As the leader of the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University, Zhou Canquan has been engaged in clinical and basic research on assisted reproductive technology and reproductive endocrinology for nearly 20 years. In the reproductive center where he works, nearly ten thousand cases of in vitro fertilization (IVF) treatments have been completed, and more than 4,000 infertile couples have had their own babies through various assisted reproductive technologies. Recently, a reporter visited Professor Zhou Canquan to learn about the development of IVF technology.
● Science and technology are the original driving force for social progress. Over the years, IVF technology itself has continued to develop, from intracytoplasmic sperm injection (ICSI) to preimplantation genetic diagnosis (PGD), humans continue to challenge nature to achieve the dream of freedom.
Ten years later, in 1988, China's first IVF baby was born at Peking University Third Hospital. Actually, hospitals like Guangzhou No.2 People's Hospital (now renamed as the Third Affiliated Hospital of Guangzhou Medical College) and the First Affiliated Hospital of Sun Yat-sen University were also researching this technology around the same time as Peking University Third Hospital. In 1989, the first and second IVF babies in Guangdong were born at Guangzhou No.2 People's Hospital; at the end of 1990, the IVF baby cultivated by the First Affiliated Hospital of Sun Yat-sen University also "suddenly appeared," marking that people in Guangdong could solve reproductive problems nearby.
Infertility is showing an upward trend
Zhou: Firstly, infertility treatment should not be delayed too long to avoid decreased fertility due to advanced age, which increases the difficulty of treatment. Secondly, the state has implemented an access system for assisted reproductive technology to ensure its benign development and protect the interests of patients. Patients should avoid seeking help from institutions that lack proper conditions for assisted reproductive technology, wasting time and money. They should seek standardized treatment at approved centers. In addition, since assisted reproductive technology carries certain risks, some of which can even be fatal, such as severe ovarian hyperstimulation syndrome, it should not be abused or used as a means to bear multiple babies, ensuring the safety of mother and child.
In fact, not everyone who hasn't conceived needs to undergo IVF; other simpler methods can solve many infertility issues, such as taking ovulation drugs or artificial insemination. However, some patients often say "I want to do IVF!" as soon as they arrive at the clinic. On the other hand, using assisted reproductive technology does not solve all infertility problems; the success rate of a single treatment is only around 30%. Current technology is not the "spear" that can penetrate all aspects of infertility. If one thinks these technologies "work immediately," that is also incorrect. People need to avoid these two extreme misconceptions.
But we are already on the way.
Throughout human history, reproduction has been an important parameter indicating someone's establishment of a family and career, and also a benchmark for whether a life or a family is complete.
We hope that with the maturity, simplification, and significant domestic production of products leading to lower costs, more patients will benefit.
Zhou: In general, natural conception requires a sperm density of more than 20 million per milliliter of semen, with over 50% having excellent motility. In ordinary IVF technology, one egg needs to be "attacked" by 50,000-100,000 sperms to possibly conceive. However, a situation we often encounter is that some husbands have oligospermia or asthenospermia, with insufficient sperm quantity or poor motility. Even if we place the sperm and egg in the same dish, the sperm cannot penetrate into the egg. Some azoospermia patients have sperm in their semen but it's like "a water tower with water, just the pipe is blocked." We can directly extract sperm from the male's testicles or epididymis. Thus, we began researching new technology: can we "catch" one or two sperms under a microscope? Later, based on tracking foreign new technologies, we pioneered the intracytoplasmic sperm injection (ICSI) technology domestically. By capturing just one sperm, we can inject this precious sperm directly into the egg under a microscope to fertilize it. Then, we transfer the embryo obtained after fertilization into the wife's uterus and wait for a new life to arrive.
● For those infertile couples who yearn for a child, the emergence of IVF technology is like a "fairy wand" that can break the curse. Since the birth of China's first IVF baby in 1988, for over a decade, IVF technology has helped countless couples realize their dream of parenthood, while in the past, they could only adopt a child or live with regret for life.
Assisted reproduction is not a "panacea"
Nanfang Daily: Is there anything you would like to remind patients?
Assisted reproductive technology still needs improvement
Nanfang Daily: Are you the first in the country to pioneer preimplantation genetic diagnosis (PGD) technology?
Modern "child-giving Guanyin" makes infertile people's dreams come true
Nanfang Daily: Have you noticed a rising trend in infertility in recent years from a clinical perspective?
Zhou: There are many! For example, how to effectively utilize frozen-preserved ovarian tissue in the future. This can be done before the ovaries may be damaged, such as before undergoing radiotherapy or chemotherapy. Another example is the research on nuclear transfer embryos and tissue engineering technology. If successful, it will solve the problem of organ transplant sources for humans, saving hundreds of thousands of lives. These technologies are actively being researched by us, and we have made initial progress. However, there is still a very long road ahead.
Zhou: Not at all. Currently, there are more than 6,500 known genetic diseases, and the number is increasing by more than 100 each year. The PGD technology can only solve a few genetic diseases with clear gene structures, such as thalassemia, hemophilia, some types of muscular dystrophy, and some chromosomal abnormalities. Most polygenic genetic diseases, genetic diseases with unclear gene structures, and some diseases that might be related to genetics but whose genetic backgrounds are unclear, such as certain cancers, currently cannot be solved by technology. Therefore, in the process of exploring this mysterious "mine" of humanity with science and technology, we have just drilled a small hole.
Two technologies pioneered nationwide
However, the intricate complexity of the human body has set up barrier after barrier for its own reproduction.
Countless couples have realized their dream of parenthood thanks to IVF technology, whereas in the past, they could only adopt a child or live with lifelong regret.
During the interview, we found that many patients vividly refer to these doctors as the "modern 'child-giving Guanyin'". Although experts told us that the success rate of these technologies per treatment is 38%-40%, and only 30%-35% of people eventually give birth smoothly, after all, these modern "child-giving Guanyins" gave them a chance to make their dreams come true.
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Zhou: Yes, since it is auxiliary reproduction, it is also constrained by the physical condition of both husband and wife. If the woman is over 35 years old, especially over 40, has obvious defects in the uterine lining, suffers from adenomyosis, severe endometriosis, extensive pelvic adhesions, etc., and the man suffers from severe oligospermia, azoospermia, long-term exposure to substances that can cause genetic defects, or severe chromosomal diseases and genetic defects, the success rate of treatment with assisted reproductive technology will be lower than that of general patients.
However, for some couples, having a child is an unattainable luxury. It wasn't until 1978 that the world's first IVF baby was born.
Nanfang Daily (hereinafter referred to as Nanfang): Chinese people's thoughts are still relatively conservative. In the past, many couples encountering infertility problems would not seek medical help proactively or believed that receiving treatment would result in children who were not biologically theirs. Has this phenomenon changed now? Article source: www.ynbb.net
Nanfang: Can this technology filter out all genetic diseases?
Nanfang: Are there still many unknown areas in human-assisted reproductive technology?
Zhou: Some couples carry genes for certain genetic diseases. If they give birth to a sick child, it will bring a heavy burden to the family and society. Through this technology, cells can be extracted from the embryo for testing, and only healthy embryos are implanted into the mother's uterus. For example, a couple, both carrying the same gene for thalassemia, have a high probability of giving birth to a child with the disease, but through PGD technology, they can achieve "selective reproduction" and ensure the birth of a healthy child. In May 2000, our hospital delivered the first healthy baby in China through PGD technology.
The initial IVF technology could only solve part of the reproductive problems for some couples, while for some husbands with oligospermia or asthenospermia, and some couples carrying genetic disease genes, it remained a "great obstacle" to conceive a healthy baby. Science and technology are the original driving force leading the era's development. In the development process of over a decade, human-assisted reproductive technology has crossed one barrier after another, such as the First Affiliated Hospital of Sun Yat-sen University pioneering ICSI and PGD technology domestically in 1996 and 2002 respectively.
- Journalist's Notes
Nanfang: IVF technology has developed for many years, helping many couples realize their dream of having a child, but are there still some unsatisfactory places in this process?
Zhou: Yes, from the most primitive natural reproduction between the sexes, to humans slowly learning to use science and technology to achieve reproductive desires, and then to the distant dream of freely solving various reproductive problems, this is the path for human reproductive activities to move from the kingdom of necessity to the kingdom of freedom, and it is still far away.
Reproductive Medicine Center Director Zhou Canquan of the First Affiliated Hospital of Sun Yat-sen University believes that selective reproduction can be achieved through PGD.
Zhou: Currently, China lacks reliable large-scale epidemiological survey data, but some related data at home and abroad show that some believe the infertility rate is 2.5%, some data claim it is 15%, and some data indicate that one out of every five couples is infertile. Due to differences in the timing and subjects of the surveys, the numbers vary greatly. However, overall, with factors such as increased environmental pollution, changes in lifestyle, and high mental stress in modern people, the possibility of an increase in infertility rates objectively exists.
Zhou: Under normal circumstances, the cost of conventional IVF at our center is no less than 25,000 yuan, ICSI technology requires around 30,000 yuan, and PGD technology, due to its complexity, varies greatly depending on the type of genetic disease diagnosed. Even for the more mature and simpler ones, it requires 40,000 yuan.
Nanfang: With the rapid development of modern medical technology, many couples have had genetically-related children, but this method is not "always effective." What symptoms can affect the effectiveness of assisted reproductive technology?
Zhou: Many group data about the development of IVF today show that the incidence of malformations in offspring delivered using IVF technology is no different from that of the normally born population. Many problems with IVF involve obstetric issues, as the high rate of multiple pregnancies increases the risks for both mothers and fetuses, resulting in higher miscarriage rates, more postpartum hemorrhages, and respiratory and developmental disorders in infants due to premature births. Despite IVF technology being relatively mature and multi-fetal pregnancy reduction surgery being available as a remedy, many issues still need to be resolved.
Editorial:
Director Zhou Canquan of the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University believes that selective reproduction can be achieved through PGD.
● For infertile couples who yearn for a child, the emergence of IVF technology is like a "fairy wand" that can break the curse. Since the birth of China's first IVF baby in 1988, for over a decade, IVF technology has helped countless couples realize their dream of parenthood.
Nanfang: Do many people care about the health of babies born through assisted reproductive technology? Are they different from ordinary babies?
Nanfang: What cutting-edge topics are currently being researched in the field of reproductive science?
Nanfang: Are the costs of assisted reproductive technology high for average families?
Zhou Canquan (hereinafter referred to as Zhou): In the past, there were misconceptions about IVF, thinking they were not the parents' "real flesh and blood." In fact, IVF babies are also the offspring of the combination of sperm and eggs from both parents. Embryos survive for 3-5 days in a "test tube" (nowadays, culture dishes are used), and then are transplanted into the mother's uterus. Normal growth and development of embryos still depend on the normal functions of reproductive organs like the uterus and the entire body system. Therefore, infants rely on the mother's body to grow normally. IVF only solves problems in a very small number of steps in the reproductive process and still requires many aspects of the body's original normal reproductive functions as guarantees.