In the more than five years since the introduction of the two-child policy, the number of medical institutions approved to carry out assisted human reproductive technology in China has soared to more than 500. The number of IVF babies has grown rapidly, with more than 300,000 births a year.
Text | Wu Xiao
Edit | Yang Wenjin
Since leaving the 996 "Examination Gong ashore" three years ago, according to Shiya's plan, life has entered a new stage of having a baby. But the "creation plan" has not been implemented for nearly two years without success, and Shiya, a former strong woman, has begun to be bored - why is it so easy for others to get pregnant, but it is so difficult for herself?
After vaguely inquiring in the circle of friends, Shi Ya found that she was not alone, and the old colleagues of the previous Internet factories and the cousins who were close as girlfriends had similar troubles, "Before, I didn't want to be born or didn't let go, now I want to be born but can't be born..."
Incidence of infertility climbs to 18%
In medicine, pregnancies that have not been used for more than one year without any contraceptive measures and have a normal sexual life without success are called infertility.
In modern society, infertility is not uncommon. With the change of people's fertility concepts and lifestyles, the increase of work pressure, and the continuous postponement of women's reproductive age, infertility has become one of the major reproductive diseases that plague many couples of childbearing age.
According to data from the National Bureau of Statistics, among the women who have registered for marriage in China, the proportion of women aged 35 and above who are not the best childbearing age is increasing year by year, and the trend of late marriage and late childbearing and the increase in infertility are also increasingly overlapping. From 1990 to 2017, the average age of first pregnancy for women of pregnant age in China has been postponed from 23.4 years to 26.8 years old, and there has been a trend of continued backwards in recent years. This is not good news for women whose optimal reproductive age is 23-30 years old.
The "Lancet China Female Reproductive, Maternal, Newborn, Child and Adolescent Health Invited Major Report" published by the authoritative medical journal "Lancet" online in May 2021 pointed out that the latest national reproductive health epidemiological survey and analysis results of the team of academician Qiao Jie of the Third Hospital of Beijing Medical College show that between 2007 and 2020, the incidence of infertility in China has risen from 12% to 18%.
In many media reports, there are currently more than 40 million infertility patients in China.
Under the topic of #Soaring Demand for Assisted Reproductive Technology, which was on the hot search in September, a reporter from CCTV Finance visited the People's Liberation Army General Hospital in Beijing and found that assisted reproduction departments often have a situation that is difficult to find. With the liberalization of the three-child policy, the number of patients who come to consult assisted reproduction has increased a lot, and the average age is about 36 years old, which is higher than the previous two years.
After the hot search came out, the reporter from Guiyang also went to visit the assisted reproduction department of Guiyang Maternal and Child Health Hospital and found that there was an endless stream of patients who came to see and consult. Shi Xiaoxun, doctor of obstetrics and gynecology and chief physician of Guiyang Maternal and Child Health Hospital, told reporters that assisted reproductive technology (ART) for the pregnancy of infertile couples using medical aids, including artificial insemination and IVF, is considered to be one of the most effective ways to treat infertility. Among the various technologies of assisted reproduction, the most mainstream way of "in vitro fertilization" is what everyone often calls "IVF".
At present, about 300,000 of the newborns born in China every year are "IVF babies", and the number may continue to increase in the context of the release of the second and third births.
"There are 4 pairs of twins in the class"
With a little attention, you'll see more twins around you than ever before.
Xiaoxiao's daughter had just entered the first grade, and she told Xiaoxiao that there were 4 pairs of twins in their class, 3 of which were dragon and phoenix babies, and 1 pair was twin sisters, "but they all look different, I can recognize them at once!" Xiao Xiao understood as soon as he heard it: these pairs of twins are most likely IVF babies - as long as the fertilized eggs are sufficient and of good quality, in order to ensure the success rate, 2 or more fertilized eggs will be implanted at a time when doing IVF, and the probability of multiple eggs will be greatly increased.
The number of IVF babies has grown steadily every year since the birth of the world's first IVF in 1978, and by the time Robert Edwards, the founder of IVF technology, received the Nobel Prize in 2010, the number of IVF babies worldwide had exceeded 5 million.
In 2018, the 30th anniversary of the technology' introduction, the International Commission on Assisted Reproductive Technologies monitored the technology, which said there were more than 8 million IVF babies worldwide. In recent years, IVF has shown a rapid growth trend, and in Chinese mainland alone, as many as 300,000 IVF babies are born every year.
The "Lancet China Female Reproduction, Maternal, Newborn, Child and Adolescent Health Invited Major Report" mentioned that since the birth of the first case of IVF in Chinese mainland in 1988, in more than 30 years, China's assisted reproductive technology has developed rapidly, and the total number of cycles has exceeded 1 million cycles / year, the number of births has exceeded 300,000 cases / year, and the success rate has basically approached the level of developed countries in Europe and the United States.
"Lancet China Maternal and Child Health Invited Major Report", China Assisted Reproductive Technology Treatment Cycle Number and Fertility Outcomes (2009-2017)
In the past ten years, especially in the more than five years since the introduction of the two-child policy, the obstetrics and gynecology departments of hospitals around the world have increased reproductive clinics, and the number of medical institutions approved to carry out human reproductive assistive technology in China has soared to more than 500. After the implementation of the three-child policy in 2021, a number of provinces issued the "Human Assisted Reproductive Technology Application Plan (2021-2025)", which mentioned that new assisted reproductive institutions will be planned.
At the same time as the rapid growth of IVF, the traditional concept of "family ugliness cannot be publicized" of infertility in Chinese has gradually been abandoned, and the public's acceptance of IVF is increasing day by day.
Aunt Fang's IVF dragon phoenix grandchild is now in the third grade of primary school, and at first she was very resistant to revealing that her grandson was obtained by ivory tube, and always felt that saying it would make her daughter a little "humiliated". But as more and more neighbors and old classmates asked her about her daughter's "experience" in giving birth to twins, Aunt Fang simply broke through the window paper and began to generously teach her daughter's experience in test tubes and precautions during pregnancy.
"When the second child was not yet opened, many people felt very envious when they heard that it was a test tube twin, and they wanted to have two children. The second child was opened in the back, and people also felt that the successful twins were very powerful. Today's young people are all working overtime, eating takeaways, staying up late, living irregularly, not in good health, miscarriages, fetal protection is much more than before, and it is not surprising that they cannot be born. Fortunately, now that the technology is more and more advanced, don't worry too much, just believe in science. Aunt Fang said.
A game of money, time and body
However, in the view of Aunt Fang's daughter Rong Rong, it is not enough to believe in science, but also to have enough money and time to play with the body in order to see the dawn of victory.
Recalling the experience of doing test tubes, Rong Rong said: "Never want to experience it again. ”
Preparing to be pregnant for 6 years, Rong Rong has not waited for her child. After praying to the gods and worshipping the Buddha, and the conditioning of traditional Chinese medicine did not improve, Rong Rong, under the recommendation of her colleagues, found a number seller and hung up the expert number of a professor of the Sixth Affiliated Hospital of Sun Yat-sen University. After a series of tests, the cause of infertility was finally found - she had premature ovarian failure, her husband was weak, and she belonged to the type that was not easy to conceive. Under the advice of the doctor, Rong Rong began the road of IVF.
Because of premature ovarian failure, after 3 times of induction and finally getting the right egg, the husband's sperm quality was not very good, and he did not successfully synthesize the fertilized egg. Spent money also because of ovarian overstimulation to get ascites, did not expect even the opportunity to implant, Rong Rong cried several times for this, after crying to dry tears, and continued to drink Chinese medicine, nourish the body, ready for the next egg induction. In the end, Rong Rong took 4 eggs and successfully cultivated 2 fertilized eggs, because the physical conditions were not suitable for transplantation, and the fertilized eggs could only be frozen. Then, she adjusted her body for half a year, and finally on the 12th day after implantation, she finally tested the "two bars"!
For women who do test tubes, the emergence of "two bars" does not mean the ultimate success, in fact, everything has just begun.
The joy of the "two bars" was quickly replaced by various worries, and the wind and grass of the body would be infinitely magnified by Rong Rong: the stomach felt a little painful, was it the body's resistance to the embryo? There is a light red discharge on the panties, is the embryo about to fall? Even after coughing a few times, she wondered if "would it shake the embryo off?" Although the HCG (human chorionic gonadotropin) value of the blood test was good, and the doctor also let Rong Rong relax, but for safety reasons, she simply took leave to stay at home and stayed in bed every day.
On the 42nd day, Rong Rong went to the toilet as usual, and suddenly felt a large blood clot slipping out of her body, and when she looked down, the toilet was red, just like when she came to menstruation. "It's over!" Rong Rong felt that the sky was about to collapse, and wow wow wow crying, "It must be the baby fell!" Then the whole family rushed to pack up their things and rush to the hospital.
Fortunately, in the end, it was only a false alarm, and when she took the B super single and looked at the two small clusters inside that could already hear the fetal heart, she finally felt that the world was beautiful again. The doctor suggested that Rong Rong stayed in bed for the first time to protect the fetus, and prescribed progesterone for nearly two months, a needle every day, and when she finally did not have to hit it again, Rong Rong felt that her ass had become as hard as a stone.
Pregnant twins are much more difficult than single fetuses, because the uterus is in the anterior position, at 30 weeks, Rong Rong began to stay in bed to protect the fetus, stayed up to 36 weeks, and gave birth to a pair of healthy dragon and phoenix fetuses by caesarean section. At this point, her test tube journey was finally a victory!
After the three-child policy came out, friends joked that Rong Rong responded to the call for another one, and Rong Rong said that she did not dare to think of it - "The pain of doing test tubes, it is enough to suffer once!" ”
For almost every couple who do test tubes, especially the wife, they are under tremendous financial and psychological pressure.
It is understood that including examination and treatment, the cost of a cycle of IVF in public hospitals is generally between 38,000 yuan and 50,000 yuan; private hospitals range from 40,000 to 90,000 yuan according to service differences. More than half of the patients need two or more times to succeed, according to a promotion can be transplanted twice, more than three times unsuccessful some patients, the cost will be more than 100,000 yuan.
Secondly, a cycle of IVF requires patients to come to the hospital at least 10 to 20 times, and each time it is necessary to adjust the dosage of drugs, do ultrasound, inject blood and so on. As of December 31, 2020, there were 536 medical institutions approved to carry out assisted human reproductive technology in China, most of which were concentrated in first- and second-tier cities in economically developed provinces. Many patients can only choose to seek medical treatment in different places, and for them, the round-trip transportation costs, food and accommodation costs, and lost work expenses also account for a considerable part of the cost. Surveys have shown that about half of these women have to quit their jobs because of the perennial need for treatment.
In recent years, the call for THE inclusion of IVF in medical insurance has been very high, and the National Medical Insurance Bureau replied to Gao Li, a deputy to the National People's Congress, on September 15, "Suggestions on the Inclusion of 'Infertility' Auxiliary Treatment in National Medical Insurance to Increase Population Growth" undoubtedly made many infertility patients see hope. At present, the medical insurance department has included eligible birth support drugs such as bromocriptine, tripriline, clomiphene and other ovulation-promoting drugs into the scope of payment. The National Medical Insurance Bureau also said that in terms of diagnosis and treatment projects, on the basis of scientific calculation and full demonstration, the therapeutic assisted reproductive technology that medical insurance can afford is gradually included in the scope of medical insurance payment according to procedures.
Ivy is not the only way to go
For infertility patients, is there only one way to choose from IVF?
The answer is no.
At present, assisted reproductive technology mainly includes artificial insemination, gamete transfer and IVF (in vitro fertilization embryo transfer). However, in these three ways, the treatment of IVF has the highest pregnancy rate, and the current pregnancy rate of formal IVF specialists in domestic first-tier cities can generally reach 50%; the pregnancy rate of artificial insemination and general drug treatment is low, of which the pregnancy rate of artificial insemination is about 20%, and the pregnancy rate of drug treatment is only about 15%, so many people tend to do IVF and hope to "step in place".
Professor Liu Jianqiao, director of the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical University, has made statistics that the three hospitals of Guangzhou Medical University receive more than 10,000 infertile couples every year, and nearly 12,000 cases of embryo transfer surgery are performed every year. In these infertile couples, the proportion of people who really need to use assisted reproductive technology is only about 10%, "don't worry too much, there are some couples who can't have children temporarily as long as they wait patiently and can get pregnant directly, and some can also conceive through drug treatment or surgical treatment, etc., and only about 10% of them really need to do IVF." ”
Reproductive Medicine Center of the Third Hospital of Guangdong Medical College
But the reality is that although many reproductive experts regard IVF as the last step of assisted reproductive technology, in the semen, oocytes, pelvic environment, especially the fallopian tubes are abnormal, it is recommended to take drugs or artificial insemination and other means first, and finally ivory infant, but many patients who meet the indications of infertility do not have the patience to take the first step and the second step out of the comprehensive consideration of economic and temporal factors, often strongly require doctors to directly perform IVF surgery. They will even ask doctors to do the third generation of IVF technology, simply because the current "third generation technology is the most advanced".
"The difference in algebra is only to distinguish between different technologies, different technologies correspond to different indications, and there is no problem that three generations are better than one or two generations." Dr. Tan Ying of the Reproductive Medicine Center of Guangdong Reproductive Hospital said. The third generation of embryo preimplantation genetic testing (PGT) is more based on technology such as gene chips, targeting abnormal chromosome number structure, single gene genetic diseases, etc., if there is no genetic disease and rare disease, the third generation of technology is not used.
Compared with which assisted reproductive technology to use, fertility experts are more concerned about the age of patients.
Li Yuan, director of the Fertility Center of Beijing Chaoyang Hospital, found in the clinic that the age of patients has a great relationship with the success rate of assisted reproduction, with the increase of women's age, the pregnancy rate and live birth rate of assisted reproduction treatment are significantly reduced, compared with patients under 35 years old, the FRESH cycle live birth rate of ART (assisted reproductive technology) in patients aged 38-40 years old has decreased by 50%.
Professor Liu Jianqiao believes that the younger the age of the husband and wife, especially the age of the woman, the higher the success rate when doing IVF. "For example, if people under the age of 35 come to do it for the first time, their own conditions are good, and the success rate of only one embryo can reach 55%-60%, and if two embryos are released, the success rate is more than 60%. If the patient is 35-38 years old, the success rate may be only 40%; if it is over 40 years old, the success rate may be only more than 20%; if it is over 45 years old, the success rate may be only 5%. ”
This reminds people that IVF should also be done early.
"I very much hope that couples of childbearing age will establish their own fertility plans as soon as possible, after preparing to give birth, first understand the basic knowledge of fertility, and indeed when there is no result in a year of hard work, go to the regular obstetrics and gynecology department or reproductive medicine center as soon as possible to check which part of infertility is bothering you with fertility problems." After that, the doctor will take as simple and natural methods as possible to help you, and indeed when these methods are not effective, take assisted reproductive technology as soon as possible, so that a healthy baby can be obtained with relatively little intervention. When referring to the advice for infertility patients, Academician Qiao Jie of the Third Hospital of Beijing Medical College said so.
(At the request of the interviewee, ShiYa, Xiaoxiao, and Rong Rong are pseudonyms.) ）
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