate of the patient. But if the person is older, say 38, and has had regular sex for two years but is not pregnant, they have about a 1 percent chance of getting pregnant naturally, and twice that is only 2 percent. Unlike artificial insemination, the success rate of IVF, which is related to the patient’s own condition and the hospital’s medical care, is, on average, about 40 percent or less.
The odds are also due to various factors surrounding pregnancy, mainly sexual dysfunction or low sperm count on the male side, and more complex on the female side, which may be due to fallopian tube failure, ovulation disorders due to various factors, and the inability of a fertilized egg to properly fertilize due to endometrial problems or immune problems. There is not enough data on the proportion of these factors that contribute to infertility in the Chinese population, however, Peng Hian Dong points out that among the patients attending Chiayi, “there are more and more patients with polycystic ovaries” – polycystic ovary syndrome (PCOS) is a relatively high incidence in women of reproductive age. However, its etiology is unknown, its incidence is unclear, and even the diagnostic criteria are not yet uniform in countries around the world.
According to a British study in 1987, about 40% of the causes of infertility in couples were from the male partner, another 40% from the female partner, and 20%, with more complex causes, were related to both men and women. However, it is clear that in China, the couples suffering from infertility are almost always women who are under the most stress.
Egg Freezing
During the interviews for this article, the story of an actress who went abroad to freeze her eggs became a hot topic. When I asked various interviewees about egg freezing, one person involved in assisted reproductive medical services abroad replied, “Usually, we look at egg freezing separately from assisted reproductive treatment like IVF. This is because the latter is a treatment, while the former is more of a woman’s right.”
This is another complex aspect of fertility, involving the roles, rights or obligations of men and women in it, and the equality and inequality that manifests itself through these things.
Analysis of the “Crazy Baby Maker” App IVF Assistant
In 1960, feminist leader Sanger met with Dr. Pincus and said, “I need a cheap, easy-to-use, foolproof method of birth control, preferably a pill that a woman can take every morning with her orange juice or while brushing her teeth, without consulting the man on her pillow. Pincus invented the pill, which is now widely used as a short-acting contraceptive. What people, especially modern women, love about egg freezing is the sense of control over their own fertility that lies behind it.
It’s a hot topic, whether it’s high-tech companies offering egg freezing benefits to their female employees, or the most recent news – “egg freezing parties”. It was a cocktail party in Los Angeles, California, in March 2015, attended by a hundred successful women in high heels and elaborate professional suits, hosted by a start-up company whose main business is egg freezing, and attended by women mostly in their 30s and older and single. At the party, the host company’s reproductive scientist – also a woman – stood at the podium in a peach suit and introduced the audience to egg freezing: like some form of egg donation, by a younger you for an older you, “as women, it’s wonderful to have that autonomy.”
In 2012, a report from the American Society for Reproductive Medicine (ASRM) announced that egg freezing had moved beyond the experimental stage. The report’s lead author, Samantha Pfeifer, director of the ASRM Executive Committee, concluded that egg cryopreservation could be used for patients who need to preserve their fertility due to diseases such as cancer. However, the report does not support the use of the technology to delay childbearing or as an “insurance strategy” for young women to prevent possible future fertility problems, because “more extensive, clinically specific data are needed to demonstrate the safety and efficacy of oocyte cryopreservation. “.
Columbia University professor and New York Times contributor Abby Rabinowitz attended the famous egg-freezing party, which she described as “a marketing campaign disguised as a girlfriends’ talk. Not only that, but in her op-ed back home, she insightfully discusses how “despite the new options, women are still bound by the cultural presumption that they must become mothers, a presumption that women who do not have children must deeply regret it in the first place – and egg freezing may reinforce this the impact of this presumption.”
”I don’t want to submit to this unfortunate social norm reinforced by egg freezing: that wealthy women can have children the way they want, when they want, while poor women cannot; that we must have a biological connection to our children; and that even if the inability to conceive is partly the result of male infertility, infertility is still the fault of women and therefore a problem that women need to be responsible for addressing.”
”‘[Egg freezing] gave me the feeling that fertility is all about the woman.’ A friend told me; she added that the egg freezing thing made her feel ‘alone, humiliated, and hopeless.”
Incidentally, Abby is one of the clients of the egg freezing service. Seven years ago, Abby had her 22 eggs frozen because of endometriosis, a condition that can cause infertility.
Among my interviewees, I was advised to read the tweets of a “sister” who also suffered from endometriosis and had severe bilateral blockage of her fallopian tubes due to endometriosis. divorced because the male parent could not accept the child born from IVF technology.
I asked a single girl born in ’85 who had studied abroad, worked in a famous company and was currently starting her own business, “Would you go for egg freezing?”
”No,” she said, “that’s the way life is, there are gains and losses, and I accept the outcome.” The moment she answered this question, she had a proud smile on her face, the pride of a 30-year-old woman.
Prospects
Are China’s fertility hospitals overcrowded because there are too few of them? In the United States, with a population of more than 300 million, the number of fertility clinics in 2012 was 486; in Japan, with a population of more than 120 million, the number of fertility clinics was more than 500; and in China, according to data from the Health Planning Commission, as of December 31, 2012, the number of fertility clinics totaled 358. In contrast to the data from the Health Planning Commission, if you search for “infertility” on Baidu, you will get more than 100 million results, and on the first few pages of these search results are illegal private hospitals and advertisements for IVF treatment in overseas medical institutions such as Japan, the United States and Thailand.
China’s first IVF baby, Zheng Mengzhu (front row, right), with the mother of IVF, Professor Zhang Lizhu, who delivered her on Feb. 23, 2008, in Beijing.
What is the international level of China’s assisted reproduction technology? According to Zhao Weipeng, “China has accumulated a lot of experience in assisted reproduction treatment. It is keeping up very fast, and basically what is available internationally is available in China. The few top assisted reproduction centers in the North, Guangzhou and other regions have almost no gap compared to their international counterparts in terms of technology content, technical services and success rates.”
Some of the people who undergo IVF abroad do so because of the poor consultation experience in China, for example, long lines, privacy-free consultation rooms, electronic bulletin boards and call announcements. One IVF attendee in Japan told me that in Japan, each attendee is given a walkie-talkie and the doctor contacts the attendee through the machine, where the waiting room is also about 1/3 the size of a Chinese clinic, yet quiet and orderly.
Another difference between IVF abroad and in China is the anesthesia. The textbook says that “most of the pain during egg collection is due to peritoneal irritation as the needle passes through the peritoneum, pain as the ovaries move, and pressure pain from the intravaginal ultrasound probe”, but in China, most egg retrieval procedures are done without anesthesia. I once asked a patient if it would hurt. The answer was, “I’ve come for IVF, why would I be afraid of pain?” When I asked a Chinese doctor why egg retrieval in China could not be done with anesthesia like what an actress experienced in the United States. The answer I received was simple, “lack of manpower.”
In addition to the consultation experience, the other part of the IVF experience abroad is mostly due to policy and regulations. Surrogacy is not allowed in China, and for egg donation, China’s law does not completely prohibit it; it simply states, “only for eggs left over from human assisted reproduction treatment cycles.” However, this provision is poorly enforceable because it is almost impossible to get couples who still need assisted reproductive treatment themselves to donate their eggs. Most of the group of patients who have a few embryos left over are called “rich women,” and most of them, “are just short of eggs.”
As something you only start thinking about when you reach a certain age, the cruel thing about fertility is that once the problem is identified, the window of time left for you to do so is usually not long, especially if you already need and have started IVF treatment. Very few of my interviewees have lasted more than 5 years on IVF treatment, and as you progress through treatment, your mental state, physical fitness, financial strength, and couple’s relationship can be extremely challenged. One domestic fertility doctor told me about his “failed” IVF patients, and the final conversation between them was often, “Doctor, this is the last time, if this doesn’t work, I’ll get a divorce.” And one medical assistant who went abroad for IVF told me that she would encounter cases of divorce during IVF, and one female client who was preparing for IVF in the U.S. told her, “I’m divorced, but want IVF to go ahead as planned, with donor sperm instead, and the baby to be my own.”
For fertility and age, the Clinical Guidelines adopted by the Society of Obstetrics and Gynecology of Canada (SOGC) in 2010 include a special chapter on Advanced Fertility and Fertility. The guidelines state, “Women should be informed of age-related infertility in their 20s and 30s, while other reproductive health issues, such as sexual health or contraception, are a major part of women’s health care. Women of childbearing age should be aware that their pregnancy success rates with spontaneous versus assisted reproductive technologies (unless donor eggs are used) decrease significantly from the late 30s onward. Because of the decline in fertility after age 35 and the increased time required to conceive, women older than 35 should visit a fertility clinic after 6 months of trying to conceive.”
The relationship between age, egg stores and live egg production rate
In fact, in recent years, Qiao Jie, president of Beihang Hospital, who is the chairman of the Reproductive Medicine Branch of the Chinese Medical Association, has often mentioned in the media that he feels very sad every time he sees the long queues in front of the clinic, which is supposedly a very normal process for human reproduction. Qiao Jie believes it is important to strengthen reproductive health education, and the content of such education, in one interview, she said: “I very much hope that couples of childbearing age will establish their own fertility plans as early as possible, and after preparing for childbirth, first understand the basic knowledge of fertility, and indeed, when there is no result after a year of effort, go to a regular obstetrics and gynecology or reproductive medicine center earlier to check If these methods really don’t work, take assisted reproductive technology as early as possible so that you can get a healthy baby with relatively little intervention.”
Beyond reproductive health education, the practical problems encountered by those who visit the clinic are obviously much more numerous. Discrimination, for example, is not yet recognized by society as a highly prevalent condition, and it can be equated with “sexual impotence” or even attributed to a “curse” on the family. Most people are ashamed to go to fertility clinics for fear of discrimination, and most parents of IVF babies keep this a family secret, even though there is no evidence that children born from IVF technology are any different physically or psychologically from other children. Then there are the fertility documents required to undergo assisted reproduction treatment – such documents are usually required to be issued back in the place of origin, and the requirements for issuing the certificate vary from place to place, and some places require the hospital to issue a certificate of infertility diagnosis first, “often getting to make several trips back and forth and spending enormous amounts of time and energy. “
From egg retrieval to transplant, even the smoothest process can cost more than 20,000 yuan, should health insurance cover all or part of the cost of the patient? Again, this is a question. Among the doctors I interviewed, the answers to this were not uniform. Proponents cited the example of Japan, where couples who meet certain criteria can receive at least one IVF treatment for free, while others pointed out that assisted reproductive treatment is currently “expensive and has a low success rate” and that it may not be time for the public purse to cover it. Both sides, however, support financial support for infertile patients who have lost their families, who, after all, are often not in a good financial position. One doctor even mentioned the possibility of using some more operational egg donation policy for them (the lost); after all, “time is of the essence for these people.”
In 2008, Wang Yifei, then chairman of the Reproductive Medicine Branch of the Chinese Medical Association, wrote: “What exactly should be the place of assisted reproductive technology in the allocation of health resources in China, how to establish an effective mechanism for graded consultation, screening and referral in China, and how to make a reasonable layout of assisted reproductive technology in China in order to fully utilize the limited health resources to their maximum The benefits.”
”The emergence of each new technology inevitably brings with it a series of ethical, legal, social and resource allocation considerations; each country must also develop norms and guidelines that are both in line with common international norms and appropriate to its national context. However, the purpose of norms and guidelines is not to restrict the development of science and technology, but rather to provide a supportive policy environment that is permissive and orderly for their healthy development.”