前不久，美国前第一夫人米歇尔·奥巴马（Michelle Obama）的第一部自传小说《BECOMING》问世，里面也分享了很多他们的隐私。奥巴马夫妇结婚5年，经历过一次自然流产后再也没有怀孕，和常人一样，他们也异常焦虑，在朋友的介绍下他们来到芝加哥某医院的不孕不育科做检查，医生建议米歇尔克罗米芬促排卵，几个周期下来，卵泡发育并不是很好，他们开始尝试试管助孕。和所有做试管的不孕妇女一样，她需要连续几周每天给自己注射促排卵药，几乎每天需要B超检查和抽血。

书中有一段非常形象的描述：“事实证明，两个彼此深爱的有着强烈进取心的人并不能凭意志力怀孕，生孩子不是能打拼的事情，就这件事情而言，努力和回报之间没有必然的联系。我发现自己在暗自思忖：我想要孩子吗？是的，我太想了，想到这儿，我举起针头，扎进了肉里。”几乎所有生殖中心就诊的女性都能感同身受。经过两轮试管，1998年他们迎来了第一个女儿玛利亚，2001年第二个女儿娜塔莎出生了。

Not long ago, the first autobiographical novel "BECOMING" by former US First Lady Michelle Obama came out and shared a lot of their privacy.The Obamas have been married for 5 years. They have never been pregnant after a spontaneous abortion. Like ordinary people, they are also very anxious. Under the introduction of friends, they came to the infertility department of a hospital in Chicago to do an examination. The doctor recommended Michele to use Clomiphene for ovulation inductions, however, the follicular development is not very good in a few cycles.therefore, they began to try in vitro fertilization.Like all infertile women who are doing test tubes, she needs to give herself a ovulation-stimulating drug every day for weeks, requiring B-ultrasound and blood drawing almost every day.

There is a very vivid description in the book: "The facts prove that two people who are deeply loved by each other and have a strong and enterprising spirit can not be pregnant with willpower. It is not a matter of hard work to give birth to children. In this matter, efforts and rewards have no necessary connection between them. I find myself thinking: I want children? Yes, I think too much. When I think about it, I lift my needle and plung it into the flesh."Almost all women in the reproductive center can feel the same.After two cycles of test tubes, they ushered in their first daughter, Maria in 1998, and Natasha, the second daughter in 2001, was born.

每年我们也经常会遇到很多不孕不育的夫妇来我们医院生殖中心寻求助孕治疗，很多夫妻的情况和奥巴马总统夫妇很相似。

Every year, we often encounter many infertile couples who come to our hospitals reproductive center for help in pregnancy treatment. Many couples are similar to the Obamas .

小佳已经32周岁，是上海某医院儿科医生，工作强度大，经常夜班翻班，巨大的压力下她的妇科内分泌严重失调，月经很不规律，基本上2-3月来一次月经。结婚6年一直没有怀孕，家庭和社会的压力，让她倍感焦虑。2014年外院B超提示双侧卵巢多囊表现，AMH:20mg/L，中药调理月经两年后虽然月经周期较前规律但是仍然没有怀孕，2016年在外院多次促排，因卵泡发育过多或者不发育，医生不建议同房备孕。2017年经过朋友介绍来到上海仁济医院生殖医学中心做试管，经过对夫妇双方专业的身体评估，本科以“女方多囊卵巢综合征，男方少弱精子症”建议第一代试管（IVF）助孕，给予微刺激方案促排，最终获卵15枚，2017年7月行第一次胚胎移植后，获临床妊娠，于2018年4月足月剖宫产分娩一个可爱的女儿。

Xiao Jia is 32 years old. She is a pediatrician at a hospital in Shanghai. She has a strong work intensity and often shifts to work at night. Under the great pressure , her gynecological endocrine is seriously disordered. The menstruation is very irregular. She has not been pregnant for 6 years, and her family and social pressure has made her feel anxious. In 2014, B-ultrasound showed bilateral ovarian polycystic manifestations.AMH:20mg/L.After two years of Chinese medicine treatment，although the menstrual cycle is more regular, but still not pregnant. She received many ovulation inductions in 2016, but it didn’t work.In 2017,she came to Reproductive Center of Shanghai Renji Hospital to receive a professional body assessment of both couples.based on "female polycystic ovary syndrome, male less azoospermia" ,the reproductive experts recommended the first generation of test tube (In vitro fertilization,IVF) ,with mild-stimulation protocol, and finally get 15 eggs.After the first embryo transfer in July 2017, she got a clinical pregnancy, and a lovely daughter gave birth in a full-term cesarean section in April 2018.

多囊卵巢综合征（polycystic ovarian syndrome, PCOS）是育龄期女性最常见的生殖内分泌疾病，是引起无排卵不孕和高雄激素血症的主要原因，其发病率高达10%。PCOS的基本特征包括雄激素过多（表现为多毛和痤疮），月经不规律引起稀发排卵或者不排卵，B超提示单侧或双侧卵巢多囊样改变（双侧卵巢内有≥12个直径为2-9mm的小卵泡）。此外PCOS还有其他的临床特征，表现在黄体生成素增加、胰岛素抵抗、肥胖及脂代谢异常、II型糖尿病发生风险增加、妊娠期糖尿病及妊娠高血压疾病发生率增加、长期缺乏足够孕激素拮抗使子宫内膜癌发生风险增加。

Polycystic ovarian syndrome (PCOS) is the most common reproductive endocrine disease in women of childbearing age. It is the main cause of anovulatory infertility and hyperandrogenism, and its incidence rate is as high as 10%.The basic characteristics of PCOS include excessive androgen (expressed as hairy and acne), irregular menstruation causes sparse ovulation or no ovulation, and B-ultrasound suggests unilateral or bilateral ovarian polycystic changes (ovarian follicles ≥ 12, diameter 2 to 9 mm).In addition, PCOS has other clinical features, including increased luteinizing hormone, insulin resistance, obesity and abnormal lipid metabolism, increased risk of type 2 diabetes, increased incidence of gestational diabetes and pregnancy-induced hypertension, and chronic lack of sufficient progesterone increases the risk of endometrial cancer.

育龄女性如果月经经常推迟或者闭经，建议及时来生殖医学中心接受专业的指导和治疗，虽然PCOS会引起不孕和其他的并发症，但是经过必要的促排卵治疗或者试管助孕，几乎每个妇女都能迎来自己可爱的宝宝，仁济医院生殖医学中心愿意帮助你早点实现做妈妈的愿望。

If women of childbearing age are often delayed or amenorrhea, it is recommended to come to the Reproductive Medicine Center for professional guidance and treatment. Although PCOS can cause infertility and other complications, almost every woman will welcome their own cute babies through ovulation induction or in vitro fertilization. The Reproductive Medicine Center of Renji Hospital is willing to help you realize your mothers wishes earlier.

作者：上海仁济医院生殖医学中心 余琴梅