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Column expert introduction
Li Kunming
Shanghai First Maternity and Infant Health Hospital
Chief Physician of the Department of Assisted Reproduction
Associate Professor, Doctoral Supervisor
Specializes in infertility and assisted reproductive technology: IVF, artificial insemination, and menstrual disorders, endometriosis, polycystic ovaries, etc.
Text/Li Kunming
Edit/Mona
As we all know, the comprehensive two-child policy was officially implemented on January 1, 2016, and the policy stipulates: adhere to the basic national policy of family planning, improve the population development strategy, fully implement the policy that a couple can have two children, and actively carry out actions to deal with the aging of the population. After May 31, 2021, the three-child policy will be fully rolled out, encouraging everyone to have more children and making population reserves for national development.
Since the liberalization of the policy, there has been a wave of fertility upsurge, but from the perspective of the absolute number of births and the birth rate of the country, it is still not optimistic. In the most recent year of 2021, 10.62 million people were born, with a birth rate of 7.52 per thousand; 10.14 million deaths, with a mortality rate of 7.18 per thousand; and the natural growth rate was 0.34 per thousand. The country's population of 504 million people, including 385 million floating population, will increase by 480,000 in 2021, the lowest since 1962.
Of course, in daily clinical work, we will often face couples with second and third children. The survey shows that 60% of women with two or three children are over 35 years old, and most of the women who urgently have a second child are over 40 years old.
In 2015, the ovarian low response expert consensus of the Reproductive Medicine Branch of the Chinese Medical Association was limited to ≥40 years old for elderly women, and the reproductive function of elderly women decreased, mainly manifested as a decline in ovarian reserve function, a decrease in the response to drug ovulation, an increase in the incidence of low response, a decrease in the number of eggs obtained, and a decrease in egg quality, which brought about an increase in the probability of aneuploidy of the embryo, an increase in the probability of embryonic abortion, and an increase in the risk of mother and child during pregnancy.
So for friends who have two or three children, what do you need to pay attention to?
1
Fertility consultation
Need both husband and wife to see a doctor, especially elderly patients, in addition to the routine physical examination, it is more necessary to check fertility, such as sex hormones, the number of sinus follicles, sperm quality, a comprehensive assessment of physical health, while making necessary adjustments to the lifestyle, friends of this age, work pressure, socialization, and some tobacco and alcohol habits, these have to be adjusted, the so-called "desire to do good, must first use the weapon."
02
Quasi-natural pregnancy or assisted reproduction
The doctor will decide whether to try pregnancy naturally or assisted reproduction according to your test results, not every patient has to do IVF, if the natural pregnancy conditions are available, you can try pregnancy yourself; of course, for the following cases, it is recommended to assist fertility treatment: women over 38 years old in tubal infertility, or patients with abnormal diseases in the III-IV period, or severe hypothrospermia in men, etc., especially patients with low ovarian reserve (AMH<1.1ng/ml) in women should actively respond.
Also, do you want to take a "three-generation" test tube? For women over the age of 38, patients with good ovarian reserve, who can get pregnant before but are prone to fetal arrest can be considered, "three generations" is optional and not mandatory, this needs to be discussed with their own needs and doctors.
03
Previous mode of delivery
Whether the previous birth was a vaginal birth or a caesarean section is very important for infertile couples who need to have a second/third child, especially friends with frozen embryos.
If you have had a vaginal birth, the uterus has not had fibroid removal surgery, there is no partial cervical resection surgery (LEEP), there is no internal and surgical disease, and you can tolerate and accept twin pregnancies, then it is completely possible to transplant two frozen embryos, the pregnancy rate is higher, of course, followed by about 25% of twin pregnancies. If we only accept a single pregnancy, then we transfer only one embryo.
If the previous mode of delivery was by caesarean section, it is recommended to transfer only one frozen embryo when performing frozen embryo transfer, and in order to improve the pregnancy rate, single blastocyst transfer can be considered.
04
Keep in a good mood
Based on my clinical experience and clinical data, most women with second/third child needs who undergo frozen embryo transplantation have a high success rate, which is higher than that of their peers.
One of the reasons is that frozen embryos are embryos when the patient is relatively young, the quality is relatively good, as long as the frozen recovery is passed, the implantation rate is maintained at the level of the age group of the patient's egg retrieval;
Another reason is that most of them are very relaxed, there is already at least one child in the family, the attitude towards the second child / third child, relatively more Buddhist, there is the best, no can also be accepted, under the blessing of this attitude, it is easier to get pregnant.
I wish that friends who need two/three children can get pregnant smoothly, and friends who are still working the way to one child do not have to envy and hate, maybe before long, the second treasure and the third treasure will also come!
This article is reproduced from Dr. Li Kunming's popular science article, the copyright belongs to Dr. Li Kunming, if there is any infringement, please contact xiaobian to delete