Confucius said: food, sex, sex too! It means that sex, like eating, is a human instinct, to use a medical term, these are unconditioned reflexes. It can be seen that sex is so important to human beings themselves, sex is not only to meet the pleasure, but also an important point is the reproduction of offspring, as Confucius’s favorite disciple Mengzi said “unfilial has three, no descendants for the big!” But just having sex does not necessarily mean that you can get pregnant.
The following basic conditions must be met for pregnancy to occur.
First, the male semen is normal or close to normal
Second, normal sexual life and good cervical condition
Third, normal follicle development and ovulation
Fourth, the fallopian tubes are open
Fifth, the endometrium is well tolerated
With the development of society, the proportion of college students and postgraduates is increasing, and the number of late marriages and late childbearing is gradually increasing, generally when college students graduate, they are already 24-25 years old, and without the help of their families, they will struggle for at least 7-8 years before they can pay for a house and get married. I believe that many “white bones” are facing fertility problems.
China’s marriage law provides that men aged 22 years old, women aged 20 years old can be legally registered to marry, men aged 25 years old or women aged 23 years old first marriage, for late marriage. If a woman reaches the age of twenty-four and gives birth for the first time, or if a woman reaches the age of twenty-three and becomes pregnant after marriage, she is considered to have given birth late. Due to the current situation of overpopulation in China, the state advocates late marriage and late childbirth while strictly implementing family planning, but ignores the negative effects of late marriage and childbirth, not to mention the lack of attention to publicize the dangers of advanced maternal age, leading the public to even think that the later the marriage and the later the childbirth the more the state advocates.
In fact, from a physiological point of view, there is a saying that women are best to complete their first birth within 15 years after her first menstruation, the general age of menarche 11-16 years old, so 25-30 years old is the best age for physiological childbirth, this time, the body’s systems are the healthiest state, the reproductive system is fully prepared for the conception of new life, regardless of egg quality and ovulation pattern This is the best time to get pregnant, and the success rate is undoubtedly higher and the risk of pregnancy is relatively low.
After the age of 35, a woman’s ability to conceive decreases significantly due to the aging of her egg cells and the lower quality of her eggs, which significantly increases the chances of pregnancy and the risk of pregnancy, as well as the risk of having an abnormal fetus. The medical term for this is the “folding stick phenomenon”.
For men, there is no clear biological age of fertility as there is for women, and newspapers are full of stories about children from 12-13 years old to grandfathers in their 70s, but in general, fertility is stronger from the time the secondary sexual characteristics are developed (around 16 years old) to 35 years old. Some semen screening studies have shown a significant decrease in male semen viability and an increase in malformed sperm after the age of 35.
What is infertility
A man or woman of childbearing age who has lived together sexually for a normal period of time after marriage without using contraception and has not conceived for more than two years is said to have infertility (Infertility). (WHO standard is one year), the incidence rate is 10%-15%, the former of which is 30% for the female factor, 30% for the male factor, 30% for both factors, and about 10% for unknown reasons. Infertility is also divided into: primary infertility: those who have never had a pregnancy without contraception;
Secondary infertility: those who have a history of pregnancy and have not been pregnant for two years after cohabitation without contraception; absolute infertility: couples with congenital or acquired anatomical and physiological defects that cannot be corrected and cannot be conceived (no uterus); relative infertility: couples who are temporarily infertile due to some factors that prevent conception, but can still conceive once they are corrected.
What can cause infertility
Ovulation disorders
① Hypothalamic-pituitary-ovarian axis dysfunction ② Ovarian pathology (PCOS, premature ovarian failure, etc.) ③ Abnormal adrenal and thyroid function
Anovulatory fertilization
Menstrual history, basal body temperature measurement, ultrasound, basal endocrine measurement, pituitary CT, MRI
Endocrine adjustment, ovulation induction
Fallopian tube factors
Obstruction or loss of peristaltic function of the fallopian tubes due to inflammation, malformation, hydrocele, etc.
Inability to transport eggs
Tubal lavage, tubal iodography, hysteroscopy
Tubal perforation, tuboplasty, separation of adhesions
Uterine factors
submucosal fibroids, endometritis, endometrial tuberculosis, polyps, uterine cavity adhesions, etc.
Impairment of fertilization
Diagnostic curettage, hysteroscopy
Diagnostic curettage, hysteroscopy
Cervical factors
Cervicitis, mucus abnormalities and immunological abnormalities
Affecting sperm entry
Post-coital test, cervical mucus semen compatibility test
Artificial insemination
Vaginal factors
Abnormal vulva development, inflammation, etc.
Influence on sperm entry
Gynecological examination
Surgical correction
Male side: mainly sperm production disorders and sperm transmission disorders (first improve sperm quality by various means, then seek assisted reproductive technology)
①Semen abnormalities: congenital or acquired low semen volume, azoospermia, oligospermia, aberrant sperm and incomplete semen liquefaction, etc.
② Sexual function abnormalities: external genitalia dysplasia or impotence, premature ejaculation, non-ejaculation, retrograde ejaculation, etc. so that sperm can not enter the vagina
③Immune factors: destruction of the immune barrier in the reproductive tract causes sperm and sperm plasma to produce anti-sperm antibodies in the body, resulting in self agglutination of semen and inability to cross the cervical mucus.
Both men and women: lack of sexual life, mental tension and immune factors, etc.
Treatment principles
Firstly, the organic diseases of the reproductive system that cause infertility should be removed, and then assisted reproductive technology should be considered.
Infertility is treated differently depending on the cause. They generally range from simple to complex, from medication to surgery and finally to IVF.
Medication: For patients with irregular menstruation, polycystic ovary syndrome, luteal insufficiency, or mild abnormalities in the male partner’s semen, medication can be used to achieve natural conception.
Surgical treatment: For infertility caused by incomplete blockage of fallopian tubes, pelvic adhesions, male partner’s varicocele, etc., it is possible to achieve natural pregnancy after surgical treatment such as hysteroscopic separation of adhesions and ligation of varicocele.
Artificial insemination and in vitro fertilization (IVF): generally applicable to couples who have not been pregnant for many years, or are desperate to get pregnant, mainly for cases such as abnormal semen of the male partner, obstruction of ovulation or blocked fallopian tubes of the female partner.
What is Assisted Reproductive Technology
Assisted Reproductive Technology (ART) refers to a series of techniques to treat infertility (pregnancy) by manipulating eggs, sperm, fertilized eggs and embryos. It can be divided into two categories: artificial insemination, in vitro fertilization-embryo transfer (IVF-ET, commonly known as in vitro fertilization) and derivative techniques.
Artificial insemination: Artificial insemination refers to the insertion of semen into the female reproductive tract through non-coital means for the purpose of conception.
According to the source of semen: artificial insemination by husband (AIH) and artificial insemination by donor (AID)
Depending on the site of semen injection: intrauterine insemination (IUI), intra-fallopian tube insemination (GIFT), etc.
Intrauterine insemination (IUI): Semen is washed and processed to remove dead sperm, white blood cells, antibodies and other components from semen plasma and semen, and 0.3 to 0.5 ml of good quality sperm is selected and injected into the uterine cavity through a catheter during the ovulation period of the female partner to achieve pregnancy.
In vitro fertilization-embryo transfer and its derivative techniques are assisted reproductive techniques that involve removing eggs from a woman’s body, culturing them in vitro for a period of time to fertilize them with sperm, and then transferring the embryonic blastocysts that have reached a certain stage of development into the mother’s body for the purpose of pregnancy. The main techniques include conventional IVF-ET, intracytoplasmic sperm injection (ICSI), pre-implantation genetic diagnosis (PGD), gamete/embryo freezing, cytoplasmic replacement (nuclear transfer), egg donation, in vitro maturation of immature eggs, etc.
In vitro fertilization-embryo transfer (IVF-ET), or in vitro fertilization, is a technique in which the eggs are removed vaginally under ultrasound guidance and fertilized with treated sperm in a Petri dish when they are mature, after being cultured and developed to a certain stage and then transferred into the woman’s uterine cavity, where they will continue to develop into a fetus after implantation.
Indications for IVF with artificial insemination.
1. Infertility for cervical reasons (abnormal mucus secretion, AsAb+)
2. Male and female genital tract abnormalities and psychological factors leading to inability to have sexual intercourse
3, mild male oligosperm, weak sperm, poor liquefaction (sperm count >20×106/ml, viability >40%, a+b grade sperm >25%)
4, mild endometriosis
5.Non-specific immune infertility
6, unexplained infertility (confirmed by hysteroscopy)
Contraindications
1. blockage of fallopian tubes
2. female non-ovulation (PCOS, etc.)
Azoospermia, anovulation and menopause (if the male partner has sperm by epididymal puncture, intracytoplasmic single sperm injection can be performed; anovulation can be assisted by using donor eggs from others)