Episode Transcript
Dr. 琼斯: The mammalian miracle of growing babies inside you is amazing. 是的, that's a lot of M's in one sentence, but what do we know and what don't we know about implantation? And what do couples do and doctors do to try to make it work better?
播音员: 涵盖妇女健康的所有方面，这是“妇女健康的七个领域”. Kirtly Jones on 范围.
Dr. 琼斯: 在人类, eggs are sort of squished out of the follicle, 这是卵巢排卵时的囊肿里面有卵子. 好吧. It usually works. 这并不难理解，大发娱乐可以在其他哺乳动物身上进行研究，比如实验室老鼠. The fallopian tube picks up the egg, which is surrounded by a cloud of sticky cells, and moves the egg and its cells into the tube. 好吧. 我明白了.
精子, which were deposited in the vagina, swim up the cervix, 子宫, and out the tube and meet the egg. 好吧. 对于这些小家伙来说，这似乎很难，而且还有很长的路要走，但他们有很多. 卵子和精子互相认出对方是人类，只有一个精子进入卵子. 现在, that's amazing, and there are so many of them. And the egg gets fertilized.
好吧. 大发娱乐基本上理解这一点，大发娱乐可以在试管婴儿实验室里观察人类卵子和精子的情况. 大发娱乐知道很多卵子、精子和受精卵都是不正常的, 所以很多时候这个过程不会走得更远. But if things are normal enough, the fertilized egg starts to divide, 在输卵管细胞上小小的手指的大发娱乐下沿着输卵管向下移动，到达子宫，此时胚胎已经发育到有100多个细胞和专门的细胞可以进入子宫内膜并开始在内膜下钻洞. And, after that, we really don't have a clue as to what happens at all.
The human process of implantation is not necessarily like mice or cows. We actually are much less efficient. 在植入的不同阶段取出子宫来研究发生了什么是不可能的. 与大发娱乐共享基因和生殖生物学的灵长类动物越来越少，它们受到保护，不受此类研究的影响. 植入, the process of the embryo burrowing under the 子宫 lining, capturing some of the blood supply of the 子宫 lining, 和成长 enough to make a placenta, which then grows to feed the embryo and fetus, is mostly a mystery.
据认为，在有生育能力的夫妇中，大约五分之一的受精卵会使孩子存活下来. In infertile couples, it doesn't happen that often, and sometimes we don't know why or what to do about it. 因此，许多没有怀孕的夫妇转向体外受精. It is thought about 1% of all the babies born in the U.S. were conceived with IVF, and that makes about a million babies in the U.S. over the years. Hundreds of thousands of cycles of IVF are done each year in the U.S. 但是你可以把看起来很可爱的胚胎放进一个女人的子宫里，却无缘无故地没有怀孕.
这导致医生和患者试图想出一些策略来增加植入的机会. In the old days, 大发娱乐让一个女人在床上倒着躺了一天，她把胚胎放在子宫里，希望它不会掉出来. Then we had women rest for hours, then an hour, then 15 minutes, 然后根本没有，因为随机试验表明，胚胎移植后平躺似乎对植入没有影响. 有些人尝试了针灸，希望它能通过一些古老的智慧来大发娱乐植入，大发娱乐了解这些智慧就像大发娱乐了解植入一样. 随机试验表明，针灸并不比假针灸和植入效果更好, 但医生和病人都不顾一切地想让这个非常昂贵且耗费生命的过程发挥作用.
Some years ago, 有人提出，如果你在试管受精前一个月破坏子宫内膜, 也许它会在愈合过程中引起反应，从而增加植入的机会. Given that we have no clue about implantation, it seemed like an idea. And some early studies suggested it might have a small effect, 增加胚胎成功植入和生长的可能性. 现在, 这与园艺不同，你先刨开泥土，然后把种子撒在地上，希望它们能长得更好，而不是直接把种子撒在地上, although it sort of sounds like that.
子宫内膜破裂称为子宫内膜刮伤，实际上发生在试管婴儿周期的前一个月. It can be done in several ways, 但最常见的是将一根尖端有锋利边缘的小管子插入子宫, through the cervix, and move it around back and forth, sort of scuffing up or scratching the 子宫 lining. So does it work? Some people thought it did. Some studies suggested it might, and patients and doctors were desperate.
In a widely read medical journal, the "New England Journal of Medicine,在试管婴儿周期之前，一项关于子宫内膜抓挠和不抓挠的大型随机试验报告称，抓挠没有大发娱乐. There was no difference. Not exactly a surprise. At least it didn't hurt. Well, actually, it did hurt. 对大多数女性来说，在子宫里插入一根管子并让它旋转是不舒服的. 对医生来说，收费可能是200到600美元. Well, no, don't scratch that.
Lots of things have been tried. Word gets out on the web, 患者要求进行一些干预或其他可能增加怀孕机会的干预. 我承认我自己有一些神奇的想法，在我做试管婴儿医生的那些年里，我把胚胎放回接受试管婴儿的病人的子宫里. 将一小滴液体注入胚胎之间有几分钟的时间, or better one embryo, into the top of the 子宫. 当实验室的胚胎学家检查试管并确保胚胎已经消失时, it's a couple of minutes. 我会练习深呼吸，想象胚胎在子宫里快乐地植入, 和成长, and seeing children at our IVF picnic. I didn't tell patients that I did this little exercise, but it seemed like a good use of a few quiet minutes. Magical thinking. What I really wanted was some kind of tissue super glue, but somebody actually tried that, and it didn't work.
So what do we do when we don't know what to do? 不孕不育和早孕流产的世界里充满了善意的治疗方法，试图大发娱乐人们生下他们希望的孩子. 大多数, 至少, haven't been harmful -- acupuncture to increase IVF implantation, aspirin to prevent miscarriage, and many others. But before we suggest it or offer it to patients who want it, we should 至少 know that it won't hurt physically, 在情感上, or financially. 大, well-done randomized trials are very expensive, and in the IVF world, usually not funded by our government, but they need to be done. As patients and consumers of reproductive health care, 大发娱乐应该试着从医生那里得到最好的信息，深呼吸，尽大发娱乐所能. And thanks for joining us on 范围.
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