On January 19, the "Special Focus" edition analyzed the reproductive difficulties faced by one-sixth of contemporary couples with the title "Why is it so hard for urban men and women to have a child?" What to do if all methods have been tried but still unable to conceive? Should ancient reproductive techniques be used? In that case, in vitro fertilization (IVF) would be the only choice. However - having an IVF baby is also difficult.
□ Reporter Chang Hui, Intern Li Pengyun
Supporting Experts:
- Sun Yingpu, Director of the Reproductive Center and Chief Physician at the First Affiliated Hospital of Zhengzhou University
- Zhang Cuilian, Director of the Reproductive Research Institute and Chief Physician at the People's Hospital of Henan Province
- Jia Xiugai, Deputy Director of the Obstetrics and Gynecology Department and Chief Physician at the People's Hospital of Henan Province
- Liu Zixia, Director of the Reproductive Medicine Center at the 91st Central Hospital of the PLA
- Bo Liwei, Associate Researcher at the Affiliated Hospital of the Henan Provincial Family Planning Scientific Technology Research Institute
◆ Reading Prompt: With the increase in infertility rates, human assisted reproductive technology has also been developing continuously. "Years ago, if the fallopian tubes were blocked, it met the government's adoption criteria, and one could get a certificate to adopt a child, but now IVF technology has given many previously hopeless couples their own children," said Zhang Cuilian. Since the birth of the world's first IVF baby in Britain in 1978, by 1998, the ratio of IVF babies to naturally conceived infants in Europe had reached 1:100, meaning that out of every 100 babies, one was an IVF baby.
However, doubts and concerns about IVF technology have persisted, and hospitals need to explain through the media.
Infertility should first be treated conventionally
"For IVF, people should first consider not whether they dare to do it, but whether they should do it," said Bo Liwei, who believed that the indications for IVF must be strictly controlled. He informed the reporter that 70% to 80% of male infertility patients can achieve pregnancy through conventional treatment, "For example, inflammation, psychological factors, etc., these should first undergo conventional treatment. Even if conventional treatment fails for certain diseases, such as congenital absence of the vas deferens, artificial insemination should be considered first. After all, the conception environment of IVF and natural conception cannot be completely identical, so natural methods are still the best." He said that human reproduction is naturally spontaneous, and the less artificial intervention, the better. Zhang Cuilian also stated: "Unless there is severe oligospermia or asthenospermia, insufficient sperm density and motility, and artificial insemination followed by uterine injection still fails to result in pregnancy, IVF should be considered. Generally, we suggest considering IVF after three or more unsuccessful attempts at artificial insemination."
Compared to male infertility, female infertility is harder to treat. Jia Xiugai informed the reporter: "Not to mention the many unknown causes of infertility currently, there are over 200 known factors that can affect pregnancy, and many cases involve multiple factors. Resolving one issue may lead to another, and the goal is to achieve pregnancy. Therefore, the cure rate for female infertility is not very high." She emphasized that the conventional treatment process must first be followed. "If infertility occurs, or if there are repeated miscarriages or fetal stops, we need to investigate the cause and exclude known factors." For example, if the problem lies with the uterus or fallopian tubes, targeted anti-inflammatory or unblocking treatments should be applied; if miscarriage or premature birth occurs after pregnancy, check whether it is due to thin endometrium, antibody issues, or environmental effects on sperm quality, then conduct targeted treatment. If no cause is found, non-specific treatments can be administered. Only after various treatments fail, or if the age is too advanced to complete this process, should IVF be considered.
IVF technology mainly overcomes fallopian tube blockages (also applicable to moderate to severe endometriosis, ovulation disorders, stubborn polycystic ovarian syndrome, unexplained infertility, and immune infertility, as well as male oligoasthenoteratozoospermia). Attempting IVF for other infertility factors will not be very helpful. Jia Xiugai said that IVF is not a universal panacea, nor is it the first choice. Whether or not to proceed with IVF should be judged by specialized doctors.
How much do you know about IVF?
As a technology that most people have not come into contact with, IVF has also gone through a process of gradually being recognized and accepted. "When we first started doing IVF, even people in our hospital asked how big the test tube actually was? Some doctors even thought babies were grown in test tubes. In reality, the embryo spends only about three days in the so-called 'test tube' before being implanted in the mother," said Sun Yingpu with a smile.
Are children born through IVF technology weaker or have developmental issues compared to regular children? Such questions arise because some believe that natural conception takes place in a dark, silent environment where sperm and egg combine in the fallopian tube fluid, whereas artificial assistance cannot fully replicate the natural conception environment, potentially affecting the embryo. But reproductive medicine experts told reporters that with the advancement of technology, the simulation of culture medium with human body fluids has improved, and the conception process strives to mimic a light-free environment. Currently, follow-up studies on children born through IVF show no significant differences compared to naturally delivered children. The world's first IVF baby already has their own child, which serves as a good proof.
Experts expressed that IVF technology indeed alleviates the distress of many infertile couples. As a technique recognized and promoted by numerous countries, it should be considered safe and trustworthy.
What is the success rate of IVF?
One of the most concerning questions for infertile couples considering IVF is the success rate. "They say the success rate is only twenty to thirty percent, why is it so low?" Many couples considering IVF are worried.
Currently, China does not have official statistics on IVF-related materials. From the UK government's official IVF website, I found that between 2005 and 2007, the success rate for women under 35 years old undergoing IVF in the UK reached 48%.
"When IVF technology first began, the success rate was indeed only twenty to thirty percent, but in recent years, with the maturity and improvement of the technology, the success rate has increased significantly," Sun Yingpu informed the reporter. Factors contributing to the increase in IVF success rates mainly lie in the improvement of drugs, culture medium, and breakthroughs in the technology itself. Liu Zixia introduced: "The technology is becoming increasingly developed. Previously, for severe cases of insufficient sperm count and motility, even if the ova and sperm were retrieved, if they couldn't combine, we were powerless. Nowadays, with the development of intracytoplasmic sperm injection (ICSI) technology, we can artificially assist the combination of sperm and ova into embryos."
Zhang Cuilian also believed that human factors affecting the success rate cannot be ignored, "The skills and experience of the operator are crucial. It's important to minimize intermediate processes to avoid excessive exposure of sperm, ova, and embryos. Operation times are measured in seconds, requiring stability, accuracy, gentleness, and speed. Additionally, the cultivation environment also plays a role."
Sun Yingpu explained: "It's like planting a seed in the ground; if it doesn't sprout, it could be due to poor soil or problems with the seed itself. Thus, failing once or twice with IVF does not mean it will never succeed, as the condition of each embryo and the mother varies each time."
Two Major Doubts About IVF
Is IVF painful? Some couples inquire whether IVF is a painful procedure. The concern among many stems from online accounts shared by previous participants. "Many online posts say it's extremely painful, some even claim they fainted from the pain. I've fainted before during a fallopian tube radiography, so I'm particularly afraid," one female patient expressed. Zhang Cuilian clarified: "During the IVF process, embryo implantation does not cause pain. There might be slight discomfort during the few minutes when eggs are retrieved, but it's not unbearable. Pain sensitivity varies from person to person, so some may feel more pain. Nowadays, there is painless egg retrieval technology available, where pain-sensitive individuals can opt for painless retrieval. This involves administering medication intravenously, allowing them to sleep for a few minutes."
Then, does painless egg retrieval, similar to painless abortion, excessively damage the reproductive system without sensation? "Egg retrieval needles are very fine; they just puncture, similar to an injection, rather than scraping the entire uterus as in an abortion. A needle hole heals easily and won't cause more damage than conventional methods," Zhang Cuilian explained.
Is IVF expensive? "I've heard that IVF costs around 100,000 yuan?" Many patients consult doctors about this. Is it really that expensive? According to information obtained from the Reproductive Centers at Zhengzhou University's First Affiliated Hospital and the People's Hospital of Henan Province—two of the earliest institutions in Henan to perform IVF—if the woman is under 30 years old and follows the normal procedure, the cost for one cycle of IVF is approximately 20,000 yuan. Using domestic drugs reduces the cost to about 8,000 to 9,000 yuan, and adopting natural cycle egg retrieval without using ovulation-inducing drugs brings the minimum cost down to just 5,000 to 6,000 yuan. The main factor influencing IVF costs is the woman's age and the type of drugs chosen.
Zhang Cuilian provided a detailed breakdown of the fee items and standards: IVF costs include pre-treatment physical examinations, ovulation-inducing medication, egg retrieval, incubation, implantation, and post-treatment progesterone and other drug support fees. Many of these are one-time consumable costs, such as a single egg retrieval needle costing over 400 yuan, a single transfer tube costing over 200 yuan, and maintaining a constant temperature and humidity environment for the culture medium costing over 3,000 yuan for three days. The operation fee during surgery is only over 1,000 yuan.
Sun Yingpu introduced: "Ovulation-inducing drugs are relatively expensive, and younger patients use about half the dosage of older patients, making this a significant cost difference." It is understood that a single imported ovulation-inducing drug costs over 300 yuan, while domestic ones cost around 200 yuan.
"The cost of IVF also depends on the chosen protocol. Nowadays, there are over a dozen protocols, among which the micro-stimulation protocol has garnered attention," Zhang Cuilian said. The micro-stimulation protocol reduces the use of ovulation-inducing drugs (injections), avoiding excessive stimulation of the ovaries. For instance, it was previously recommended that older women use more ovulation-inducing drugs, but since aging ovaries respond poorly, even with medication, only one or two eggs may be induced. Hence, it is now suggested that medication can be avoided, opting for natural cycles to retrieve eggs or taking oral medications instead, which cost about 3 yuan per day.
It is understood that if ovulation-inducing drugs are used and the results are good with a higher number of eggs, they can be frozen. If the first cycle fails, the second cycle only requires an additional 2,000 to 3,000 yuan for IVF. If there are no extra eggs left, a new egg retrieval is required, and apart from examination fees, the cost is almost the same as the first cycle.