The winter in Shanghai is like a roller coaster, the temperature rises and falls, and finally a heavy snowfall makes people experience the feeling of winter. Maybe it’s because of the saying “Snow makes a good year” that I have been enjoying the pleasure of a good harvest these last two weeks. One by one, the new father brought me a pile of happy eggs, and it looks like I will have to make up my breakfast with them this month. The happiest thing is that the six pairs of oldest difficulties who were seen in my preconception clinic for infertility have also reported one after another after more than six months of treatment and conditioning. The main goal of the preconception clinic is to prevent birth defects and improve the quality of the population. In the actual examination and consultation, the most easily found or the most obvious problem in the examination results is actually infertility, followed by smaller problems are often common factors that cause spontaneous abortion, while the problems and factors leading to birth defects are often the most hidden and the least easy to regulate. Therefore, we need to remind you that preconception medical examination is not a panacea. Subjects detected with problems before conception often have a good prognosis under the supervision of doctors, while birth defects with the most serious consequences require more self-protection of the couple before conception with regard to their own habits and living environment. Even as we treat infertility, we still cannot forget about eugenics. Measure of infertility According to previous statistics, about 2/3 of couples can get pregnant within 3 months after marriage without contraception, up to 75%~80% within 6 months, and about 85% within a year. According to the criteria of the World Health Organization’s Standard Examination and Diagnosis Manual for Infertile Couples, couples who have regular sexual intercourse and have not conceived for more than 12 months without contraception are considered to be diagnosed with infertility, and it is estimated that about 8-10% of couples will have some infertility problems. According to this criterion, in a follow-up survey of more than 700 couples who received free preconception care at our preconception clinic for more than two years, 56% became pregnant within 3 months without contraception, 78% became pregnant within 6 months, and only 2.3% became pregnant within the 6th to 12th month, and about 19% became infertile. Perhaps because of the effectiveness of preconception clinics in educating about presumed ovulation and ease of conception, the majority of pregnancies were obtained within six months without contraception, while only a very small number of people “escaped” the diagnosis of infertility after six months. Since there are many factors that affect fertility, delaying the diagnosis for a long time may make it difficult to treat a disease that was easily treated, and the psychological burden caused by the delay in completing the fertility plan will be difficult to correct, so in my preconception clinic, I recommend that those who have not conceived after six months of trying to conceive should undergo further testing or treatment as soon as possible, even though they have not yet been diagnosed with infertility. The prevalence of infertility is high Our data on infertility alone shows that the rate is already similar to the highest prevalence reported in the United States and Japan. There may be many reasons for this. In a metropolis like Shanghai, the pressure of study and life, irregular work and rest, lifestyle habits such as eating too much and moving too little, socializing in the light of the world, and urban pollution such as radiation and air are some of them. Late marriage and late childbirth, missed the best age for childbirth, the increased risk of various metabolic diseases and reduced fertility is perhaps another aspect. It should not be overlooked that the current couples of childbearing age are the new generation of the post-80s to post-90s, a generation whose adolescence coincides with China’s reform and opening up. Environmental pollution, problematic food and high parental expectations may be one of the important factors in their declining fertility, as evidenced by the marked increase in the rate of declining sperm vitality and menstrual disorders in this age group. The most impressive was a 28-year-old patient whose small amount of red discharge from just one pad could suggest each menstruation, and whose uterus was examined to be only the size of an adolescent girl. The reason analyzed with her parents was that the family was well off at the time and two wild snappers a week were causing trouble. What are the many reasons affecting fertility Fertility and sterility are a contradictory unity, and any disease or factor that interferes with the reproductive link between men and women can cause infertility. The World Health Organization classifies the diagnosis of infertility into 16 categories for men and 22 categories for women according to the subsequent treatment. We do not need to understand the complex diagnostic and therapeutic process, but we should have a preliminary understanding of the most basic aspects of reproduction so that we can identify problems in time to protect ourselves or cooperate with the doctor for further diagnosis. In men, the main components are the neuroendocrine regulation of the male reproductive system, sperm production in the testes, maturation of sperm in the epididymis, mixing with seminal plasma secreted by the seminal vesicles and prostate during sperm discharge to form semen, sperm discharge from the male reproductive tract and input into the female reproductive tract, sperm fertilization with the egg in the female fallopian tube, and so on. In the female, the main components are the neuroendocrine regulation of the female reproductive system, the recruitment of follicles in the ovary and the maturation of the dominant follicle, the expulsion of the egg and the capture of the fallopian tube, the meeting and fertilization of the male sperm in the abdomen of the fallopian tube, the normal division and movement of the fertilized egg to the uterine cavity, the normal hatching and implantation of the blastocyst, the preparation of the endometrium, the acceptance of implantation and the support of embryonic development, etc. Fertility disorders can occur when any of these many links are disturbed and affected by disease or factors, so infertility is often not a stand-alone disease, but the result of one or many diseases and factors. The doctor’s idea of examination and diagnosis is actually to consider each of these links in reverse. Infertility is not that scary Male infertility Sperm quality is the key When diagnosing male infertility, the first consideration is whether sperm can enter the female reproductive tract normally, thus screening for problems with intercourse and/or ejaculatory dysfunction, such as erectile dysfunction, severe premature ejaculation where ejaculation occurs before entering the female reproductive tract, non-ejaculation, retrograde ejaculation, etc. It is worth drawing attention to the fact that some men have all normal sexual function in normal times, however, due to excessive fertility pressure, once they reach the female partner’s ovulation period, they develop erectile or ejaculatory dysfunction. Therefore, it is especially important to relax and regulate stress, even if there is a functional disorder, the current treatments can be completely resolved. The next consideration is whether the sperm can fertilize the egg in the fallopian tube, which involves the number, vitality and function of the sperm, etc. Special analysis of semen quality can lead to a preliminary diagnosis of azoospermia, oligospermia, weak sperm, abnormal spermatozoa and abnormal seminal plasma, etc. If necessary, the doctor will also use the sperm acrosome function test, in vitro culture overnight test, seminal plasma exfoliated cell analysis test, immunological test, etc. If necessary, the physician will further investigate the function of spermatozoa by means of sperm acrosome function test, in vitro culture overnight test, seminal plasma exfoliation cell analysis test, immunological test, etc. In the case of sperm plasma abnormalities, biochemical tests of sperm plasma and exfoliative cell analysis can help to understand diseases of the prostate and seminal vesicles; in addition to sperm plasma factors, it is more important to consider whether there are factors affecting the maturation process of sperm in the epididymis and/or the process of spermatogenesis in the testis. In the case of oligozoospermia and azoospermia, it is necessary to consider whether the spermatogenesis of the testes is obstructed due to an obstruction of the spermatozoa discharge process or is impaired due to various congenital or acquired factors. Although the treatment of male infertility is still lacking in specific drugs, as long as the diagnosis is clear and the persistent influencing factors are removed, the majority of male infertility can be successfully conceived through 1~2 courses of treatment. For example, in the 4 cases of oligospermia screened in this year’s preconception clinic, 2 cases with pituitary hormone deficiency were conceived after 2 courses of hormone therapy, and the other 2 cases with testicular factors were conceived after single sperm puncture. The other two cases with testicular factors have also been successfully conceived by in vitro fertilization technique. Of the 5 cases of azoospermia identified during the same period, 2 cases were confirmed to have testicular failure and could only be treated by donor sperm, while the other 3 cases found sperm in testicular puncture, 2 of which have undergone in vitro fertilization treatment, 1 of which was successful, 1 is preparing for the second treatment, and the other case was found to have a short arm deletion of Y chromosome during the preparation for in vitro fertilization treatment, which means he can only have daughters and needs Pre-implantation genetic diagnosis was done and further treatment is still in progress. Female infertility Seeds, soil, and transport channels are all important The same principle is followed in the diagnosis of female infertility. Although reproductive tract infections, certain immunological factors, and congenital or acquired developmental abnormalities, among others, can affect some of these components and cause infertility, simply put, the three basic conditions that are considered in the initial determination of female fertility are the seed (egg), the soil (uterus and endometrium), and the transport channel (fallopian tubes). The menstrual cycle is formed by the cyclic cycle of follicle recruitment, growth, maturation, rupture and ovulation and luteal formation and shrinkage, so observing the menstrual cycle for normal patterns is the easiest way to indirectly determine egg development. The menstrual blood is formed by the cyclical exfoliation of the endometrium, so the volume of menstruation and its properties also indirectly reflect the condition of the endometrium. At present, in fertility clinics, doctors usually do further examination by transvaginal B-mode ultrasound. One type of ultrasound diagnosis that is meaningful for fertility testing is chosen on the 6th to 8th day of the cycle, which on one hand can easily exclude organic problems such as ovarian cysts, uterine fibroids, hydrocele, congenital anomalies, etc. On the other hand, the number of sinus follicles can be counted to have a preliminary understanding of the reserve function of the ovaries. The other is to calculate the ovulation period according to the patient’s menstrual cycle and choose to start monitoring the development of the follicles 1~2 days before the ovulation day. normally, the mature follicles are between 18~24mm and the thickness of the endometrium should be 9~11mm during the same period. if the follicles do not grow much or disappear prematurely, the development of the eggs may be impaired. if they are too large and still do not ovulate or start to absorb, it indicates there may be a follicular luteinization syndrome. If the thickness of the endometrium is less than 5mm or less, experience with IUI tells us that conception is not possible. Whether through observation of the menstrual cycle or diagnosis by ultrasound, those who are suspected of having ovulation disorders should be further examined neuroendocrinologically in order to clarify whether it is the boss (pituitary hormones) who refuses to give bonuses or the workers (ovaries) who do not work well, so as to choose the appropriate treatment. Endocrine disorders are also the most common causes of female infertility, commonly seen in hyperprolactinemia, polycystic ovary syndrome, The common causes are hyperprolactinemia, polycystic ovary syndrome, premature ovarian failure, etc. In my personal opinion, any examination and treatment of the fallopian tubes is invasive. Except for patients with a history of multiple miscarriages, a clear history of pelvic inflammatory disease or a history of secondary dysmenorrhea, early examination can be considered, but generally a test should be considered after all examinations (including male examinations) and treatment suggest that everything is normal. . The history of the development of obstetrics and gynecology is much longer than that of male science, and the treatment methods and measures are much more than those of men, and the efficacy of treating female infertility is also more precise than that of men. In the analysis of the factors causing infertility, about 1/3 of them are the problems of the male partner, 1/3 of them are the problems of the female partner, and the other 1/3 are the problems of both partners. Therefore, in the diagnosis and treatment of infertility, it is a very important principle that both spouses are diagnosed and treated together, and the examination is far easier for men than for women, so it is the duty and responsibility of the husband to reject the traditional concept of active male participation. May all love be fruitful! As doctors, we will do everything we can to protect you.