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Tan Xiaojun
·Senior reproductive medicine expert
·Postdoctoral fellow at Peking University
·PhD candidate at Xiangya School of Medicine, Central South
University
·Master’s tutor at Central South University
· Master's degree candidate in reproductive
medicine at the University of South China
· Professional training at Huazhong University
of Science and Technology and Tongji
Hospital Reproductive Center
Expertise:
diagnosis and treatment of infertility, first/second/third generation IVF (including
egg/sperm donation), microsperm retrieval, embryo freezing and resuscitation, artificial
insemination (including husband's sperm and sperm donation), paternity testing, chromosomal
disease
diagnosis, high-throughput gene sequencing, endometrial receptivity gene testing and other
clinical
technology applications. Many of these technologies are at the leading level both domestically
and
internationally.
38-year-old pregnant for two years without pregnancy, advanced pregnancy, Guangzhou assisted reproduction, ovarian reserve evaluation, salpingography process, ovulation monitoring, IVF examination process, natural pregnancy and never pregnancy?
38-year-old pregnant for two years, don't just doubt "time is not enough": 6 directions to help you see whether it is age or method deviation.
38-year-old pregnant for two years and not pregnant, is it not enough time or the wrong method? This kind of situation usually does not belong to the stage of simply "waiting", but needs to systematically evaluate the changes of ovulation, fallopian tube, semen, uterine environment and age-related fertility.
Definition: 38-year-old pregnant for two years, not pregnant, what do you think medically?
Let's start with the conclusion: 38-year-old pregnant for two years and still not pregnant, the focus is usually no longer "enough time", but "have you missed the window of timely evaluation and adjustment of the plan".
The World Health Organization defines infertility as not getting pregnant after 12 months of regular and unprotected sex. For women aged 35 and over, the American Society of Reproductive Medicine recommends starting the evaluation after trying not to get pregnant for 6 months; When you are older, you usually put more emphasis on early examination and intervention. In other words, the 38-year-old has been pregnant for two years, and it is already a group that should systematically investigate the reasons, rather than just waiting.
Crowd: Which 38-year-old pregnant women should be examined as soon as possible?
Not all "not pregnant" are exactly the same. Clinically, the following groups of people need to be more vigilant:
Irregular menstruation: It suggests that there may be abnormal ovulation, decreased ovarian function or endocrine problems.
Previous history of pelvic inflammatory disease, ectopic pregnancy and tubal surgery: the risk of tubal factors is higher.
Dysmenorrhea is obvious, sexual intercourse pain or pelvic pain: endometriosis needs to be considered.
There are many previous abortions and uterine cavity operations: it is necessary to pay attention to the endometrium and uterine cavity environment.
The man's long history of smoking, drinking, staying up late or abnormal semen: the male factor can not be ignored.
It has been tried for a long time to calculate the ovulation date, but the method is single: it may not be that there is no effort, but the monitoring method is not accurate.
From the first-principles point of view, pregnancy involves at least four links: having available eggs, being able to excrete, being able to reach sperm, and being able to implant embryos. After the age of 38, if any link goes wrong, the waiting cost will be higher than when you were young. ACOG pointed out that women's fertility will decline with age; At the same time, the risk of miscarriage will also increase with age.
Expert tip: 38-year-old pregnant for two years, not pregnant, it is not recommended to just revolve around "trying for a few more months". Age-related changes in egg quality can often not be reversed by extending the waiting time.
Technology: What should I look for? It is not that the more projects, the better, but that the key factors should be grasped first.
Many people mistakenly think that "pregnancy failure = direct test tube". This is a common misunderstanding. The standard path is usually to evaluate the cause first and then decide the treatment level. Common inspection points include:
Main significance of common inspection in investigation direction
Ovulation function, menstrual history, basic hormones and B-ultrasound monitoring ovulation to judge whether ovulation is regular.
Ovarian reserve AMH, AFC and basic FSH were used to evaluate the trend of ovarian reserve.
Tubal factors salpingography and ultrasound related examination to see whether the fallopian tube is unobstructed.
Uterine factors Yin Chao, uterine cavity evaluation to see if there are polyps, fibroids, adhesions, etc.
Determination of sperm quantity, vitality and morphology by male factor semen analysis
Other factors: thyroid gland, prolactin, metabolism, etc.
The American College of Obstetricians and Gynecologists pointed out that infertility evaluation usually includes physical examination, laboratory examination and imaging examination, and the purpose is not to "do the whole set", but to try to find out the key reasons for not being pregnant. ASRM also emphasizes that the assessment should be systematic, timely and give priority to less invasive methods.
Here, we should also point out a common premise error: low AMH does not mean that you must not be pregnant naturally; Normal AMH does not mean that fertility must be fine. ACOG clearly mentioned that AMH test is not suitable for predicting natural fertility alone, but it is more suitable for comprehensive judgment in the framework of ovarian reserve evaluation.
Q&A: Five most common questions about 38-year-old pregnant for two years.
Is it because I don't have enough time? Just wait?
Mostly not.
For the 38-year-old who has been pregnant for two years, it is usually not a priority to continue "pure waiting". Because from the guide point of view, people over 35 years old should enter the assessment when they are not pregnant for 6 months. Not pregnant for two years, indicating that at least the basic etiology screening should be completed.
2. As long as the menstruation is normal, does it mean that ovulation is no problem?
Not necessarily.
Menstrual regularity can indicate the possibility of ovulation, but it cannot completely replace ovulation monitoring. Although some people seem to have a normal cycle, they may still have luteal function problems, ovulation quality problems or abnormal follicular development.
3. Pregnancy has always failed. Is the problem mostly in the woman?
This judgment is not objective.
WHO pointed out that infertility may come from female factors, male factors, or both factors or reasons are unknown. Clinically, male semen analysis is usually a part of basic evaluation and cannot be omitted.
4. Is it easier to get pregnant with the more frequent sex?
Not necessarily, the key is the effective frequency.
NICE suggested that having sex every 2-3 days during pregnancy preparation can help optimize the chances of conception. Over-reliance on "precise ovulation day" sometimes increases anxiety and reduces the stability of execution.
5. Is it too soon to suggest assisted reproduction after examination?
It depends on the reasons, and it is not appropriate to generalize.
If there are serious fallopian tube problems, obvious decline in ovarian reserve, and too long overlapping time of age factors, the path to artificial insemination or test tube is not necessarily "too fast"; However, if the timing of ovulation is unclear, the man is slightly abnormal or has endocrine problems, it may be reasonable to standardize the treatment first. The key is not "do it or not", but whether it meets the medical indications.
Summary box: 38-year-old pregnant for two years, the real question is not "can you wait", but "has the reason been identified and the path is right?"
Process: What's the more reasonable next step?
From the practical point of view, it is suggested to proceed as follows:
Step 1: First, change "ineffective efforts" into "assessable efforts"
Make it clear whether it is a regular and unprotected sex life.
Review whether ovulation is estimated only by App for a long time.
Check whether the man has never checked semen.
Step 2: Complete the basic fertility assessment.
It is suggested to go to the reproductive medicine or gynecological clinic of a regular hospital as soon as possible to complete the following basic projects:
When necessary: thyroid function, prolactin, infection and other related examinations.
Step 3: Determine the path according to the result.
Ovulation is the main problem: first correct ovulation and endocrine problems.
Tubal problems are obvious: consider further treatment or assisted reproduction.
Male factors are prominent: first deal with male factors.
Age+ovarian reserve decreased significantly: it is generally not recommended to repeat inefficient attempts for a long time.
Step 4: Set the time boundary.
The biggest difference between 38 years old and 28 years old is not only "can you be pregnant", but also that the trial and error time is shorter. If the evaluation and treatment have been standardized for a period of time and there is still no result, the next step is often to be more active, rather than extending the natural trial cycle indefinitely. ASRM also stressed that fertility assessment and treatment should take into account age and medical history to avoid unnecessary delay.
Summary: Do you understand "insufficient time" or "wrong method" in one sentence?
When a 38-year-old woman is pregnant for two years, it is usually not a simple lack of time, but more likely that the age factor has been superimposed on the decline of fertility, and at least one link in ovulation, fallopian tube, uterine environment, man's semen or pregnancy preparation method needs to be corrected systematically.
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