标签： 上海风月网

Authors: Deputy Chief Physician Zhu Xiaodan, Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine.

At present, the global fertility problems are increasing day by day, and the overall fertility of women is on the decline. Women are facing various pressures in modern society, including occupational pressure, family pressure, social expectations, and the unhealthy lifestyle that follows, which makes the fertility of contemporary women decline more and more "younger". At present, the incidence of infertility is as high as 10%~18%. In 2023, the birth rate in China was as low as 6.4‰.

National birth rate

In the reproductive endocrinology clinic, patients often ask: How is my fertility? Can you still be born? Faced with such a question, today, let’s talk about this topic.

As we all know, to complete a successful pregnancy, women need the cooperation of the whole reproductive system and all organs of the whole body. Therefore, the evaluation of female fertility is divided into three parts: the first part is the evaluation of ovarian reserve function, the second part is the evaluation of the structure and function of uterus and fallopian tube, and the third part is the evaluation of general state.

First, the ovarian reserve function

The ovarian reserve function of women refers to the quantity and quality of eggs, that is, the "inventory" of follicles with growth and development functions. The number of follicles in women has been determined at birth and is non-renewable. With the increase of age and the progress of menstrual cycle, the number of eggs gradually decreases. So how do we evaluate how much "inventory" there is in the ovaries?

1. Age

Age is the primary factor to evaluate fertility, and the best reproductive age for women is 23~32 years old. With the increase of age, fertility gradually decreases, pregnancy rate and live birth rate decrease, and abortion rate increases. With the increase of age, ovarian function declines irreversibly, and the number of follicles and the quality of eggs decrease. Age-related abnormal vascularization, oxidative stress and free radical imbalance in the ovary will lead to the decline of oocyte quality, which will lead to fertilization failure or abnormal embryo development.

The picture comes from the Internet.

2. Basic follicle stimulating hormone (bFSH)

BFSH is the level of serum FSH on the second to fourth day of menstruation, and it is one of the indexes to evaluate ovarian reserve function. The main reasons for the increase of bFSH level are the aging, the decline of ovarian function, the decrease of E2 secretion, the weakening of negative feedback on hypothalamus-pituitary-ovarian axis, and the subsequent increase of FSH. When the serum level of bFSH is higher than 10u/L, the ovarian reserve function is decreased, and when the serum level of bFSH is higher than 18u/L, the live birth rate is almost zero.

3. Basic estradiol (bE2)

BE2 refers to the level of serum E2 on the 2nd to 4th day of menstrual cycle, which can be used as an index to evaluate ovarian reserve function. When the bE2 value is more than 74.9 pg/ml (274.134 pmol/L), the ovarian function is decreased or the pregnancy outcome is poor when in vitro fertilization (IVF) is performed, and the number of embryos obtained is small.

4. FSH/LH (follicle stimulating hormone/luteinizing hormone) ratio

FSH/LH ratio can be used as an index to reflect ovarian function, and can also be used as a sign of ovarian response to gonadotropin to predict pregnancy outcome. When FSH/LH > 2, it is suggested that the ovary may have a bad reaction to gonadotropin in assisted reproductive technology. When FSH/LH > 3.6, the ovarian function is obviously decreased, and the cancellation rate of IVF ovulation cycle is high.

5. Anti-Miller hormone (AMH)

AMH is mainly produced by primary follicles, preantral follicles, sinus follicles, etc. It regulates the growth and development of follicles and is not regulated by hypothalamus-pituitary-ovary axis. As a reliable index of ovarian reserve function, it can be detected on any day of menstrual cycle. Serum AMH concentration was negatively correlated with age. AMH value reaches its peak in adulthood (about 25 years old), generally drops significantly after 36 years old, and approaches zero when approaching menopause.

6. Inhibin B(INH-B)

INH-B appears from the pre-antral follicular phase and is regulated by FSH. INH-B level, as a direct index to predict ovarian reserve function, reflects ovarian reserve. On the third day of menstruation, the blood INH-B < 45 ng/L indicates that ovarian function is decreased.

7. Sinus follicle count (AFC) and ovarian volume

AFC, ovarian volume and ovarian interstitial blood flow parameters can be used as evaluation indexes of ovarian reserve function and responsiveness. AFC is significantly correlated with age and basic hormones. With age, the number of follicles decreases exponentially. Ovarian volume can reflect the number of follicles and the situation of ovarian reserve pool from another angle. With the increase of age, ovarian function declines and ovarian volume shrinks. The most commonly used parameters of ovarian stromal blood flow are the peak velocity of ovarian stromal blood flow (PSV) and resistance index (RI). High PSV and/or low RI indicate that the ovarian interstitial blood supply is abundant and the ovary responds well to gonadotropin.

Second, the evaluation of the structure and function of reproductive tract

Because of the special anatomical structure and physiological function of female reproductive tract, the evaluation of reproductive tract structure and function is also an important link in fertility evaluation, including vagina, cervix, uterus, fallopian tube and pelvic cavity.

1. Detection of vaginal microecology

Female reproductive tract flora is closely related to every step of ovulation, sperm transport, fertilized egg implantation, pregnancy and delivery. Reproductive tract infection of women of childbearing age affects their reproductive health, damages their reproductive function and increases the risk of infertility.

2. Detection of cervical lesions

Cervical diseases tend to be younger, which are closely related to fertility and pregnancy outcome. Regular gynecological physical examination, cervical liquid-based thin-layer cytology (TCT) and human papillomavirus (HPV) screening should be conducted to detect cervical diseases as soon as possible.

3. Detection of uterine abnormalities

Non-invasive ultrasound, such as hysteromyoma and endometrial polyp, is the most widely used examination method to evaluate the receptivity of uterus and endometrium, and to evaluate the shape, thickness, volume, peristalsis wave, uterine artery and hemodynamic parameters of endometrium. Hysteroscopy is the gold standard for the diagnosis of endometrial lesions, which can accurately identify cervical lesions, intrauterine lesions, abnormal endometrial morphology and abnormal tubal opening through endoscopy. Endometrial biopsy can also be performed. At present, there are cytokines, various receptors, endometrial receptivity chips and other detection methods to evaluate endometrial receptivity, and the research on endometrial receptivity is constantly expanding.

4. Tubal patency test

Including salpingostomy, hysterosalpingography/contrast-enhanced ultrasound and laparoscopic salpingostomy. At present, hysterosalpingography has become a research hotspot with its unique advantages (real-time dynamic, visualization and no radiation), and has gradually become the first choice for tubal patency examination. Liquid drainage has some shortcomings, such as invisibility, blindness and great difference. X-ray radiography, as a traditional method of tubal patency examination, mainly has the disadvantages of adverse reaction of contrast agent and radiation damage. Laparoscopic salpingostomy is the "gold standard", but it is not the first choice for the time being because of invasion, hospitalization, high cost, surgery and anesthesia.

The picture comes from the Internet.

5. Detection of pelvic factors

Pelvic diseases are closely related to female fertility, such as pelvic endometriosis, pelvic tuberculosis, pelvic adhesion, tubal diseases, hysteromyoma, ovarian tumors and pelvic inflammatory diseases. Laparoscopic surgery can find and diagnose abnormal pelvic conditions in time. For infertility caused by fallopian tube factors or uterine cavity factors, hysteroscopy combined with laparoscopy can treat pelvic cavity, fallopian tube and uterine cavity diseases accordingly, which has important clinical value for female fertility evaluation, diagnosis and treatment.

6. Female reproductive tract dysplasia

Abnormal development of female reproductive tract includes abnormal development of vagina, cervix, uterine body and fallopian tube, with or without abnormalities of ovary and urinary system. The combination of pelvic ultrasound and MRI examination is the best examination method for reproductive tract dysplasia.

Third, the general state assessment

In terms of systemic diseases, we should evaluate whether there are diseases that affect fertility or are not suitable for fertility, such as thyroid diseases, familial genetic diseases, blood system diseases, cardiopulmonary diseases and tumors.

1. Thyroid diseases

Abnormal thyroid function can lead to infertility and poor pregnancy outcome, so it is suggested that women with family planning should monitor thyroid function. Clinical hyperthyroidism can lead to abortion, premature delivery and thyroid crisis, and timely treatment can significantly reduce these risks; Infertile women with subclinical hypothyroidism should be treated with levothyroxine (LT4).

2. Hereditary diseases

According to the etiology, it can be divided into monogenic diseases, polygenic diseases, chromosomal diseases, mitochondrial genetic diseases and somatic genetic diseases, which have the characteristics of congenital, lifelong and familial. It is suggested that couples with rare diseases or couples who have given birth to rare diseases should have genetic testing and genetic counseling, reproductive risk assessment and guide reproductive decisions. The genetic diagnosis (PGD) before embryo implantation was provided after the pathogenic gene locus and genetic mode of the family were clarified.

3. Other general conditions

Nutritional status is a very important factor in regulating reproductive process, which is closely related to female reproductive function. For example, obesity and malnutrition have adverse effects on internal environment, egg quality and embryo development. In addition, mental state, living environment and systemic factors also need comprehensive consideration. Whether a woman’s whole system can withstand pregnancy is also the concern of fertility evaluation, including whether she is complicated with diabetes, hypertension, heart disease and tumor.

4. Who needs fertility assessment?

1. Couples who have been pregnant for more than 1 year without pregnancy;

2. People who have had many bad pregnancies in the past;

3. People who have had multiple abortions or ectopic pregnancy in the past;

4. Women of childbearing age with less menstrual flow, irregular menstrual cycle and dysmenorrhea;

5. Obese or thin people (BMI>24 or BMI<18.5);

6. White-collar workers who stay up late and work overtime for a long time;

7. People who use computers and mobile phones for a long time to work in a radiation environment;

8. People with smoking, drinking, drug addiction and other habits.

In a word, fertility assessment can help women understand their fertility potential and possible fertility problems. In fact, whether you have the desire to have children at present or not, regular fertility assessment can help you plan your birth plan reasonably, receive corresponding medical help in time, and don’t leave regrets for your life!

　　Abstract: Socialism with Chinese characteristics Road is the choice made by China people in the long-term exploration and practice led by the Communist Party of China (CPC). One of the important reasons why this road is getting wider and wider and showing strong development vitality is that it is endowed with distinctive China characteristics in adhering to the basic principles of scientific socialism, scientifically grasping the development laws of human society and fully drawing lessons from the achievements of human civilization.

　　The Communist Party of China (CPC) led the people of China through arduous exploration and great practice of revolution, construction and reform, and embarked on a road of their own: Socialism with Chinese characteristics Road (hereinafter referred to as China Road). This road is an innovative road that the Communist Party of China (CPC) led the people to adhere to the basic principles of scientific socialism, scientifically grasp the laws of human social development, and fully draw lessons from the achievements of human civilization. This road is getting wider and wider, and it shows strong development vitality.

　　Adhere to the basic principles of scientific socialism and create and develop Socialism with Chinese characteristics.

　　The basic principles and theoretical logic of scientific socialism include not only the scientific judgment of the development trend of human society, the scientific exposition of the essence of socialism, but also the scientific conception of a better social state in the future. Marxism holds that the development of human society from capitalism to socialism and communism is a natural historical process and an inevitable historical trend. Socialist society is a society in which a new type of state power and social system is established under the leadership of Marxist political parties, and the overwhelming majority of workers become masters. It is the institutional advantage of socialism to overcome the contradiction between socialization of production and private possession of production materials in capitalist society by establishing new forms of social ownership such as public ownership of production materials; It is an objective requirement of socialism to jump out of the cyclical economic crisis of capitalist production and continuously increase the total productivity by implementing new modes of production and economic operation. In the process of its establishment and continuous development, Socialism with Chinese characteristics has always adhered to these basic principles, given full play to the institutional advantages of socialism, and greatly improved the level of social productive forces.

　　At the same time, Socialism with Chinese characteristics continued to innovate and develop on the basis of practice, endowing scientific socialism with distinctive China characteristics. Since the founding of New China 70 years ago, the road of China has become wider and wider, which has opened up a new realm for the development of scientific socialism. Especially since the 18th National Congress of the Communist Party of China, the CPC Central Committee with the Supreme Leader as the core has United and led the people of all ethnic groups in China to promote the overall layout of the "five in one", coordinate and promote the "four comprehensive" strategic layout, take charge of the "four greats", draw a strategic road map for adhering to and developing Socialism with Chinese characteristics in the new era, and start a new journey of socialist modernization. Adhere to the basic economic system with public ownership as the mainstay and multiple ownership economies developing together, unswervingly consolidate and develop the public ownership economy, unswervingly encourage, support and guide the development of the non-public ownership economy, give full play to the decisive role of the market in resource allocation, better play the role of the government, and stimulate the vitality of various market players; It is clear that the most essential feature of Socialism with Chinese characteristics is the Communist Party of China (CPC)’s leadership, the greatest advantage of Socialism with Chinese characteristics system is the Communist Party of China (CPC)’s leadership, and the party is the highest political leadership; Wait a minute. This series of new ideas, new strategies and new measures not only adhere to the basic principles of scientific socialism, but also make new development according to the characteristics of China’s times.It enriches and develops our Party’s understanding of scientific socialism and the law of Socialism with Chinese characteristics’s construction.

　　History and reality have eloquently proved that the successful opening and continuous expansion of China Road is not only the success of Socialism with Chinese characteristics, but also the victory of socialism. It is the innovation of China’s road that makes scientific socialism glow with great vitality in China in the 21st century, and makes more and more people in the world face up to and believe in Marxism and socialism.

　　Scientifically grasp the development law of human society and constantly open up a new situation in socialist modernization.

　　Modernization is the call of the times since the 20th century and the embodiment of the development law of human society. After the founding of the People’s Republic of China, our party led the people to carry out socialist transformation quickly, and gathered the strength of the whole society to build an independent and complete national economic system, build the "four modernizations" and strive to promote economic and social development. After the Third Plenary Session of the Eleventh Central Committee of the Communist Party of China, China carried out reform and opening up, devoted itself to building a well-off society, and made continuous progress towards achieving common prosperity for all people, greatly accelerating the process of socialist modernization. Socialism with Chinese characteristics has entered a new era, and building China into a modern socialist power has become the second century-long goal of the whole party and people.

　　The modernization of human society is the general trend, but how to realize modernization needs to be explored by each country in combination with its own reality. Modernization is not "Westernization", and it cannot be imitated by others, let alone imitated by others. The mode of modernization in western countries through colonization and plunder has become a thing of the past, and it is impossible to copy and will not reappear. Some countries copied the western model, resulting in national chaos, great damage, and even become vassals of western developed countries. In order to speed up the modernization drive in the primary stage of socialism and realize the Chinese dream of the great rejuvenation of the Chinese nation, China must persist in being upright and innovative, and explore its own roads and methods on the land of China with the strategic determination of "sticking to the green hills and not relaxing".

　　In the past 400 years, the modernization led by western industrial civilization has achieved great development of human society. However, this development model, which opposes man and nature and exchanges economic growth at the expense of the ecological environment, has become increasingly desperate. The worsening resource depletion, ecological degradation and climate warming are alarm bells for the western modernization road. Modernization and green mountains and green rivers cannot be neglected. China firmly adheres to the civilized development road of production development, affluent life and good ecology, and regards "beauty" as an important connotation of modernization, which fully embodies the great innovation of China’s socialist modernization road. In the process of modernization, the harmonious coexistence between man and nature will be maintained, and the overburdened earth will be "recuperated". China’s ecological civilization construction has embarked on a new road of modernization for human society.

　　China road not only has distinctive China characteristics, but also has a broad world vision and broad human feelings. At present, human society, especially developing countries, is facing a series of common problems in modernization. For example, how to achieve national prosperity, national rejuvenation and people’s happiness under the background of economic globalization and in the increasingly fierce international environment; How to make the fruits of development benefit the whole society and let all people live a happier and more dignified life; How to make the system more suitable for the development of productive forces and promote the development of productive forces to a higher level; Wait a minute. Socialism with Chinese characteristics has responded effectively to these questions. For this reason, China Road has expanded the way for developing countries to move towards modernization, provided a brand-new choice for those countries and nations in the world who want to speed up their development and maintain their independence, and contributed China wisdom and China’s plan to solving human problems.

　　Occupy the moral commanding heights of human civilization and progress, and promote the construction of a community of human destiny.

　　Today, we live in a world full of contradictions. On the one hand, material wealth is accumulating, science and technology are changing with each passing day, and human civilization has developed to the highest level in history; On the other hand, regional conflicts, terrorism and refugee flows are one after another, and anti-globalization, unilateralism and bullying go hand in hand. "What’s wrong with the world? What should we do?" The question of the world issued by the Chairman of the Supreme Leader was deafening. The development of human society will inevitably be marked by a specific historical stage, but it is a historical trend to replace backwardness with progress, eliminate disasters with happiness and resolve barbarism with civilization, which is the correct value orientation of a country’s economic and social development and the moral place of human civilization and progress.

　　Facing the great changes that have never happened in the world in a century, and at the crossroads of the development of human society, we are increasingly aware that the earth is the common home of mankind, and the world is a big stage for all countries to seek common development, not an arena for all countries to wrestle with each other, and we cannot lead the world to chaos for our own selfish interests. The long-term development of the world cannot be based on the fact that one group of countries are getting richer while another group of countries are long-term poor and backward. That beggar-thy-neighbor approach, passing on the crisis and harming others’ interests is neither moral nor sustainable. Abandoning the cold war mentality and zero-sum game, abandoning the jungle law of the jungle, mutual respect, equal coexistence, peaceful development and common prosperity are the right ways in the world. China Road is such a right path on earth. The road of China lies not only in that the Chinese nation has ushered in a great leap from standing up, becoming rich and becoming strong through great practical achievements, but also in that its basic value orientation is to achieve national development and contribute to world development through win-win cooperation.

　　China Road is a road of peaceful development and is committed to building a community of human destiny together with other countries in the world. In this new world development picture, it is no longer the law of the jungle, nor the winner takes all. There is no distinction between the center and the periphery, and there is no difference between the sovereign state and the colony. Every country and every nation can achieve "beauty and beauty" in "beauty" and achieve win-win sharing in joint construction. It advocates that the destiny of the world should be shared by all countries, international rules should be written by all countries, global affairs should be governed by all countries, and development achievements should be shared by all countries, so as to promote the development of the global governance system in a more just and reasonable direction. As an important practical platform to promote the building of a community of human destiny, the Belt and Road Initiative has enriched the concept of international cooperation and the connotation of multilateralism, opened up a new space for world economic growth, built a new platform for international trade and investment, expanded new practices for improving global economic governance, and made new contributions to enhancing the people’s livelihood and well-being of all countries.

　　Behind the concept of development stands the concept of civilization. Over the years, some people in the West have always worried that China’s strength will pose a threat to the world. In fact, since ancient times, Chinese civilization has lived in harmony with the world and advocated harmony among all nations. Zheng He’s seven voyages to the West spread the seeds of peace and the glory of culture. A civilization with peace and harmony as its basic values is peaceful and kind in history, and it is also peaceful and kind today and in the future. Comrade Supreme Leader pointed out, "China, the lion, has woken up, but this is a peaceful, amiable and civilized lion." The Chinese nation has always emphasized "one country under the sun" and "harmony without difference", advocated harmony between the people and the world, and looked forward to a beautiful world of "a trip to the main road and the world serving the public". This value concept has been fully reflected in the road of China through creative transformation and innovative development, as well as in the initiatives and concrete practices to promote the construction of a community of human destiny. (The Supreme Leader of the Central Party School (National School of Administration) New Era Socialism with Chinese characteristics Thought Research Center: Xin Ming)