The Political Bureau of the CPC Central Committee held a meeting on May 31 this year, and the meeting pointed out that it is necessary to further optimize the fertility policy, implement the policy that a couple can have three children and supporting measures, which is conducive to improving China's population structure, implementing the national strategy of actively responding to population aging, and maintaining china's human resource endowment advantages.
The main data results of the seventh national census show that the birth population in 2020 is about 12 million, in addition, the total fertility rate of women of childbearing age in China in 2020 is 1.3, which is at a low fertility level. China's birth population has declined for the fourth consecutive year since 2017. As a result of the "14th Five-Year Plan" period (2021-2025), the number of women of childbearing age in China will continue to decrease, with an average annual decrease of more than 4 million people, while the number of women of childbearing age aged 20 to 34 years old in the period of fertility will decrease by an average of more than 5 million per year. If the fertility rate cannot be significantly increased, the number of births in China will continue to decline in the next few years. The "endless decline" of the birth population obviously does not meet the requirements of long-term balanced development of the population.
Among the 31 provinces in the country, Tibet has the highest fertility rate, first-tier cities are generally low, and Anhui has the highest proportion of second children.
After the opening of the comprehensive two-child policy, the enthusiasm of the post-70s and post-80s to have a second child is the highest, and now many young people after the 90s are reluctant to get married and unwilling to have children. A comprehensive two-child policy will neither reverse the downward trend in births nor meet the expected combined fertility rate of 1.8. In this case, it is imperative to introduce a three-child policy. There are many people who complain that the three-child policy will only make it more difficult for female workers to find employment, and the four mountains that weigh on the three-child policy, education, housing, medical care, and pensions, which one has not been removed by the fool. Whether to have children or not, how many children to have, depends on whether this society can make young people calm down and see hope. Many policies have been introduced everywhere, the most of which is the vacation incentive, and some places can take 180 days of maternity leave for three children, which is very generous, but in fact, it increases the burden on enterprises and also leads to discrimination against women. In fact, the most vocal among the public is the provision of cash subsidies and inclusive childcare services to effectively reduce the cost of childbirth, parenting and education. The comprehensive fertility rate in 2020 is 1.3, and the fertility rate is still declining in 2021, so it is time to take practical and effective measures to change the current situation of not being able to afford to be born, cannot afford to be raised, and the fertility rate continues to decline. The state is also planning to implement some specific supporting policies and adopt support measures in the fields of finance, taxation, insurance, education, housing, and employment to reduce the burden on families, parenting, and education. As a reproductive physician, my advice is for young women to have one child as soon as possible, and the second child and three children are orderly and planned depending on their physical condition.
An important influencing factor in pregnancy
1. Good ovarian function, advantageous follicle development
Women generally have 1-2 healthy and mature eggs released during the menstrual cycle every month, and there is a chance to get pregnant until there is ovulation. The following methods are used to detect ovulation: changes in basal body temperature, changes in LH, cervical mucus, and ultrasound monitoring of ovulation. The first three methods are relatively simple to monitor ovulation, but the fourth method is the most accurate for vaginal ultrasound monitoring of ovulation.
2. Patency of fallopian tubes
Tubal failure is one of the main causes of infertility in women. The main causes of tubal obstruction are tubal dysplasia, acute and chronic tubal inflammation, etc. To know whether the fallopian tubes are patency, the commonly used and effective methods are salpingogram and tubal fluid.
3. The thickness and form of the endometrium are suitable
Vaginal ultrasound can check the uterine cavity, if there are abnormalities in the uterus such as uterine adhesions, uterine polyps, etc., hysteroscopy and surgery are required.
4. Semen routine and morphology are generally normal
Men's semen examination is a non-invasive examination, but also the first test for middle-aged couples to prepare for pregnancy, the man checks for 2-7 days of abstinence before examination, check the amount of semen, sperm count, sperm motility, sperm malformation rate.
The three-child policy has been liberalized, and 20+ women have a child as soon as possible
When a woman chooses to have a baby at 25, the egg quality in the body is one of the best moments in a woman's physical development stage. The optimal age for women to have children is 23-28 years. Therefore, the later the birth time, the more the egg will be affected by the environment and pollution, and the quality of the egg cells will also decline. Therefore, women of childbearing age should develop good living habits and eugenics during the preparation for pregnancy. After the age of 35, ovarian function begins to decrease, and the quality of eggs decreases, which relatively increases the difficulty of conceiving "second and third children". Therefore, if conditions permit, women of childbearing age should give birth as early as possible before the age of 35 to avoid the risk of having children at an advanced age. Women whose first child is a cesarean section should have their uterus scars checked before becoming pregnant again. During the preparation for pregnancy, it is necessary to adjust the living habits:
1. Do not smoke or drink alcohol. Toxins in cigarettes can not only harm the egg, but also cause ovarian aging, and long-term alcohol abuse can also lead to ovarian aging. To protect good seeds, stay away from alcohol or tobacco.
2. Do not stay up late and work and rest regularly. Often stay up late, the rules of life are disrupted, the body's biological clock will also be disrupted, directly affecting the female endocrine environment. The imbalance in the secretion of hormones can affect the development and ovulation of the egg. Conditioning endocrine is a very long process, instead of wasting time in this regard, it is better to develop a regular life of going to bed early and getting up early.
3. Get up and walk around often Many women now sit for a long time because of their work. Sitting still for a long time is the most detrimental to blood circulation in the pelvic cavity. If you can't exercise regularly, then seize every opportunity to get up and walk!
4. Avoid unplanned pregnancy: the uterus is like the soil that gives birth to life, and whether it is a medical abortion or a surgical abortion, it is tantamount to artificially destroying the land, and surgical abortion may also cause tubal adhesions, endometriosis and other problems leading to infertility. Therefore, if you do not want to conceive immediately, you must do a good job of contraception and protect your fertility.
Women with problems with preconception examination and significant loss of ovarian function should go to the reproductive clinic as soon as possible, there is no magic elixir that can restore the ovaries with declining function to young, and the only thing that can be done is to seize the time and give birth as soon as possible before the ovaries do not decline more severely.
With the three-child policy liberalized, can older women still have another life?
On the issue of fertility, the medical community has always considered that over 35 years old is considered an elderly woman. 37 years old is the inflection point of the decline in ovarian function, and 45 years old is the ceiling of fertility. Of course, it does not mean that it is not easy to get pregnant at the age of 35, and it is impossible to have children at the age of 45. Rather, the most difficult problem at this age is the decline in ovarian reserve function. The ovarian reserve function of elderly women is drastically reduced, and the chance of pregnancy is greatly reduced; at the same time, the probability of chromosomal abnormalities in the released eggs is significantly increased, and the risk of complications during pregnancy is also greater. For middle-aged couples, trying to conceive is a race against time, and they should seek help from a professional fertility center as soon as possible.
The focus of women's advanced age is not to maintain the body, because age can not be adjusted back, the key is to go to the reproductive center as soon as possible for medical consultation, do ovarian function assessment, do fertility assessment. Of course, if the woman is old and has a basic disease of the body, such as hypertension, heart disease, etc., it still needs targeted treatment, then go to the obstetrics department, go to the relevant department to assess the impact of fertility on the state of the body. Your doctor will give you relevant fertility advice. Tell you what you can and can't, how likely it is, how unlikely it is, and the question of benefits and risks. Elderly women should avoid unprincipled maintenance in the preparation stage of pregnancy, and do not waste what little childbearing time they have left.
1. Do fertility assessment in advance
Fertility assessment is carried out in advance in order to detect problems as early as possible, many elderly couples have at least one history of childbirth, some people have a history of miscarriage, ectopic pregnancy, etc., these conditions have an impact on the IVF process, or the success rate. Detect problems early and actively treat them.
2. Regular life schedule
In daily life, it is necessary to supplement comprehensive nutrition, ensure adequate sleep every day, especially pay attention to active exercise, so that healthy living habits have an important impact on regulating the body and will have a key role in promoting ovulation.
3. Adjust the psychological state and actively prepare for pregnancy
Negative emotions such as depression, anxiety, and nervousness will bring pressure to pregnancy preparation, and this kind of quick-to-win mentality will even cause women's endocrine disorders, which will reduce the chance of pregnancy.
How to prevent birth defects when trying to conceive at an advanced age?
Advanced age is a high-risk group of birth defects, but birth defects are preventable and controllable.
Carrier screening can be carried out in the pregnancy preparation stage, and high-risk groups can use PGT to screen embryos.
During pregnancy, NT, noninvasive DNA, villus sampling, amniocentesis and other tests can be taken to minimize the occurrence of birth defects and reduce the harm to the mother.
Pregnant women of advanced age are more likely to have a variety of chronic medical diseases, such as high blood pressure and diabetes. At the same time, advanced age is also a high risk factor for pathological pregnancy, such as gestational diabetes, gestational hypertension, placenta previa, scarring the uterus, etc. These comorbidities and complications largely threaten maternal health. Taking hypertension in pregnancy as an example, compared with pregnant women aged 25 to 30 years, the prevalence of hypertension during pregnancy in pregnant women aged 35 to 40 years is 1.22 times that of the former, while the prevalence of pregnant women over 40 years old can reach 1.63 times. The pathological basis of hypertensive diseases during pregnancy is mainly the damage of the endothelium of the whole body vessels, which in turn leads to placental ischemia, induces fetal intrauterine distress, and even leads to the occurrence of serious complications such as placental abruption and cardiovascular and cerebrovascular accidents.
At 25 years old, it is much easier to have a smooth birth than at 35 years old. Because 25-year-old women have great uterine expansion and contraction, good elasticity of the birth canal, soft joints of the pelvis, and have the basic physiological conditions for vaginal delivery. Giving birth at the age of 35 will face the risk of dystocia, so more people choose caesarean section. Because women grow older, the joints of the birth canal and perineum and pelvis will become hard and difficult to expand, and the contractility of the uterus and the stretch of the vagina will also decrease.
As a reproductive doctor, one of the things you most want to remind is to do the right thing at the right age--- pregnant and have a child early, once you miss the optimal fertility age, you will pay more hardships in order to have children. We must not pin all our hopes on modern medicine, after all, there is no miracle medicine for rejuvenation, let alone a magic doctor for rejuvenation.