In vitro fertilization and embryo transfer: The technique of removing gametes from the human body to fertilize them under in vitro conditions to form embryos, and then transferring the embryos to the uterine cavity for implantation to establish pregnancy, also known as IVF. 1. Indications: 1. The female partner has gamete transport disorders caused by various factors, such as bilateral tubal obstruction, tubal agenesis, severe pelvic adhesions or history of tubal surgery and other tubal loss. Wang Bin, Department of Reproductive Medicine, Dongguan People’s Hospital 2. Ovulation disorder: refractory ovulation disorder after repeated conventional treatment, such as repeated induction of ovulation or COS, or those who have not obtained pregnancy even after treatment combined with intrauterine insemination techniques. 3.Endometriosis: endometriosis causes infertility and pregnancy is not obtained after conventional drug or surgical treatment. 4.Little, weak and teratozoospermia in male: male infertility with little, weak and teratozoospermia or compound factors in the male partner, who has not obtained pregnancy after treatment with intrauterine insemination technique, or the severity of the male factor is not suitable for intrauterine insemination. 5. Immunological infertility and unexplained infertility: repeated intrauterine insemination or other conventional treatments still do not result in pregnancy. Contraindications: 1. serious mental illness, acute infection of the genitourinary system and sexually transmitted diseases in either sex; 2. genetic diseases that are not suitable for childbirth as stipulated in the Maternal and Child Health Law and cannot be genetically diagnosed before embryo implantation; 3. serious drug addiction in either sex; 4. exposure to teratogenic rays, poisons and drugs in either sex and in the period of action; 5. 5. The female partner’s uterus does not have the function of pregnancy or serious physical disease cannot tolerate pregnancy. The basic preoperative examination items that both men and women must complete: female examination items male examination items detailed medical history and physical examination detailed medical history and physical examination ABO blood group, RH blood group, blood routine, urine routine ABO blood group, RH blood group, blood routine, urine routine coagulation function, liver and kidney function, geodynia examination geodynia examination hepatitis B two to half, hepatitis series, HIV, syphilis hepatitis B two to half, hepatitis series, HIV, syphilis Hepatitis B, HIV, syphilis, TORCH virus, SLE, infertility series Basal sex hormone measurement Basal sex hormone measurement (in case of abnormal semen) Post-coital test (in case of suspected immune infertility) Mycoplasma, Chlamydia, gonococcus, white belt routine MAR test, PCT or SCMC (in case of suspected immune infertility) ECG Semen routine and morphology (in case of abnormalities) (at least 2 test results if abnormal) Chest radiograph Vertex enzyme activity test Gynecologic ultrasound Sperm DNA fragmentation Hysterosalpingography or laparoscopy Hysteroscopy (when problems in the uterine cavity are suspected) AZF (before ICSI) Chromosomal examination (for patients with hereditary diseases, history of poor fertility, history of recurrent miscarriages) 2. If there is no abnormality in the examination results, a medical record will be created for you to start the fertility cycle treatment; 3. descending regulation: controlled superovulation is generally done by first using GnRHa to make the FSH and LH in the body descending regulation, and the medication will be started in the mid-luteal phase, i.e. on the 20th day of menstruation; 4. controlled superovulation: since the pregnancy rate of natural cycle is very low, controlled superovulation is used to achieve the purpose of obtaining multiple eggs and embryos 5. Around the 5th day of menstruation, intramuscular injection of ovulatory drugs is started, and the dose is adjusted after 3 days of ultrasound monitoring of follicular development. To evaluate the effect of ovarian stimulation and to determine the time of egg retrieval, the follicle size should be monitored by vaginal ultrasound, and the LH (luteinizing hormone) and E2 (estrogen) values should be checked with blood sampling to adjust the dosage of medication. When two to three or more follicles are larger than 1.8 cm in diameter and the number of follicles above 1.4 cm is comparable to the E2 value, human chorionic gonadotropin (hCG) may be injected to promote follicle maturation. The number of eggs obtained varies depending on the age of the patient and the dose of the drug used. The eggs are retrieved 34 to 36 hours after the hCG injection. 7. Egg retrieval: The most commonly used method of egg retrieval is under local or general anesthesia, guided by vaginal ultrasound, and the needle is passed through the vaginal fornix to the ovaries to aspirate the eggs, which are then transferred under a microscope to a Petri dish containing embryo culture fluid and incubated in a 37°C incubator. 8. Sperm retrieval: The sperm is removed on the same day as the egg retrieval. Wash hands before sperm retrieval and retain semen in a small sterile cup by masturbation method without touching the rim of the cup or the inside of the cup. The extracted semen was processed by density gradient centrifugation or upstream method. 9. In vitro fertilization and culture: 4-6 hours after egg retrieval, the treated sperm and eggs are subjected to conventional in vitro fertilization-embryo transfer (IVF-ET). 12-18 hours later, fertilization is observed under a microscope and culture is continued. 10. Embryo transfer: Currently, most embryos are transferred on the 3rd day after egg retrieval. The embryos can develop to the 6 to 8 cell stage. According to the regulations of the Ministry of Health, the number of embryos to be transferred is decided according to the patient’s age and the number of cycles of pregnancy assistance, and the extra embryos can be frozen and preserved. Embryo transfer is very painless and usually does not require anesthesia. Bed rest for 2-4 hours after embryo transfer. 11. Luteal support: progesterone supplementation after embryo transfer, currently progesterone is mostly given by injection to support the corpus luteum; 12. Morning urine test on the 14th day after embryo transfer to determine whether pregnancy is present; 13. Ultrasound to check the number of fetuses and embryo implantation site 2-3 weeks after pregnancy. 4. Pregnancy rate: about 40-60% in our department. Intra cytoplasmic sperm injection (ICSI): ICSI is a technique that uses microscopic manipulation to inject a single sperm directly into the oocyte plasma to establish a pregnancy. I. Indications for single sperm intracytoplasmic injection (ICSI): 1. Severe oligo-, hypo- and teratozoospermia (must be confirmed by 3 or more tests). 2, irreversible obstructive azoospermia. 3, spermatogenic dysfunction (excluding genetic defects due to disease) 4, immune infertility. 5, In vitro fertilization failure. 6.Sperm acrosome abnormalities. 7. Pre-implantation embryo genetic testing is required. 8, Fertilization failure or very low fertilization rate in previous treatment cycles. 9, ICSI-assisted fertilization is required after cryopreservation of eggs or after maturation of immature eggs in vitro culture. 10. Repeated IV failure. Contraindications: 1. serious mental disorders, acute genitourinary infections, sexually transmitted diseases in either sex; 2. genetic diseases that are not suitable for childbirth and cannot be diagnosed before embryo implantation as stipulated in the Maternal and Child Health Law; 3. serious drug addiction in either sex; 4. exposure to teratogenic rays, poisons and drugs in either sex and during the period of action; 5. 5. The female uterus does not have the function of pregnancy or serious physical disease can not tolerate pregnancy. 3. Treatment procedures: 1. Both men and women must complete some basic examinations: Female examination items Male examination items Detailed medical history and physical examination Detailed medical history and physical examination ABO blood group, RH blood group, blood routine, urine routine ABO blood group, RH blood group, blood routine, urine routine Coagulation function, liver and kidney function, geodynia examination Geodynia examination Hepatitis B two-to-one half, hepatitis series, HIV, syphilis Hepatitis B two-to-one half, hepatitis series, HIV, syphilis Basal sex hormone assay Basal sex hormone assay (in case of abnormal semen) Post-coital test (in case of suspected immune infertility) Mycoplasma, Chlamydia, gonococcus White belt routine MAR test, PCT or SCMC (in case of suspected immune infertility) ECG Semen routine and morphology (in case of abnormalities) (at least 2 test results) Chest X-ray Parietal enzyme activity test Gynecological ultrasound Sperm DNA fragmentation Hysterosalpingography or laparoscopy Hysteroscopy (when uterine cavity problem is suspected) AZF (before ICSI) Chromosome examination (for patients with hereditary diseases, history of poor fertility, recurrent miscarriages) If the examination results are not abnormal, a medical record will be created for you to start treatment for the assisted conception cycle; 3. Descending regulation: Controlled superovulation is generally used first to bring down the FSH and LH in the body with GnRHa, and the medication is started at mid-luteal phase, i.e. on the 20th day of menstruation; 4. Controlled superovulation: Since the pregnancy rate of natural cycles is very low, controlled superovulation is used to achieve the goal of obtaining multiple eggs and embryos, and 5. Intramuscular injection of ovulatory drugs should be started around the 5th day of menstruation and the dosage should be adjusted after 3 days of ultrasound monitoring of follicular development. To evaluate the effect of ovarian stimulation and to determine the time of egg retrieval, the follicle size should be monitored by vaginal ultrasound, and the LH (luteinizing hormone) and E2 (estrogen) values should be checked with blood sampling to adjust the dosage of medication. When two to three or more follicles are larger than 1.8 cm in diameter and the number of follicles above 1.4 cm is comparable to the E2 value, human chorionic gonadotropin (hCG) may be injected to promote follicle maturation. The number of eggs obtained varies depending on the age of the patient and the dose of the drug used. The eggs are retrieved 34 to 36 hours after hCG injection. 7. Egg retrieval: The most commonly used method of egg retrieval is under local or general anesthesia, guided by vaginal ultrasound, and the needle is passed through the vaginal fornix to the ovaries to aspirate the eggs, which are then transferred under a microscope to a Petri dish containing embryo culture fluid and incubated in a 37°C incubator. 8. Sperm retrieval: The sperm is removed on the same day as the egg retrieval. Wash hands before sperm retrieval and retain semen in a small sterile cup by masturbation method without touching the rim of the cup or the inside of the cup. The extracted semen was processed by density gradient centrifugation or upstream method. 9. In vitro fertilization and culture: 4-6 hours after egg retrieval, the treated sperm and eggs are subjected to single sperm intracytoplasmic injection (ICSI). 12-18 hours later, fertilization is observed under a microscope and culture is continued. 10. Embryo transfer: Currently, most embryos are transferred on the 3rd day after egg retrieval. The embryos can develop to the 6 to 8 cell stage. According to the regulations of the Ministry of Health, the number of embryos to be transferred is decided according to the patient’s age and the number of cycles of pregnancy assistance, and the extra embryos can be frozen and preserved. Embryo transfer is very painless and usually does not require anesthesia. Bed rest for 2 to 4 hours after embryo transfer. 11. Luteal support: progesterone supplementation after embryo transfer, currently progesterone is mostly given by injection to support the corpus luteum; 12. Morning urine test on the 14th day after embryo transfer to determine if pregnancy is present; 13. Ultrasound to check the number of fetuses and embryo implantation site 2-3 weeks after pregnancy. Pregnancy rate: about 40-60% in our department. Instructions for consultation: IUI medical records: Usually on the 3rd~5th day of the woman’s menstruation, the couple should bring the test results, three certificates (marriage certificate, family planning service certificate and ID cards of both parties), and then go to the nurse station on the first floor of the Department of Reproductive Medicine to organize the test sheets, fill in the basic information and sign the informed consent form, after completion, the nurse will arrange for you to be seen by a doctor. After the consultation, we will first take your medical history and take a detailed look at the couple’s medical history, as well as the female partner’s ultrasound to monitor the follicles in the month (ultrasound is also available during menstruation). After the treatment cycle, the woman will need to follow the doctor’s instructions for regular medication and follow-up ultrasound monitoring (please make an appointment at the registration desk after each visit for the next ultrasound monitoring), and monitoring until the follicles are the right size for the IUI. IVF medical record: Usually on the 18th~22nd day of the woman’s menstruation (depending on the treatment plan, some need to visit the clinic on the 2nd~3rd day of the menstruation to open the medical record), the couple should bring the test results, three certificates (marriage certificate, family planning service certificate, ID card of both parties), and then go to the nurse’s station on the first floor of the Reproductive Medicine Department to sort out the test sheets, fill in the basic information, sign various informed consent forms, and after completion The nurse will arrange for you to be seen by a doctor. After the consultation, you will first need to take a medical history, a detailed medical history of the couple, and ultrasound monitoring of the woman’s follicles or ovulation for the month. After entering the treatment cycle, the woman will need to follow the doctor’s instructions for regular medication and follow-up ultrasound monitoring (please make an appointment for the next ultrasound monitoring at the registration desk after each visit), and monitoring until the follicles are the right size for the egg retrieval procedure.