試管嬰兒「MIT」

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1993 / 11月

文‧張瓊方 圖‧薛繼光


過去,許多人專程到台灣看牙齒,檢查身體,現在,許多人專程到台灣求子。


去年聖誕節前,李太太和先生從香港來台灣,此行既不是洽公,也不是旅遊,而是專程來台灣做試管嬰兒手術。她表示,在香港做一次要十萬港幣(新台幣三十多萬),在台灣做只要三分之一的花費。「價格便宜,技術又好,當然來台灣做嘍!」她說。

海外華僑,歸國求子

先生先回香港,李太太則在台灣朋友家住了一個半月,確定成功受孕後,她高高興興地帶著肚子裡的「聖誕禮物」回香港了。她表示,明年還要再來生第二胎。

李太太並非特例,台北榮民總醫院婦產部科主任張昇平指出,榮總每年平均為五百人次的病人作試管嬰兒手術,而從海外歸國求子者,平均在五十人以上。每年的暑假和聖誕節前後是「旺季」,對象以來自美國、日本、香港、東南亞各國的華僑為多。

根據張昇平與成功大學醫學院副教授劉志鴻的分析,華僑不遠千里回台灣接受試管嬰兒手術的原因,不外是:費用低、溝通容易、技術好。

由於一般保險不給付人工生殖的醫療費用,因此,做一次手續複雜的試管嬰兒所費不貲。以美國為例,一個周期的治療費用(不論成敗),大約要一萬美金;在英國一個周期的治療費用需一萬英鎊(新台幣四十多萬)。相較之下,我國一個周期新台幣七∼八萬的治療費用,較為合理。

而溝通方面的困擾,也導致僑居異邦的國人寧可回台灣就醫。劉志鴻表示,施行試管嬰兒手術的步驟較繁複,需要詳細的雙向溝通,而醫學名詞解釋起來相當不容易;文化背景、語言若相同,溝通起來較容易。

技術高、收費低

張昇平表示,美國、澳洲、英國、比利時等國家,在試管嬰兒生殖科技上都有不錯的發展。而這兩、三年來,我國試管嬰兒生殖科技已達國際水準。

以榮總為例,目前榮總試管嬰兒每週期的成功率約在三成左右。而根據美國「生育醫學雜誌」的報導,一九九一年全美國試管嬰兒成功率平均為廿五%。

從量的方面來比較,全美有一百七十五個試管嬰兒中心,一年做超過兩百人次的只有十六個中心。張升平指出,去年做了五百人次的榮總,「排前五、六名一定沒問題!」

目前我國從事試管嬰兒生殖治療的醫學中中心與開業診所,大約有二十個。其中以榮總、台大、長庚、中山醫院為大本營,人數較多。

先後在台大、成大進行試管嬰兒研究、治療,去年自行開業的劉志鴻表示,台灣從事試管嬰兒生殖治療的都是年輕一輩的醫生,彼此互相合作,帶動進步。國外一有新技術,國內很快就跟進。

民國七十八年,劉志鴻締造了全亞洲第一例冷凍胚胎的試管嬰兒成績。其他像精密的「精卵顯微注射手術」、「胚胎外殼打洞協助孵化」等最新科技,台灣已經有二、三個醫學中心在做了。

為什麼不能?

事實上,國內試管嬰兒技術的精進,與大量的需求有密切關係。

「不孝有三,無後為大」,不論身居何處,凡是中國人,似乎都不免要背負「傳宗接代」的責任和使命。

不幸的是,面臨生育問題的夫婦,有越來越多的趨勢。根據中華民國不孕症醫學會理事、前成大醫學院婦產科主任劉志鴻的估計,目前台灣每七對夫妻就有一對不孕,總計約有四十七萬對的夫婦面臨生育的困擾。

比起十年前十分之一的不孕比例,今天不孕案例增加的速度令人心驚。究其原因,劉志鴻指出,現代人越來越晚婚,即使結婚了也延後生小孩,增加不孕的機率。加上社會風氣開放,性關係日益複雜,工作壓力增加、環境污染的毒害,對男女的生殖系統造成了直接傷害,卵巢功能與精蟲的質量變差,生育機能自然降低。

最後一線「生機」

所幸,人工生殖科技的發展,解決了部分的不孕問題。

今年七月,一對飽受不孕折磨的夫妻,經由試管嬰兒科技協助,順利生下一名女嬰後,不禁喜極而泣。

這對夫妻結婚六年,先生是家中獨子,母親又已守寡近三十年。面對寡母的殷殷期盼、親朋好友的關切詢問、左鄰右舍的善意關懷,這對夫妻的沈重壓力,可以想見。他們歷經各種檢查,先後在四家醫院做過七次試管嬰兒手術,期間甚至還遠赴美國試管嬰兒成功率最高的醫院治療,結果失望而歸。

在無計可施、萬念俱灰的情況下,他們曾有過認領、娶妾、去大陸借腹生子,甚至離婚的想法。所幸他們的鍥而不捨,終於獲得上天的垂憐,經由劉志鴻醫師的鼓勵與治療,終於求子成功。

這位苦盡甘來的父親,寫給醫生的感謝信中提到了初聞喜訊時的心情,他寫道:「十個月前的某日下班,我正路經塞車的十字路口,你來電告知內人已懷孕,當時心情的激動、喜悅,久久不能自己。足足有五、六分鐘無法手握方向盤,致使交通大亂……」

製造過程不簡單

而一般試管嬰兒的手術是這樣的:

試管嬰兒的操作過程,分體外授精與胚胎移植兩個部分。

首先,接受治療的病人要接受排卵藥物的刺激,以使卵巢生長較多的卵泡,並以超音波觀察卵泡發育情形,直到卵子成熟,再經由腹腔鏡或超音波導引採集卵子。

將取出的卵子與經過清洗處理的精子放入培養皿中受精,在與人體環境相同的培養箱堙]攝氏卅七度、五%的二氧化碳、百分之百的濕度)培養約四十八小時,當受精卵分裂成二至四個細胞時,再將胚胎植入母體子宮中,讓胚胎著床、發育。植回母體後就要靠母體的子宮來孕育,和一般的懷孕過程無異。

如此一個循環稱為「一週期」,有人第一個週期就成功,有人做好幾個週期還是無法成功。張昇平指出,一般而言,做六個週期仍未成功者,成功的機會就很小了。劉志鴻也表示,大約有十%的人,怎麼做都不會成功,至今原因不明。

張昇平指出,自然懷孕過程中,受孕的受精卵大約在七十二小時左右會由輸卵管進到子宮腔著床。而試管嬰兒在體外操作的三天時間,僅僅是取代輸卵管的功能而已。

由此可見,試管終究無法取代子宮。所謂「試管嬰兒」,指的是在試管內受精,並非在試管內孕育。人工生殖科技只不過是增加不孕者的受孕機率而已,離「造人」實在還有一段很遠的距離。

生母變養母

但是,並非所有的不孕者都能接受試管嬰兒科技的治療,也不是所有不孕者藉由試管嬰兒科技的協助,都能順利求子得子。

劉志鴻指出,試管無法取代子宮的孕育功能,「代理孕母」又與民法抵觸,一直無法通過。因為民法規定:孩子從誰的肚子出來,誰就是法定的母親。如此一來代理孕母變成了法定母親,提供卵子者反成養母。因此,就算人工生殖科技再如何進步,對子宮缺損或因故割除子宮者而言,毫無幫助。

幫助最大的,則數輸卵管疾病的病人。劉志鴻表示,過去輸卵管阻塞嚴重的病人,幾乎沒有生育的希望。試管嬰兒大幅提昇這類病人的懷孕機會。

根據張昇平的估計,接受試管嬰兒手術幫助的,有八十%是輸卵管阻塞的病人,十%是子宮內膜異位症患者,其餘尚有男性不孕、不明原因的不孕症……等。

此外,做試管嬰兒還得具備一些基本條件。張昇平指出,首要條件是:夫妻雙方身心健康,不得有其他疾病。之外,年齡上也有限制,男性在五十五歲以下,女性以不超過四十五歲為原則。

手工精製、與眾不同?

今年七月、九月,三軍總醫院、長庚醫院,分別發生產婦產下唐氏症試管嬰兒的案例,不禁加深人們對人工生殖科技的疑慮。許多人不解,胚胎既是經過篩選,為何不做好「品質管制」呢?

事實上,人工生殖操作過程中所做的篩選,無關遺傳基因的優劣。劉志鴻解釋,篩選的目的是要增加受孕的機會。以精蟲來說,外型完整、活動力較強者,功能較佳;胚胎則以圓、透明、均勻、沒有碎片者功能較好。劉志鴻強調:「胚胎的功能與遺傳基因並沒有直接的關係。」

既是如此,任何自然受孕胎兒可能發生的疾病,經由人工生殖也一樣會發生,包括染色體突變引起的唐氏症。劉志鴻認為,產下患有唐氏症的試管嬰兒,應該歸咎產前檢查的疏失,無關試管嬰兒的操作技術。

根據統計,試管嬰兒的畸型比例與自然生產差不多,大約在二∼三%之間。

試管資優兒?

關於試管嬰兒的身心發育情況,也是人們關注的焦點。

榮總曾經對該院出生的試管嬰兒做追蹤調查,發現他們身心方面的發展都與一般兒童無異,智商方面則稍微高出一般兒童。榮總小兒部主任陳淑貞表示,由於追蹤到的人數隻有五十位,結果只能作為參考,不具代表性。

劉志鴻指出,法國曾對數千例的試管嬰兒做過追蹤,發現他們與自然生產產下的兒童並無差別。

他認為,後天環境較好可能是導致部分試管嬰兒智商較高的原因。因為做一次試管嬰兒的費用在七∼八萬之間,一般說來,至少要中上程度的家庭才負擔得起。再加上孩子得來不易,受到的照顧與關注自然較高。

國內第一個試管嬰兒——張小弟,就是一個例子。

張小弟今年八歲,就讀小學三年級,是個資優生。張媽媽認為,兒子之今天所以「還不錯」,後天的環境影響很大。光看張小弟上過的才藝班——鋼琴、英文、繪畫、數學推理、自然科學,就不難想見,家堿O如何不遺餘力地栽培他。

之外,家長的教育程度也是值得參考的因素。根據榮總的調查,試管嬰兒的家長中,大專以上程度佔七十%,其餘三十%是高中、初中程度。

科技的瓶頸

國內技術雖已達一定水準,目前試管嬰兒生殖科技仍遇到兩個難題,一是年齡的障礙;其次是胚胎不易著床。這兩個難題也造成試管嬰兒的成功率不如想像中高。

據估計,試管嬰兒的流產率高達廿五∼三十%,是自然受孕者的二倍左右。其中的關鍵在孕婦年齡。劉志鴻指出,女性年齡越大卵巢功能越不好,流產率也就越高。卅五歲時,流產率約二十%,四十歲時,就超過三成;到四十五歲流產機率已高達一半了。

此外,胚胎在體外培養時,外殼容易硬化,導致胚胎植入子宮後不易著床。目前醫界利用雷射將胚胎打洞,讓胚胎較容易破殼而出,以便著床,使這個問題獲得改善。對於反覆失敗的病人,很有幫助。

除了流產率較高之外,試管嬰兒多胞胎的機率,也比自然生產高出十倍以上。劉志鴻表示,胚胎植入時,植入越多懷孕的機會越大。因此,一般病人都會要求多植入一些。「最好以四個為限」,劉志鴻表示,多胞胎容易產生併發症,像早產、高血壓、糖尿病、毒血症……等,必要時應該要「減胎」,以確保安全。

傳宗接代靠試管

縱然我國試管嬰兒生殖技術已達國際水準,但劉志鴻對於國人不重視基礎研究感到憂心,他表示:「大家只急著學步驟,不去研究原理,只懂皮毛的結果,一旦遇到困難就會不知所措。」

張昇平也表示:「大家一窩蜂地做,不是好現象」,他指出,試管嬰兒只是生殖內分泌的一小部分。現在大家只在加強臨床成就,而不去從事基礎研究了。

「能生育者,永遠無法了解不孕的痛苦」,一位不堪鄰居譏笑的不孕婦人如是說。然而,科技的助力畢竟有極限,如何讓當事人去面對失敗的結果,或許是一個更值得探究的課題。

〔圖片說明〕

P.22

試管嬰兒生殖科技,為不孕者帶來一線生機。

P.24

「精子顯微注射」,是利用顯微儀器將精子直接注入卵子內,以提高受孕機會。對精蟲稀少或活動力差者,很有幫助。

P.24

多餘的胚胎,可置於攝氏零下一百九十六度的液態氮中冷凍儲存,可以免除一再取卵的麻煩。

P.25

試管嬰兒製造過程

1.接受排卵藥物刺激,促使卵巢生長較多卵泡。

2.待卵泡成熟,由超音波導引取卵。

3.胚胎在體外培養約四十八小時,受精卵分裂成二∼四個細胞時,即可植入母體。

4.胚胎植入母體的管道有二,由陰道植入俗稱IVF;作腹腔鏡植入稱TET。

P.25

利用腹腔鏡將胚胎植入母體,手術過程只需廿到卅分鐘。

P.26

台灣第一個試管嬰兒——張小弟,是個多才多藝的資優生。

P.27

為人母的喜悅,已使林月惠忘卻求醫過程所受的折磨。

P.28

歸國求子成功的華僑,在母親節前夕寄給醫生的謝卡,還附上兩個寶貝的照片。(張昇平提供)

P.29

劉志鴻和試管嬰兒及家長們合影。(劉志鴻提供)

相關文章

近期文章

EN

Test-Tube Babies (Made in Taiwan)

Chang Chung-fang /photos courtesy of Hsueh Chi-kuang /tr. by Brent Heinrich

In the past, many people traveled to Taiwan from foreign lands in order to see a dentist or have a physical examination. Today, many people come to Taiwan in search of offspring.


Right before Christmas of last year, Mrs. Li came with her husband to Taiwan from Hong Kong. This visit was not for business nor was it for a holiday; it was especially to receive a "test-tube baby" operation. She explains that in Hong Kong to have the operation requires HK$100,000 (more than NT$300,000); in Taiwan it costs a third of the amount. "The price is cheap and the technology is good. Of course, we came to Taiwan to have it done!" she says.

Her husband left early to return to Hong Kong, and Mrs. Li stayed at the house of a Taiwan friend for a month and a half. After the operation was confirmed a success, she joyously return to Hong Kong, carrying in her tummy a little Christmas gift. She added that next year she would come again to conceive her second child.

Seeking a child in the motherland:

Mrs. Li is anything but unique. Chang Sheng-ping, Director of Obstetrics and Gynecology at Taiwan Veteran's General Hospital, points out that Veteran's General averages 500 patients undergoing in vitro fertilization (popularly known as "test-tube baby" operations) every year, more than 50 of whom are overseas Chinese. The heavy seasons are summer vacation and around Christmas, at which time overseas Chinese from all sorts of countries--the United States, Japan, Hong Kong, and Southeast Asia--arrive in large numbers.

According to the analysis of Chang Sheng-ping and Associate Professor at National Cheng Kung University Hospital College of Medicine Liu Chi-hung, the reasons for overseas Chinese' traveling large distances to receive test-tube babies usual ly are low cost, ease in communication, and advanced technology.

Because artificial reproductive technology is not covered by health insurance, the price for the complicated in vitro fertilization procedure is exorbitant. For example, in the United States, the cost of one cycle of treatment (whether it succeeds or fails) is approximately US$10,000. In England the price of one cycle of treatment is about £10,000 (more than NT$400,000). By comparison, the fees in Taiwan of NT$70,000 to NT$80,000 are quite reasonable.

Furthermore, the problems of communication also lead many overseas Chinese to return home for medical help. Liu Chi-hung explains that the in vitro fertilization procedures are delicate and complex. They require detailed communication, and medical explanations are not easy to understand. With a common cultural background and language, communication is much smoother.

High technology, low, low price:

Chang Sheng-ping observes that many countries such as the US, Australia, England and Belgium have already developed good skills in the science of making test tube babies, and in the last two or three years, Taiwan has attained an international standard in this area, as well.

For example, at Veteran's General Hospital, the success rate for each cycle of in vitro fertilization is about three out of ten. According to a report in the US journal Fertility and Sterility, the success rate for test-tube babies in America in 1991 was 25% .

In terms of volume, the United States has 175 in vitro fertilization centers; only 16 of these centers treat more than 200 patients a year. Chang Sheng-ping points out that last year Veteran's General treated more than 500 patients. "It easily ranks number five or six in the world."

Approximately 20 medical centers or clinics are currently engaged in in vitro fertilization treatment. Among these, Veteran's General, National Taiwan University Hospital, Chang Gung Memorial Hospital, and Chungshan Hospital take the lion's share of patients.

Liu Chi-hung, who did research and treatment in the area of test-tube babies first at the National Taiwan University Hospital, then at Cheng Kung University, and who entered into private practice last year, asserts that all the physicians working with in vitro fertilization are of the younger generation, and they often cooperate with each other. When new technology appears in other countries, Taiwan quickly follows suit.

In 1989, Liu Chi-hung set a record by being the first physician in Asia to successfully complete in vitro fertilization using frozen embryos ("Cryopreservation of Embryos"). Already there are two or three medical centers performing the latest techniques, such as "Micromanipulation of Sperm and Eggs" and "Assisted Hatching."

Where the problem comes from:

In reality, there is a close connection between advances in test-tube baby technology and the high demand.

As Confucius declared, "There are three great unfilial acts, and the worst of these is not bearing offspring." It seems that no matter where you live, if you are Chinese you are not exempt from the responsibility and mission of carrying on the family line. Unfortunately, there tend to be more and more couples who face problems in child bearing. According to a study taken on behalf of the Chinese Fertility Society by Liu Chi-hung, former director of Obstetrics and Gynecology at Cheng Kung University College of Medicine, currently one out of every seven married couples can not achieve pregnancy. Overall, approximately 470,000 couples face some form of disturbance in giving birth.

Compared to ten years ago, when only one in ten couples could not achieve pregnancy, the rapid increase in the number of cases of infertility today is startling. Having researched the causes, Liu Chi-hung points out that modern people are increasingly getting married at a later time in life, and after marriage they put off bearing children even further. This increases the rate of infertility. Moreover, with social liberalizations, sexual relationships have become more complex. With increased work pressure and the ill effects of environmental pollution, the reproductive systems of both men and women have sustained direct damage. The capabilities of the ovary and the potency of the sperm have gotten worse, and the likelihood of childbirth has naturally diminished.

Last chance to board the childbirth train:

Fortunately, the development of in vitro fertilization has solved some of the problems of infertility.

In July of this year, a married couple who had suffered the torment of infertility received the assistance of in vitro fertilization technology and smoothly gave birth to a baby girl. They were so happy that they both burst into tears. This couple had been married six years. The husband was an only son, and his mother had been widowed for nearly 30 years. When faced with his mother's nervous expectations, the anxious enquiries of close friends and the well-meaning concern of neighbors, their sense of great pressure could be easily understood. They had gone through all kinds of examinations and undergone in vitro fertilization seven times at four different hospitals. They had even traveled to the United States to attend the hospital with the highest success rate for in vitro fertilization, and returned disappointed.

Having exhausted all possibility and finding themselves in a hopeless predicament, they had considered adoption, finding a mistress, or going to mainland China to hire a woman to bear them a child. They had even begun to entertain thoughts of divorce. Fortunately, their perseverance finally won the pity of heaven, and with the encouragement and treatment of Doctor Liu Chi-hung, they finally succeeded in bearing a child.

This father who now knew joy after so much pain wrote a thank you note to the doctor, in which he described his sensation upon receiving the good news: "After work one day ten months ago, I was stuck at an intersection in a traffic jam, and you telephoned to inform me that my wife was pregnant. At that moment I was so excited and joyful that for a long time I couldn't contain myself. For as long as five or six minutes I couldn't control the steering wheel, and I caused a great mess in traffic . . . ."

The process of creation is not simple:

Most in vitro fertilization operations proceed in the following manner. The process of test-tube baby creation is divided into two stages: external fertilization and implantation of the fertilized embryo.

Firstly, the patient undergoing treatment must receive medicine to stimulate ovulation, so that the ovaries produce more follicles. The follicles' growth is observed with ultrasound until the eggs have matured, at which time laparoscopy or ultrasound is used to precisely extract the eggs ("Transvaginal Ultrasound-Guided Ovum Pickup").

The extracted eggs and cleanly processed sperm cells are placed in a petri dish for fertilization. They must be cultivated for 48 hours in a petri dish that is perfectly compatible with the internal environment of the human body (37℃, 5% CO2, 100% humidity). After two to four eggs are fertilized, the embryos are implanted in the mother's womb and allowed to stabilize and grow. After they are returned to the mother's body, they must enter the mother's uterus, in the same manner as any other pregnancy.

This kind of circulation is called a "cycle." Some women meet with success on the first cycle; others go through several cycles with no favorable outcome. Chang Sheng-ping observes that patients who have already gone through six cycles without becoming pregnant have a very slim chance of a positive result. Liu Chi-hung also estimates that 10% of the patients will not meet with success no matter what methods are used, and the reasons remain unclear.

Chang Sheng-ping points out that during the process of natural pregnancy, fertilized eggs that result in pregnancy usually leave the fallopian tube and enter the uterus within 72 hours. Test-tube babies only have the three days spent in the external fertilization process to substitute for the passage through the fallopian tube.

It is evident, therefore, that the test tube will not eventually replace the womb. The popular term "test-tube baby" only indicates the place where insemination occurs; pregnancy can never be accomplished in a test tube. In vitro fertilization techniques can only increase the chances of pregnancy for those with few other alternatives. We are still a great long way from "creating human life."

Natural mother becomes foster mother:

Not every infertile woman can receive treatment through in vitro fertilization. Neither can everyone who seeks help through this procedure necessarily gain the child they long for.

Liu Chi-hung notes that the test tube can not take the place of the womb. But surrogate motherhood is also in conflict with the law, and it has consistently been unable to be legalized. Civil law in the Republic of China stipulates that the woman who physically gives birth to a child is that child's legal mother. In this way, the surrogate mother becomes the legal mother; conversely, the real mother becomes the adoptive mother. Because of these problems, no matter how much in vitro fertilization techniques improve, they will be of no help at all to women with injured wombs or those who have previously received a hysterectomy.

Those whom it helps the most are patients with diseases of the fallopian tubes. Liu Chi-hung notes that in the past women with severely blocked fallopian tubes had nearly no hope of bearing children. In vitro fertilization greatly increases the chances of pregnancy for these kinds of patients.

According to Chang Sheng-ping's estimate, 80% of patients receiving the aid of in vitro fertilization suffer from blocked fallopian tubes. Ten percent suffer adverse troubles in the membrane wall of the uterus. The remaining patients seek help because of reproductive problems of the male partner, uneasily determined pregnancy problems, etc.

Besides this, to undergo in vitro fertilization, one still must fulfill several basic conditions. As Chang Sheng-ping explains, the first condition is that both the husband and wife be healthy both physically and mentally. They must have no other medical problems. In this regard, there is also a limit in age. As a rule, men must be under 55 years; women must be under 45.

Are manufactured children different?

This year in July and September Tri Service General Hospital and Chang Gung Memorial Hospital independently discovered cases of test-tube babies with Down's Syndrome. This hardly alleviates the suspicions that people have about in vitro fertilization. Many people can not comprehend the cause of these problems: since the embryo has undergone screening beforehand, how can they not perform "quality control"?

Actually, the screening involved in the in vitro fertilization process has nothing to do with the good or bad properties of the genes. Liu Chi-hung explains that the purpose of the screening process is to increase the likelihood of pregnancy. Sperm cells with the soundest forms and the most powerful motion will have the most successful fortunes. In terms of the embryos, those which are round, transparent, uniform, and have no jagged imperfections are most likely to do well. Liu Chi-hung emphasizes, "The success of an embryo doesn't necessarily have any relationship with its genetic makeup."

Therefore, any disease or impairment that a naturally fertilized embryo may fall ill to, an artificially ferilized embryo may, as well. This includes Down's Syndrome, which is brought about by mutation in the chromosomes. Liu Chi-hung believes that test-tube babies with Down's Syndrome should be attributed to inadequate testing during pregnancy; it has no connection to the in vitro fertilization process. According to estimates, the rate of abnormality among test-tube babies is about the same as that among naturally conceived children, approximately 2-3%.

Specially gifted test-tube children?

How test-tube babies grow in body and mind is also the focus of many people's attention. In the past Veteran's General carried out a follow up investigation of some test-tube babies born in the hospital. They discovered that the physiques of test-tube babies are about the same as any other children; in the realm of intelligence, they tend to be slightly higher. Chen Shu-chen, director of pediatrics at Veteran's General, notes that follow up investigation only includes fifty children, so the results can only be used as a reference and are not necessarily representative.

Liu Chi-hung points out that France carried out follow up research on several thousand test-tube children and found them to differ in no way from naturally conceived children. He feels that the reason that some test-tube babies have a higher IQ is that after birth the home environment is better. With the price of one cycle of in vitro fertilization standing at NT$70,000 to NT$80,000, any family that can afford the operation is at least in the upper middle class. In addition, the child was not easily brought into the world, and it is natural that it receive better care and attention.

The first test-tube baby born in Taiwan--a little boy surnamed Chang--is a good example. Master Chang is eight years old this year. Currently in the third grade, he is considered a gifted student. Mrs. Chang believes that today the boy "is pretty good," and this is probably due to the good effects of his home environment. Judging only from the many after-school lessons he is made to take--piano, English, painting, math and logic, natural science--it is not difficult to realize that his family spares no effort in grooming the child.

Furthermore, the education level of the Parents is another factor for reference. According to a survey by Veteran's General Hospital, 70% of parents with test-tube children have educations at a college level or higher, 30% have educations at the high school or junior high level.

Technology's bottleneck:

Although Taiwan's technology has reached a certain level, in vitro fertilization technology is still meeting two kinds of difficulties. The first is the age barrier. The second is that embryos do not easily affix themselves in the womb. These two problems have made the success rate of in vitro fertilization not as high as it could be.

According to estimates, the rate of miscarriages after in vitro fertilization is as high as 25% to 30%, twice as high as natural conception. The crucial matter is the would-be mother's age. Liu Chi-hung observes that the older a woman is, the less effective are her ovaries, and the miscarriage rate is higher. For women 35 years of age, the miscarriage rate is 20%; for those 40 years of age the rate surpasses 30%; for women 45 years of age, the rate of miscarriage is already 50%.

Besides this, when embryos are being cultivated outside the body, their shells ("zona pellucida") tend to harden, which leads to the embryos not easily taking root in the womb after they are implanted. Currently, the medical world uses lasers to pierce the shell, making it easier for the embryo to break out of its shell and escape, thus affixing itself in the womb. Thus, this problem has seen some improvement. For patients who have experienced repeated failures, it can be a great help.

Besides a higher rate of miscarriages, in vitro fertilization also increases problems related to multiple embryos. The rate of multiple embryos is more than ten times higher than natural conception. Liu Chi-hung explains that at the time of embryo implantation, the more embryos implanted, the greater the likelihood of pregnancy. Because of this, most patients request that many embryos be implanted. "It is best to draw the limit at four," says Liu Chi-hung. Multiple embryos can produce complications, such as premature delivery, high blood pressure diabetes, toxemia, and so forth. It is important to cut down the number of embryos to ensure safety.

Finding an heir in a test tube:

Even though Taiwan's in vitro fertilization technology has reached an international standard, Liu Chi-hung feels concern that little attention is paid within the country to basic research. "Everyone is only anxious to study the procedures, without researching the underlying reasons. They just understand the superficial results; when they run into problems, they're lost at sea."

Chang Sheng-ping notes, "Everyone started doing it at once, in a swarm. It's not a good thing." He points out that in vitro fertilization only involves one small part of the reproductive endocrine system. Everyone is at present only increasing clinical accomplishments, not engaging in basic research.

"Those who can bear children can never understand the pain of those who can not," says a barren wife who can not stand the ridicule of her neighbors. Perhaps it is a deeply rooted conviction that one must produce an heir; perhaps it is the unceasing pressure from in-laws. People deeply crave flesh-and-blood offspring, to maintain matrimonial love and to affirm the position of the household. To Chinese people, the advent of testtube babies not only relieves the troubles of women who can not conceive; it also relieves the burden of the spirit.

There is a limit, after all, to the help that science can provide. How it can help people address the failures in the affairs they pursue is perhaps closer to the heart of the question.

[Picture Caption]

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In vitro fertilization technology provides new hope for infertile women.

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"Micromanipulation of Sperm" uses microscopic instruments to guide the sperm into the egg to increase the chances of fertilization. It is a great aid to men with a low sperm count or low virility.

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With the use of "Cryopreservation," multiple embryos can be stored in liquid nitrogen at -196℃, thus avoiding the trouble of extracting eggs from the womb a number of times.

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Using laparoscopy to implant embryos in the uterus takes only about 20 to 30 minutes.

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The Process of Creating Test-tube Babies

1.Ovulation medicine is injected, inducing the production of surplus eggs.

2.Ultrasound is used to extract the eggs after they have matured.

3.The egg undergoes external fertilization, and the embryo is cultivated for about 48 hours. After the fertilized egg divides into two or four cells, it is implanted in the mother's body.

4.Implanting the embryo in the mother's womb can be accomplished via two different channels. Insertion through the vagina is customarily termed "In Vitro Fertilization and Embryonic Transfer (IVF/ET); insertion using laparoscopy is termed "Tubal Embryo Transfer" (TET).

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Taiwan's first test-tube baby, little Master Chang, is a gifted student.

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The joy of becoming a mother wiped from Lin Yueh-hui's memory all the torments of the medical process.

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An overseas Chinese who succeeded in finding heirs in the motherland mailed a thank you card to the doctor on the eve of Mother's Day, pasting on it photos of her two darling children. (courtesy of Chang Sheng-ping)

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Liu Chi-hung with test-tube babies and their parents. (photo courtesy of Liu Chi-hung)

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