After the introduction of the national “two-child” policy, a reporter asked me whether there would be a “blowout” of patients. I said, “probably not”; those under 25 years old are not concerned; those between 25 and 35 years old are not in a hurry, and only those over 35 years old may have the urge to “fight for the day and night”. Now, 2 months later, the number of women who come to the hospital for fertility counseling is roughly in this age group. Do I need fertility counseling to have a second child? Some of my girlfriends asked me this question. I answered that counseling is not necessary for having a second child, but there are certain cases where counseling is necessary. For example, the following three women. Fertility Counseling for Older Women A 43-year-old woman came to the clinic. She laughed at herself when she came to the consultation and said that she originally had no intention of having another child, but once the national “two-child” policy was announced, she felt like scratching her heart and fidgeting, and although she knew that she was getting older, she couldn’t help but come to consult with a doctor. During the consultation, I learned that she had given birth to a boy at full term 18 years ago, and had a history of ectopic pregnancy 2 years later, with the left fallopian tube removed. She has been on strict contraception since then and has never missed a beat. “My periods are still normal. Can I get pregnant again? Also am I too old to have a bad baby?” I replied to her that at 43, she was of advanced age when it came to fertility, and that normally the chances of getting pregnant would be reduced compared to a younger woman, as well as the tubal problems all needed to be understood. Even though he was still currently on birth control, it was not too much of a stretch to intervene early with testing for a woman of advanced age. I prescribed two tests for her: 1. Evaluation of the couple’s fertility, including tests of the woman’s ovarian function and the man’s semen. 2. 2. Checking the patency of the fallopian tubes. Whether it is fluids or imaging, I suggested tubal imaging. I made a note for this test, suggesting that it be elective. That is, it doesn’t have to be immediate, it doesn’t have to be immediate. You can also look forward to checking it some time after you are off birth control. 3. Regarding the risk of having a child at an advanced age, that is, the question of whether the child will be “good” or “bad”, in principle, the risk is equal to the chance. In principle, the risks are equal to the chances. The risk of having a child with congenital anomalies increases with age, especially after 35 years old, and this is mainly due to a decline in the quality of the egg cells. You have no relevant medical history and can leave these issues aside for the time being. It is important to have the required prenatal checkups when you are pregnant. In the state-mandated maternity checkups, there will be ultrasound, blood tests, amniocentesis, and other measures to keep an eye out for you and help you have a good baby. Fertility Counseling after Embryo Failure A 36-year-old woman came to our clinic. She came to us with a question. When her first child was 2 years old, she had an “embryo abortion”, but at that time, she did not want to have a child, so she did not take any tests. Now that I am planning to have a baby, I am wondering if it will happen again. We have been using birth control for all these years, and I was afraid that it might happen again, so I thought that I would have to get cured before I could get pregnant. I said, “You want to be cured and then get pregnant, this is an ideal state. However, the causes of “miscarriage” or “embryonic deactivation” are very complicated, and even if you “try everything”, you will not be able to find the cause in about 50% of the patients. A spontaneous abortion is usually highly improbable. The success rate for a second pregnancy is as high as 80%. Therefore, from a medical or economic point of view, there is no need to “go to all the trouble” of doing a lot of tests. The onset or progression of a disease has to be repetitive in its symptoms. As I always say, if you fall down at a young age, you can only say that you are not careful; if you fall down frequently, then you need to take a good look. Besides, there is no single test or treatment that can prevent you from having a similar situation at all. The medical term for three or more consecutive spontaneous miscarriages (including embryo termination) that occur before the 28th week of pregnancy is recurrent miscarriage (RSA). Since miscarriage itself can affect a woman’s physical and mental health, when there are two spontaneous miscarriages, the doctor will also recommend a systematic examination if the patient requests it. Of course, there are still some things to be instructed. One is to pay attention to avoid overwork after pregnancy, proper rest is still necessary, but absolute bed rest is not recommended; the second is to avoid excessive mental stress, too much psychological pressure can do harm rather than good to the maintenance of pregnancy. Furthermore, if embryonic arrest occurs again, chorionic villi should be retained for chromosome analysis at the same time of abortion, the result of which can explain the reason why some of the early embryos stop developing. Fertility counseling after cesarean section The third patient has some questions and some “ideas” for counseling. Her first child was delivered by cesarean section. She is now 5 years old. The national policy has made her mother-in-law fidgety. All day long she is encouraged to have another child and wants a boy. She has no problem with having another one, but the fact that she must have a boy puts a lot of pressure on her. To be on the safe side, she wanted to have two. The question she asked was whether she could have two babies after a cesarean section. It’s good to have two children and to “spend the time to give birth”, but it’s a bit difficult to realize. First of all, let’s talk about twin births. In the natural state, the chance of having two babies is only about 1%. In reality, the increase in twin births is mostly related to the use of assisted reproductive technology and ovulation stimulating drugs. This is because multiple pregnancies (including twins) carry significant risks for both mother and child. They are prone to miscarriage, preterm labor, birth of low-birth-weight babies, etc., and increased complications in pregnant women. Therefore, doctors do not recommend the misuse of ovulation drugs for twin pregnancies. In addition to the risk of multiple births, the misuse of ovulation stimulants can also lead to doubts about one’s own fertility because of the “doctor’s help and still can’t get pregnant” (the chances of getting pregnant with help are not 100%), which leads to over-testing and over-treatment. In addition, this woman has a keloid uterus. The high rate of cesarean sections in this country creates a high risk of re-pregnancy with a keloid uterus. The main risks of scarred uterus are uterine rupture, pregnancy in the scarred area and placental implantation in the scarred area. These conditions may cause life-threatening hemorrhage during pregnancy and delivery. It is a serious complication of pregnancy. Twin pregnancy itself increases the volume of the uterus and the size of the placenta, making it more susceptible to these conditions. Therefore, it seems that this woman wants to carry two children, but also want to spend the birth of the idea is: knowing that the mountain has a tiger, preferring to go to the tiger mountain. It is a popular saying that ideals are plentiful but reality is very bone-dry. I advised her to get pregnant naturally by removing the contraceptive method. She should be evaluated for uterine scar healing before pregnancy. During pregnancy, she should undergo more frequent checkups to find out where the embryo is implanted. Nowadays, many hospitals have been inspired by the national policy to set up “two-child” fertility counseling clinics to assess fertility and fertility risks. If you have a fertility problem, the fertility counseling clinic can be in close contact with you.