Assisted "baby-making": the infant holding rate under the age of 30 exceeds 55%

Assisted reproductive technology refers to the technique of conceiving an infertile couple through medically assisted means, including artificial insemination, in vitro fertilization- embryo transfer and its derivation techniques, which consist of four stages: the examination stage, the ovulation induction stage, the egg retrieval stage, and in vitro fertilization, culture, embryo transfer and post-transfer treatment.

With the change of fertility policy, problems such as difficulty in giving birth at an advanced age and infertility have become more prominent, so assisted reproductive technology has also received more and more attention. The reporter noted that in the past six months, Shanghai, Hebei, Henan, Tianjin, Shaanxi and other provinces have successively issued the "Human Assisted Reproductive Technology Application Plan (2021-2025)", and in the "Women and Health" section of the "Guangdong Provincial Women's Development Plan" recently released by Guangdong Province, it is also mentioned again to "standardize infertility diagnosis and treatment services; standardize the use of human assisted reproductive technology".

What is the current status of assisted reproductive technology? The reporter interviewed Professor Liang Xiaoyan, director of the Reproductive Center of the Sixth Affiliated Hospital of Sun Yat-sen University.

Text, photo/Guangzhou Daily all-media reporter Cheng Yilun

During the interview, the reporter learned that although the total demand for assisted reproduction has not increased significantly, for families with advanced reproductive age and infertility, assisted reproductive technology is still an option.

IVF technology is ripe

The age of the parents determines the rate of live births

Professor Liang Xiaoyan said that at present, the outpatient volume of the Reproductive Center of Zhongshan Sixth Hospital is about 20,000 person-times/month, and nearly 9,000 egg retrieval operations are performed every year.

According to the "2017 Statistical Bulletin on the Development of China's Health and Health Undertakings", the infertility rate of couples of childbearing age in China has climbed from 2.5% to 3% in the 1980s and 1990s to about 12% to 15% in recent years; due to environmental changes, delayed childbearing age, life pressure and other factors, the number of infertility has increased, which makes assisted reproductive technology more and more accepted.

According to Professor Liang Xiaoyan, according to the hospital's data, most of the families who come to "make babies" through assisted reproductive technology are first-born families or two-child families, and the proportion of families who choose to have three children through assisted reproductive technology is only 2%. Liang Xiaoyan revealed that the content of patients' consultation at the reproductive center of the hospital is still based on the success rate of pregnancy at the age of 35 to 40, the risk and the impact on the health of children.

"After the introduction of the two-child policy, the total demand for assisted reproductive technology has indeed seen a short-term increase, and from the perspective of the number of consultations and surgeries in our hospitals, there have been more obvious fluctuations, but over time, this fluctuation has also quickly stabilized." Professor Liang Xiaoyan revealed that this phenomenon is mainly because the people who choose IVF are often mainly people over 35 years old, and there are indications for IVF. According to data from the Reproductive Center of Zhongshan Sixth Hospital, in November 2021 alone, 25% of the people under 30 years old, 20% over 38 years old, and more than half of the people who underwent IVF surgery in the hospital were between 30 and 38 years old.

Professor Liang Xiaoyan said that after decades of research and application, the current IVF technology has been quite mature. "At present, our technology has made significant progress, such as the improvement of egg quality and the improvement of culture liquid composition. But this progress is implemented at the practical level, and it is not possible to satisfy every family. Clinically, we talk about the infant holding rate, the maternal infant holding rate under 30 years old can reach more than 55%, but only 15% to 25% over 40 years old. ”

This data is also basically consistent with the relevant data on the live birth rate of China's assisted reproductive technology treatment cycle released by the Reproductive Medicine Branch of the Chinese Medical Association in 2018: 48.09% under 35 years old, 39.91% at 35 to 37 years old, 26.41% from 38 years old to 40 years old, 12.07% from 41 years old to 42 years old, 5.69% from 43 years old to 41 years old, and 5.27% from 44 years old to 44 years old. The basis for improving the live birth rate is high egg quality, but at present, in clinical research, improving egg quality is still a major challenge, "The first factor that determines the success rate is still the age of the parents, so we call on everyone to be born when they should be born." Instead of hoping to improve egg quality through technology, fertility should be completed at the right age. ”

"Studies have shown that the quality of eggs is the best at the age of 25 to 35 years old, and beyond this stage, the egg (quality) declines significantly, especially in women of advanced age, the rate of egg chromosomal abnormalities is very high." Professor Liang said.

Someone strives to finally "realize the dream"

Someone keeps the excess embryos for later

The development of assisted reproductive technology for the potential of "making babies" cannot be ignored. Professor Liang said that one of the patients she received finally "realized his dream" after many efforts: at that time, the patient underwent six consecutive IVF operations in the outer hospital, but each time was an early death due to heart abnormalities shortly after the birth of the child, which caused psychological harm to the patient and his family. "Finally, we used the third generation of IVF technology to screen her embryos, select genetically abnormal embryos, re-transfer genetically normal embryos, and successfully help patients conceive healthy children." Professor Liang Xiaoyan said.

Some insiders said that at present, among the families who come to consult the birth of IVF, there are many families facing special circumstances, such as the first child who is found to have a physical defect after birth, or a family that has lost its independence. These struggling partners seeking help with assisted reproductive technologies often belong to elderly couples.

On December 23 last year, Ms. Shi from Guangzhou walked into a reproductive medicine center for the third time for a preconception examination. The 43-year-old is already a mother of two children, looking back on her pregnancy journey, Ms. Shi is particularly emotional: in 2018, because she has reached the age of 40, Ms. Shi, who has been married to her husband for two years and has not been able to have children, finally chose artificial insemination and gave birth to the first and second children through IVF. "Two assisted reproductions have allowed me to have both children, and now the country has opened up three children, and I was thrilled when I saw the news." Because my husband and I are only children, the older we get, the more we feel that children are the best companions. While I still have eggs, I want to take good care of my body. ”

Some patients, although they do not currently have the intention of having a second child, said that because the first child is born through assisted reproductive technology, there are still remaining embryos frozen in the hospital, so it is not excluded that there will be plans to have a second child in the future. "When we gave birth to a child, we succeeded after only one operation, and now there are still some embryos stored in the hospital, if future conditions allow, we still have plans to have a second or even a third child." Ms. Hu, 35, said.

It is understood that after the successful embryo transfer, 60% of families will choose to continue to save excess embryos for the second or third child.

Source: Guangzhou Daily