Test-tube baby

　　The causes of IVF should be considered from both male and female sides. If any factor is abnormal in the conditions for conception, it can hinder conception.

　　1. The causes of IVF include male factors accounting for about 40% of the cases. (1) Factors affecting sperm production: such as congenital maldevelopment of the testes or cryptorchidism, which do not produce sperm, or acquired inflammation, such as tuberculous orchitis or varicocele affecting sperm production. (2) Factors affecting sperm transport: diseases of the epididymis or congenital obstruction of the vas deferens can affect sperm ejaculation. (3) Factors affecting the entry of seminal fluid into the cervical canal: such as short penis, hypospadias, premature ejaculation, impotence, etc., which can affect sexual intercourse, unable to ejaculate seminal fluid into the vagina, reaching the cervix. (4) Abnormal seminal fluid: such as necrotic sperm, sperm dysfunction, seminal fluid being too thick, etc.

　　2. The causes of in vitro fertilization (IVF) include female factors accounting for about 45% of the cases. (1) Factors affecting oocyte development: Dysfunction of the hypothalamus-pituitary-ovary axis affects oocyte maturation or interferes with ovulation; congenital incomplete ovarian development, surgical removal of the ovaries, changes in the external environment, and emotional stress can all affect ovulation. (2) Factors affecting the transport of oocytes, sperms, or zygotes: After ovulation, the oocytes enter the fallopian tube, and sperms射入阴道后 also need to pass through the uterine cavity and fallopian tube to meet the oocytes, and the zygotes also enter the uterine cavity via the fallopian tube. Research has found that many women with reproductive tract inflammation have a bacteriophage in their vaginal discharge, cervical secretions, and endometrium, which may be the cause of infertility. It is estimated that this is related to the bacteriophage attaching to the tail of the sperm, affecting sperm motility. In women with unexplained infertility, the detection rate of bacteriophages is as high as 85-95%, while in the control group of fertile women, it is only 23%. After treatment, the pregnancy rate can be significantly improved. (3) Factors affecting sperm ascent: such as vaginal septum, vaginal cervicitis, cervical stenosis, or endocrine disorders leading to thick cervical mucus.

　　3. In the etiology of IVF, the factors of both men and women account for about 15%, mainly immunological infertility. Sperm, oocytes, zygotes, gonadotropins, sex hormones, and secretions throughout the pregnancy process all have a certain antigenicity, which can cause immune reactions leading to infertility. This immune reaction can be divided into two types, one is allogeneic immunity, referring to the immune reaction caused by the sperm, seminal plasma, proteins or desquamated cells secreted by the male reproductive tract, or the zygote causing the female immune reaction, producing corresponding antibody substances to counteract them. The other type is autoimmune, referring to the sperm, seminal plasma, or oocytes and reproductive tract secretions of the male entering the surrounding tissues, causing autoimmune reactions, producing corresponding antibody substances, affecting the vitality of the male sperm or oocytes.

　　4. Other factors, such as malnutrition, metabolic disorders, chromosomal abnormalities, or physical and mental factors, can all cause infertility.

　　In general, in vitro fertilization (IVF) technology is safe, but some complications may occur.

　　1. Ovarian Hyperstimulation Syndrome

　　Due to the growth of multiple follicles, some factors in the body change, causing fluid to leak from the blood vessels into the peritoneal cavity, even into the thoracic cavity, leading to pleural effusion. The incidence rate is about 10%. Most people have mild symptoms, such as abdominal distension, discomfort, and mild nausea, which may not require treatment; however, a few people may experience severe abdominal distension, oliguria, abdominal pain, loss of appetite, and even symptoms such as chest tightness and shortness of breath. In such cases, intravenous fluid replacement may be needed, and in some cases, hospitalization for treatment may be required. Less than 1% of people may develop thrombosis or renal failure.

　　2. Damage caused by oocyte retrieval

　　(1) Bladder injury, the patient may have hematuria, which is usually treated by catheterization and bladder irrigation to achieve hemostasis.

　　(2) Occasionally, the bowel or pelvic blood vessels may be punctured.

　　(3) Ovarian hemorrhage: In some cases, the punctured ovary may continue to hemorrhage, and sometimes it may be necessary to open the abdomen for hemostasis.

　　(4) Pelvic Infection

　　3. Ovarian Torsion

　　Due to the growth of multiple follicles caused by ovulation induction therapy, or the formation of multiple corpus luteum cysts after oocyte retrieval, the ovaries become significantly enlarged. At this time, excessive activity or rapid change in posture by the woman may lead to ovarian torsion. The patient may experience sudden severe abdominal pain, accompanied by nausea and vomiting. If the twisted ovary cannot be复位 in time, surgical treatment may be required, and in severe cases, surgical removal of the necrotic ovary may be necessary.

　　4. Multiple pregnancies

　　Due to the transfer of multiple embryos into the uterus, the rate of multiple pregnancies caused by IVF technology is significantly higher than that of natural conception, about 25-30%. The risk of late pregnancy loss and preterm birth in multiple pregnancies is significantly higher than that in single pregnancies. The risk of gestational diabetes, gestational hypertension, difficult labor, and postpartum hemorrhage in mothers is significantly increased. Therefore, multiple pregnancies are not beneficial to both the mother and the child. Currently, many IVF centers are beginning to reduce the number of transferred embryos or perform single embryo transfer to lower the rate of multiple pregnancies. For those with triplet or more pregnancies, reduction of pregnancy must be performed, and for those with twin pregnancies, it is recommended that the patient consider reduction of pregnancy.

　　5. Ectopic pregnancy

　　The incidence of ectopic pregnancy in the general population is 1% to 2.5%. Although IVF involves transferring the embryo into the uterus, due to the influence of tubal chemoattractants on the embryo, the embryo may migrate to the fallopian tube, implant and develop there, causing ectopic pregnancy. Sometimes, the embryo may also implant in the cervix and other locations. Therefore, receiving IVF treatment does not prevent the occurrence of ectopic pregnancy. On the contrary, the incidence of ectopic pregnancy in women receiving IVF treatment is higher than that in the general population, ranging from 2% to 4%.

　　1. Tubal blockage: Tubal blockage is one of the main causes of female infertility at present. Tubal blockage affects the normal combination of sperm and egg, making it impossible for women to conceive, and thus leading to the situation where women cannot give birth. Tubal blockage may be caused by various reasons, with common causes including inflammatory infection and unclean sexual intercourse.

　　2. Kidney deficiency: This condition is mostly caused by both innate deficiency and postnatal malnutrition. In addition, if a woman has an excessive frequency of sexual life, it can also cause kidney deficiency. The human kidneys are the essence of the human body, and kidney deficiency will directly cause the patient's physical condition to decline, and it will also affect the function of the patient's reproductive system, leading to difficulties in conception or easy miscarriage in women.

　　3. Anovulation: A woman's ovulation is necessary for her to have the opportunity to conceive. Therefore, if a woman cannot normally ovulate, which is called anovulation, she will definitely not be able to ovulate. In this case, the patient may not be able to detect the occurrence of ovulation.

　　4. Malnutrition: Pregnancy imposes a great burden on a woman's body. If a woman's physical condition is poor and she cannot meet the conditions for conception, she will not be able to give birth normally.

　　5. Abnormal leukorrhea: When there are conditions such as vaginitis, cervicitis (cervical erosion), endometritis, adnexitis, pelvic inflammatory disease, and various sexually transmitted diseases, there may be an increase in leukorrhea, yellow color, odor, lumpy or watery discharge, or accompanied by pruritus and pain in the vulva, and these diseases can also affect fertility to varying degrees.

　　6. Symptoms before and after menstruation: A series of symptoms such as premenstrual breast swelling, menstrual headache, menstrual diarrhea, menstrual edema, menstrual fever, menstrual mouth ulcer, premenstrual facial acne, menstrual urticaria, menstrual depression or irritability, which occur periodically in some women before and after menstruation, are often caused by endocrine disorders and abnormal corpus luteum function, which can often lead to infertility.

　　7. Lower abdominal pain: Chronic lower abdominal pain, pain in both sides of the abdomen, or lumbosacral pain often occur when there are pelvic inflammatory disease, myometritis, ovarian inflammation, endometriosis, tumors of the uterus and ovaries.

　　8. Milk leakage: Milk leakage from the breasts during non-lactation or after squeezing often indicates hypothalamic dysfunction, pituitary tumors, prolactinoma, or primary hypothyroidism, chronic renal failure, etc. It can also be caused by birth control pills and antihypertensive drugs such as nifedipine. Milk leakage often occurs with amenorrhea leading to infertility.

　　In vitro fertilization not only brings a great economic burden to the family but may also cause some serious complications, so doing a good job in positive prevention is very crucial.

　　(1) The prevention of in vitro fertilization should popularize scientific and health knowledge, master the principles of conception. With the progress of medicine, knowledge about sex is no longer a mysterious and shameful matter. It should be widely publicized to make people understand sexual knowledge, reduce the occurrence of diseases, especially diseases of the reproductive organs, to create favorable conditions for pregnancy.

　　(2) In vitro fertilization should focus on prevention, early detection, and treatment of diseases that can cause infertility. Reduce surgery and pay attention to the first pregnancy. Some infertility patients may have caused menstrual irregularities or uterine cavity adhesions due to operations such as curettage, abortion, or removal of cervical polyps, which can affect fertility. Reducing surgery and paying attention to the first abortion can be of positive significance in preventing infertility.

　　(3) In addition to preventing in vitro fertilization, it is also important to maintain a cheerful mood and reduce mental stress. Being too eager to have a child often leads to infertility. Especially for the elderly or those who have been married for several years without children, the mood is more tense, which interferes with the neuroendocrine function.

　　(4) Pay attention to self-protection and reduce the occurrence of infertility. Some people engage in special work, such as exposure to radiation, certain toxic substances, and high-temperature work, etc., should strictly implement the provisions of labor protection regulations, take serious measures for self-protection, and reduce the factors of infertility to the minimum extent.

　　(5) To孕育种子，应知晓聚精之道。节制性生活对预防不育也极为重要。

　　For the examination of in vitro fertilization (IVF), it is first necessary to clarify the cause of infertility and understand whether it is suitable to undergo 'IVF'. The main examinations to be done include:

　　1. Report of fallopian tube patency examination: X-ray film of hysterosalpingography with iodine oil, report of hydrotubation under ultrasound, or hospital certificate of laparoscopy or laparotomy can all be provided.

　　2. Examination for ovulation: pathological report of endometrial tissue within one year and the recent three-month basal body temperature chart.

　　3. Routine laboratory test report on the husband's semen in the past half year.

　　4. Reports on hepatitis B surface antigen antibody, e antigen antibody, and core antibody, hepatitis C antibody, liver function, blood type, female erythrocyte sedimentation rate, tuberculin test; serum HIV antibody.

　　After the above information is complete, you can go to the infertility treatment center for consultation. Before officially entering the cycle, go for a gynecological examination ten days before the expected menstrual period, and undergo a trial transplantation to detect the depth of the uterine cavity and the direction of the catheter during embryo transfer.

　　The diet of IVF patients should pay attention to the following points:

　　One, IVF patients can have small and frequent meals, and the diet should be light and easy to digest. They can eat some sour fruits like jujubes and oranges, but should not eat pickled vegetables.

　　Two, during the middle three months of pregnancy, the fetus gains 10 grams of weight per day, and the pregnant woman's food intake should increase accordingly. Because the uterus expands and compresses the intestines, constipation is easy to occur, so pregnant women should eat more vegetables and drink more water.

　　Three, in the last three months of pregnancy, the fetus doubles in weight, and the brain cells increase dramatically, which is a critical stage for the pregnant woman's nutrition. It is important to pay attention to a sufficient and balanced diet.

　　Four, during the middle and later stages of pregnancy, an additional 9 grams of high-quality protein should be added to the daily diet, which is equivalent to 300 grams of milk, two eggs, or 50 grams of lean meat. If it is plant-based protein, an additional 15 grams should be consumed, which is equivalent to 200 grams of tofu or rice.

　　Five, during pregnancy, the blood volume increases by 30%, requiring 700 milligrams of iron to produce red blood cells, which is three to four times the daily requirement. It is advisable to eat more lean meat, poultry, fish, and other animal products, eat pork liver two to three times a week, and if necessary, take iron supplements, but IVF patients should not drink tea.

　　Six, if IVF patients do not consume much dairy products, it is advisable to take calcium tablets and get plenty of sunshine.

　　Seven, IVF patients should supplement sufficient vitamins, eat 500 to 700 grams of vegetables per day, and it is best to eat a serving of fruit after lunch and dinner.

　　Eight, control the amount of salt, avoid overly salty food, which is beneficial for patients with lower limb edema.

　　The conventional method of Western medicine for treating IVF:

　　Ovulation induction therapy

　　Since not every egg can be fertilized, and not every fertilized egg can develop into a viable embryo, it is necessary to obtain multiple eggs from the female body to ensure the availability of embryos for transplantation. This requires ovulation induction therapy for the female.

　　Before entering the IVF cycle, in most cases, women are required to take birth control pills in the previous cycle to suppress ovulation. This can prevent the fetus from being affected by the application of GnRH agonists before menstruation (which may lead to abortion). Additionally, for those with irregular menstrual cycles, taking birth control pills is convenient for determining the timing of ovulation induction. Moreover, taking birth control pills can also prevent the formation of physiological ovarian cysts, which is beneficial for ovulation induction therapy.

　　On the second day of the menstrual cycle, or after satisfactory suppression of GnRH (reproductive hormone and uterine and ovarian ultrasound examination results meet the requirements), women begin to apply ovulation induction drugs. The doctor judges the condition of follicle growth based on the results of ultrasound monitoring and serum hormone determination and decides whether to adjust the dosage of ovulation induction drugs. When the follicles mature, hCG injection is given to promote the final maturation of the oocytes. Usually, oocytes are retrieved 36-38 hours after hCG injection.

　　Oocyte Retrieval

　　The doctor uses a special oocyte retrieval needle under B-ultrasound guidance to puncture mature follicles through the vagina and aspirate the oocytes. Oocyte retrieval is usually performed under intravenous anesthesia, so women do not feel any pain from the puncture process.

　　In Vitro Fertilization

　　Sperm Retrieval: When the female retrieves eggs, the male retrieves sperm. After the semen is processed through a special washing process, the sperm and eggs are placed in a special culture medium to achieve natural fertilization. This is what is called conventional fertilization.

　　Embryo Transfer

　　A very thin embryo transfer catheter is used a few days after fertilization to transfer the best embryo into the maternal uterus through the cervix, the number of embryos to be transferred is decided based on age, embryo quality, and the outcome of previous IVF, usually 2-3 embryos. In recent years, to reduce the rate of multiple pregnancies, some centers have chosen single embryo transfer or at most 2 embryo transfers.

　　Since the embryo transfer catheter is very thin and the doctor's movements are gentle, patients usually do not have any pain.

　　Luteal Support

　　Due to the application of GnRH agonists/antagonists and ovulation induction drugs, as well as the loss of follicular granulosa cells caused by oocyte retrieval, women usually have insufficient luteal function during the oocyte retrieval cycle and need to apply progesterone and/or chorionic gonadotropin for luteal supplementation/support. If there is no pregnancy, discontinue progesterone and wait for the menstrual period. If pregnancy occurs, continue to apply progesterone, usually until 3 weeks after the fetal heartbeat is seen by B-ultrasound.

　　Confirmation of Pregnancy

　　Serum HCG is measured 14 days after embryo transfer to determine whether pregnancy has occurred. Serum HCG is measured again 21 days after embryo transfer to understand the development of the embryo. Vaginal ultrasound examination is performed 30 days after embryo transfer to determine whether there is intrauterine pregnancy and whether there is fetal heartbeat.