回放：为什么人工授精会失败——即使一切看起来都正常

今天我们聊聊为什么人工授精会失败？

Today we talk about why do IUIs fail?

我是马克·阿莫斯医生，这里是“生育星期二”节目。

I'm doctor Mark Amols, and this is TacoBoutFertility Tuesday.

仔细想想，人工授精按理说不该失败才对。

When you think about it, it actually doesn't make any sense why an IUI wouldn't work.

你想啊，你促排卵，取精子，然后直接注射到子宫里。

I mean, you're making extra eggs, you're taking sperm, and you're injecting it right into the uterus.

听起来应该能成功。

I mean, in your mind it should work.

而且确实，理论上讲应该成功。

And it really should when you think about it.

但让人意外的是，人工授精的成功率其实并不高。

But what's surprising is, is that IUIs actually are not very high chances.

每次人工授精的成功率大概在百分之十到百分之二十二之间。

Each IUI is going to be somewhere between about ten to twenty two percent.

如果你做的是更激进的治疗，成功率会更高，大概在百分之十五到二十二之间。

Now, if you're doing something more aggressive, you're going be in the higher fifteen to twenty two percent range.

但如果你选择温和一点的方式，比如只用来曲唑或克罗米芬，成功率可能只有百分之十二到十五。

But if you're doing something a little milder, like just Femara Clomid, you might only be between about twelve and fifteen percent.

所以，虽然看起来应该有效，但重要的是要明白，并不是每次都能成功。

And so, although it does seem like they should work, it's important to understand that they don't all the time.

我告诉你这些，不是想让你觉得它们没有成功的可能。

I don't tell you this because I want you to feel there's no chance of them working.

它们确实有效。

They do work.

我更希望你能明白，应该设定一个预期，就是成功率会比较低，可能需要几个周期才能成功。

I more want you to understand that you should set expectations that it's going to be lower chances, that could take a few cycles to work.

然而，即使我提前告诉病人这些，并让他们做好准备，第一次尝试失败的可能性比成功更大，但当真的失败时，他们还是会非常沮丧。

However, even when I tell patients this, and I prepare them ahead of time that the chances are better that it won't work than will work on the first try, they're devastated when it doesn't work.

所以，今天我想谈谈为什么IUI会失败。

And so, today I want to talk about why does it not work?

为什么有些东西看起来应该绝对有效，却偏偏没效果呢？

Why does something seem like it should absolutely work, not work?

上一集我们聊了做人工授精的原因，这确实对成功与否有一定影响。

In the last episode, we talked about reason why IUIs are done, and that does play a little bit of a part into things working or not.

所以很明显，如果你做人工授精的理由不对，那它很可能就不会成功。

So clearly, if you're doing an IUI for the wrong reason, then it's not likely going to work.

比如说，如果你的输卵管堵塞了，还去做人工授精，那你是不可能怀孕的。

So for example, if your tubes are blocked and you're doing IUIs, you are not going to get pregnant.

因为输卵管堵了，精子根本到不了卵子那里。

Because your tubes are blocked, sperm can't get to the egg.

如果你的精子数量太低，总数少于一千万的话，那人工授精很可能就没用。你的医生可能抱着希望去做，但实际上，很可能不会成功。

If your sperm is too low, if it's less than 10,000,000 sperm total, then there's a good chance IUIs won't work, and that your doctor is probably doing them hoping it will work, but in reality, it's probably not going to.

我想讨论的是，当人工授精的时机合适，但结果还是没成功的情况。

What I want to talk about is when it is the right time to do IUIs and then it still doesn't work.

我们最常做人工授精的情况，一个是原因不明的不孕，另一个就是男方因素的问题。

And the most common times that we do IUIs are going to be with unexplained infertility, and then we're also going to do it with male factor problems.

当然，做人工授精还有其他原因，比如因为无法同房或者同房疼痛而选择人工授精，但最终，这些情况也适用同样的道理。

Now, there are other reasons to do IUIs that people may choose such as not not able to have intercourse or painful intercourse requires them to do IUIs, but in the end, this still applies to them.

所以，正如我们上一集讨论的，人工授精的目的是绕过宫颈，因为那里可能存在不利环境，同时通过将数百万精子直接放入子宫而不是只有几十万，来改善精子参数。

So as we discussed in the last episode, the purpose of IUIs is to bypass the cervix, where there could be a hostile environment, plus you're helping improve the sperm parameters by now putting millions into the uterus versus only hundreds of thousands.

自然同房时，只有几十万精子能进入子宫，而现在则能有数百万。

Naturally, you have intercourse, only hundreds of thousands of sperm get into the uterus, whereas now millions get in.

所以，通过改善精子质量、增加数量，并绕过宫颈，你就能提高成功率。

So by improving the sperm, by increasing the quantity, and by bypassing the cervix, you're able to have success.

那我们来谈谈不明原因不孕。

So let's talk about unexplained.

不明原因不孕并不意味着没有问题。

Unexplained infertility does not mean there's not a problem.

只是说明我们不清楚具体问题是什么。

It just means we don't know exactly what the problem is.

所以，可能存在未被发现的问题，这不是因为医生不称职，而是因为现有的检查手段无法覆盖所有情况。

And so there's the potential that there could be a problem that's unrecognized, Not because the doctors bad their job, but because the testing we have doesn't cover everything.

比如说，你的输卵管。

And for example, your tubes.

输卵管检查说管子是通的，并不代表它们功能正常。

Just because the tubal test says the tubes are open, doesn't mean that the tubes are functional.

管子可能是通的，但那些把卵子拉向输卵管的小手指可能不工作。

You could have open tubes but the little fingers that pull the egg towards the tubes may not be working.

所以在这种情况下，一切看起来都正常，但你真的没法通过人工授精怀孕。

And so in that situation, everything looks good but you really cannot get pregnant with IUIs.

精子也是一样。

The same thing with sperm.

精子看起来可能不错，但我们要记住，这些只是统计数据。

Sperm may look good, but we have to keep in mind that these are just statistics.

我们只是说，如果精子在这个参数范围内，出现问题的概率较低。

We are just saying if sperm is in this parameter, there is lower chance there will be problems.

但这并不意味着不会出现问题。

That doesn't mean there can't be problems.

我经常把精子比作NBA选秀球员。

I always make in the comparison of sperm to NBA draft picks.

很多年前，选NBA球员的时候，他们看的是球员的历史表现，看他们在大学打得好不好，那时候一直都是这么做的。后来开始有了各种数据指标，他们发现，只要看球员的身高、臂展、弹跳力，就算他不是特别出色的球员，也能判断出他在NBA会打得不错。

Years ago, when they used to pick NBA players from the draft, they looked at the history of the player, they would say how well did they do, did they do really well in college, and that was kind of the way we did it all the time, and then when metrics started coming out and they started realizing, you know, if we just look at height of the player, if we look at the wingspan, how high they can jump, even if they're not a great player, we can determine that they're going to be pretty good in the NBA.

所以当他们开始用这种方法之后，成功入选的球员比以前光看过去表现要多得多。

And so when they started doing that, they started having more players make it on successfully than just using the old technique of looking at their past.

但重要的是要明白，有时候也会有一些特别大的水货。

But what's important to understand about this is, is sometimes there's been some really big flops.

就是纸面上看起来特别厉害。

Where when you look on the paper, it looks amazing.

感觉会是下一个迈克尔·乔丹。

It's gonna be the next Michael Jordan.

但实际打起来，表现却不怎么样。

But then in real life, they don't do that well.

精子也是一样的道理。

Well, same thing goes for sperm.

精子在纸面上看起来可能很棒，我们会说，哇，这简直是精子界的布拉德·皮特。

Sperm can look really good on paper and we're like, wow, that's the Brad Pitt of sperm right there.

但实际上，到了关键时刻，精子可能表现不佳。

But in reality, the sperm may not be well on game day.

到了比赛日，它可能表现不佳。

On game day, it may be falling short.

更进一步，精子可能还存在无法使卵子受精的问题。

Going a step further than that, there can also be issues with the sperm being able to fertilize the egg.

所以精子必须与卵子相互作用才能使其受精。

So the sperm has to interact with the egg to fertilize it.

精子顶部有一个叫做顶体的东西。

There's the thing called an acrosome on the top of the sperm.

有些精子的顶体可能不太好，或者存在问题。

In some sperm, it's not as good or there could be problems.

现在的问题是，对于不明原因的不孕不育，确实没有很好的测试来检查精子使卵子受精的能力。

Now the issue is, again with unexplained infertility, there really isn't a good test to check the sperm ability to fertilize the egg.

因为就算用老鼠的卵子来测试，那也没用，那不是你的卵子。

Because even if you use the mouse egg, that doesn't matter, that's not your egg.

如果用别的女性的卵子来测试，也帮不上忙，因为那不是你的卵子。

If you use another woman's eggs to test it, it doesn't help because it's not your eggs.

所以，我们唯一能知道精子能不能受精的方法，就是做试管婴儿，把精子和卵子放在一起，看看能不能成功。

So the only way we could ever know the sperm can fertilize the egg is by doing IVF, putting the sperm with the eggs and seeing if they work.

如果不行，那我们就能退一步说，好了，问题就在这里，他的精子不能很好地让卵子受精。

And if they don't, then we can take a step back and say, okay, here is the problem, his sperm can't fertilize the eggs well.

所以你看，有些情况下人工授精确实不会成功，但我们真的没办法提前知道它不会成功。

So as you can see, there are situations where IUIs will not work, but there is really no way to know they won't work.

你永远无法知道精子能不能受精。

You can never know if the sperm is going to fertilize.

你也永远无法真正知道输卵管是否通畅。

You can never truly know if the tubes are functional or not.

而这就是试管婴儿派上用场的地方。

And that's where IVF comes in.

并不是说试管婴儿这个治疗有多神奇，比人工授精好很多，而是它绕过了所有问题。

It's not that IVF is this amazing treatment that is so much better than IUIs, it bypasses everything.

所以即使你对情况判断错了，试管婴儿也有办法绕过。

So even if you're wrong of what's going on, IVF has got bypasses.

所以如果是输卵管问题，人工授精没成功，你猜怎么着？

So if it's a tubal problem and the IUIs didn't work, guess what?

现在试管婴儿就能成功了。

IVF works now.

如果是精子问题，没法进入卵子，那现在试管婴儿可以通过ICSI，也就是把精子注射进去，来解决问题。

If it's a sperm issue, not being able to get into the egg, IVF now can work by doing ICSI where we inject the sperm in.

如果是精子看起来不错但功能不太行的问题，试管婴儿也能解决。

If it's an issue where the sperm just isn't working well, but looks good, again IVF will fix it.

要记住的是，人工授精并不能解决所有问题。

What's important to remember is that IUIs can't fix everything.

实际上，它只能解决少数几个问题。

Matter of fact, they only fix a few problems.

所以，适合做人工授精的人，大约有百分之五十的几率能怀上。

And so the people who should do them, about fifty percent of people will get pregnant with them.

但那些不适合做人工授精的人，怀孕几率自然就更低了。

But people who should not do IUIs obviously will have a lower pregnancy chance.

你要记住最重要的一点，别把人工授精当成一个试金石，觉得它不行，试管婴儿也不行，因为它们是两种完全不同的治疗方式。

The most important thing for you to keep in mind, is that don't think of IUI as this treatment, that if it doesn't work, then that means IVF won't work, because they're completely different treatments.

我总爱开玩笑说，人工授精不像汉堡王的小皇堡，试管婴儿也不是大皇堡，只是更大、更好的版本。

I always make the joke that IUI is not like a junior whopper burger at Burger King, and IVF is a whopper, just a bigger version, better version of it.

相反，如果人工授精是小皇堡，那试管婴儿就像你吃过的最好的墨西哥卷或菲力牛排。

But instead, if IUI is the junior whopper, then IVF is going to be like the best taco or filet mignon you've ever had.

这是完全不同的治疗方式，成功率也不一样。

It's a completely different treatment that has different success rates.

不是因为试管婴儿更好，而是因为它能绕过所有问题，让我们获得更多。

Not because it's better, but because it bypasses everything and then allows us to get more.

人工授精是一种非常有用的治疗方式，而且效果很好。

IUIs are a very useful treatment and they work a lot.

要记住的重要一点是，当它们没成功时，不要自责，你没有做错什么。

The important thing to remember is, is when they don't work, don't blame yourself, you didn't do anything wrong.

它们不能解决所有问题，实际上只能解决少数几个问题。

They can't fix everything and they really only fix a few things.

有时候我们做人工授精，以为这是正确的治疗，但后来发现并不是。

And sometimes we do IUIs thinking they're the right treatment and later find out they weren't.

但我们尝试它们的原因是它们简单、方便、压力小，而且大多数时候都有效。

But the reason we try them is because they're easy, they're a lot simpler, they're less stressful and they work most of the time.

所以当你去做人工授精时，记住，第一次可能不会成功，但我们建议尝试三到四次。

And so when you go into an IUI, remember, it may not work on the first try, but we recommend doing about three to four tries.

如果到那时还没成功，那就是时候进行更多检查或者转向试管婴儿了。

If it hasn't worked by then, then that's when you move on to either more testing or going on IVF.

记住，没成功不是因为你做了什么，而是因为人工授精不能解决所有问题。

Just remember, it didn't work, not because of something you did, but because IUIs can't fix everything.

好了，希望你们喜欢这一集。

Well, hope you guys enjoyed this episode.

老规矩，如果你喜欢我们的节目，请在您常听的播客平台上给我们好评，打五星。

As always, if you like what you hear, please review us, give us five stars on your favorite podcast media that you listen to.

期待下周再和大家聊更多话题。

I look forward to talking to you again next week with more subjects.

另外，如果你有任何想让我们讨论的话题，欢迎通过我们的Facebook页面给我留言，或者发送到tbftnewdirectionfertility.com。

Again, if you ever have any that you would suggest, please send a message to me either through our Facebook page or by sending it to tbftnewdirectionfertility dot com.

我非常乐意回应。

I'm more than happy to address it.

下周见，这里是TacoBout Fertility Tuesday。

Until next week, this is TacoBout Fertility Tuesday.