(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy) Abstract: In medicine, the optimal age of fertility for women is generally considered to be between 25 and 34 years old, and once it exceeds 35 years old, the ability to conceive decreases significantly. If you want to prepare for re-fertility at an advanced age, the couple needs to seek help from a reproductive medicine specialist as soon as possible to figure out their fertility and do all the pre-pregnancy tests strictly and carefully. In this case, the patient’s fertility has significantly decreased, and she received help from assisted reproductive technology to save time for pregnancy preparation and to solve the problem of fertility needs. Basic information】Female, 42 years old 【Disease type】Female infertility, ovarian hypofunction, uterine adhesions, subclinical hypothyroidism 【Visiting hospital】Shanghai Tenth People’s Hospital 【Visiting time】November 2021 【Treatment plan】Regulation of thyroid function (eugenol) + hysteroscopic separation of uterine adhesions + mild stimulation program to promote ovulation [oral medication fadilan to activate endogenous hormones + The treatment cycle] 4 months, hysteroscopic treatment in December 2021, and one successful IVF treatment in February 2022 [Treatment result] successful conception, all normal in labor and delivery I. Initial interview Ms. Zhang is 42 years old, her husband is 44 years old. She has a normal sex life and has been preparing for her second child for 4 years without pregnancy. She had regular menstruation, 5/25 days, and a fertility history of 1-0-3-1. The patient had one early abortion before marriage with her husband. She had a full-term cesarean section in 2007 and was physically fit, followed by instrumental contraception and two unplanned pedestrian abortions in 2009 and 2016 to terminate her pregnancy. she has been preparing for her second pregnancy since 2018, during which she has not been pregnant by intermittent TCM and self or hospital ultrasound monitoring of ovulation. in 2020, iodine oil imaging at an outside hospital suggested that the fallopian tubes were patent bilaterally, with possible mild endometrial adhesions. in March 2021 The sex hormones FSH/LH 11.8/4.98 IU/L were checked on the third day of menstruation at the external hospital, while the male partner’s semen routine was generally normal. The patient and his wife were very anxious at the time of consultation because they had conceived very easily before and did not expect to prepare for their second child for 4 years without success. After understanding the entire pregnancy preparation process, the couple was advised to complete a fertility evaluation. Based on the results of our examination, we had a meeting with the couple to discuss their fertility plan, as the female patient was older than 40 years old, her menstrual cycle was shortened, her FSH value was elevated during her menstrual period, while her AMH value was decreased, and the total number of follicles in both ovaries was less than 5. The total number of follicles was less than 5, and she was diagnosed with hypovarianism, which was the main reason why they had not conceived for 4 years. This is the main reason why they have not conceived for 4 years. Considering the couple’s urgent fertility requirements and their own fertility had already declined, they were advised to adopt the IVF option. The patient had both subclinical hypothyroidism and uterine adhesions, so our plan for the patient was to improve the pre-testing examination in the first month, while the patient adjusted her lifestyle and eugenol to control her thyroid function, and at the same time, the woman underwent hysteroscopy on the 4th day of her menstruation to remove the uterine adhesions. The patient and the couple actively cooperated in adjusting their mentality and lifestyle, arranged daily exercise for the couple together, and strictly followed the medication prescribed by the doctor. In February 2022, according to the ovarian condition of the woman, she was given a mild stimulation ovulation promotion program with oral drug Fadilan to activate endogenous hormones + exogenous hormones (injectable urotropin) to promote follicle development. 5 eggs were obtained and 2 high quality embryos + 1 high grade blastocyst were formed after fertilization. The patient’s uterine adhesions had just been treated, her endometrial thickness was 7.4 mm during the ovulation cycle, and her morphology was triple A. She was eligible for transfer. Therefore, one 4AB blastocyst was transferred on day 5 after egg retrieval and luteal support was given. 10 days later, blood HCG 459.0 U/L was measured and conception was confirmed. The development of the embryo was monitored closely and regularly, and everything is going well. I am very glad that the patient was able to conceive successfully. In addition, the patient should pay attention to the following matters: 1. After successful conception, the patient is advised to pay more attention to rest and avoid strenuous activities so as not to affect the growth and development of the fetus and cause miscarriage; 2. 3. Pay attention to a reasonable diet in daily life, replenish the body’s energy needs in a timely manner, achieve a balanced and light diet, and avoid excessive consumption of spicy and stimulating food. If there are uncomfortable symptoms, go to the hospital in time. V. Personal insight In the era of two children and three children, we want not only to increase the number of children, but also a smooth conception process and healthy and lively offspring. However, the relatively old age of the current re-birth population is often faced with a number of problems: 1, fertility decline: the number and quality of eggs decline after the age of 35, and women who have had abortions and other uterine operations may cause damage to the endometrium, leaving scarring or thinning of the endometrium, making the ability to conceive significantly reduced; 2, bad maternity history: if a woman’s previous pregnancy had embryonic abortion, mid-pregnancy miscarriage, fetal death If a woman had an embryonic abortion, miscarriage during pregnancy, fetal death in utero, or gave birth to a child with a major disease, the pathological reasons may also affect the pregnancy again and the fetal growth and development, which need to be corrected by screening; 3. Increased pregnancy complications: such as hypertension, diabetes, premature birth, low birth weight babies, placental abruption and other pregnancy complications. Therefore, it is recommended that when you encounter infertility, you should go to the reproductive department of the hospital to check the specific causes and prepare for pregnancy correctly under the guidance of your doctor. In addition, it is important for senior women to have strict maternity checkups during pregnancy, closely monitor the development of the fetus, eat a reasonable diet, and seek medical consultation if there are any uncomfortable symptoms, so that they can have a good birth.