Ep 196: Just Keep Swimming – How Intrauterine Insemination (IUI) Works

它没那么复杂，而且还能稍微提高你的成功率。

It's less involved, and it gives a slight bump to your success rates.

所以它是一个很好的起点。

And so it's a good starting place.

就像是，这是一种让你初步接触生育治疗的方式，不会让你觉得一下子就被扔进深水区。

Like, it's a it's a way of dipping your toe into the fertility treatment world without feeling like you are plunging directly into the deep end.

所以，你知道我要说什么，从我们的角度来看，就是……

So the way Bet you know what I was gonna say is kind of from our perspective, having...

你知道，我们做了很多试管婴儿。

Know, we do a lot of IVF.

从我们的角度来看，我们觉得，这就像是小试牛刀。

From our perspective, we think, oh, it's kinda dipping your toe in the water.

让我很惊讶的是，有多少人觉得

It's really amazing to me how many people feel like

对很多人来说，他们觉得……

they're for a lot of people.

做人工授精的时候，感觉就像在奥运会的泳池里游泳一样。

Swimming in an Olympic pool when they do IUI.

所以，你知道，每个人都有自己的节奏。

And so, you know, it's kind of everybody has to go at their own pace.

很多时候，有些人一开始只是用口服药物。

A lot of times, sometimes sometimes people will just start out with oral medicine.

但对我们来说，我们真的建议把这两种方法结合起来，而不是单独做其中一种。

But for us, we kind of really recommend doing both of those together rather than doing either one of them separately.

所以我对人工授精的总结是，我们把更多优质的精子送到它们该去的地方，在它们该到的时候。

So the way that I kind of summarize IUI is we're getting more good sperm where they need to be when they need to be there.

所以当你同房的时候，大部分精子都流失在阴道里了。

So when you have intercourse, most sperm are lost in the vagina.

这就是人类身体的结构。

It's just the way humans are are are built.

我们有很多病人来诊所。

We have lots of patients who come in.

他们说，嗯，我们同房之后，有一些会流出来。

They're like, Well, after we have sex, some of it comes out.

这正常吗？

Is that normal?

这完全正常。

And that is absolutely normal.

那么，Carrie，如果一个人因为各种原因要做IUI，而且他们处于异性恋关系中，我们到底是怎么获取精子的？

And so, Carrie, tell us if somebody is going to be doing IUI for a variety of reasons and they are in a heterosexual relationship, how exactly do we get the sperm?

精子是怎么处理的？

What's done with the sperm?

这个过程是怎样的？

Kinda what is that process?

我们获取精子的方式就是礼貌地请他帮忙。

So the way that we get the sperm is we ask him nicely.

他得自己完成。

He has to do it by himself.

我们诊所没人会帮他，所以你想都别想。

No one from my clinic is gonna help him, so don't you even think about asking.

我不反对他伴侣在旁边帮忙，但绝对不能有润滑剂。

Have no objections to his partner helping him out there, but no lubricant.

任何会影响后续精子处理的东西都不能用。

Nothing that's gonna interfere with with processing the sperm afterwards.

所以，包括唾液。

And so Including saliva.

对。

Yes.

所以你应该说包括唾液。

So you're supposed to say including saliva.

比如，我很遗憾地告诉你，你得用最原始的方式了。

Like, I I regret to inform you you're gonna have to do this the hard way.

没有双关的意思。

No pun

是有意的吗？

intended?

我

I

不知道。

don't know.

这个……

This...

我觉得这期节目会引发很多关于精子的笑话。

I feel like this episode's gonna generate a lot of sperm jokes.

所以也许我们一开始就讲那个会笑的精子是件好事。

So maybe it's good that we started with the laughing sperm.

知道。

Know.

要说的。

Gonna say.

我们一开始就用了那个小插曲，挺好的。

We started it with the right little little side thing.

所以，我们希望他大概禁欲两到五天，也就是说，在预计做人工授精的两到五天前，他要排一次精。

So, so we want him to have roughly two to five days of abstinence, meaning he ejaculates at some time two to five days before we think the IUI is gonna happen.

关于时间安排，我们待会儿可以再细说。

We can talk about timing more in a minute.

然后他通常在人工授精当天早上来，你知道，比她计划来的时间早几个小时，把样本交过来。

Then he comes in typically the morning of the IUI, you know, a couple hours before she's planning on coming in and gives the specimen.

所以通常就是通过手淫，然后收集到杯子里。

So it's most often done by, just masturbation, and you collect it in a cup.

也有其他方法，比如用收集套，但总的来说，用杯子收集是最简单的方式，能拿到好样本，不用费劲。

There are other things like collection condoms, but by and large, the collecting in the cup is the easiest way to go about this to get a good sample that you don't have to fight with.

但如果你想在家里或者附近的酒店用套子收集，一定要从我们这里拿套子，我们不想用普通市售的套子，因为里面有杀精剂。

But if you do want to collect with a condom at home or in a hotel room close by, make sure you get the condom from us we don't want to just use a regular condom over the counter because it has spermicidal agents in it.

所以从我们这里拿的套子，是我们可以用来处理你的精子样本的那种。

So the condoms that you get from us are ones that we can then use to, you know, to prepare your sperm specimen with.

拿到精子之后，就会送到实验室去。

Once you get the sperm, it then goes to the laboratory.

然后，男科实验室，也就是……

And so the andrology lab, which is...

实验室分两部分。

There's two parts of the lab.

一部分是胚胎学，负责把卵子和精子结合，培养它们，比如囊胚、活检等等这些。

There's embryology, which is what deals with putting eggs and sperm together, growing them out, you know, blastocysts, biopsies, all of that.

另一部分就是男科实验室。

And then there's the andrology lab.

男科实验室专门处理精子。

And the andrology lab is solely focused on sperm.

所以，就他们的工作来说，男科医生其实挺正常的。

And so for for what they do, andrologists are remarkably normal.

精子送到那里之后，他们要做的是把精子和精液分开，因为……我跟患者解释的时候，花了好多年才意识到，说“把精子和精液分开”这种说法不太合适，大概半年后我才反应过来，这说法确实有点尴尬。

When you get the sperm there, what they're going to do is they wanna separate out the sperm from the seminal fluid because, and I had to actively work for many years as I was describing to patients this, saying we need to separate out the sperm and the fluid that he comes in because I realized, like, six months in, that is not good phrasing.

怎么了？

What's up?

你会得到精液，也会得到精子。

You get you get the seminal fluid, you get the sperm.

你不能直接把精子样本放进她的子宫里，因为那样她会非常生气，对你，对我。

You can't just take a straight sperm sample and put it in her uterus because she will be incredibly cranky with you, with me.

那会很疼。

It hurts.

对我们来说也是。

And with us.

很疼。

It hurts.

就像……

Like...

而且最严重的情况下，你可能会发生过敏性休克。

And and at its worst, you can get, like, anaphylactic shock.

这种情况不常发生，但这就是为什么要处理这些样本。

It doesn't happen very often, but there's a reason to process these samples.

所以他们的做法是把它离心分离。

And so what they do is they spin it down.

他们放进离心机里，想把所有精子集中在一处，液体留在上面。

They put in a centrifuge, and they wanna split up all the sperm concentrated in one place and all the fluid on top.

然后他们可以把上面的液体去掉，留下剩下的精子小团块，放进一种很容易耐受的缓冲液里。这样如果我们把它放进你的子宫，精子可以轻松游出来，你也不会因为我们放进去的东西导致剧烈痉挛、让你难受而对我们发脾气。

And so they can just take off that fluid and then take the remaining little pellet of sperm and put it in a very easily tolerated symbol fluid, just a buffer, that if we put it in your uterus, the sperm can easily swim out of it and you will not be cranky at us for putting something in your uterus that's gonna cause massive cramping and be a bad day.

很好。

Very good.

很好。

Very good.

现在，对于我们的听众中可能没有男性伴侣的人来说，不管什么原因，你们是怎么通过这种方式获取精子做宫腔内人工授精的？

Now for our listeners who may not have a male partner, for whatever reason, how how how do you acquire sperm for an IUI that way?

你绝对不要上Craigslist去找。

You do not go on Craigslist.

你不会去Craigslist上找的。

You don't go on Craigslist.

我们可能也想提一下，就是那个，怎么……

And we may wanna mention too how the, like, how the...

病人来做IUI的时候，大概会经历些什么。

What the patient goes through kinda when, you know, when you come in for the IUI.

不过回答你的问题，基本上，有几家非常靠谱的精子库。

But to answer your question, basically, there are several very reputable sperm banks.

我们跟这边的加州精子库聊过。

We've talked to California Cryobank here.

还有好几家其他的，比如那个提供“笑精”的，Fairfax。

There's several other ones, the one that provided the laughing sperm, for example, Fairfax.

你的诊所会知道，而且很可能能给你一些建议，告诉你他们通常跟谁合作，跟谁合作效果比较好。

Your clinic will know and probably be able to give you some idea of who they typically work with, who they've had good results with.

那些精子库的捐精者都必须经过检测，而且检测非常严格，包括他们的家族背景、遗传病史，还有是否吸烟等等。

Donors that go through those banks have to be tested, and they're tested very rigorously in terms of their family background, their genetic history, whether they're smokers or not.

他们会接受筛查，包括一些传染病检测，比如HIV、乙肝、丙肝，还有一些你可能没听说过的，比如CMV，也就是巨细胞病毒。

They're screened with testing, some infectious disease testing, things like HIV and hepatitis B, hepatitis C, other things that you've not heard of, probably like something called CMV or cytomegalovirus.

他们通过这些方式进行全面筛查。

They're screened through all those ways.

他们的精子最初是冷冻保存的。

Their sperm is frozen initially.

精子会被隔离六个月，也就是说这期间不能使用。

It's quarantined for six months, meaning it can't be used.

然后他们会再次进行检测。

They're retested again.

等到所有检测结果都显示他们依然非常健康，那时这些精子才会被提供出来，供你在网上查看和选择。

And then at that point, once all those tests come back that show that they're still very healthy, then that's the sperm that's available that you're able to look at online and choose.

而且你可以选择不同的精子库，它们会列出不同的特征。

And you can choose different banks have different characteristics that they list.

他们会列出头发颜色、眼睛颜色、种族等信息。

They list hair color, eye color, ethnicity.

有些精子库会列出不同的信息。

And some of the banks will list different things.

我觉得现在有些精子库已经开放了……

I think some of the banks now have open...

实际上，我记得西雅图精子库有开放注册，就是捐精者完全……

In fact, I think Seattle Sperm Bank has open enrollment where, you know, the donor fully...

完全知道你的孩子将来可能会来找他们、见他们或者类似的情况。

Is fully aware that your child may at some point come to see them or meet them or something like that.

所以每个精子库在提供的服务上都有点不一样，如果你用他们的精子的话。

So every bank's a little bit different in terms of the things, the offerings they have for you if you use their sperm.

很好。

Very good.

那如果你是单身或者同性恋关系，而你有朋友愿意捐精给你呢？

And what if you are single or in a same sex relationship and you have a friend who wants to give you sperm?

那基本流程是什么样的？

What what what is the basic process of that?

所以这算是已知捐赠，处理方式和匿名捐赠有点不一样。

So that's considered a known donation, which is handled just a little bit differently than anonymous donation.

所以不管精子从哪里来，都必须经过FDA检测，而且是要送到特定的实验室，不是随便哪个实验室都行。

So no matter where you get that sperm, it has to go through FDA testing, which is the specific set of labs sent to a specific lab, not just any old laboratory.

问卷内容挺详细的，取精的时候还要做身体检查。

It is a pretty extensive questionnaire and it's a physical exam done at the time of sperm collection.

所以只要用的是非亲密伴侣的精子，这些步骤都是必须的。

And so that has to be done whenever you're using sperm from someone who's not an intimate partner.

如果是已知捐赠者，精子库就会负责这些。

When you are doing a known partner, and that's what the sperm banks are going to do.

他们会把所有事情都处理好。

And so they're going to take care of all that.

但如果你找的是朋友、熟人或者其他人，那你就得额外做一些事情。

But if you have a friend or an acquaintance or whomever that you're going to work with, you have to add on a couple things.

第一，这些检测是由你的诊所来做，而不是精子库，这也没问题。

So number one, it's your clinic doing all that testing instead of a bank, which is fine.

这些我们都已经准备好了。

We're all set up for that.

然后你还需要确保有法律协议，因为从一开始就要明确这是你的孩子。

And then you also have to make sure there is a legal agreement in place because you want it to be very clear from the outset that this is your child.

你拥有父母权利，而那个人没有义务……

You have parental rights, that that person is not obligated to do...

以任何方式支付抚养费。

To give child support in any way.

而且过去有一些有趣的法庭案例，这让这一点变得极其重要。

And there have been some interesting court cases along the line that made that super important.

你还需要确保双方都进行心理评估。

And you also need to make sure that there's a psych evaluation on both sides of it.

这不是在评估谁适合做父母。

And this is not looking at is anybody fit parent wise for this.

这其实是在确认，这个做了你二十年朋友的男人，并不是想借此机会永远赖在你的生活里。

What this is looking for is making sure that this guy who's been your friend for twenty years, this is not the way he's trying to sneak into your life forever and ever.

没错。

Amen.

而且你们俩确实很合适，或者如果这是……

And that you guys are actually a good fit or that if this is...

你知道，有时候会是家人、姻亲，或者其他人。

You know, sometimes it'll be a family member, in law, whomever.

目的是确保五年后感恩节晚餐时，你们有了孩子，孩子开始扔食物，大人们不会因为背后有什么社会矛盾而生气，也跟着扔食物。

The goal is to make sure that when you're sitting down at Thanksgiving dinner five years from now when you've got this kid and the kid starts throwing food, that the adults don't all pile in and start throwing food too because they're mad about whatever social situation is going on behind the scenes.

所以这就是心理评估的原因。

And so that's the reason for the psych visit.

我们要确保一切顺利，你们考虑过要告诉孩子什么吗？

We wanna make sure that everything is copacetic, that you guys have thought about what are we gonna tell this child?

什么时候告诉他们？

When are we going to tell them?

怎么告诉他们？

How are we going to tell them?

还有其他人会知道吗？

Is anyone else gonna know?

如果会的话，是谁、为什么、怎么知道、什么时候知道，这些都要考虑。

And if so, who and why and how and when and all those things?

所以很多工作其实就是坐下来，认真把这件事的长期影响想清楚。

And so a lot of it is just the logistics of sitting down and really thinking through the long term ramifications of this.

而且几乎没有人通不过这个心理评估。

And it is extraordinarily rare for someone to not get a pass on that that psyche vow.

经常有人回来说，天哪。

Oftentimes have people come back and say, oh my god.

我们一开始还挺怀疑的，但真的很感谢你逼我们做了这件事。

We were we were skeptical, but thank you so much for making us do that

因为，对。

because Yeah.

想想那些……

Think about all the...

我们现在在考虑所有这些真正相关的事情。

We're now thinking about all these things that are really relevant.

特别是告诉孩子他们是精子捐赠者所生这件事，你知道，在同性伴侣或单身女性家庭里，这不一定是什么大事。

And especially with disclosure of telling a child that they were created from a sperm donor, you know, that's that's not necessarily a big deal in a same sex couple or a single female, whatever.

但尤其是在异性恋夫妻中，人们会默认精子的来源，你知道，这……

But especially when you've got heterosexual couples where there is an assumption made of where that sperm came from, you know, the...

这比告诉孩子真的有圣诞老人要严重得多。

It's it's on a much bigger scale than telling your kid there really is a Santa Claus.

这件事最终很可能会被揭开，而且后果会更严重，比如‘你为什么不告诉我？’

It's it's something that will eventually probably come out, and there will be far bigger ramifications of why didn't you tell me?

你知道吗？

You know?

当孩子们从小就把这件事当作他们世界的一部分来长大时，

And and when kids grow up with it as just a natural part of their world Part

它就成了他们身份的一部分。

of who they are.

是他们身份的一部分。

Part of who they are.

他们不会去想这件事。

They don't think about it.

但如果你在18岁、21岁、25岁，或者第一个孩子出生时，突然得知这个爆炸性的消息，那就会导致信任问题。

But when you find out all of a sudden in a bombshell when you're 18 or 21 or 25 where your first child is born or whatever, that that leads to trust issues.

没人需要那样。

And nobody needs that.

完全同意。

Absolutely.

好的。

Alright.

那我们回到主要话题，宫腔内人工授精。

So kind of back to our main topic, IUIs.

我们之前谈到了样本的准备。

So we we talked about kind of the prep of the specimen.

那做IUI的当天具体要做些什么呢？

What what is involved, like, the date of the IUI?

大家对此总是很紧张，这也很正常。

So people are always really nervous about this, and rightfully so.

我觉得就像去看牙医一样。

I was akin to going to the dentist.

我去看牙医做牙齿治疗的时候，他们在我的嘴里弄来弄去，我看不到他们在做什么，也不知道什么时候会疼，总是感觉很紧张。

When I'm going to the dentist to have some tooth thing thing done, they're doing all this stuff in my mouth, and I can't see what they're doing, and I don't know when it's gonna hurt, and I'm always feeling jumpy.

所以我真的会尽量引导我的病人，一步步跟他们解释这个过程。

So I really try and walk my patients, talk my patients through this.

而且，你知道，在很多诊所，包括我们这里，很多时候是护士或注册护士来操作IUI的。

And, you know, at a lot of clinics, and ours included, a lot of the times our nurse practitioners or our RNs actually do the IUIs.

对大多数人来说，这其实是个挺简单的过程。

It's really a pretty simple procedure for most people.

我们的医护人员会把病人带到检查室。

So our provider brings the patient back to the exam room.

放入窥器的方式和做宫颈抹片检查时一样。

Speculum is put in just like you're going to have a Pap smear.

所以你会保持同样的姿势。

So you're in that same position.

医学术语叫截石位，就是脚踩在马镫上的那种姿势。

The medical term for that is lithotomy, where you're in the stirrups.

这样我们才能看到你的宫颈。

And that's just so we can see your cervix.

宫颈就像是一个小软木塞，位于子宫腔和阴道之间，上面有个小孔。

Your cervix is almost like a little cork between your uterine cavity and your vagina, and it's got a little hole in it.

基本上，我们会放入窥器，然后取一根细导管，粗细和搅拌咖啡的吸管差不多，但更长，而且通常更柔软。

And so essentially what we do is we put a speculum in, we take that little catheter that's about the size, the caliber of a straw that you'd stir your coffee with, except it's longer, and it's usually a lot more flexible than that.

我们会把它穿过宫颈管。

We put it up through the cervical canal.

当我们确定导管已经到达子宫腔中间时，通常是从宫颈口到子宫顶部的距离大约是七厘米。

Once we're pretty certain we're in the middle of the cavity, and we know, you know, usually about seven centimeters from the beginning of the cork, beginning of the cervix to the top of the uterus.

所以，大概在五厘米半、六厘米、七厘米左右的位置，我们把精子注射进去，而且我们会慢慢注射，尽量让精子都留在里面，因为子宫的容量很小，我们会尽量减少注入的液体量，这样精子就能全部留在里面。

So somewhere, you know, five and a half, six, seven, somewhere in there, we inject the sperm and essentially we do it real slowly to try and keep as much in there because the volume of your uterus is pretty small and we try and decrease the total volume of what we put in there so that it all stays in there.

偶尔会有少量液体漏出来，但基本上我们能把所有样本都注入子宫腔内。

Every now and then, a little bit can leak out, but essentially we get all that specimen up inside the uterine cavity.

这个过程非常简单，几乎不痛。

That's a pretty simple, pretty painless procedure.

有时候，当导管通过宫颈管时，人们会感到有些痉挛。

Every now and then, people will have cramping as we put the little catheter through the cervical canal.

但一般来说，我们不需要怎么扩张宫颈管，所以大多数人不会感到太多不适。

But, generally, we don't have to dilate the cervical canal very much, so most people don't really have a lot of discomfort.

其实这和做宫颈抹片检查差不多。

It's pretty similar really to having a Pap smear, basically.

那么，我们把导管放进去，把精子样本注入子宫后，精子会做什么？它们会多快开始行动？

So after we put in the catheter and we put the sperm sample inside the uterus, what do the sperm do, and how quickly do they do it?

它们会开始游动，朝着输卵管游去，就像苏珊刚才示范的蛙泳那样。

So they start swimming, and they start swimming towards the tubes as Susan is demonstrating the breaststroke there.

所以它们开始朝着输卵管游去。

So they start swimming towards the tubes.

现在，就像艾比说的，IUI的好处在于，精子不是停留在子宫的门口或入口外面，而是已经穿过了宫颈管——这个通道本来是用来阻挡外来物质的——并且它们位于子宫的更深处，更接近那个T形分叉点，在那里它们可以选择向左或向右进入任一侧的输卵管。

Now the advantage with the IUI, like Abby said, is that instead of being positioned outside the doorway or entry to the uterus, they have already gone through the cervical canal, which is designed to keep things out, and they're up higher in the uterus, so they're closer to that t junction where they can choose to go right or left into either of the tubes.

现在，根据卵子从哪一侧排出，局部的一些激素会对输卵管产生影响。

Now depending on which side the egg is coming from, some of the local hormones that are sitting there have an influence on the tube.

所以，这会让卵子所在那一侧的输卵管更加活跃，输卵管内膜上的微小纤毛会推动精子朝正确的方向前进，同时也推动卵子朝正确的方向移动。

And so it makes the one that is on the side where the egg is coming from a little bit more active in having the tiny little hairs on the lining of the tubes, push push the sperm in the direction that they need to be going, push the egg into the direction they need to be going.

因此，精子开始进入输卵管，这个过程其实非常快，大约只需要十五到二十分钟。

And so the sperm starts traveling into the tubes, and that happens really pretty quickly, like within the space of about fifteen, twenty minutes.

所以，

So

他们做过一些标记研究，来观察精子到达目的地有多快，以及它是否会再出来等等这些情况。

they've done they've done some labeling studies to show how quickly it gets where it needs to be and whether or not it comes back out and and all of those things.

所以，就像艾比说的，可能会有少量精子流出来，但大部分精子都会准确到达它们该去的地方，前提是它们能够游动，从而开始寻找卵子。

So, you know, like Abby said, you can have a little bit come back out, but for the most part, that sperm is going exactly where it needs to be assuming that it's able to to swim in order to start finding the egg.

非常好。

Very good.

所以我想提一点，在生育治疗中，很多事情都取决于时机。

So one thing that I like to mention, there's a lot of things we do in fertility care that depends on timing.

对吧？

Okay?

而IUI的时机很重要，可能没有做试管婴儿时那么重要，因为……

And timing for IUI is important, probably not as important as it is when we do IVF because the...

首先，进入子宫的精子其实可以存活大约七十二小时，这算是很长的时间了。

First of all, sperm that end up inside the uterus can actually survive for about seventy two hours, which is a long time.

对吧？

Okay?

而且有一些不错的研究表明，如果我们能在十二小时内让精子进去……

And also there's some pretty good studies that show that if we get that sperm in, you know, within twelve...

比如，如果我们触发你排卵，精子接触到卵子，或者卵子接触到精子，反过来也一样。

Like, so if we trigger your ovulation, sperm that are exposed to your egg or egg that's exposed to the sperm vice versa.

如果那个……

If that...

我们其实有一些余地，大概十二到四十多个小时，基本上不会影响结果。

We have some leeway, really about twelve to about forty something hours that it essentially doesn't doesn't change the outcome.

所以这方面是有一些灵活性的。

So there's there's some flexibility in that.

现在重要的是我们要知道你的排卵时间，因为一旦排卵，卵子只能存活大约十二个小时。

Now the important thing is for us to know when you ovulate because once you ovulate, that egg is only good for about twelve hours.

所以这才是关键。

So that's that's the big thing.

但如果精子稍微早一点到位，那也没关系。

But if we have sperm there a little bit early, that's okay.

所以这一点很重要，因为我知道大家都担心时机，想确保一切都很精确。

And so that's important because I know we're all worried about timing and we wanna make sure everything's precise.

有时候，人们会说，我本来要做人工授精，但我的预约时间已经过了十五分钟了。

And sometimes, you know, people will be like, I'm supposed to have my IUI and my appointment was fifteen minutes ago.

其实这没关系的。

And it's like, this is okay.

真的没关系。

This is okay.

我们有这个灵活性。

We have that flexibility.

有时候，有的男士可能需要早上来取精，比如上班之前，而人工授精要到下午才做。

Now sometimes we might have guys who need to come collect sperm in the morning, maybe before they go to work and their IUI isn't until that afternoon.

那这种情况怎么处理呢？

How does that work?

一般来说，我们会先处理精子，把它准备好，然后像凯莉之前说的那样，把精子浓缩到很小的体积，再放进培养箱里。

So generally we prepare the sperm, we get it all ready, and we concentrate the sperm into a small volume like Carrie was describing before, and then we put it in the incubator.

通常放进培养箱之后，精子可以在里面待挺长时间的，没问题。

And generally when you leave in the incubator, it can be fine in the incubator for quite a while.

所以并不是说我们一准备好精子，就得马上把病人叫进来做人工授精。

So it's not like the minute we prepare it, we have to bring the patient in immediately and do the IUI.

但如果它在你的车里放上十二个小时，那就有问题了。

Now, if it's sitting in your car in a cup for twelve hours, that's a problem.

所以，对于住在离生育诊所很远的一些听众来说，有几种办法可以解决这个问题。

So for for some of our listeners who do live a long way off from wherever your fertility clinic is, there's a couple of ways that that can be dealt with.

第一，大多数生育诊所都会有一个私人的取精室，你可以在那里完成。

Number one, most fertility clinics are going to have a private collection room at the clinic that you can collect there.

你也可以在酒店房间里完成。

You can collect maybe at a hotel room.

请不要在停车场里做，因为我知道以前有病人这么干过，首先，我不想听到这种事。

Please do not collect in the parking lot because I know I've had patients do that in the past, and one, I don't wanna know it.

第二，这有点违法。

Number two, moderately illegal.

你要是被警察抓了，我们就没法做人工授精了。

You get arrested, we can't do the IUI.

我们只是提醒一下。

We're just saying.

比如说，你住得

Like, you live

在监狱里。是的。

in jail Yes.

别做那种事。

Don't do those kind of

进监狱之前，你不能先把样本送到我们办公室吗？

Can't drop it off at our office before you go to jail.

但是有一家公司叫Protex，他们生产专门的杯子。

But there there are special cups produced by a company called Protex.

我偶尔会给那些住得远的病人用这些杯子。

I use these occasionally for my folks who live a good distance away.

而且，你知道，我有很多病人住在……

And, you know, I have a lot of guys who live in...

在油田工作或者类似的地方，那种灵活性是没有的。

Who work in the oil fields or things like that where that flexibility isn't available.

所以用这些特殊的杯子，你可以收集精子，它们里面有特殊的化学物质和介质，能帮助保护精子。

And so with these special cups, you can collect and they have special kind of chemicals and media within them that help protect the sperm.

这样就能给你更多时间，超过通常从收集到送到实验室的那一个小时。

And so it gives you more than that hour that is typically allowed from the time of collection to when it needs to arrive at the lab.

所以要知道，你用来收集的杯子不管怎样都是特殊的。

So just know that the cups you are gonna collect in are special no matter what.

如果你有距离或时间上的特殊情况，跟你的诊所谈谈，因为他们通常有办法帮你解决这个问题，但别等到最后一刻才说。

And if you have some special circumstances regarding distance or time, talk to your clinic because there's often things that they can do to help maneuver the situation, but don't do it at the last minute.

如果你觉得可能有问题，比如时间或距离可能是个问题，尽早告诉我们，别拖。

If you think something might be going on, that timing or distance may be an issue, tell us sooner than later.

这样我们就有更多灵活性。

That gives us more flexibility.

苏珊，那么

Susan, so

我有个问题想问你，然后也有个评论。

I have a question for you and then a comment too.

其实我我我不用那些容器，因为我的大多数病人住得近，可以直接采集。

So I I I don't I don't really use those containers because most of my patients are close enough that they can collect.

时间窗口是多久？

What's the time frame?

如果男方采集了，样本送到你们办公室需要多长时间？而且做IUI的话，整个时间安排是怎样的？

If a guy collects, how long does it take for the specimen to get to your office, and what's the time frame for IUI with all that?

实际上，这些杯子，我觉得能保护精子大概六到十二个小时。

So actually, these cups, I believe, protect the sperm for somewhere between six to twelve hours.

时间挺长的。

It's a long time.

比我通常需要的时间长多了。

It's way longer than what I normally need.

通常我需要三到四个小时的时间窗口，这远远超过了。

Usually I need about a three to four hour window, and it is way beyond that.

它们公司自己标称了能维持多少小时。

They're rated by their own company for a certain number of hours.

我们自己做过测试，我们对这个小时数很有信心，但我知道这远远超过四个小时。

We've done our own testing that we're like, we feel very comfortable with this number of hours, but I know it's it's way beyond four hours.

在纳什维尔，音乐产业对我们来说是个大问题。

So in Nashville, the music industry is a big issue issue for us.

我们有很多人经常出差，不只是名人，还有音乐家、巡演导演和巴士司机。很多时候这些人会离开好几天。

We have lots of people that travel, and it's not just the famous people, it's the people who are the musicians and the tour directors and the bus And so a lot of times those people are out of town for several days.

所以另一个选择，虽然不是我们最喜欢的，但也是一个选择，就是冷冻精子作为备用。

And so the other alternative, which is not our favorite alternative, but it's an alternative, is to free sperm for backup.

我们知道在试管婴儿中，使用冷冻精子效果很好。

And so we know with IVF, if we use frozen sperm, it works really well.

而且大多数情况下，即使是异性恋夫妻，其中一方可以提供新鲜精子，冷冻精子效果也不错。

And for the most part, even, you know, in a heterosexual couple who has a partner that could donate fresh sperm, it still works well.

实际上，对于我们的同性伴侣或单身女性，我们必须使用冷冻精子。

And in fact, with our same sex couples or single females, we have to use frozen sperm.

我们不能使用新鲜精子。

We can't use fresh sperm.

所以用冷冻解冻的精子，确实能让人怀孕。

So people definitely get pregnant with, frozen thawed sperm.

所以对于那些伴侣经常出差的夫妻来说，冷冻精子算是我们的另一种选择。

And so for some of our couples that the partner travels, that's kind of our other alternative is to free sperm.

这样等病人来了，我们直接把精子解冻，然后做人工授精就行了。

And then that way we can just thaw it out when the patient's here and do the IUI.

那冷冻精子对哪些人不合适呢？

Who is frozen sperm not a good idea for?

那些精子数量本身就有很大问题的人。

Someone who has a really questionable count to begin with.

一般来说，当我们决定做人工授精时，精子数量大致分为两类。

So when we're deciding to do IUIs, in general, there's there's two classes that sperm counts fall in.

一类是数量充足，完全不用担心的情况。

One is the more than enough, nobody's worried about it, kind of counts.

这类人的精子冷冻后效果也很好。

Those guys do just fine when we freeze their sperm.

不过还有第二类，就是那些边缘性的精子数量，因为我们在处理精子的时候看的是总的活动精子数。

There's the second group, though, which is the more borderline counts because we are looking at a total modal count when we are processing the sperm.

如果有人——这是什么意思，凯莉？

If someone What does that mean, Carrie?

对，继续说。

Yeah, going there.

意思就是，如果有人来检查，精子数量是两千万，精液量是一毫升，其中百分之五十是活动的，那么总的活动精子数大约是一千万，因为那两千万里面有一半是真正在活动、可以用的。

So what that means is if someone comes in and they have a count that's 20,000,000 and they've got one milliliter of fluid and they've got 50% of it that is moving, the total modal count is about 10,000,000 because half of those 20,000,000 are actually moving and therefore usable.

另一半是不动的。

The other half aren't swimming.

虽然在停车场里玩漂移可能很有趣，但那对我们没什么用。

And while it may be fun to do donuts in the parking lot, that doesn't do us any good.

所以我们需要做的是把那些活动的精子处理出来，然后使用它们。

And so what we need to do is we need to get those movers processed, and that's what we're gonna use.

所以当一个人的精子数量不太稳定的时候，比如说你有两千万，但只有百分之二十五是活动的。

So when someone has kind of a shakier count, like, let's say you've got 20,000,000, but only 25% are moving.

到那时候，你预期的总活动精子数大概只有五百万。

At that point, you're only expecting a total modal count of about 5,000,000.

如果你冷冻它，我们知道冷冻过程中会损失一些。

And if you freeze that, we know we're going to lose some in the freeze.

这是正常的。

That's normal.

这是意料之中的。

That's expected.

只要你有考虑到这一点，通常不是问题。

That's typically not a problem as long as you account for it.

所以对于这些情况，有多余的冷冻样本就挺好的，因为如果你需要再取出一管，你可以这么做。

And so those are the ones where having extra frozen samples is kind of nice because if you need to pull out a second vial, you can do that.

而且有时候我们发现，即使是那些精子数量完全正常的男性，一旦冷冻，就会暴露出潜在的功能问题，甚至可能是一些不太严重的功能障碍。

And sometimes what we find is even those guys who have totally normal counts, once you freeze it, it exposes the it exposes the underlying function and potentially a less strong Dysfunction.

功能障碍。

Dysfunction.

对。

Like Yeah.

就是……

Show...

它确实会暴露出功能障碍。

It it shows the dysfunction.

所以当你去做的时候，你预期会有个一千万、两千万，结果突然只有两百万，因为功能障碍被暴露出来了。

And so when you go to thought, you're expecting to get, you know, ten, twenty, however many million, and all of a sudden you've got 2,000,000 because it's exposed the dysfunction.

所以这就是……

And so that's a...

有这些信息是好事，但当天往往挺打击人的，因为之前你根本不知道。

It's good information to have, but it oftentimes is kind of traumatic the day of because you don't know it until then.

所以我们通常还是会继续做授精，因为

And so we still go ahead and typically do the insemination because

只需要一个好的就行。

only need one good one.

因为你只需要一个好的。

Because you only need one good one.

而且我们都有过这样的经历，觉得这次不会成功，因为精子数量只有七十五万，就这么多。

And all of us have stories of, don't think this is gonna work because the count is, you know, three quarters of a million and that's it.

结果没想到，她怀孕了，一切都很好。

And and lo and behold, she's pregnant and everything's fine.

所以我们还是会继续做，因为我们想抓住每一个机会。

So we're still gonna do it anyway because we wanna maximize every opportunity that we get.

但这意味着以后我们可能会说，好吧，我们需要新鲜的样本。

But it means that going forward, we may say, okay, we have to have a fresh sample.

我们需要大量的备用。

We have to have a ton of backup.

你更适合做试管婴儿，而不是人工授精。

You're more of a candidate for IVF than you are for IUI.

所有这些讨论就从那时开始了。

Like, all of those discussions start happening at that point.

这让我们想到另一个话题，就是一个测试，可能除了精子数量之外，还能给你一些别的信息。

And that kind of brings us to another topic that we were gonna talk about, about a test that potentially could give you an idea beyond just doing a sperm count.

是的，苏珊。

Yes, Susan.

在我们进入那个话题之前，因为那很重要，哪些人适合做IUI呢？

Before we get to that, because that's a very important thing, who are good candidates for IUI?

我们刚才在讨论一些数字，凯莉。

We're talking a little bit about numbers, Carrie.

在你的诊所里，什么情况会让你对IUI感到有信心，推荐给别人做，而哪些人可能不太适合IUI呢？

In your clinic, what makes you feel warm and fuzzy about an IUI, recommending IUI to somebody versus who are people who maybe IUI is not the greatest idea?

所以我希望总的活动精子数通常至少要有五百万。

So I want a total modal count of typically at least 5,000,000.

这差不多是我们的一个标准。

That's that's kind of our cutoff.

这个标准有点随意。

It's somewhat arbitrary.

其实这是个浮动标准，所以就算只有一百万，我们通常还是会做。

There is a sliding scale, which is why when we have a million, we'll still do it anyway.

但一般来说，一旦超过500万，我们的把握就会大很多。

But typically, once you hit about 5,000,000 above that, there's a much higher level of comfort there.

所以精子经过处理后，最终数量得达到这个标准。

And so you need to have that by the time the sperm is totally processed.

另外，做人工授精的夫妇或患者还需要输卵管是完全通畅的。

The other thing that a couple needs to have or a person going through IUI needs to have is fully functional tubes.

因为如果输卵管不通或者功能不好，我们在做人工授精的过程中做的任何操作都无法绕过它们。

Because if those tubes aren't open and if they're not working, there is not a single thing that we do during an IUI treatment that that bypasses them.

所以如果你的输卵管因为各种原因没有功能、缺失或者其他问题，导致卵巢和子宫之间无法连通，那么把精子放进去就等于把它送进了死胡同。

And so if you have tubes that are nonfunctional for whatever reason or absent or whatnot, then if there is not a way to connect the ovary and the uterus, then putting sperm in is just putting it into to a dead end.

精子没地方去，也找不到卵子，没法结合，这样是行不通的。

It doesn't have anywhere to go, and it can't find the egg, they can't have a party, and it's not gonna work.

所以我们不会在这种情况下进行人工授精。

So we're not gonna do that.

所以，判断一个人是否适合做人工授精，主要就看这两个标准。

So those are the two biggest criteria for determining if someone's a candidate for an IUI.

一是精子数量要够，二是输卵管要完全通畅。

You have to have sufficient numbers of sperm and you have to have tubes that are fully functional.

艾比，那卵巢功能有问题的人怎么办？

Abby, what about people with certain ovarian function?

嗯，如果女性有卵巢早衰，完全不排卵，那就有问题了。

Well, if a woman has premature ovarian failure, she doesn't ovulate at all, that's a problem.

凯莉说了，比如输卵管不通。

Carrie said, like, she doesn't tubes open.

另外，有时候我们会担心卵子数量少，而且我们知道做试管婴儿的话，如果卵子数量少，确实会影响成功率。

And the other thing is, you know, sometimes we worry about low egg count, and we know that with IVF, for sure, if somebody has a low egg count, that can negatively affect their success.

但是，这么多年来我们一直在测AMH这个血液指标，实际上，这周我就遇到一个病人，AMH只有0.2，第一次做人工授精就怀孕了，而且情况看起来不错。

But, you know, over the years that we've been doing egg counts like AMH, the blood test AMH, in fact, I've had a person this week who did her first IUI with an AMH of 0.2 and is pregnant, and it looks good.

所以我觉得现在真的不能再用这个作为标准了。

So I don't know that you can really use that as a criteria anymore.

我觉得我们以前确实会担心这个。

I think we used to worry about that.

但如果你不排卵，比如有低钾性闭经，那确实是个问题。

But certainly, if you're not ovulating, if you have hypokalemic amenorrhea, that's a problem.

这是我们之前讨论过的一个问题。

One of the questions we talked about earlier.

如果你排卵不规律，那精子跟卵子要相遇，你肯定得排卵才行。

If you have irregular ovulation, you know, you have to be ovulating in order for the sperm and the egg to get together.

所以我觉得这些都是很重要的因素。

So I think those are important things.

如果病人不排卵，你得给他们用药来帮助排卵。

You need to start people on medications to help them ovulate if they're inovulatory.

凯莉，你先说，然后我也有话要说。

Go ahead, Carrie, and then I wanna say something.

另一个极端就是多囊卵巢综合征的患者，她们卵泡多得数不清，这数字可是有科学依据的。

So the other extreme, which is the PCOS patients who have, approximately a zillion and a half eggs, that is a scientific number.

有时候他们……

Sometimes they...

通常，她们就诊时本身就没有排卵，这也是她们来看病的原因。

Usually, when they're coming in, they don't ovulate in the first place, which is why they're seeing this.

我们会给她们用药来促进排卵过程。

And we're giving them medications to help along the ovulation process.

其中一部分是口服药，另一部分是注射剂。

And part of that is an oral medication, part of that is an injectable medication.

我们可以在这期节目里聊聊这个话题，或者它可能值得单独做一期节目。

We can we can either talk about that this episode or probably worth its own episode.

对。

But Yeah.

当我们使用这些药物时，大约15%的多囊卵巢综合征患者对口服药没有反应。

When we are giving those, about fifteen percent of women with PCOS aren't gonna respond to the oral meds.

所以我们必须使用效力更强的药物。

And so we have to use much stronger meds.

而且很多时候，在人工授精的情况下这么做并不合理。

And a lot of times that doesn't make sense to do in the context of an IUI.

所以药物是好的，但没有什么东西是完美的。

So the meds are good, but nothing is perfect.

所以有时候，如果我们给的药物无法让卵泡长大、成熟并排出，那么换一种方法可能更有意义。你知道，你正在做常规治疗，但身体就是不给面子，好像在说：‘不，去你的，我不干了。’

And so sometimes it makes more sense to take a different approach if the medications we're giving can't elicit an egg growing, getting big, releasing all of those things where, you know, you're, you're doing routine treatment and the body is just like, Nope, screw you, I'm out.

我们可不想在做人工授精时给你用药，让你排出十个卵子。

We don't wanna give you medicine and make you ovulate ten eggs when we do IUI.

那……

That...

那是不行的。

That's a no no.

真的。

True story.

真的。

True story.

我们可不想让你上《时代》杂志封面，我也不想跟你一起上。

We don't want you on the cover of Time magazine, and I don't wanna be there with you.

所以这就是

So that is a

那是上电视的料。

TV shows for you.

没什么。

Nothing that.

不。

No.

不。

No.

不。

No.

如果你想因为这个出书，那答案是：不行。

If you're if gonna get a book deal because of it, the answer is no.

所以我想稍微谈一下卵巢储备功能减退的问题。

So I'd like to comment a little bit about diminished ovarian reserve.

首先，我觉得这取决于你想要几个孩子。

So one, I think it depends on how many children you're wanting to have.

对吧？

Okay?

因为如果你卵巢储备功能减退，而且你只关注现在，并且我们接受可能只有一个孩子，那么人工授精是一个更可行的选择。

Because if you have diminished ovarian reserve and you're only focused on right now and we are okay with potentially only having one child, IUI is is more of a viable option.

但如果你因为AMH水平、FSH或年龄来找我，说有卵巢储备功能减退，那影响可能很大，因为我们不知道你的卵巢会以多快的速度继续老化。

But if you come to me with diminished ovarian reserve either because of AMH levels, FSH, or age, that that can have a big impact because we don't know how quickly your ovaries are going to continue to age.

而且还有……

And there's...

有时候，卵巢老化的速度会比其他人快得多。

Sometimes it's gonna happen a lot faster than than it may in others.

我的意思是，如果你41岁来找我，告诉我你想要三个孩子，人工授精可能不是最适合你的选择。

I mean, if you come to me and you're 41 years old and you tell me you wanna have three children, IUI is probably not gonna be the best option for you.

我的意思是，用人工授精让你怀孕的可能性还是有的，虽然概率比较小。

I mean, there's a reasonable chance I could get you pregnant using IUI, though it is it is moderately small.

我记得大概十年前或十五年前有一项研究，针对40岁以上使用促排卵药物加人工授精的女性，成功率大约是百分之四，虽然不是完全不可能。

I mean, there was a study done probably about, gosh, it was probably ten or fifteen years ago that looked at people using injectables with IUI who are over 40 years of age, and they have about a four percent take home baby rate, which is not impossible.

你知道，这比二十分之一还低一点，而且确实比试管婴儿便宜很多，但是……

You know, it's a little less than one in twenty, and yes, it's a whole lot less expensive than IVF, but it...

这……

It's it...

你知道，这个成功率还是不太理想。

You know, it's still not that great at odds.

所以……

So the...

这些因素你都应该继续考虑，结合你自己的整体情况和目标来看。

These are things that that should continue to go through your mind kind of looking at your own personal big picture and what your goals are.

因为一旦怀孕了，就是怀孕了，这当然很好，但我们也要确保这对你未来的生育计划可能带来的其他影响。

Because once you're pregnant, you're pregnant, which is fantastic, fantastic, but but we we also also wanna wanna make sure how it may have other implications for your your family building goals.

所以，怎么说呢……

So kind of...

既然我们已经聊过这个了，我们想稍微谈谈一个检查，它可以给你一些更多信息，看看IUI是不是更好的选择。

Since we've covered that, we wanna talk a little bit about a a test that can make some, give you some more information to see if IUI is a better option.

那这个检查是什么呢，Abby？

And and what test would that be, Abby?

那就是精子QT检查。

That is the sperm QT test.

这真的挺有意思的，也挺酷的，因为我们终于有了一个和IVF不一定相关的新检查。

It's really kinda fascinating and really kinda cool to actually have a new test that we can do that doesn't necessarily relate to IVF.

我是说，某种程度上也相关，但这是一个可以对精子做的检查，真正看看精子的功能如何。

I mean, it does in a way, but it's a test that we can do on sperm to really look and see kind of how the sperm functions.

这个检查的制造商说，这就像看看引擎盖下面，看看精子的遗传物质，真正看看精子是否具备所需的条件，能够结合并穿透卵子，进入卵子。

The makers of the test say that it's a way to look under the hood of the sperm, to look at the genetics of the sperm and really see if the sperm kind of has what it takes, the right stuff to bind to and penetrate the egg and get into the egg.

所以它真正告诉你的是，如果你是IVF领域的新患者，你来了，我们跟你讨论做精子检查，丈夫或伴侣的精子数量很好。

So what it really tells you is if you're a new patient in the IVF world, you come in, we talked to you about doing a sperm test, Husbandpartner has a great sperm count.

这算是更进一步了。

This is sort of the next level.

所以如果他的精子数量很好，那就要看你们是不是真的适合做人工授精。

So if he has a good count, it's like, okay, are you guys really a candidate for IUI?

我们通过做精子QT测试来判断这一点。

And the way we figure this out is by doing the sperm QT test.

他提供一份样本，甚至可以用他做精子测试时的那份样本。

He collects a sample and can even be the same sample as what he does his sperm test with.

检测后，结果会显示他的精子数量是极好、良好、正常还是不错。

It's evaluated and basically it comes back and says that he has an excellent count, a good count, normal count, good count.

功能极好，功能良好。

Excellent function, good function.

功能不佳。

Poor function.

所以即使功能不佳，如果他的数量...

So even Poor if his numb...

这意味着，即使他的精子数量看起来很好，如果他……

What that means is even if his numbers look great, if he...

如果他的精子功能看起来不太好，那我们可能就会建议你不要做人工授精，而是做体外受精。

It doesn't look like his sperm functions very well, then we probably would be talking to you about not doing IUI, but doing in vitro fertilization.

而且在这个过程中，即使他的精子在精子QT测试中表现不佳，也不意味着精子在体外受精中效果不好。

And in that process, even his sperm is poor with the Sperm QT test, doesn't mean that the sperm doesn't work well with IVF.

这只是意味着，如果你打算做人工授精，精子可能无法像你希望的那样进入卵子。

It just means that the sperm really can't get into the egg in the way you would hope if you're gonna do IUI.

所以当我们看精子QT时，它测量的是精子内的一些小基因，这些基因要么被开启，要么被关闭，而这些开关是通过生命过程来调节的。

So when we're looking at sperm QT, what it's measuring are little genes within the sperm that have either been turned on or turned off, and these have been turned on or off through process of life.

好的，所以有时候我们知道有一些暴露因素，比如饮酒、使用大麻、吸烟、肥胖、其他健康问题等等。

Okay, so sometimes we know there are some exposures, things like alcohol use, marijuana use, nicotine use, obesity, other health issues, different things like that.

所以有时候会有一些可以识别的东西，有时可以调整，可能改善你的精子QT功能，让你回到正常范围。

So sometimes there's something that's identifiable that sometimes can be modified that can potentially improve your sperm QT function and kind of get you back into that normal range.

但很多时候，很多时候我们做不到。

But a lot of times, a lot of times we can't.

所以我们经常遇到这样的情况，有人来就诊，可能他们刚处在一段新关系中，他们会说，他的精子质量很好，他都有四个孩子了，然后我就会问，那些孩子多大了？

And so often we'll have people who come in and maybe they're in a new relationship and they're like, he's got great sperm, he's got four kids, and I'm like, how old are those kids?

然后他就会说……

And he's like...

他们会说，九岁、十二岁、十五岁和二十岁。

They're like, nine, 12, 15, and 20.

我就会说，那很好。

I'm like, that's great.

那是对十年前情况的一个很好的分析。

That was a very good analysis of what was going on ten years ago.

所以当……

And and so when...

如果某人的精子QT检测结果不好，这并不意味着他不能通过IUI怀孕，但基本上意味着你的成功率大约是通常我们给某人报的或预期的一半。

If somebody does have a poor sperm QT, it doesn't mean he can't get pregnant with IUI, but it essentially means your success rates are about half that what we would normally quote or expect for somebody.

所以再次强调，取决于你的目标是什么，以及你的资源情况，还有试管婴儿是否适合你，这些都会影响这个决定。

And so again, depending on what your goals are, and kind of what your resources and whether IVF's the right thing for you can play into that decision making factor.

不过我们对这个检测感到非常兴奋，因为我们……

But we are quite excited about having this test because we...

我们做精液分析已经很久了，但一直没有太多其他的检测手段。

We've had the semen analysis for a long time and we haven't had a whole lot of other things.

Carrie，你还有什么要补充的吗？

Carrie, do you have anything else to add to that?

我还有最后一点，之前忘了提。

I have one final thing that I meant to mention earlier.

这个跟精子QT无关，只是关于IUI的一般情况。

I have, and this is not about the sperm QT, this is just about IUI in general.

很多时候，我会遇到一些男性，他们的总活动精子数可能……

A lot of times I'll have guys that are like, you know, maybe their total model count...

我觉得不同诊所的标准可能不一样。

And I think it's different for different practices.

我们通常的目标是大约800万，500万到800万之间，差不多这个范围。

We usually say about 8,000,000 is our goal, five to 8,000,000, somewhere in there.

对，差不多就是这个范围，我们希望你的精子数量能达到这个水平。

Yes, somewhere in there is kind of where we want your sperm count to be.

所以如果一个男性的总活动精子数只有两百万，他会问，那如果我留两三次样本，把它们合在一起，然后冷冻再解冻，行不行？

So like if a guy has like a total modal of 2,000,000, he'll go, well, what if I leave like two or three specimens and put them together and then we freeze them and thaw them?

但这样做的问题在于，就像Carrie之前提到的，精子解冻后大约有一半或者一定比例会死亡。

And so the problem with that is, as Carrie mentioned earlier, when you thaw sperm, about half of them or a certain percentage of them die.

所以如果你本身精子数量就低，再冷冻解冻，其实帮不上什么忙，我想表达的就是这个意思。

And so if you already have a low count and then we freeze and thaw them, it really doesn't help you, I guess is what I'm trying to say.

如果你第一次也是唯一一次样本的总活动精子数不达标，那把它们合在一起冷冻再解冻，可能也没什么用，因为最后你得到的还是……

If you don't have that total motile count with your first and one and only specimen, it probably doesn't help to like put them together and freeze them together and then thaw them together because you end up...

最后还是精子数量很少，而且通常质量也不太好。

Still end up with a low amount of sperm that generally doesn't do very well.

我遇到那些临界情况的病人时，有时候他们上个月做了人工授精，但数值比我们预期的要低。

One thing I do when I have patients who are borderline, maybe they did an IUI the month before and their numbers were lower than we expected.

然后我就特别想把这些数值提上去。

And like, I'd really like to bump up those numbers somehow.

我们会做我们所说的连续两次人工授精。

We'll do what we call back to back IUIs.

我们会在一天触发排卵，第二天他取精，然后我们做一次人工授精。

So we'll trigger on one day, the next day he'll collect and we'll do an IUI specimen.

因为之前跟你说过，我们在时间上有灵活性，如果这次人工授精的精子样本非常好，我们可能不需要做第二次。

And because I I told you we have that flexibility on the timing, if that IUI specimen is fantastic, we may not need to do the second one.

但在触发排卵后的两天内，我们仍然有时间准备另一次人工授精，增加精子接触的机会。

But we have still the availability in that timeframe for two days after trigger to be doing another IUI prep and gaining extra sperm exposure.

有时候我们甚至会让病人...

And even sometimes we'll have people go...

我会告诉他们，在人工授精后十二小时内同房，以最大化精子和卵子的结合机会。

I will tell them to have intercourse within twelve hours of the IUI to kind of maximize that egg and sperm interaction.

而且有不少人通过这些额外的选择成功怀孕了。

And and a decent number of people get get pregnant with with those additional, you know, options.

但就像你说的，Abby，冷冻精子确实会带来一些损失。

But again, as you mentioned, Abby, freezing freezing sperm really kinda takes takes a toll.

所以如果你一开始精子质量就处于临界水平，冷冻通常不是最佳选择。

And so if you have borderline sperm to begin with, freezing usually isn't the best option.

好的。

Alright.

好的。

Alright.

嗯，我觉得我们已经聊了很多关于IUI的内容。

Well, I think we have talked a lot about IUI.

聊了很多。

Covered a lot.

我们涉及了很多很棒的话题。

We've a lot of great subjects.

是的。

We did.

是的。

We did.

所以，亲爱的听众朋友们，非常感谢你们的收听，别忘了下周继续收听更多内容。

So to our audience, thank you so much for listening, and be sure to tune in next week for more.

另外，记得订阅并给我们留下评论。

Also, sure to subscribe and leave us a review.

我们很期待听到你们的反馈。

We'd love to hear from you.

我们在Instagram、Facebook和YouTube上都有账号。

We're on Instagram, Facebook, YouTube.

所以关注我们、订阅我们，随时了解所有关于生育的最新信息。

So follow us, subscribe, and stay updated on all things fertility.

也可以访问我们的网站fertility.suncensored.com提交问题。

Also visit us on fertility.suncensored.com to submit questions.

所有问题都会在我们的播客“Ask the Doc”环节中匿名回答，我们也非常想听听你们的想法。

All questions will be answered on our podcast anonymously for the Ask the Doc segment, and we'd love to hear your ideas.

所以，尽管发来吧。

So send them in.

和往常一样，这个播客仅供娱乐，不能替代你自己的医生的医疗建议。

And as always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician.

好的。

Alright.

我们下周见。

We'll see you next week.

回头聊。

Talk to you soon.

拜拜。

Bye.

拜拜。

Bye.