IVF: The science of cycling a half circle around the earth

The proliferation of human beings is a natural process of natural selection, but not everyone's birth is plain sailing. After the British medical scientist Robert Edwards ran a full distance around the earth on a bicycle, Luis Brown, the world's first test-tube baby, was born in 1978. As the world's first test-tube baby, Brown is still very healthy. After her, there have been more than 5 million test-tube babies born in the world. In 2010, Edward was awarded the Nobel Prize in Medicine.

Behind this assisted reproductive technology is the continuous deepening of human understanding and exploration of the reproductive process, which is the continuous development of reproductive medicine. Today, Prof. Qiao Jie, President of Beijing Third Hospital, China's authoritative expert on reproductive medicine, and chairman of the Reproductive Medicine Branch of the Chinese Medical Association will comprehensively and in-depthly interpret this very young but rapidly developing science for us.

The interviewed doctors: Qiao Jie Dean of Peking University Third Hospital, Professor of Medicine, Chief Physician, Doctoral Supervisor, National Outstanding Youth Fund winner, Cheung Kong Scholar Distinguished Professor, New Century Million Talent, Ho Leung Ho Lee Foundation, Chief scientist of the "Special Reproductive and Development Program" of the Ministry of Science and Technology. He is currently the chairman of the Reproductive Medicine Branch of the Chinese Medical Association and chairman of the Reproductive Medicine Branch of the Beijing Medical Association. He has been engaged in clinical and basic research related to reproductive health. He studied at the University of Hong Kong as a visiting scholar and did postdoctoral research at Stanford University. A comprehensive study on the pathogenesis of infertility was conducted from the aspects of gametes, fertilization, embryos and implantation, and a systematic study was conducted on the etiology and diagnosis and treatment of polycystic ovary syndrome (PCOS).

The birth of the first test tube baby: Edwards rides half the distance of the Earth. China Medical Channel: Please Dean Qiao briefly introduce the major developments, major achievements, and hot research directions of the current domestic and international reproductive medicine?

Qiao Jie: Reproductive medicine should be the most active discipline in the field of medicine in the past 20 years, and it is also the most active discipline in the field of obstetrics and gynecology.

With changes in lifestyles, including increased work pressures, changes in diet and the environment, the decline in human fertility is very evident. According to international statistics, the incidence of infertility is about 10%. Based on this data, there are over 10 million infertile couples in China. To solve the problem of this part of people's medical science, we must understand the human reproductive process, reproductive physiology and other pathological changes. This is precisely because we humans know less, so it makes sense from the perspective of medical technology research.

Only by knowing more about human reproduction can we have more ways to help these infertile couples to solve their problems. Therefore, the British medical scientist Edwards, who was the first test-tube baby in 1978, won the 2010 Nobel Prize in medicine. The acquisition of the Nobel Prize is not only recognition of assisted reproductive technology, but also praised Edward for his in-depth research on the human reproductive process.

To this day, more than 5 million children have been born in the world through assisted reproductive technology. At present, assisted reproductive technology has been recognized by scientists worldwide. At the same time, it is also one of the most rapidly developing areas in reproductive medicine.

China Network Medicine Channel: 34 years ago, Louis Brown, the world's first test-tube baby, was born in the UK. Now that this technology has been developed, it should be said that considerable progress has been made. What is the progress?

Qiao Jie: Robert Edwards was very difficult when he was the world's first test-tube baby Louis Brown. He and the obstetrician and obstetrician Steptoe worked together. Because doctors in obstetrics and gynecology in the UK are very busy, so Edwards rides a bike to find Stillto, and they both discuss it.

At the time, no one knew what kind of egg it was. How could one get the egg out of the woman? It seemed to be a very simple question now. No one knew how to do it. Edwards once said to me in 2002 that from the time when the two of them first studied the matter to the birth of the first test-tube baby, the distance he took on a bicycle was equivalent to half a circle around the earth. It was really It took a very difficult process to be successful.

At that time, the egg was taken by laparoscopic puncture and it was still damaged. In the general anesthesia, several holes were made in the female's stomach. Nowadays, we use ultrasonic vaginal puncture, only need to use a needle that is slightly thicker than the intramuscular needle, and basically there is no wound and can not be anesthetized. Therefore, from a clinical point of view, the damage to women becomes very small.

From the laboratory technology, there has been greater progress. When Edwards was first introduced as a test-tube baby, the success rate was only 10% to 20%. Now if the women are young, the quality of sperm and eggs is good, and the condition is not very serious, the success rate can reach 60% to 70 percent.

Technological advances stem from our more detailed and in-depth understanding of the reproductive process. We have more understanding of the human reproductive process, have more knowledge about in vitro fertilization, use culture fluids closer to the human body, can help us get better embryos, and the development of microscope technology has made it possible to screen male spermatozoa The development of these technologies has made it possible to treat some infertility that could not be treated in the past.

China Network Medicine Channel: In the field of reproductive medicine, what are the challenges that are urgently needed in terms of current development and demand?

Qiao Jie: As of today, assisted reproductive technology is still a relatively low success rate in all medical disciplines. Our understanding of the human reproductive process is still very limited. Whether it is the conventional technique of embryo transfer, in vitro fertilization, or the intracytoplasmic injection of spermatozoa that assist sperm fertilization, further development is needed.

At present, the success rate of these technologies is between 30% and 50%, which does not solve all human problems. We are now faced with many problems that require answers, such as how poor egg quality can make the eggs better. There is also the problem that the embryo cannot be implanted due to the destruction of the endometrium and it is difficult to overcome. The human reproductive process is actually very interesting and profound, and there are many problems waiting for us to overcome it.

China Net Medicine Channel: People have traditional ideas. The existence of reproductive medicine seems to be to solve the problem of infertility. Obviously this is a misunderstanding of reproductive medicine. What kind of science is reproductive medicine actually?

Qiao Jie: The definition of reproductive medicine has a broad and narrow sense. The generalized reproductive medicine includes a complete process of human reproduction and other biological reproduction. In the clinical medicine, reproductive physiology, reproductive endocrinology, and reproductive pathology are all included, not just children of childbearing age, but should be born from birth. From the beginning to the adolescent woman, to the childbearing age, the whole process of menopause and old age begins.

At present, infertility may be an important aspect affecting family happiness. At the same time, it still requires a variety of techniques to treat it, and the number of disciplines covered is also relatively large. Therefore, we are more concerned. In other processes of reproductive medicine, more knowledge and physiology of health care are being adjusted, so it may be that everyone will focus on infertility here.

China Network Medicine Channel: Dean Qiao You are currently doing research on the preservation of female reproductive capacity. It sounds like you have continued the reproductive capacity of women through technical means. Many people want to know the current status and prospect of this technology. .

Qiao Jie: The preservation of female fertility is a very important issue. Women's fertility has dropped significantly. Apart from the decline in fertility under natural conditions, there are many other factors such as cancer in childhood. Under modern medical conditions, although childhood cancer treatment is good, whether radiotherapy or chemotherapy, while ensuring the health of life, fertility is lost or weakened.

These patients have reached the age of childbearing and are told that they are unable to give birth or are difficult to bear. They are very painful. If we can take this into consideration in advance and preserve their fertility, then life is different for them.

This project particularly hopes to be able to save the egg, ovarian tissue or the entire ovary and then be able to transplant it back. Therefore, the preservation of female fertility is from these three aspects. In clinical practice, the preservation of egg cells can already be carried out normally. For women who are not getting married or who need to undergo radiotherapy and chemotherapy immediately because of cancer, we can keep their eggs frozen until they need them. A 30-year-old female patient may need this oocyte 10 years later, and she will be able to save her eggs when she is 30 years old.

In addition, it is the freezing of ovarian tissues. Currently, 14 cases of ovarian tissue have been successfully frozen in the world, 20 children have been born, and have not yet been born in Asia. In China, several research groups are doing this work and we have also spent a lot of time and energy to do it. At present, we have cryopreserved ovarian tissues for more than 40 patients. Some of them were used as animal experiments to see the growth of surviving follicles. Follicle tissue cryogenic technology is currently clinically applicable. We also hope to help more patients.

For complete ovary transplantation, it is now a problem in the world and it has not been successful. Professor Wang Xiang of our research team was a urologist in Shanghai. He had successfully completed the first case of complete ovarian transplantation in the United States. Ovary transplantation in sheep has also been successful. At present, we are ready to work on monkeys. It is done on the body and finally applied to the human body. It is hoped that this research will be able to break through within a few years.

Now, oocyte cryogenic technology has been applied clinically, but because oocytes are very delicate and some cell tissues may be damaged during freezing, we need to study how to improve cryogenic technology, such as the protection of cryogenics. What does the agent use for the best frozen time, whether it is taken out for freezing or allowed to mature for a period of time, all of which require further research.