Staff at the Reproductive Laboratory of Peking University Third Hospital are performing in vitro fertilization operations.
At 7 a.m. on June 24, a long queue had already formed in the outpatient hall of the Reproductive Medicine Center of Peking University Third Hospital (referred to as Peking University Third Hospital), and the end of the queue extended to Huayuan North Road outside the gate. . Scenarios like this happen almost every day. Couples come from all over the country with full expectations, just for one wish - to have a child.
Here - the largest IVF treatment center in northern my country, thousands of babies are "born" every year. In many people's imagination, test-tube baby is "a sperm plus an egg, placed in a test tube, and a baby is created." In fact, the birth of new life is more complicated than imagined. Recently, a reporter from "Life Times" visited the Reproductive Medicine Center of Peking University Third Hospital, followed the medical staff to experience multiple medical links in depth, and fully understood the "birth" process of an IVF baby.
Location 1: Registration Triage Office
1,500 registrations per day
Every morning, the reproductive center’s lobby of more than 60 square meters They were all packed to the brim. There are six long queues at the triage office on the right side of the hall. It is also responsible for registering first-time patients and is the first stop for patients when they come to the hospital. The charge nurse Gao Ling is skillfully providing consultation and registration services to first-time patients. Patients come from all over the country, including newly married couples born in the 1990s, as well as middle-aged people who didn't want to have children until they were in their 40s.
"In the past two years, the number of patients has been significantly higher than in the past. The number of outpatient registrations every day is about 1,500. Some people have sought medical treatment everywhere before but to no avail, and they were extremely anxious when they came here." Gao Ling, a mother I can understand the patient's eagerness. She told reporters that generally speaking, first-time patients can see a general outpatient clinic to complete the preliminary examination and diagnosis. If necessary, they can then make an appointment with a specialist to further determine the diagnosis and treatment plan. "We have no limit on the number of first-time consultations. We also have outpatient clinics on Saturday and Sunday mornings. Patients can basically register when they come."
Location 2: Expert Clinic
IVF is not Success every time
Unlike other departments, infertility patients often have heavier psychological pressure, and their treatment results affect the happiness of one or even multiple families. Infertility treatment experts Zhen Xiumei knows this very well. She speaks softly to patients, and in addition to necessary medical instructions, she often also offers a few words of comfort.
Li Jiao (pseudonym) from Henan told reporters that she had not been pregnant for five years after being married. A checkup showed that both fallopian tubes were blocked. "We did not dare to tell my parents-in-law and borrow money to do IVF." "Unfortunately, their first attempt failed and the baby stopped developing after more than 10 days in the womb. Speaking of this, Li Jiao couldn't help crying. Zhen Xiumei comforted her and said: "We still have spare frozen embryos that can be transplanted. Don't be too sad, there is still hope."
"There are more and more patients now, and we have to treat up to a hundred outpatient cases a day. "Zhen Xiumei, who has worked in a reproductive center for nine years, said that when it comes to infertility, many people first think of the woman's problem. In fact, clinically, only about 40% of infertility is entirely caused by women. Common causes of female infertility include ovulation problems, blocked fallopian tubes, cervical disease, and endometriosis.
"The treatment methods for infertility vary from person to person. Some require the guidance of a doctor for intercourse, some require artificial insemination, and some require in vitro fertilization, which is often referred to as in vitro fertilization." Zhen Xiumei introduced that artificial insemination is a technique in which the man's sperm is washed and processed and then injected into the woman's reproductive tract; in vitro fertilization involves artificially removing the egg cells and sperm, combining the two to form an embryo, and then transplanting it into the woman's uterus. "It can be said that in vitro fertilization is the last step in infertility family treatment."
Zhen Xiumei said that the process of in vitro fertilization generally includes determination of indications, physical examination, ovulation induction, egg retrieval, in vitro embryo culture, embryo Transplantation, luteal support, and confirmation of pregnancy are several steps. Although from a scientific point of view, in vitro fertilization integrates many modern medical methods, this does not mean that every treatment will definitely help couples successfully create a baby. “Currently, the pregnancy rate in one treatment cycle is 40% to 50%, and the chance of getting a child is about 30% to 40%.
"Zhen Xiumei said that this is mainly related to the age of the woman. The older the age, the lower the success rate. Last year, we separately calculated the pregnancy rate of couples where the woman was under 38 years old and underwent IVF treatment for the first time in our hospital, and it was as high as 55%~ 60%, plus frozen embryo thawing and transplantation, the cumulative pregnancy rate can reach 70% to 80%. However, once the woman reaches 41 to 45 years old, the success rate is only about 10% to 20%.
< p> Location 3: Injection roomUp to 1,200 syringes are used in a day
For women who are diagnosed as infertile through outpatient clinics, one of the most common treatments is ovulation induction injections . There is a calendar hanging on the desk of nurse Wang Yanhua, which records the number of syringes they used: 800 on August 8, 771 on August 21... The maximum number was 1,200.
< p> Wang Yanhua said that in order to improve the success rate of treatment, infertile women should receive ovulation induction treatment. There are many methods to induce ovulation. The most common one is to inject according to the medication plan formulated by the doctor. For example, the short plan is to take the injection during the first natural menstruation. Starting from 3 to 5 days, the injections will be continued for 5 days. After the B-ultrasound, medicines will be continued. Some patients will adjust the dosage and medicines, increase or decrease the dosage of medicines. Some patients also need to take three or four injections at a time, in both arms. Injection into both gluteal muscles at the same time. Through ovulation induction monitoring, some women can successfully get pregnant if they have intercourse on time, but some need to wait until the eggs are almost mature to remove the eggs and undergo in vitro fertilization.Location 4: Reproductive Ward
p>Couples come together for egg retrieval and sperm retrieval
The reproductive ward is located on the second floor of the center. Tian Enyan, the head nurse, said that there are 81 beds here, except for some that require surgery. In addition to patients undergoing infertility treatment, most of them are patients who have complications during in vitro fertilization, such as multiple pregnancy reduction, ectopic pregnancy, hyperejaculation syndrome, etc. Couples who come for egg and sperm retrieval are also required. The short hospitalization is mainly to allow the woman to rest after the egg retrieval operation. When checking in, the nurse will ask the couple to take a photo together so that they can check the information during the treatment. There are about 30 couples sitting in the education room on one side of the ward. The couple is watching the admission instructions under the guidance of the nurse: rest in the ward the day before egg retrieval, do not eat before waking up from anesthesia after egg retrieval, the man collects sperm on the day of egg retrieval from the woman, how to successfully collect sperm...
In the center of the ward is the operating room and in vitro fertilization-embryo culture room, where the woman’s eggs are retrieved. Lian Ying, an embryologist at the Reproductive Medicine Center laboratory, told reporters that the doctor will inject the woman with ovulation-stimulating drugs. Monitor the development of follicles, and when the follicles mature, perform egg retrieval surgery under general anesthesia and analgesia: the doctor will use a puncture needle to puncture the ovary through the woman's vagina under the guidance of the vaginal B-ultrasound probe and puncture stent, and collect the follicular fluid. Aspirate it out, send it to the laboratory, and then pour the follicular fluid into a round dish; after finding the egg under the microscope, transfer it to a square four-well petri dish containing culture medium for culture. For the conventional insemination method of mixed egg culture, sperm and egg mixed culture is performed 4 to 6 hours after egg retrieval; for single egg injection, the egg can be removed after one or two hours of culture. Mound, single *** microinjection and other related treatments.
Compared with the complexity of egg retrieval surgery, the sperm retrieval process is much simpler. Generally, the man obtains it by himself through vaginal surgery; those who suffer from obstructive azoospermia and other special reasons cannot obtain sperm. Patients need to undergo puncture or even surgery to extract sperm.
When the eggs and eggs are successfully retrieved, they are sent to the laboratory for culture and processing.
Location 5: Laboratory
The most mysterious place for in vitro manufacturing of human embryos
The laboratory is connected to the ward and operating room, with the words "stop for idlers" standing at the door. brand. Through the glass, the reporter saw that the staff inside were "fully armed" and covered from head to toe. Lian Ying said that the reproductive laboratory is a 100-level clean laminar flow laboratory. The air here has been filtered and dusted. Outsiders are not allowed to enter mainly because they are afraid of being contaminated. The fibers, hair, oral mucus, etc. on people's clothes are all polluted. It may have a huge impact on experiments.
The removed sperm and eggs will be screened and artificial insemination will be carried out about 4 to 6 hours later.
There are two main methods of insemination. One is to artificially place eggs and sperm in the same petri dish and combine freely. This method is mainly used in women’s infertility caused by fallopian tube obstruction and other reasons. There is also oocyte in vitro injection (ICSI), which uses a needle to inject good sperm into the egg. It is mainly used for cases where the man suffers from severe oligoasthenoteratozoospermia. The fertilized eggs are then placed in an incubator that simulates the maternal environment to form embryos. Generally speaking, embryos that have developed in vitro for 2 to 5 days are suitable for embryo transfer and returned to the mother's uterus.
"In vitro fertilization does not grow in a test tube at all." Lian Ying explained that after the fertilized eggs form embryos, the doctor will transplant two into the mother's body and freeze the rest as a backup. Ten to 14 days after the embryo is transplanted into the mother's body, a preliminary test can be performed to see whether it has "landed" in the mother's uterus. "So, in vitro fertilization also grows in the mother's body, and it also takes ten months to conceive and deliver once."
Some people think that in vitro fertilization can choose gender, but the answer is no. "The combination of eggs and sperm is random and cannot be left to people's choice," Lian Ying said. In addition, since the doctor will transplant two embryos into the mother each time, the probability of multiple births is high. However, in the end, it is necessary to determine whether to reduce the fetus according to the situation. Generally speaking, single pregnancy is the safest.
Experts remind: Infertile couples should calm down
“If you don’t want it before the age of 30, you won’t want it after the age of 30” has become a painful experience for many men and women of childbearing age. Survey results released by the China Population Association show that the number of infertility patients in my country currently exceeds 40 million, accounting for 12.5% ??of the population of childbearing age. More than 20 years ago, this proportion was only 3%.
Many infertile people place their last hope on in vitro fertilization. During this process, the patient's mood can easily rise and fall, and their hopes are often dashed just as quickly. Therefore, experts remind that couples who want to undergo in vitro fertilization must first have a strong psychological quality, comfort each other, and have a peaceful mind. Zhen Xiumei emphasized that if the patient is too eager to have a baby and the patient is too nervous, it will interfere with the endocrine function and make it even more difficult to get pregnant.
Qiao Jie, president of Peking University Third Hospital and director of the Reproductive Medicine Center, pointed out that the growth of infertility is closely related to modern people’s lifestyle. Modern people are busy with their careers and have repeatedly postponed marriage and childbirth. Their bodies are overstretched and strained, and they even suffer from premature aging symptoms such as amenorrhea and hot flashes. By the time they want to have children, their fertility has significantly declined. "The best childbearing age for women is from 25 to 33 years old. After that, the function of the reproductive system begins to deteriorate, especially the ovarian function. Even if you do IVF, the success rate will be greatly reduced after the age of 40."
In addition, Zhen Xiumei reminded women to prevent unwanted pregnancies, minimize abortion surgeries, and pay attention to the pregnancy of their first child. Because after abortion surgery, improper conditioning may cause organ infections, such as fallopian tube inflammation, endometritis, etc., which may lead to infertility.