重庆市妇幼保健院生殖医学中心 罗红 目前，随着以试管婴儿为代表的辅助生殖技术的发展与成熟，全球已有超过一千万个小生命通过这项技 术降临人间。面对这项有着生命启航"临时港湾"之称的新技术，我们应当注意些什么？又该如何科学认 识和选择呢？ 揭开"试管婴儿"的神秘面纱 我们常说的"试管婴儿"，其医学专业名称是体外受精-胚胎移植技术。它是辅助生殖技术中最主要和最 具代表性的一种。可以简单理解为精子和卵子暂时离开身体，在培养皿内结合，发育成早期胚胎后，就 被医生用一根细软的管子，送回母体子宫里，待其着床并继续生长发育，直到分娩。 哪些情况能够适用 在自然受孕过程中，女性输卵管是精卵结合的唯一场所，也是将早期胚胎运送至子宫的通道。当女性输 卵管出现卵巢排卵障碍等问题时，试管婴儿技术则可取出卵子，使其与精子在体外结合。 如果男方精子数量少、活力差，自然环境下难以抵达终点。试管技术就如同"精卵直达专列"，大大缩短 相遇距离。 如果出现不明原因的无法自然怀孕，也能通过试管婴儿技术探明是否存在受精困难。 如何正确选择合适的技术 一代试管婴儿，即把一批精子和卵子放一起，自由竞争、结合，主要解决女性不孕问题，尤其是输卵管 问题；二代 ...

研究团队在浙江大学、复旦大学、上海交通大学等4家生殖医学中心开展了为期数年的多中心随机对照 试验。共纳入450对严重男性不育夫妇，其中225对接受常规第二代试管婴儿技术治疗，225对接受第二 代叠加第三代技术治疗。结果显示，两组患者在首次移植活产率，以及一年累计活产率上均无显著差 异。 新华社杭州12月24日电（记者黄筱）12月23日晚，一项由中国科学院院士、浙江大学医学院附属妇产科 医院名誉院长黄荷凤领衔的研究成果，在国际医学期刊《英国医学杂志》发表。该研究通过临床试验证 实，针对严重男性不育患者，价格更昂贵的第三代试管婴儿技术并未显示出比第二代技术更高的活产 率。这一结论为国际诊疗指南提供了关键循证依据，有望显著降低不孕治疗成本，惠及更多家庭。 专家介绍，我国每年有约5000万不孕人群，其中男性因素占40%。以往很多患者倾向于选择"更高级"的 第三代技术，单次检测费用就需要约2到3万元。此项研究将帮助患者避免不必要的医疗支出，减轻经济 负担，纠正了当前辅助生殖技术使用中的误区。 "这个结果出乎很多人意料。"黄荷凤表示，研究结果明确显示，对于严重男性不育患者，常规第二代技 术仍是首选策略，不必盲目追求更复杂 ...

"辅助生殖技术发展迅速，但我们必须清醒地认识到，最新的技术未必适合所有患者，关键是要结合自 身情况作出理性选择。"黄荷凤院士建议，只要能达成生育目标，技术越简单、越贴近自然越好，不要 盲目追求"高精尖"辅助生殖技术。 这项研究对象是精子形态异常、数量稀少、活力不足的育龄夫妇。当前，卵胞浆内单精子注射（ICSI） 技术，即俗称"第二代试管婴儿"技术，是严重男性不育患者的主要助孕手段。胚胎植入前遗传学检测技 术（PGT-A），作为"第三代试管婴儿"技术，因能提升胚胎筛选的准确性，受到越来越多医生与不孕患 者的青睐。 中国青年报客户端讯（中青报·中青网记者 李剑平）北京时间12月23日23时，中国科学院院士、浙江大 学生殖遗传教育部重点实验室主任、浙江大学医学院附属妇产科医院名誉院长黄荷凤领衔的一项试管婴 儿技术研究成果，在国际顶尖医学期刊《英国医学杂志》（The BMJ）在线发表。 来源：中国青年报客户端 那么，严重男性不育患者究竟选择第二代试管婴儿技术，还是在其基础上叠加第三代试管婴儿技术，以 实现"双重保险"的目的？这一问题在国际医学界缺乏普遍共识。黄荷凤院士团队自2018年起，联合浙江 大学、复旦大学、上海 ...

人类植入和植入失败 3D 体外模型总览图。（研究团队供图） 体外构建人类 3D 子宫模型。（研究团队供图） 首次实现人类胚胎着床全过程体外模拟。（研究团队供图） 辅助生殖是点亮生育希望的一项重要技术。然而，胚胎移植失败（RIF）的病因诊断如同"大海捞 针"。 中国科学院动物研究所近日发表于国际学术期刊《细胞》上的一项科研成果显示，基于微流控芯片 的人类胚胎3D植入模型（3D子宫胚胎植入模拟芯片），首次在实验室里完整复刻人类胚胎着床的全过 程，有望探明辅助生殖反复失败的病因。 检测流程简化：模拟胚胎着床的病理异常 在接受辅助生殖技术治疗的患者中，约有10%的个体在经历3次胚胎移植后，仍无法实现临床妊 娠。胚胎、子宫内膜、免疫系统等都有可能是失败因素。 "新技术创新构建子宫内膜模拟体系，再通过模拟胚胎着床的病理异常，更精准查找病因。"中国科 学院动物研究所研究员于乐谦说，研究发现RIF患者的子宫内膜细胞多存在凋亡细胞增多、增殖能力下 降等异常，"也就是说，孕育种子的土壤比较贫瘠"。 观测胚胎发育：解锁胚胎与母体的"对话密码" 此前，科学家虽能观察到胚胎与子宫内膜接触，却无法明确两者间的信号交流，如胚胎分泌什么因 ...

这项突破的核心在于，该芯片技术能够直接惠及临床，为患者解决三大痛点。 首先，有望精准定位"怀不上"的根源。研究团队利用该芯片发现，RIF患者的子宫内膜细胞存在凋亡增 多、增殖下降等异常。研究发现，RIF患者来源的子宫内膜囊胚植入率仅为健康人群的60%，且植入后 胚胎进一步发育能力严重不足，这直观解释了临床中"移植成功但胎停"的现象。未来，患者仅需提供少 量子宫内膜样本，即可通过该芯片评估内膜功能，告别"病因不明"。 一枚指甲盖大小的芯片，为不孕患者带来精准治疗新希望。中国科学院动物研究所于乐谦研究员团队联 合国内外单位的科研人员，成功研发出3D子宫胚胎植入模拟芯片，首次在实验室完整复刻了人类胚胎 着床全过程。该研究突破了长期困扰该领域的伦理与技术瓶颈，为阐明反复胚胎种植失败（RIF）的病 理基础提供了全新研究平台。相关研究成果23日发表于《细胞》杂志。 数据显示，我国不孕症人群已超4000万，在接受辅助生殖技术治疗的患者中，约有10%的个体经历多次 胚胎种植仍无法成功妊娠，从而陷入RIF困境。过去，RIF病因诊断像"大海捞针"，治疗多靠医生经 验"盲目尝试"，效果参差不齐。 其次，能快速筛选"最有效"的个性化 ...

Core Viewpoint - The article discusses the challenges and opportunities in reproductive health, emphasizing the importance of early childbearing and the declining quality of male sperm, while also highlighting the advancements in assisted reproductive technologies [4][5][6]. Group 1: Reproductive Health Challenges - The incidence of infertility in China has increased from 12% in 2007 to 18% in 2020, with male and female factors contributing equally to infertility [9]. - Women over 35 face significant declines in fertility due to reduced egg quantity and quality, while men also experience declining sperm quality with age [8][9]. - The societal trend of late marriage and childbearing is influenced by various factors, including career pressures and educational costs, leading to a rise in high-age pregnancies [9][10]. Group 2: Sperm Quality Decline - Data from the Central South University shows a significant decline in sperm quality, with the acceptance rate for donated sperm dropping from 45.9% in 2006 to around 20% currently [11][12]. - The World Health Organization has revised the normal reference values for sperm parameters, indicating a downward trend in male fertility [11][12]. - Factors such as lifestyle choices, including sleep patterns and stress, significantly impact sperm quality, with younger individuals showing better sperm parameters compared to older students [13][16]. Group 3: Assisted Reproductive Technologies - The Central South University reproductive center has frozen approximately 820,000 embryos, with many serving as a form of "fertility insurance" for couples [28]. - The center emphasizes the importance of sperm donation and the strict regulations surrounding it, including the anonymity of donors and the limitation on the number of births per donor [20][22]. - Advances in reproductive technology are shifting the focus from sperm donation to self-sperm storage and fertility preservation, reflecting a growing trend in the market [23][28].

Group 1 - The overall fertility rate in China is declining, with younger women (20-29 years) contributing less and older women (30-39 years) contributing more to births, leading to a net decrease in birth rates [2][3] - The average age of women seeking assisted reproductive technology (ART) has increased from the early 30s to 38 years, indicating a trend towards later motherhood [3][4] - The success rate of ART for women aged 38 is less than 50%, highlighting the challenges faced by older women in achieving pregnancy [4][23] Group 2 - The demand for ART services has increased significantly, with hospitals reporting a rise in the number of cycles performed, reflecting the trend of late marriage and childbearing [31][32] - As of October 2023, all provinces in China have included ART in health insurance, benefiting over 1 million people [32] - The industry is experiencing a "high-level stable state," with growth slowing but demand remaining strong, as more women seek ART services in urban areas [31][33] Group 3 - The psychological burden on women undergoing ART is significant, with many experiencing anxiety and stress during the treatment process, particularly during the waiting period after embryo transfer [24][30] - The focus of the ART industry is shifting from merely achieving pregnancy to ensuring the safety and health of mothers and babies, with an emphasis on reducing complications associated with high-risk pregnancies [27][30] - There is a growing trend of women actively choosing to pursue motherhood for personal reasons rather than societal pressures, indicating a shift in the perception of fertility and reproductive health [35]

Core Viewpoint - The article discusses the challenges and realities of assisted reproductive technology (ART) in China, emphasizing the importance of understanding fertility as a capability that may not last a lifetime, and the need for women to plan and make informed choices regarding reproduction [3][19][38]. Group 1: Assisted Reproductive Technology Overview - Assisted reproductive technology has rapidly developed over the past 40 years, with the first test-tube baby born in 1978 and the first in mainland China in 1988 [13]. - The success rate of assisted reproduction varies significantly with age, with women over 35 facing increased challenges in conceiving [15][17]. - The complete assisted reproductive cycle, including ovulation induction, egg retrieval, embryo transfer, and pregnancy maintenance, typically takes two to three months [8]. Group 2: Patient Demographics and Trends - There is a growing trend of older couples seeking ART services due to late marriage and childbearing, with many individuals unaware of the biological limitations of fertility [15][19]. - The incidence of infertility in China has increased from 12% in 2007 to 18% in 2020, highlighting a rising public health concern [28]. Group 3: Patient Experiences and Challenges - Many patients experience emotional and psychological stress during the ART process, often leading to anxiety about their fertility metrics [17][36]. - The article illustrates various patient stories, including those who have successfully conceived and those who have faced challenges, emphasizing the emotional journey involved in ART [19][38]. Group 4: Male Involvement in Fertility - Male fertility issues account for at least 30% of infertility cases, yet men often play a minimal role in the ART process [26][28]. - The article stresses the importance of male partners being actively involved in the fertility journey, as their support can significantly impact the emotional well-being of their partners [28]. Group 5: Medical and Social Perspectives on Infertility - The definition of infertility is complex, as many individuals diagnosed with infertility may not have other health issues, raising questions about the medicalization of fertility challenges [31][35]. - Cultural perceptions of fertility and motherhood can add pressure to women, influencing their emotional responses to infertility [36].

Core Viewpoint - Changchun High-tech Industry (Group) Co., Ltd. announced the approval of its long-acting follicle-stimulating hormone injection, Jin Sai Jia®, which offers a new option for controlled ovarian stimulation in assisted reproductive technology [1][2]. Group 1 - Jin Sai Jia® has been approved for use in conjunction with gonadotropin-releasing hormone antagonists to induce multiple follicle development, replacing the need for daily injections with a single subcutaneous injection lasting seven days [1][2]. - The demand for assisted reproductive technology has been increasing, with the launch of the first domestically developed recombinant follicle-stimulating hormone in China, Jin Sai Heng®, in 2015, which required daily injections [1][2]. - The approval of Jin Sai Jia® will enhance the company's product portfolio in women's health, creating a complete range of recombinant follicle-stimulating hormone products, including powder, short-acting, and long-acting formulations [2]. Group 2 - Jin Sai Jia® utilizes gene fusion technology to achieve long-acting effects, significantly reducing the frequency of administration compared to short-acting formulations [2]. - The dosage of Jin Sai Jia® is customized based on age and weight, minimizing the risk of injection errors and improving patient compliance and treatment efficiency [2]. - Clinical trial results from Phase II and III indicate that Jin Sai Jia® demonstrates excellent efficacy and safety [2].

Core Viewpoint - The seminar aimed to discuss the construction of a fertility-friendly society, focusing on policy support, optimization of medical services, and the standardized development of assisted reproductive technology [1][19]. Policy Support - The creation of a fertility-friendly society requires reducing the costs of childbirth, upbringing, and education, while fostering a respectful social environment for childbirth [2]. - Key policy recommendations include improving maternity insurance, establishing maternity subsidies, providing tax deductions, housing support, and enhancing childcare services [2]. Assisted Reproductive Technology - The importance of standardizing assisted reproductive technology (ART) was emphasized, with a call for enhanced public education on scientific pregnancy concepts and strict regulatory oversight [6]. - All 31 provinces have included relevant ART technologies in their medical insurance reimbursement scope, although the specifics vary by region due to economic and technical differences [9]. Research and Development - A report was presented on the establishment of a comprehensive assisted reproductive service system, utilizing AI and multi-dimensional social evaluation perspectives to enhance service quality and success rates [12]. - Innovations in ART, such as targeted sperm medications and smart embryo laboratories, are being pursued to address infertility challenges [16]. Public Awareness and Education - There is a need for targeted public education strategies to improve awareness of reproductive health, particularly among younger and older demographics [17]. - The establishment of diverse educational channels, especially through new media, is crucial for dispelling misconceptions about ART [18]. Collaborative Efforts - The seminar highlighted the importance of collaboration among hospitals and healthcare providers to enhance the quality of reproductive health services and address the challenges faced by patients in remote areas [18].