Let assisted reproduction give birth to more "birth" opportunities
Half moon talking about reporter Gao Yuan to Sun Hao
In 2022, the natural growth rate of the mainland's population will be -0.60%, the first negative growth since the reform and opening up. The fertility issue has attracted much attention, and the state has successively introduced a series of policies to accelerate the construction of a fertility-friendly society.
At present, in addition to "not wanting to give birth", "wanting to give birth" also plagues many families. The data shows that the infertility rate of couples of childbearing age in mainland China has climbed to about 12%~18%. In the face of this reality, the demand for assisted reproduction has increased significantly, and the role of related technologies in promoting fertility is also increasing. However, many people still do not know enough about assisted reproduction, and its high cost has also deterred some infertility patients.
The reporter recently interviewed Yin Zhaohong, president of Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University, on this topic. He said that assisted reproductive technology is mature and is no different from natural conception in terms of maternal safety and the incidence of birth defects in newborns; At the same time, as the country gradually includes appropriate assisted reproductive technology projects into the payment scope of the medical insurance fund, the burden of assisted reproduction costs on patients is also expected to usher in a significant reduction.
The demand for assisted reproduction is on the rise
Banyue Tan: As the president of the maternity hospital, how do you see the significance of assisted reproductive technology in building a fertility-friendly society?
Yin Zhenhong: In the hospital, I have seen many families suffering from infertility, and I have seen many joys of giving birth to children with the help of assisted reproductive technology. I believe that through modern scientific and technological means, allowing more infertility patients to enjoy reproductive rights is to continuously meet the people's yearning for a better life. Our annual outpatient capacity ranges from 1.1 million to 1.5 million, and we treat about 30,000 infertility patients every year, and many infertility patients eventually give birth to healthy children using assisted reproductive technology. Therefore, from the national level, popularizing assisted reproductive technology to the general public and reducing the cost burden of assisted reproductive treatment is an indispensable and important part of the national population strategy, and it is also the proper meaning of building a fertility-friendly society.
Half moon reporter: Judging from the situation in Beijing Maternity Hospital, has the number of people using assisted reproductive technology increased significantly in recent years?
Yin Zhenghong: Judging from the situation in our hospital, the number of people using assisted reproductive technology is increasing year by year, and assisted reproduction related departments are often full. The obstetrics and gynecology departments of our hospital are national key clinical specialties, and the annual delivery volume in recent years is 10,000~17,000, accounting for about 1/10 of the newborns in Beijing. In order to better serve the majority of patients, we actively carry out the practical activities of "I do practical things for the masses", increase the number of outpatient sources, night clinics, and weekend outpatient services, and try our best to meet the medical needs of patients.
Yin Zhenghong (second from right) visits the mother's family of three in the ward
Half moon reporter: Data show that nearly 3% of babies in the mainland are born through assisted reproductive technology. What data do you have?
Yin Zhaohong: Beijing Obstetrics and Gynecology Hospital conducted a study with other hospitals in several provinces and cities to understand the situation of birth defects in newborns during the 13th Five-Year Plan period. In this study, we looked at 350,000 births, with a natural pregnancy rate of 95.3% and an assisted reproduction rate of 4.7%. This figure is higher than 3%, but considering that the participants in the study were all large hospitals, and the assisted reproduction rate in large hospitals is already higher. Overall, in recent years, due to the pressure of social life, the delay of childbearing age and other factors, the infertility population has gradually increased, and the infertility rate of mainland couples of childbearing age has reached 12%~18%, and the number of people using assisted reproductive technology has naturally risen.
Assisted reproductive technologies have matured
Half Moon Reporter: What kind of assisted reproductive technology is generally used in the mainland at present? Is it what everyone usually calls "IVF"?
Yin Zhao Hong: We generally say that there are three generations of assisted reproductive technology. The first-generation technique refers to artificial insemination, which is a technique in which sperm is injected into a woman's reproductive tract to conceive it. The second-generation technology is a technique in which the man's sperm and the woman's eggs are removed, fertilized in vitro to develop into embryos, and then transferred into the woman's uterus. Since the embryos are grown for a period of time in vessels outside the body, this technique is colloquially referred to as the "IVF" technique. Not all infertility patients need to do "IVF" directly, some patients can try "artificial insemination" first, which is not only less expensive, but also closer to the natural condition of the human body, less traumatic. Third-generation technology refers to assisted reproductive technology that performs genetic testing before embryos are implanted in the mother for some single-gene genetic diseases or chromosomal diseases; In layman's terms, the third generation of technology is to give the embryo a "physical examination" before implantation to reduce the risk of various genetic diseases. If there is no familial genetic disease, there is not much need for third-generation assisted reproductive technology.
Half Moon Reporter: How safe is the use of assisted reproductive technology?
Yin Zhenghong: Since the birth of the world's first test-tube baby in 1978, more than 8 million assisted reproductive offspring have been born around the world. The development of assisted reproductive technology in mainland China is also rapid and has been in line with international standards. Taking Beijing Obstetrics and Gynecology Hospital as an example, we have mastered assisted reproductive technology equivalent to the advanced level of foreign countries, and the clinical pregnancy rate, live birth rate and other indicators have reached a high level. In addition, the degree of localization in assisted reproduction related drugs, reagents, equipment, etc., is also gradually increasing. Years of clinical practice have proved that assisted reproductive technology is mature and is no different from natural conception in terms of maternal safety and the incidence of birth defects in newborns.
Half Moon Reporter: To what extent can assisted reproductive technology solve the problem of infertility?
Yin Zhao Hong: Assisted reproductive technology can solve some infertility problems, including infertility caused by "sperm and eggs cannot meet" caused by fallopian tube factors, severe asthenospermia in men, severe teratospermia, chromosomal diseases, etc. However, assisted reproductive technology is not a panacea, such as patients with premature ovarian failure, ovulation with little or no ovulation, and with the decline in egg quality, it cannot be completely solved by assisted reproductive technology. There are also some patients who have planted high-quality embryos many times, but they cannot conceive, and their etiology is complex, and clinical research is needed to continuously explore effective treatments. In conclusion, assisted reproductive technologies can help, but for couples who want to have children, age is still the most important factor to consider.
The cost of treatment is expected to fall significantly
Half Moon Reporter: Generally speaking, how much does it cost to use assisted reproductive technology?
Yin Zhenghong: The cost of assisted reproduction is calculated according to a cycle, which includes preliminary examination, egg retrieval, in vitro fertilization, embryo culture, embryo transfer and other links, which takes about 3 months and costs about 30,000 yuan. If it goes well, one cycle can succeed; Of course, there are also many people who fail in a certain part of this cycle, and need to come back to another cycle, and the cost will increase accordingly. In addition, during the implementation of assisted reproductive technology, the woman needs to run to the hospital frequently, which will inevitably delay work, and people who are far from home also have round-trip travel expenses, accommodation fees and other expenses, so assisted reproduction will bring a greater economic burden to many families.
Medical staff nursing a newborn baby Photo by Cao Jianxiong
Half-moon reporter: The National Health Insurance Administration said not long ago that it will gradually include appropriate assisted reproductive technology projects into the payment scope of the medical insurance fund. To what extent do you think this will reduce the burden on patients?
Yin Zhaohong: Including assisted reproductive technology projects in the payment scope of the medical insurance fund is the expectation of the masses and an inevitable requirement for building a fertility-friendly society. At present, the detailed rules have not yet been issued in various places, and I personally hope that the basic items in assisted reproductive technology can be included in the scope of medical insurance payment, which will help patients save more than 60% of the cost, not only greatly reduce the economic and psychological burden of patient treatment, but also further compress the illegal trading space such as "having children by belly" and "surrogacy outside marriage", and alleviate social conflicts such as family disharmony caused by "not being able to give birth".
Half Moon Reporter: For infertility patients, what need special attention?
Yin Zhenghong: I have come into contact with many infertility patients, and many people have misunderstandings about this condition and assisted reproductive technology, and it is necessary to make some reminders. First of all, be sure to choose a regular hospital, find out the cause of infertility as soon as possible, and then formulate a reasonable treatment plan under the guidance of a professional doctor. Some patients like to seek remedies, which not only cost a lot of money, but also delayed the treatment time. Secondly, the mainland prohibits gender screening and illegal surrogacy, and some so-called underground channels have greater safety risks, so we must be vigilant. Finally, to maintain a good attitude, not too much psychological burden, too much psychological pressure, treatment of infertility requires enough patience and confidence, do not rush. (Contributor: Zhao Yawei)
(Published in Half Moon Talks, Issue 6, 2023)