Here’s how technology transformed babymaking

科技如何改变了生育方式

Technology is changing the way we make babies. The pioneering work of the scientists who invented IVF led to the birth of the first “test tube baby” in 1978. We’ve come a long, long way since then. 科技正在改变我们孕育生命的方式。1978年，发明体外受精（IVF）的科学家们的开创性工作，促成了世界上第一个“试管婴儿”的诞生。自那时起，我们已经走过了漫长的道路。

This week, I’ve been working on a piece about the cutting edge of IVF technologies and what’s coming next. Think AI and robots and, potentially, gene-edited embryos. My reporting has also made me think about just how much progress has been made in the last five decades. 本周，我一直在撰写一篇关于IVF前沿技术及其未来发展的文章。想象一下人工智能、机器人，甚至是基因编辑胚胎。我的报道也让我思考，在过去的五十年里，我们取得了多么巨大的进步。

Clinicians have improved hormonal treatments. Embryologists have devised ways to culture embryos in the lab for longer. IVF clinics today offer multiple genetic tests for embryos. In recent years, we’ve had reports of babies born with DNA from three people, babies born following “IVF on wheels,” babies born from decades-old embryos, and even babies “conceived” with the aid of a sperm-injecting robot. 临床医生改进了激素治疗方案。胚胎学家设计出了在实验室中延长胚胎培养时间的方法。如今的IVF诊所可以为胚胎提供多种基因检测。近年来，我们看到了关于“三亲婴儿”、通过“移动IVF”出生的婴儿、由冷冻数十年的胚胎孕育的婴儿，甚至是在精子注射机器人辅助下“受孕”的婴儿的报道。

The technology has also had a huge social impact. It has allowed for changes in the structure of families and provided more reproductive choices for would-be parents. So this week, let’s consider the technologies that have transformed babymaking. 这项技术也产生了巨大的社会影响。它改变了家庭结构，并为准父母提供了更多的生育选择。因此，本周让我们来探讨一下那些改变了生育方式的技术。

Alan Penzias, a reproductive endocrinologist at Boston IVF, has been working in IVF since the early 1990s. In those days, his lab at Yale would collect a person’s eggs, fertilize them, and culture any resulting embryos for two days, until the embryos had two or four cells. The embryos couldn’t survive any longer outside a body, so they’d be transferred to the uterus at that point. All of them. Even if there were, say, five embryos in total. Typical healthy patients could expect a live birth rate of 12% to 15%, he says. 波士顿IVF（Boston IVF）的生殖内分泌学家艾伦·彭齐亚斯（Alan Penzias）自20世纪90年代初就开始从事IVF工作。在那个年代，他在耶鲁大学的实验室会采集卵子并进行受精，将产生的胚胎培养两天，直到胚胎发育到两个或四个细胞。由于胚胎在体外无法存活更久，它们必须在那个阶段被植入子宫。而且是全部植入，即使总共有五个胚胎也是如此。他说，当时典型的健康患者活产率仅为12%到15%。

Then Penzias heard that other teams were managing to culture embryos for three days. “We thought, No, that’s not possible,” he recalls. He learned that scientists had achieved this by tinkering with the culture medium—the nutrient-rich fluid the embryos are grown in. Those three-day embryos, which had around six to 10 cells, seemed to have a better chance of resulting in a live birth. The teams culturing embryos for longer saw their success rates climb to 25% among similar patient groups, says Penzias. Again, he couldn’t believe it. “We thought they were making it up,” he says. 后来，彭齐亚斯听说其他团队成功将胚胎培养了三天。“我们当时想，不，这不可能，”他回忆道。他了解到，科学家们是通过改进培养基（胚胎生长的营养液）来实现这一点的。那些发育到六到十个细胞的三天胚胎，似乎有更高的活产几率。彭齐亚斯说，那些延长胚胎培养时间的团队，在相似的患者群体中成功率攀升到了25%。他再次感到难以置信。“我们以为他们在编造数据，”他说。

In the years since, teams have made more improvements to culture medium. Today, most IVF embryos are cultured for five or six days—a point at which they have 80 to 100 cells. The culturing process can act a little like a stress test—the embryos that make it to day six are generally more likely to go all the way and develop into a healthy baby. 在此后的几年里，各团队对培养基进行了更多改进。如今，大多数IVF胚胎会被培养五到六天，此时它们已发育到80到100个细胞。培养过程有点像压力测试——能够存活到第六天的胚胎，通常更有可能一路发育成为健康的婴儿。

Over the same period, advances in other technologies have opened up the options for what we can do with those embryos. Scientists learned they were able to freeze embryos and use them at a later date. A little over a decade ago, clinics shifted to a “vitrification” approach that rapidly cools the embryos to a glassy state. Vitrified embryos are more likely to survive freezing and thawing, so this approach quickly caught on. 在同一时期，其他技术的进步也为我们处理胚胎提供了更多选择。科学家们发现，他们可以将胚胎冷冻并在日后使用。十多年前，诊所转向了“玻璃化冷冻”技术，将胚胎迅速冷却至玻璃态。玻璃化冷冻的胚胎在冷冻和解冻过程中存活率更高，因此这种方法很快流行起来。

As a result, doctors no longer needed to transfer multiple embryos at once. This made it less likely that patients would have twins or triplets, which can increase the risk of pregnancy complications. Vitrification has also made IVF safer in other ways, including by affording patients a bit of time between fertility treatments. 因此，医生不再需要一次性植入多个胚胎。这降低了患者怀上双胞胎或多胞胎的可能性，从而减少了妊娠并发症的风险。玻璃化冷冻还通过其他方式提高了IVF的安全性，包括让患者在生育治疗之间有喘息的时间。

The hormonal treatments used in the first phase of IVF are designed to increase the production of mature eggs that can be collected. These treatments carry a small risk of a condition called ovarian hyperstimulation syndrome (OHSS), which in rare cases can be life-threatening. The ability to freeze all your embryos and use them at a later date is thought to give the body a chance to recover from hormonal treatment and reduces the risk of OHSS. IVF第一阶段使用的激素治疗旨在增加成熟卵子的产量，以便采集。这些治疗存在一种名为卵巢过度刺激综合征（OHSS）的轻微风险，在极少数情况下可能危及生命。能够冷冻所有胚胎并在日后使用，被认为能让身体从激素治疗中恢复，并降低OHSS的风险。

And because clinics are now able to culture embryos for up to a week, they can take a few of the 100 or so cells and send them for genetic testing before freezing the embryos. People undergoing IVF can get genetic readouts of all the embryos before deciding which to implant. (It is worth noting, however, that these testing technologies are not perfect.) “Those are really radical changes, and we take them for granted,” says Penzias. 由于诊所现在可以将胚胎培养长达一周，他们可以在冷冻胚胎前提取100个左右细胞中的几个进行基因检测。接受IVF的人可以在决定植入哪一个胚胎之前，获得所有胚胎的基因检测结果。（不过值得注意的是，这些检测技术并不完美。）“这些确实是根本性的变化，但我们已经习以为常了，”彭齐亚斯说。

These technologies have also changed the function of IVF. What was once a treatment for infertility is now used to preserve fertility. People who want to delay parenthood can opt to freeze their eggs or embryos and use them later. They might opt to transfer one embryo in a year’s time and a second several years later. “We’ve been able to empower women to be able to have much more reproductive choice and get more reproductive mileage from a single IVF cycle,” says Penzias. 这些技术也改变了IVF的功能。曾经用于治疗不孕症的技术，现在被用于保存生育能力。想要推迟生育的人可以选择冷冻卵子或胚胎，留待日后使用。他们可以选择在一年后植入一个胚胎，几年后再植入第二个。“我们已经能够赋予女性更多的生育选择权，并从单次IVF周期中获得更多的生育机会，”彭齐亚斯说。

People who are about to undergo cancer treatments that might damage the testes or ovaries can opt to store their eggs or sperm ahead of time, too. Scientists have even been able to preserve pieces of ovarian and testicular tissue and reimplant them later, enabling recipients to have healthy babies. 即将接受可能损害睾丸或卵巢的癌症治疗的人，也可以选择提前储存卵子或精子。科学家甚至已经能够保存卵巢和睾丸组织碎片，并在日后重新植入，使接受者能够生下健康的婴儿。

Today, more people than ever have access to safe IVF options that offer multiple paths to parenthood. Those options look set to expand. But if you want to find out more about the AI and IVF robots, you’ll have to read this week’s story, here! 如今，比以往任何时候都有更多的人能够获得安全的IVF选择，这些选择为为人父母提供了多种途径。这些选择似乎还会进一步扩大。但如果你想了解更多关于人工智能和IVF机器人的信息，请阅读本周的报道！