In 1978, the first case of IVF Louise Brown was born in the United Kingdom, and ten years later, the first case of IVF in China was born in the Third Hospital of Beijing Medical College. In the more than four decades since the development of IVF technology, it has brought new life to more than 8 million infertile families around the world. It is used by infertility patients as a path to salvation. It's been hard, but it's full of hope.
On the morning of December 8, 2016, 36 hours in advance, after the HCG injection (also called night injection, which is to simulate the LH peak to promote the final maturation and ovulation of oocytes), empty the bladder, naked and lying on the operating table, the operating room was a little cold and a little dark, I was waiting for an egg retrieval operation, which was the most important step I tried to do IVF.
"Spread your legs, put them on your legs, and don't move around." My surgeon and nurse appeared, who gently propped open my vagina with a peepire, and then used the surgical forceps to clamp a disinfectant towel dipped in saline and cleaned it inside and out along the propped vagina.
After eating the doctor's dolling in advance, I only felt some cold whizzing in my lower body, and when the doctor put the sterilized probe into the vagina, I knew that the operation was about to begin.
△ (Egg retrieval surgery is underway.) Photograph: Zou Biyu)
Under ultrasound guidance, the slender needle in the doctor's hand entered the pelvic cavity through the vault of my vagina and reached the surface of the ovaries. And the deep needle in the follicle cavity through the negative pressure suction constantly adsorbed, "Oh, poof..." I felt a numb tearing sensation, not painful, but very swollen.
As the feeling of swelling became more and more frequent, I began to feel a little nauseous, but I did not dare to move, and I could not tighten my ass because of nervousness, because as long as I moved, the puncture needle would easily puncture and cause the egg to shatter.
The procedure lasted less than 10 minutes, but the procedure was unforgettable.
△ (Containing a container containing follicle fluid, the operating room doctor will put it into a small test tube after successful egg retrieval, and then the staff will immediately take the test tube to the doctor in the laboratory for the next test.) Photograph: Zou Biyu)
Half an hour later, the surgical notebook that the nurse handed me clearly stated: The number of eggs retrieved was 19. At the same time as me, there was also my husband's self-sperm retrieval session. He abstained from sex 4-7 days in advance, and obtained sperm through DIY (do-it-yourself) in the sperm extraction room next door to the egg retrieval operating room.
The sperm and eggs will be combined in the embryonic laboratory and returned to the hospital after three days to check the number of embryos. The number of embryos, in a sense, is the number of lives. Therefore, egg retrieval is often regarded as the most important step by patients with the IVF cycle.
My husband and I have been with me for many years, months of frequent disorders, when I went to the hospital at the age of 24 for a comprehensive gynecological examination and learned that I had PCOS polycystic ovary syndrome.
This is a common reproductive endocrine metabolic disorder characterized by menstrual abnormalities and ovulation abnormalities, clinical manifestations of hyperandrogens, or polycystic changes in the ovaries under ultrasound, with the main clinical manifestations being irregular menstrual cycles, infertility, obesity, hirsutism, and/or acne.
At that time, I was still young and didn't take it seriously, but I remember the attending doctor saying, "You have many and small follicles, you don't grow up, and it's very difficult to conceive." ”
Fast forward to my 28th birthday, my friends around me have given birth to children one after another, and then they all began to care about when I would be born...
I never used contraception all these years, but I never got pregnant, my husband was an introvert, spoiled me, I could feel his desire for children, sometimes I could sneak through the traces of his mobile phone to find him looking for a way to solve the problem, but he didn't say anything to me.
Having a baby suddenly became a matter that had to be solved and was in front of me. I began to use my rest days to wander around the gynecological clinics of major hospitals, and the answer was "polycystic, recommended test tubes".
After receiving the unanimous advice from the three general hospitals, I said to my husband, "I'm going to quit my job and concentrate on IVF." After listening to my words, he looked at me with some shocked eyes, rubbed his hands again and again, and then hugged me tightly.
After national day in 2016, I stepped through the doors of the fertility hospital for the first time.
Although there was an advance reservation, I still made a big rush early in the morning. But unexpectedly, at five o'clock in the morning, the hospital gate was already lined with patients who were seeing patients, and I tried to tiptoe, but I still didn't see the head of the person in the front.
△ (People queuing at the entrance of the reproductive hospital.) Source: Courtesy of the author)
According to the "Survey Report on the Current Situation of Infertility in China" jointly released by the Chinese Oral Association and the National Family Planning Commission, the incidence of infertility in China is 12.5% to 15%, and the number of patients has reached 50 million, accounting for 12.5% of the total population of childbearing age, that is, one in every 8 couples will have infertility problems.
IVF became the last hope of our group.
In the genetics and reproduction department of a private hospital, no matter what the cause of infertility, there will be a set of assembly line examination steps after seeing the doctor. On the day of the consultation, the doctor gave me and lao Public a complete set of examination sheets, a full 17 pages.
Because homework is done in advance, the woman's examination needs to be done within the 2-5 days of menstruation and within one week after the end of menstruation, so I deliberately chose the first consultation time on the regular holiday.
The husband spent a day to complete this set of tests, which involved: semen routine, prostatic fluid routine, chromosomal examination, blood routine, thyroid function and preoperative four (hepatitis A, hepatitis B, syphilis, AIDS) and other tests.
The examination items that the woman needs to do cover six items of sex hormones and vaginal ultrasound, which are to check the situation of the woman's uterus and ovaries. Routine leukorrhoea, mycoplasma, chlamydia, and gonococci tests are done to see the underlying infection. Blood tests are the same as in men, including blood routine, thyroid function, and preoperative four items (hepatitis A, B, syphilis, AIDS).
Finally, there are Pap smears (TCT), chromosomes, and AMH tests, of which AMH tests are very important indicators to assess a woman's ovarian function and ability to conceive.
When all the test reports are out, the doctor will screen each person according to the specific situation, select those patients who can only be conceived by IVF technology, and arrange the IVF program. Once the plan is established, it is officially "entered into the cycle".
What is a "feed cycle"? It means that you and your husband have passed the final audit after the preliminary examination and reached the standard of IVF. That day, the medical assistant changed a special case manual for me, and when I held the blank book, I was a little scared, I didn't know which page of the book would be recorded, I would succeed. It's like a book with no exact answers, full of unknowns.
Specific IVF regimens are generally divided into: ultra-long regimens, long regimens, short regimens, antagonist regimens and microstimulation regimens. They are mainly named according to the length of the cycle time, but also involve subtle differences in medication. The specific choice of option is determined by the patient's own medical history, some patients will have a cycle of up to several months, and some will complete the entire IVF process within a month.
According to the examination report, my ovarian function is relatively good, and the doctor chose the ovulation induction program for me.
The long program is currently the most commonly used ovulation induction regimen and is suitable for most infertility patients under the age of 40.
In layman's terms, the IVF cycle is to let the eggs in the mother's body grow and develop together on a unified starting line to maturity through medication, and then surgically remove.
Because normal women follow the natural physiological cycle, the follicle follows the law of recruitment, selection, growth and development to maturity, it will only appear one dominant follicle and eventually discharge, and the other follicles will be atresia.
After the doctor took me in, he asked the nurse to prescribe me a 17-day dose of downgrade, Dafelin.
Daferin can be used in combination with gonadotropins in in vitro fertilization-embryo transfer (IVF-ET) to allow many follicles to develop synchronously, induce ovulation, and increase the number of follicles in IVF surgery.
According to the doctor's advice, the injection needs to be injected every morning, so every day when I get up, I will carry the ice bag containing the injection, walk to the nearby community hospital for injection, and sometimes the nurse who injects will ask a question of concern, but I can clearly feel their strange eyes, and I always smile and say, "No way, I can't get pregnant." ”
Even medical staff will look at this matter with colored eyes, which is even more difficult for ordinary people to understand. Since then, I've been deliberately trying to avoid letting people know I'm doing IVF. There's no empathy in this world, and I just want a child of my own.
After the long and difficult downgrade cycle, I returned to the hospital and upgraded to a "second-level player" and entered the promotion cycle.
The stimulation cycle involves blood draws, injections, and ultrasound monitoring, repeating and repeating until the follicle matures. Injections are given during ovulation to develop follicles rapidly, blood is drawn to see changes in hormones in the body after daily injections, and ultrasound B is used to directly observe the growth of follicles.
In order to be able to produce results in the morning, I would rush to the outside of the hospital in the early morning to queue up, and there were always raw or familiar faces around me. Most of the time, everyone bows their heads and clings to their secrets.
The injection is performed after the blood is drawn, and the induction and lowering needles are inserted into the abdomen two or three fingers away from the navel once a day. After each injection and other reporting time, I sat in the hallway of the hospital for a while, watching those who had the same fate as me hurry through in front of my eyes.
The state of anxiety, nervousness, nervousness, and fatigue looped across their faces, and looking at them, I felt as if I were looking at myself in a mirror.
I vividly remember one morning, after the eldest sister in front of me typed a blood draw report from the machine, she sat on the ground and cried, and she kept saying like a repeating machine, "It's been seven times, why can't it work?" Surrounded by silent people who did not yet know our fate.
No one dared to help, it lasted about 10 minutes, the eldest sister wiped her face and stood up, she took the paper that pronounced "life and death", kneaded it vigorously, threw it into the trash can in the corner, went downstairs alone, and left without looking back.
△ (Acupuncture drug gonafine, is a recombinant gonadotropin, used during ovulation induction, with gonafen can stimulate multi-follicle development. It needs to be inserted into the abdomen two or three fingers away from the navel. )
The B ultrasound monitoring room every morning is another scene, the door is full of more than a hundred people standing locally, like "prisoners" letting the wind line up to advance towards the B ultrasound room, although the four machines in one room have been spinning non-stop, they have to wait for hours to arrive.
△ (People waiting in line for B ultrasound Courtesy of the author)
I cycled back and forth on days like this, when my arm could no longer find the right place to draw blood, and my stomach was no longer intact to insert needles, and the follicles in my ovaries were finally about to mature. After the ultrasound monitoring, the doctor arranged a time for me and my husband to take the eggs and sperm by themselves. The medical assistant took the list and told me in detail the details of the operation day word by word.
When I took the order, I was suddenly a little afraid - I was going to the "battlefield".
Because the egg retrieval surgery stimulated the ovaries, in order to prevent ovarian pedicle twist and ascites, I lay at home for three days, returned to the hospital after three days, and the ultrasound showed that the ascites was still severe, so the doctor canceled my fresh embryo transplantation, saying: "After three menstrual cycles, the hospital entered the week (period) again, and transplanted frozen embryos."
The only fortunate thing is that the 19 eggs taken were eventually matched into 6 embryos, although the grades are somewhat different, but all meet the requirements of frozen embryos, and they will be frozen in a liquid nitrogen tank at minus 196 degrees Celsius.
△ (Doctors observe the growth of fertilized embryos under a microscope.) The fertilized embryos will be cultured in a laboratory setting for a period of time, after which the doctor arranges surgery again according to the situation, placing the embryos into the patient's uterus. Photograph: Zou Biyu)
And a 37-year-old sister who entered the cycle with me, this time it is the third egg retrieval, she has tried the long program, microstimulation and antagonist regimen, but the previous embryos are still out of bed, this time 7 eggs were retrieved, and finally none of them were matched.
The last time I saw her, she said to me, "I don't try, I've been too tired for a few years." You're still young, keep it up. "After that, I never saw her again.
There is no way to put in fresh embryos, so you have to wait for another three months of frozen embryo transfer. And I look forward to May with the mood that seems to have won the victory.
After entering the week again, I began to move between the hospital and my home again, somewhat like when I was in school, and I had to complete tasks every day. The body had long been accustomed to the pain of flesh and skin, as if there was no pain, but the long wait and repeated examinations consumed most of the expectations, and when the physical indicators were once again qualified, the doctor set me to transfer the embryos on June 1.
On a very good day, at 10:31 a.m., in the dark operating room where the eggs were retrieved, I lay on the original operating table, waiting to merge with the embryo.
The doctor took the assistant and handed over the embryo that had been resuscitated in advance, repeating it over and over again, "Please tell me what your name is and what your husband's name is." ”
Although fingerprint recognition and portrait confirmation have been carried out long before the operation. But I know that they are making a final confirmation, because there is no room for confusion in ethical and legal issues.
After confirming that there was no error, also under the guidance of ultrasound, the doctor slowly inserted the external tube into the vagina, followed the cervix to the uterine cavity, and selected a warm soil in the uterus for my embryo and placed it. The whole process took less than 2 minutes, but I had a feeling of being in a trance.
It took 14 days to wait for the "lottery", but on the eighth day after the transplant, I measured two bars that had never appeared before with the test strip, looking at the looming "squadron leader", I was very happy every day, I began to talk to my husband, what kind of bed we want to buy, what kind of supplies to buy, which hospital to go to give birth to the best, you can obviously feel, my husband is also very excited.
On the day I went back to the hospital to "draw the lottery", the weather was particularly good, I felt that the sun was warm, and I was also warm. I arrived at the hospital very early, in time for the first blood draw, and got the results at noon, which said hcg33.3, pregnancy.
Before I could wait for the doctor's consultation, my lower body began to bleed. After the doctor's examination, he shook his head while telling me, "According to clinical experience, hcg33.3 after 14 days of transplantation is a biochemical pregnancy, stop taking the drug, and go home to wait for a spontaneous abortion." ”
At that time, the head "buzzed", how could the pregnancy wait for a natural abortion? Am I hearing it wrong? Is the doctor reading it wrong?
The doctor told me in a calm tone, "Biochemical pregnancy refers to the early miscarriage that occurs within 5 weeks of pregnancy, and a positive can be detected in the blood draw and pregnancy test strips, but the ultrasound can not see the pregnancy sac, it is also called 'subclinical abortion'." There are many reasons for biochemical pregnancy, generally embryo quality problems, survival of the fittest, is common. A lot of people have this situation because there are no labor pains, so most of them don't know it. ”
In this way, my first IVF experience ended in failure.
During the days when I went home to recuperate, I was extremely depressed, crying and throwing tantrums at every turn, and could not see any news related to my children. Sometimes I dream, I dream of those scenes of queuing in the early morning, walking through the crowded aisles, countless injections of medicine into the body, countless tubes of blood pumping out of the body, all kinds of cold instruments swimming in the body, and accompanied by a long wait for the results of the test...
Since the beginning of the pregnancy, the pain of the body is only the pain of the skin and flesh, and the sense of loss in the heart after the failure has reached the heart, making people have no power to fight back.
The feeling was magnified little by little, as if it was about to swallow itself up.
"The child is fate, and when he comes, we can't decide." Even without children, we'll be fine. "My husband saw my melancholy.
"But I want to be a mother, and I want to give birth to our child."
"Then rest first, and when we're ready, we'll try again." The husband said cautiously.
"What if it fails again?"
"You and I!" I will always be with you. The husband's eyes were unusually firm.
After a full summer of rest, I went through various examinations again, there were more bruised indentations on my arms, dozens of needle eyes were added to my stomach, and looking at the needle eye scabs in my stomach, I told myself to look at the opening point, because the more I cared, the more likely I was to lose.
On Halloween, the two embryos were once again put inside and I took the baby home.
Cautiously lying at home for 14 days, I never got out of bed except for eating and going to the toilet. Although the limbs were a little numb, they did not dare to move around casually, for fear that something would fall out, for fear of waiting for a disappointing result.
It was the day of the lottery again, I was sleeping, after drawing blood, sitting in the corridor of the hospital, I personally experienced what is called the degree of seconds like a year, until my husband handed me the result, which said: hcg290, pregnant.
My hands holding the report trembled uncontrollably, and tears welled up, only this time it was tears of happiness that finally succeeded.
△ (The child's first B-ultrasound photo.) Courtesy of the author)
For the next three months, I still needed to inject progesterone every day to save my tire. And the body because of the non-absorption of the needle medicine appeared countless lumps, often painful to the point of not being able to sleep.
Subsequently, I experienced a big blow, and the B ultrasound showed that one of the twins did not have a fetal heartbeat. Fortunately, the dead embryos were slowly absorbed by the body, and I was afraid to carry the remaining child until her condition was completely stable.
By the summer of 2018, in the days of the previous year's biochemical pregnancy, I had harvested the best gift, my daughter. And those moments that I thought I couldn't survive, like the scabs of needle eyes, remained in my heart forever.
△ (The best "gift" came to us.) Source: Courtesy of the author)
News of discarding newborn babies and abusing children can often be seen on the Internet. I guess maybe their children came too easily, easy enough to give up and torture at will. Or maybe they think it's a very fault-tolerant and very low-cost thing.
But no one will forgive them, because they will never understand how much disappointment and pain someone has experienced in order to have a child.
In April, my husband and I decided to add another brother or sister to our daughter, and in the countless mornings that followed, I would be in the invisible line at the entrance to the hospital. Of course, there is no shortage of flesh and skin ahead, but there are also unknown new life will bring hope and joy, making me feel that all of this is worth it!
Review expert: Liu Dong'e 丨 Chief Physician of Reproductive Medicine Center of Xiangya Hospital, Central South University
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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