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💴 | Infertility treatment, which is a hot topic in the changing administration.What are your current support measures?


Infertility treatment, which is a hot topic in the change of government.What are your current support measures?

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In addition, the number of couples who have experience in infertility treatment has reached about 3%, and it is hoped that support measures for infertility treatment will be enhanced.

Actual conditions of infertility treatment 1. Approximately 16 in 1 of all babies are born by infertility treatment (assisted reproductive technology) Statistics Day 2018 ... → Continue reading

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infertility(Funin) is in a natural state妊娠It refers to a state in which pregnancy cannot be maintained for a certain period or more.FertilityIn normal couples (fertility), about 3% get pregnant in 50 months, 6-70% in 80 months, and about 1% in 90 year after vaginal ejaculation.WHO,Japan Obstetrics and Gynecology AssociationBoth are defined as "a condition in which a man and a woman who wish to become pregnant are having sexual intercourse without contraception but cannot become pregnant within one year."It is found in 1-10% of couples wishing to become pregnant.The American Society of Reproductive Medicine also recommends that women over the age of 15 be tested after half a year of having vaginal ejaculation but not becoming pregnant.[1][2][3][4]..This section mainly describes female infertility caused by age-related decline in fertility or illness.

For infertility caused by male sperm problems and genital insufficiency,Male infertility"Or"Sexual dysfunctionSee.


whoIs defined byHealthy men and women who want to become pregnantcontraceptionDon't dosexual intercourseHave been pregnant for over 12 monthsIs[1][5][6]. The American Society of Reproductive Medicine also states that “More than 1 years", and further "If you're over 35, you should start a medical exam if you don't get pregnant if you haven't had contraception for more than 6 monthsIs recommended[5]. In some cases, a condition that does not lead to pregnancy is distinguished from primary infertility, and a condition that does not lead to more than one pregnancy/postpartum pregnancy is distinguished from secondary infertility.

20158/29,Japan Obstetrics and Gynecology AssociationAt the Board of Directors defined the definition of infertility from the past two years,1Changed to[2].

In Japan, couples with normal fertility wish to become pregnantVaginal ejaculationIt is said that within 6 months, 65%, 1% in 80 year, 2% in 90 years and 3% in 93 years will become pregnant.[7]..In addition, when both are infertile to ejaculate in the vagina at the appropriate age for pregnancy, about 24% have problems only on the male side, 41% have problems only on the female side, and there are problems with both sexes. It is said that there are 24% of cases and 11% of cases of unknown cause.[8].

On the other hand, if you become pregnant but habitually have a miscarriageInfertilityThat is.Recurrent miscarriage may be incorporated as part of infertility in a broad sense, but the concept is basically different.The Japanese Society of Reproductive Medicine also includes age-related infertility and effective egg depletion in women aged 45 and over in the category of "infertility."All elderly women of humanity are infertile, and no one is not infertileIs recognized as[9].

Japan is,In vitro fertilization in hopes of becoming pregnant, and the age of women themselves is increasingWhen collecting eggs by in vitro fertilization, there are many "natural cycles" in which only eggs that grow naturally in the ovaries are collected, instead of the method of administering drugs in advance and culturing a large number of eggs in the ovaries. There is.However, this non-culturing method has not been performed in other developed countries due to its low success rate, and the clinical practice guidelines of the British Institute for Health Technology Assessment <NICE> states that "in vitro fertilization in the natural cycle is for patients. Do not propose. "For the above two reasons, the International Committee Monitoring Assisted Reproductive Technologies (ICMART) reports that the number of in vitro fertilizations is the highest in the world, but the number of births per egg collection is the highest. The rate is the lowest in the world, and it is reported that "the country that cannot give birth due to fertility treatment, the highest in the world"[10][11].

A couple who decided to end fertility treatmentSpecial adoptionHowever, according to the Civil Code, the age difference between parents and children should be less than 15 years old for children, 25 years old or older for parents and 20 years old or younger when the child turns 65 years old. Children under 0 when they were 45 years old[12]Because it is limited to, it may not be in time to consider special adoption after giving up treatment.[13][14].

Infertility history

The cause of infertility exists in both men and women,Half of them are due to the male side[15].

On the other hand, the factors of infertility due to aging are largely biased toward women. According to the Japanese Society of Reproductive Medicine, regardless of health condition,Women over the age of 45 are almost impossible to become pregnantBecomes The success rate of pregnancy under 35 years old exceeds 3%, but if it exceeds 35 years, it will fall to the middle of 2%. Therefore, a couple who wants even one childIt is good to plan your family by considering giving birth by the age of 34..

However, 20% of women in their 6s are also infertile, and the younger the woman, the higher the chance of becoming pregnant.Therefore, in order to start infertility treatment early, the condition of her body should be examined by an obstetrics and gynecology department. Some people say that they should be educated by compulsory education so that they can get it. Women's insurance coverage for infertility is also up to age 40 in Germany and highest in age 42 and below in France.[16][17]. In addition, treatment of infertility in Japan, such as artificial insemination and in vitro fertilization,Health insuranceDoes not apply[17]. Some people argue that infertility is not a disease based on this[18].

Still more1989Even reaching someFeminist"The idea that infertility is sick even though there are no health problems leads to the idea that women who do not have children are not alone. In addition, the physical burden on women due to infertility treatment is extremely high. In addition, there is an example of denying that infertility is a disease, saying, "Illness is not recognized even from the aspect that it does not matter for a single person."[19].

Ministry of Health, Labor and WelfareNational Institute of Population and Social Security ResearchOf the Birth Trend Basic Survey conducted every five years2010According to the 14th Birth Trend Basic Survey, the percentage of those who are 20 to 49 years old who have been anxious about infertility/treatment and have undergone tests and treatments is 16.4%, which is increasing with aging.[20].

Female infertility, which is not due to age, is often associated with ovulation disorders. Similarly, male infertility is due to spermatogenesis disorders of unknown cause in 9%. In this case, there is no technical probability of treating males, and the age of ovulating ova, which is difficult to treat, is consistent with the actual age, regardless of the appearance youth such as anti-aging. The ovum that was ovulated at the age of 35 is the ovum that was created in the female body 35 years ago. Therefore, the longer the period in the ovary of "aging of the egg", the lower the quality of the egg and the function of the egg.[21].

Causes of female infertility

whoAccording to statistics, such as sperm and ovarian diseasesInfertility causes that do not consider agingIt is reported that the cause is only in men, 24%, only women is 41%, both men and women are 24%, and unknown is 11%.[8].Due to agingInfertility, on averageHealthy man is 40 years oldFromHealthy woman is 26 years oldFertility declines from[22].

The following factors have been suggested to cause infertility:

Age-related egg aging and decreased fertility

Ministry of Health, Labor and WelfareAge is the most common cause of infertilityRevealed[23].A woman has a fixed number of eggs at birth and decreases with age to reach menopause.Eggs are already set in the ovaries at the birth stage of the woman, and unlike sperm, there is no new production increase.After the first menarche, it will continue to decrease with each ovulation and fertilization.For this reason, the egg ages and ages with the woman,After reaching the maximum pregnancy probability around the age of 20, the number and quality of the pregnancy decline in the 30s, and it is said that the pregnancy ability will be lost at the age of 45, which is about several years before the menopause.Moreover, on average at the age of 50menopauseThe number of eggs in the ovary becomes physically zero.[24][25].. Around 50 years oldmenopauseAlthough the number of ova in the ovary is physically zero, it is called infertility, but it is not a disease or syndrome, but a physiological phenomenon that all women follow with aging. The Society of Reproductive Medicine treats it as "infertility".

Abnormal sex differentiation

Hermaphroditism,Turner syndrome,Kleinfelter syndrome,Congenital adrenal hyperplasia,Testicular feminization syndromeIt is well known that such animals become infertile. Various genetic abnormalities such as abnormalities on the Y chromosome and chromosomal abnormalities are known, but basically they can be understood by the concept of female infertility and male infertility as described below.

Infertility due to female disease

To get pregnantovulationThen,FertilizationAnd transport fertilized eggs,ImplantationNeed to If any of these are impaired, female factors cause infertility. It is easy to understand by considering endocrine/ovulation factors, fallopian tube factors, and uterine factors separately. The highest frequency is due to the fallopian tube factor.

Endocrine ovulation factor
These abnormalitiesAmenorrheaIt is usually accompanied by abnormal menstruation. Abnormal hypothalamic pituitary system, hyperprolactinemia,Polycystic ovary syndrome,Luteal dysfunctionAre known. Secondary amenorrhea is a very common disease, especially of the hypothalamus. Primary amenorrhea is extremely rare.AmenorrheaSummarize the causes of.
As for primaryKalman syndrome,,and so on. As for the secondary,Anorexia nervosa,Weight loss amenorrheaAnd so on. Kalman syndrome is a hereditary disease associated with anosmia, which is a syndrome accompanied by decreased gonadotropin production in the hypothalamus and general malformation. Frehrich's syndrome is a syndrome that has female symptoms of obesity and developmental disorders of the genitals as two main features, and has an organic disease in the hypothalamus.CraniopharyngiomaMost often due to visual abnormalities and intracranial hypertension. Lawrence Moon Beadle syndrome is a disease with the six main features of obesity, retinitis pigmentosa, polydactyly, syndactyly, dysfunction of production and familial onset. , With uremia and mental disorders. Chiari Frommer syndrome is hypothalamic hyperprolactinemia associated with pregnancy and lactation. Argon Zudder-Castille syndrome is hypothalamic hyperprolactinemia that occurs regardless of pregnancy or breastfeeding and has no abnormalities in the saddle of Turkey.
Examples of the primary type include. As secondarySheehan syndrome,Pituitary adenomaAnd so on. Forbes Albright Syndrome is due to the presence of an organic disease (usually an adenoma) in the pituitary glandHyperprolactinemiaThat is the case.
As for primaryTurner syndromeAnd so on. As secondaryPolycystic ovary syndrome(PCOS) ,, ovariectomy, etc.Early ovarian dysfunction is hypergonadotropin hypoestrogenemia (menopausal pattern) before the age of 40.When the number of eggs becomes 0, or when the sensitivity of FSH and LH becomes extremely difficult.In general, induction of ovulation is extremely difficult.In addition, amenorrhea such as uterine and vaginal is also present.
Fallopian tube factor
As the cause of the fallopian tube, hydrosalpinx and obstruction of the interstitial area of ​​the fallopian tube are known. HydrosalpinxGenital chlamydia infectionIt is the adhesion around the fallopian tube caused by. Oviductal interstitial obstructionEndometriosisIt occurs as a result of repetitive inflammation such as Chlamydia infection. When these disorders occur, the transport and interaction of eggs and sperms are blocked, leading to infertility. It should be noted that chlamydial infections are often asymptomatic even infertility. Chlamydia infections are rareFitz-Hugh Curtis SyndromeCause perihepatic inflammation. It is important for differentiating upper abdominal pain in young women. Even if you do not have infertility, if the transport capacity of the fallopian tube is reduced due to inflammationEctopic pregnancyIt is easy to cause it, so be careful.
Uterine factor
Most have abnormal uterine morphology. Uterine malformation,Uterine fibroid,Endometriosis,Usherman syndromeAre known. An immunological abnormality may be the presence of anti-sperm antibody in the cervix. in this caseHuman test(Abstinence for 2 days, cervical mucus is collected after sexual intercourse, and it is normal if there are 10 or more motile sperms) to evaluate the interaction between cervical mucus and husband sperm.Another way to evaluate without sexual intercourse is to collect cervical mucus and see if sperm enter the cervical mucus.Infertility after cesarean section is often caused by cesarean section scar syndrome.

Pregnancy and childbirth ability according to female age

健康な男性が40歳を越えてから生殖能力が下落し出すのに対して、健康な女性は胎児期に卵子数ピークの約700万を迎え、その後は下落し続ける。出生時に200万、思春期に20-60万、平均約26歳で大きく下落し始め、平均32歳で更に下落し、40後半から50歳の閉経時に0になる。これはAging of the eggIs reported as medicallyReduced number of eggsとPoor quality of the eggMeans. By the way40-year-old woman after advanced fertility treatment of around XNUMX million yenThe chance of having a baby safely by in vitro fertilization is 8.1% of the total number of treatments and 45% at the age of 0.5.Without treatment, the birth success rate is even more severe.出産児童の染色体異常率も20歳では1/1667、30歳では1/952、40歳では1/106、45歳では1/30と、年齢とともに急激に増加する。20歳の出産と比較すると、40歳で約16倍、45歳で約56倍と、発生頻度が高くなっていく[22][26][27].. The ability of a healthy woman to become pregnant and give birth is the firstovulationIt begins at the time (generally 11-12 years) and ends at the last ovulation (generally around age 50). As a rule of thumb for human beings, the pregnancy rate is low during the period from the first ovulation to several years (generally in the early teens) because the body does not grow to the necessary and sufficient state for pregnancy and childbirth. Up to the early teens had the ability to become pregnant and give birth[28][29][30][31], 20s are the most likely to get pregnant[16], After the late thirties, it gradually decreases due to the deterioration of the ova and uterine capacity[28][29], In the late 40s, the ability decreased significantly[28][29], Close to zero for people over 50, but there are very few exceptions for births over 50[28][29].

With the Ministry of Health, Labor and WelfarewhoIt is,Total fertility rateAs a definition for calculating, the population is women aged 15 to 49 years. There are births under 15 years old and over 50 years old, but they are not included in the statistics for calculating the total fertility rate because they do not affect the accuracy of the statistics.

Irregular menstruation and infertility in young people

Because there are individual differences,Even in teens, women below the standard deviation of egg count have only the average number of eggs in their late 10s.All women go to obstetrics and gynecology because of juvenile infertilitymenarcheIt is recommended that the ovaries and eggs be examined when they are young. In particular, if the menstrual cycle is stable between 28 and 32 days and does not correspond to the planned menstruation, even if there is menstruation, there is a high possibility of infertility such as anovulatory cycle that does not ovulate.[32][33].

Egg aging and insurance coverage age

Some people think that they can give birth to any number of children, but there is a suitable age for pregnancy, and the older a woman is, the more difficult it becomes to become pregnant. So in GermanyUp to 40The infertility test and infertility treatment are within the scope of public health insurance, the infertility test is free, the next step such as artificial insemination is half the self-pay, age limit exists[34].. It has been pointed out that "aging of eggs" due to aging, which has been taboo in Japan, is the main cause of difficulty in pregnancy after age 26. Healthy male and female couples with no disease in either women or men are less likely to become pregnant due to aging eggs[16][35][36].

For healthy menMake a new germ cell (sperm) each time, Even healthy womenGerm cells (eggs)Is differentiated and formed from the time of developmentAfter that it will not be newly created.. As a result of this difference, the age of sperm is a few days after birth at the time of fertilization, whereas the age of the egg is the age of the woman at ovulation + 1. No matter how young a woman's body (somatic cells) looks, you cannot know the damage done to an egg (germ cell). The term "egg aging" here meansSignificant drop at about 26 years old on average, 33 years old, it rapidly deteriorated, almost lost fertility at the age of 40, and reached zero fertility at the time of menopause around the age of 50. "Ovarian aging" is a general term for the decline of egg function. The number of follicles in the ovary decreases with age, the number of egg granulosa cells decreases, inaccurate segregation of nuclear chromosomes, mitochondrial DNA. Is thought to be decreased, and the ability of the endoplasmic reticulum to uptake calcium is reduced.[22][37].

Cryopreservation of eggs

Originally, this is a treatment method for future birth protection for women who become infertile due to radiation therapy etc., but in order to avoid the infertility problem due to aging of the egg,A technique for cryopreserving young eggs in liquid nitrogenAnd some women store their eggs until after marriage[16].. A woman who had an egg frozen before treatment in April 2009 to receive radiation therapy for acute myelogenous leukemia melted the frozen egg in 4 after radiation was completely cured in 2015, and re-frozen the fertilized egg after microinsemination. , In February 2016, fertilized eggs were transferred to the mother. He became pregnant at the age of 2018 and gave birth to a healthy child in October of the same year. In this way, there are cases in which fertilized eggs were transplanted into the body in the first half of thirty years, 2 years after freezing the ova in the early twenties, and delivery was successful.[38].. However, a method applying the frozen egg technology of cattle in dairy farming[39], Immature eggs and mature but unfertilized eggs (immediately before and immediately after ovulation) have low freeze tolerance, so even young frozen eggs in their early twenties may not always be 20% successful with current technology[40][38].

Doctors who treat infertility said, "The age of marriage is gone, but the age of pregnancy is not moving.[41]'"There is always a suitable age for pregnancy." "Egg rejuvenation is impossible." "Eggs do not rejuvenate no matter how young they look."I tell you. Doctors said that it was not known that there was a close correlation between female aging and infertility, and that in vitro fertilization and egg freezing were associated with the age of the frozen egg and the current age of the mother. It is revealed that there are problems that current fertility treatment cannot solve if there are no young eggs at the time of surgery[16].

Birth rate according to the age of infertility treatment

The probability of giving birth after infertility treatment using in vitro fertilization is 30% ​​at the age of 19.9 years, 35% at the age of 16.3 years, 40% at the age of 7.7 years, and 45% at the age of 0.6 years.[42].

Second infertility

Since there were no major problems with reproductive function between the couple, the condition in which the first person was given but the second person was not given is called "second infertility".The cause is that the age of the first child is rising, so the age when the second child is desired is also inevitably raised, and when the second child is desired, the quality of the egg, the health of the ovaries, and the quality of the sperm are improved by aging. Eyes It is difficult to get pregnant because it is lower than when pregnant.Men who can have children even in old age are often overlooked, but there are cases where sperm quality deteriorates due to stress and aging.Second infertility after sexual intercourse for more than 1 yearIn this case, a sperm test is also required.The possibility that a couple who has given birth once and has one child will not have the next child (infertility rate) is20-24歳が5%、25-29歳が9%、30-34歳が15%、35-39歳が30%、40-44歳で64%And as the age goes up[43][44].. It is rare for women over the age of 0 in the late 40s, when the number of ova is XNUMX, to become spontaneously pregnant.[45][46]..夫の精子の検査で異常が見られない場合、妻が閉経前で排卵自体はしていても、一人目時よりすでに卵子が老化しているため、精子が自然妊娠で受精できる状態ではなくなっているIf the husband's sperm test shows no abnormalities, the sperm is no longer ready for fertilization due to spontaneous pregnancy because the wife has ovulated before menopause but the egg has already aged since the first time. Is[45]..このように年を重ねる度に卵子や精子といった生殖細胞は老化するので、年を取るほど体外受精による妊娠も成功する確率は低くなるIn this way, germ cells such as eggs and sperms age with each passing year, so the older you get, the lower the chance of successful pregnancy by in vitro fertilization.[46][47].

Infertility and miscarriage risk associated with aging

Until now in Japanese educational settingsSex educationIt is,contraceptionとVD(Venereal disease), and the problem of egg aging has hardly been taught.[48][16].. Even if the media reports on the case of an entertainer giving birth to a child over the age of 40, it is not explained that this is a medically unique case. As a result, the problem of egg aging has come to the forefront without being recognized.[49][16].

For women and the trend of late marriage,Life planIf you definitely want a child, marriage, pregnancy, and childbirth in your 20s are being encouraged, and social development to support it is required.[50].

In JapanHouse of Councilors Member of the House of CouncilorsAccording to a research information magazine published for, "Medically, the function of the ovary deteriorates after the age of 35." At the beginning, it is difficult to get pregnant over 32 years old,'' he said.[51].

Even after undergoing advanced infertility treatment such as in vitro fertilization and microinsemination in 2018, the percentage that reached from pregnancy to delivery is35% at age 18.4, 45% at age 0.9Is. The miscarriage rate is 35% at the age of 20.1, 40% at the age of 34.6, and 45% at the age of 63.2. There is an opinion that the infertility rate and the miscarriage rate increase with each aging, so it should not be considered that "it can be delivered by infertility treatment even at the age of 40".[52].

Male infertility

In Japan, when there are 1200 million couples, about 10% are infertile couples, and the causes of infertility are "female only" 41%, "male only" 24%, and "both men and women" 24%.1200 in 54 million couplesIs the cause of infertility on the male side.As mentioned above, the cause is found on the male side at a rate that seems to be close to half of infertility.Furthermore20% of men aged 40-3Is a male infertility patient without being aware of100 out of 5The cause of infertility is male only.Female infertility is widely known as obstetrics and gynecology, but there are few facilities that specialize in male infertility.Urology in some hospitals and clinicsIt is done only in.Furthermore, it has been pointed out that only 1% to 2% of all male infertility patients receive medical treatment there.[53].

Causes of male infertility

Fertility in healthy men begins to decline on average at age 40[22].. 30-year-old males have 45% less fertility than 25-year-old males[54] ..Therefore, the cause of male infertility under 40 years old, which is not the cause of age, is that there is a problem in the process of sperm production such as inability to form or mature sperm.Sperm dysfunction, There is a problem even after ejaculation after healthy sperm production, such as impaired sperm transport routeSperm passage disorder, Seminal vesicles and prostate inflammation affect spermGenital disorders, Unable to fuck/ejaculateVaginal ejaculation disorderな どSexual dysfunctionIt has been known[54].

Male infertility by causeSperm dysfunction 90%,Sperm passage disorder 5%,Sexual dysfunction 3%,Hermaphroditism,Turner syndrome,Kleinfelter syndrome,Congenital adrenal hyperplasia,Testicular feminization syndromeIncluding abnormalities on the Y chromosomeOther causes 2%Is. Thus, spermatogenic dysfunction accounts for the majority of all causes of infertile men[54].

Since 90% of male infertility is caused by sperm dysfunction, semen analysis is basically performed first.By analysis of semen functionAsthenozoospermia,AzoospermiaSuch as the diagnosis. These causesChromosomal abnormality,Varicocele, Orchitis, cryptorchidism, and idiopathic nature are known. Congenital dysfunction, congenital dysgenesis, vas deferens, epididymitis are known.ProstatitisIt has been known.It should be noted that one of the causes of sperm dysfunction is considered to be deterioration due to aging. In 2005CopenhagenA study of 2,100 subjects found that sperm DNA damage in men over the age of 45 was significantly higher than in older groups, according to a report from the European Conference on Human Reproductive Sciences (ESHRE) held in. High, twice as high as men under 30


Regarding infertility diagnosis, in addition to general health surveys, hormone analysis by blood analysis,semenThe survey will be conducted. Of male infertility, lack of sperm motility, oligospermia,AzoospermiaEtc. are diagnosed by inspection of semen. Also, in the case of male causes, problems with the Y gene are also involved in infertility,PCRDiagnosis by law is being attempted.

For female infertility, analysis of thyroid stimulating hormone amount, female hormone amount, and diagnosis of female reproductive organs are performed. The cause of infertility may not be identified. If the cause of infertility can be treated, the causative disease is treated, and if no abnormality is found, the timing method is first instructed, and if it is invalid after trying for half a yearArtificial insemination, ART (in vitro fertilization or microinsemination) is considered. There is a screening test for infertility for the diagnosis of infertility that requires medical intervention and is also called a bridal check. The test items for endocrine ovulation factors include basal body temperature, hormone load test, and blood hormone measurement. As the fallopian tube factor, Chlamydia test, particularly cervical antigen, blood antibody titer and hysterosalpingography are known. Uterine hysterosalpingography other than uterine factor testUltrasonographyAnd MRI are known. In the case of male factors, semen examination is performed first. If any of these anomalies are found, further scrutiny is conducted.


Timing method

For infertility of unknown cause, it is highly likely that the timing is inconsistent. Therefore, it cannot be said that the method using drugs or surgical means does not affect the mother's womb, so at the stage when the definite cause is unknown.Timing methodIs often taught.

Artificial insemination

in Japan's case,Artificial inseminationMainly conducts artificial insemination by Husband (AIH). Artificial Insemination by Donor (AID) is performed only in a few registered medical facilities in Japan. The orthodox way isOvulation induction method, And tens of thousands of sperm are artificially injected into the uterine cavity. The collected spermatozoa are generally administered after extracting motile sperm by a sperm washing concentration method. By ovulation induction methodOvarian hyperstimulation syndromeThere is a risk of becoming (OHSS). Aversion to sexual contactVaginal ejaculation disorderIt is considered to be the best solution as a solution in case of the above.

Assisted Reproductive Technology (ART)

Summarize the general procedure of (Assisted Reproductive Technology; ART). FirsteggとspermTo collect. The ovulation induction method is used to collect the ova, and the ovary is punctured by promoting the development of follicles to collect a plurality of ova. Sperm are collected manually. As of 2014, the method after this isIn vitro fertilization(In Vitro Fertilization; IVF)Microinsemination(IntraCytoplasmic Sperm Injection; ICSI; Ikushi). Generally, ICSI is used when IVF fails, but ICSI is selected from the beginning when male infertility (low sperm motility and poor malformation rate) is known. IVF fertilizes sperm and eggs in culture. ICSI injects sperm directly into the egg cells under a microscope. Once the fertilized egg is obtained, it is allowed to grow in the womb (In Vitro Fertilization-Embryo Transfer; IVF-ET).BlastocystTransplantation ((In Vitro Fertilization-Blastocyst Transfer; IVF-BT) may be performed after culture. After transplantation, hCG is administered to the mother as luteal maintenance therapy.

Formerly, laparoscopic transplantation of sperm and ova into the fallopian tube (Gamate Intrafallopian Transfer; GIFT), laparoscopic transfer of fertilized eggs into the fallopian tube. (Zygote Intrafallopian Transfer; ZIFT; Jifuto) was used, but as of 2008, it is rarely implemented. Advances in culture technology have made it possible to obtain fertilized eggs that are more mature in the culture medium. Previously, IVF-ET, which transfers embryos from the early embryos (up to the 8-cell stage) was the mainstream, and because there were also three transplants, multiple pregnancy was very common. In recent years, the number of IVF-BTs that transplant 3-1 morulas or blastocysts (2 in principle) has increased, and the multiple pregnancy rate has also been reduced.

Fallopian tube salpingoplasty (FT)

Among various causes of infertility, it is said that obstruction and stricture of the fallopian tube account for 30%. Falloscopic Tuboplasty (FT) is a fertility treatment for tubal obstruction and stricture. Insert a catheter with a balloon into the uterus and use a very thin (1 mm or less) endoscope called a salpingoscopy to observe the inside of the fallopian tube and gradually expand the balloon from the opening of the fallopian tube into the fallopian tube. It is a treatment method of inserting and releasing obstruction or stenosis by a physical principle. Regarding the surgical effect, it is said that the fallopian tube opening rate is 9% or more and the pregnancy rate within 1 year after the operation reaches 3%. Although this is a treatment method where health insurance is effective and the cost burden is considerably reduced, the number of hospitals where surgery is performed is limited and it has not been widely spread. It is becoming less common due to the spread of in vitro fertilization (ART).

Ovulation induction, luteal maintenance

Clomiphene therapy and gonadotropin therapy are well known.

Clomiphene therapy

It is a treatment used for 1st degree amenorrhea, rare menstruation, anovulatory cycle, and part of polycystic ovary syndrome. Is an estrogen analogclomipheneIs administered. It acts on the diencephalon and binds to the receptor competitively with endogenous estrogen and secretes GnRH (gonadotropin-releasing hormone). As a result, the pituitary secretes FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which stimulates the ovary to induce ovulation. From the 5th day of the menstrual cycle or withdrawal bleeding, take clomiphene citrate tablets (trade name: Clomid, cellophene) 50 mg 1T (2T when ineffective) for 5 days. Depending on the disease, other drugs may be used in combination with clomiphene. clomiphene-GestagenCombination therapy is known.

Gonadotropin therapy

The 2nd degree amenorrhea and the cases where clomiphene therapy is ineffectiveGonadotropinTreatment may be induced to induce ovulation. Gonadotropin therapy is a multiple pregnancy,Ovarian hyperstimulation syndromeThere is a fatal risk such as (Ovarian hyperstimulation syndrome; OHSS), so it is desirable to give it after a sufficient explanation. The hMG-hCG and PMS-hCG therapies are well known. This is to administer hMG/PMS, which has FSH-like action, and then hCG, which has LH-like action. As a rule of thumb, 150 mg of hMG is intramuscularly administered every day from the 5th day of the menstrual cycle or withdrawal bleeding, and once follicle maturation (average diameter 16 mm or more), hCG of 5000 units is intramuscularly administered once.Luteal dysfunctionAs a post-treatment, HCG 3000 units are administered once a day, 3 times every other day from the 3rd day of the high temperature phase, and luteal replacement is performed with or. However, for gonadotropin therapyOvarian hyperstimulation syndromeCan cause large numbers of follicles to develop and ovulate, causing ovarian swelling, pleural and ascitic fluid retention, and blood concentration. Treatment of ovarian hyperstimulation syndrome is administration of albumin to improve blood concentration by infusion and to improve hypoalbuminemia. Oligouria may result in low dose dopamine. A swollen ovary may cause pedicle torsion, resulting in acute abdomen. The most severe types are cerebral infarction, acute liver failure, acute renal failure,ARDS,DICIt can be life-threatening.Polycystic ovary syndromeIn the case of (PCOS), it is especially likely to occur and caution is required.


[How to use footnotes]
  1. ^ a b The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009
  2. ^ a b “The Japan Obstetrics and Gynecology Association reviews the definition of infertility in one year”. NHKnewsweb(July 2015, 8). http://www3.nhk.or.jp/news/html/20150829/k10010208921000.html 2015/8/30Browse. 
  3. ^ "Mechanism of natural pregnancy and causes of infertility | Kitami Infertility Outpatient | Nakamura Commemorative Aisei Hospital”(Japanese). Nakamura Commemorative Aisei Hospital, Kitami Obstetrics and Gynecology Department. 2020/10/4Browse.
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  7. ^ Illness can be seen Vol.9 "Gynecology / Breast Surgery" Published by Medic Media, P76 ISBN-978 4896324624
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  9. ^ http://www.jsrm.or.jp/public/funinsho_qa03.html
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  11. ^ "Im limit is coming soon... but the truth about fertility treatment "backward countries" Nippon". Kodansha(July 2016, 7). https://gendai.ismedia.jp/articles/-/49292?page=3 2020/5/6Browse. 
  12. ^ The minimum and maximum age difference between 14 years old on the child side and 25 years old on the parent side and 0 years old on the child side and 44 years old on the parent side under the Civil Code
  13. ^ "About special adoption system". Ministry of Health, Labor and Welfare. 2020/5/6Browse.
  14. ^ "Foster parent types and requirements”. Public Interest Incorporated Foundation National Foster Parents Association. 2020/5/6Browse.
  15. ^ “Sperm rotates and moves forward” Research over Britain overturns the dogma for over 300 years”. Television Tokyo Channel 12, Ltd.(July 2020, 8). https://www.tv-tokyo.co.jp/news/original/2020/08/03/012795.html 2020/8/14Browse. 
  16. ^ a b c d e f g Yoshimasa Asada; Mayumi Sugiura; Atsushi Tanaka; Bunpei Ishizuka; Makiko Arima (February 2012, 2).I can't give birth like I gave birth-Impact of egg aging-”(Japanese). Close-up modern. NHK online. 2012/2/18Browse.
  17. ^ a b “Teacher! Can I get pregnant?” Page 246, Harune Nakamura, Mayumi Shimizu, 2017
  18. ^ “Reproductive Technology as Culture” p.279
  19. ^ Azumi Tsuge, "Reproductive Technology as Culture: Narratives of Doctors Involved in Infertility Treatment" p.272-p.275 Matsurasha December 1999 ISBN-978 4879842091 Continued research is required for the latest information.
  20. ^ Birth Trend Basic Survey|Ministry of Health, Labor and Welfare
  21. ^ [1]Can you prevent aging of eggs? What is Male Infertility? Basics of infertility that are scary if you do not know
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  28. ^ a b c d National Institute of Population and Social Security Research> Demographic Data Collection> 2012 Edition> 4.Birth / family planning
  29. ^ a b c d Ministry of Health, Labor and Welfare> 23 Vital Statistics Monthly Report Annual Total
  30. ^ Infertility: Let's Know the Illness: Japanese Society of Obstetrics and Gynecology
  31. ^ ART data collection
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  34. ^ "Obstetrics and Gynecology Gynäkologie Tips for getting a medical examination in Germany and living in good health --Full of information on living in Germany! German news digest". www.newsdigest.de. 2020/9/8Browse.
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  36. ^ Sakiko Ontsu "What is one of the major causes that makes pregnancy difficult? What is aging of the egg?"/"Newton," October 2012 p.10
  37. ^ Sakiko Ontsu "What is one of the major causes that makes pregnancy difficult? What is aging of the egg?"/"Newton," October 2012 p.10
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  40. ^ Tomoko Okimura "In vitro fertilized egg production technology using transvaginal egg collection-To aim for more excellent successor beef production-" RIKEN Newsletter February 22 Toyama Prefectural Agriculture, Forestry and Fisheries Research Center Livestock Research Institute
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  47. ^ Website: American Center for Disease Control and Management Assisted Reproductive Technology (ART)> ART Reports and Resources> ART 2009 Report “Are older women undergoing ART more likely to use donor eggs or embryos?” [3]Than.
  48. ^ NHK Living Information Blog
  49. ^ "Jaguar YokotaExpectations and swelling due to childbirth, the reality of fighting against the Arafo generation “ovum aging” striving for pregnancy” “Weekly Toyo Keizai” 6404:56-9
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  53. ^ [4]Male Sterility-Asada Ladies Clinic
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Related item

外部 リンク

  1. ^ Cancer Navi. “I want you to know that there are ways to protect fertility”(Japanese). Cancer navigation. 2020/10/4Browse.
  2. ^ "How old do you think you can get pregnant?AMH test to know the reserve capacity of the ovaries Second half ② ~ Eliminate what you did not know and do life planning without regrets ~”(Japanese). Huff post (September 2016, 11). 2020/10/4Browse.

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