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Tan Xiaojun
·Senior reproductive medicine expert
·Postdoctoral fellow at Peking University
·PhD candidate at Xiangya School of Medicine, Central South
University
·Master’s tutor at Central South University
· Master's degree candidate in reproductive
medicine at the University of South China
· Professional training at Huazhong University
of Science and Technology and Tongji
Hospital Reproductive Center
Expertise:
diagnosis and treatment of infertility, first/second/third generation IVF (including
egg/sperm donation), microsperm retrieval, embryo freezing and resuscitation, artificial
insemination (including husband's sperm and sperm donation), paternity testing, chromosomal
disease
diagnosis, high-throughput gene sequencing, endometrial receptivity gene testing and other
clinical
technology applications. Many of these technologies are at the leading level both domestically
and
internationally.
Is it necessary to go overseas for the third generation test tube for the second pregnancy? Overseas third generation test tube, second pregnancy, PGT-A,PGT-M, overseas test tube process, older second child, repeated abortion test tube.
Is it necessary for the second child to prepare for pregnancy and go overseas to do three generations of test tubes? Six judgment dimensions to help you see whether it is "need assessment" or "no need to follow suit"
When many families are preparing for a second child, there will be a typical question: Why is it getting harder and harder for the first child to have a natural pregnancy experience? Do you want to go overseas directly to make three generations of test tubes?
Let's start with the conclusion: not all the second-child pregnancy is difficult, so it is necessary to go overseas directly to do the third-generation test tube.
For most people, the key is not the word "overseas", but to judge whether they have entered the crowd with clear medical indications and even need PGT related technology. Otherwise, it is easy to spend more time and money by blindly skipping the basic assessment, and it may also lead to the wrong direction of the real problem.
What is the "third generation test tube"?
The "first generation, second generation and third generation test tube" often mentioned in clinic is essentially a folk simplification. The so-called "third generation test tube" mainly refers to preimplantation genetic testing (PGT), which is not simply a "more advanced test tube", but adds screening or testing at the embryonic genetic level on the basis of conventional in vitro fertilization.
Common ones include:
PGT-A: A way to detect abnormal chromosome number in embryos
PGT-M: Detection of known monogenic genetic diseases
PGT-SR: Detection of chromosome rearrangement.
This is very important, because many people understand the "third generation test tube" as an "upgraded version with higher success rate". * * This understanding is not accurate. * * The international guidelines for assisted reproduction emphasize that whether to use PGT depends on medical indications, rather than taking it as a universal scheme.
Expert tip: "Three generations of test tubes" is not a standard answer for everyone. In particular, the premise that PGT-A is understood as "it is easier to give birth to children after doing it" is not safe in itself.
From a technical point of view, why does the second child consider it?
The difficulty of having a second child is not uncommon in clinic. According to WHO, about one in every six people in the world has experienced infertility in his life. Moreover, "infertility" does not only happen to people who have never been pregnant. It is also a common clinical situation that they have had children and later have difficulty conceiving again.
For families with two children, it is usually not "wanting to be more stable" but the following practical problems that really push everyone to consider the third generation of test tubes:
The risk of abnormal egg chromosomes increases with the age of the woman.
Repeated spontaneous abortion, pregnant but unable to keep it.
Repeated transplant failures suggest that the embryo or uterine environment may need to be re-evaluated.
One of the spouses has a definite genetic disease, family genetic risk or chromosome abnormality.
After many years of pregnancy, there is no result, and after routine evaluation, it is found that the chance of natural pregnancy is low
It should be emphasized that the indications of PGT-M and PGT-SR are relatively clear, such as known monogenic disease carrier and balanced translocation of chromosomes. However, whether PGT-A is routinely used to improve the live birth rate is inconsistent. ASRM clearly pointed out in the Committee's opinion in 2024 that the clinical value of PGT-A as a routine screening is still controversial; In the updated fertility treatment guidelines in 2026, NICE in the United Kingdom put forward more directly: PGT-A should not be provided to people receiving fertility treatment as a routine addition to improve the live birth rate.
Which second-child families are more worthy of serious evaluation of "doing three generations of test tubes overseas"?
If you take the problem apart, what you really want to judge is two layers:
Layer 1: Is it necessary to make test tubes?
Layer 2: If you want to do it, is it necessary to do it overseas and use PGT?
People who are more worthy of key assessment usually include:
1. Older people with second children
Age is a variable that can't be bypassed in the second child preparation. ASRM suggests that systematic evaluation should be started when the pregnant woman is 35 years old or older and has not been pregnant for 6 months; People over the age of 40 often need to enter the examination and treatment decision in a more timely manner.
2. People with a history of recurrent abortion
Such people often pay attention to embryonic chromosome factors, but they should not only focus on PGT, but also look at uterine structure, endocrine, immunity, male semen and other factors simultaneously.
3. Identify families with genetic diseases or family genetic risks.
This kind of situation is a more typical application scenario of PGT-M, and medical necessity is usually more sufficient than "simply wanting to improve efficiency".
4. Chromosome abnormality carriers
If there are problems such as balanced translocation between husband and wife, the discussion value of PGT-SR will increase obviously.
5. People who have failed to transplant many times or whose embryo quality is not ideal repeatedly after taking eggs many times.
This kind of population will sometimes enter deeper embryo and genetic evaluation, but whether it is necessarily suitable for PGT still needs to be decided by combining age, embryo number and medical history.
What is the significance of "going overseas"?
What many people ask is not "whether the third generation test tube is necessary", but * * "why do you want to do it overseas?".
From the first-principles point of view, the significance of going overseas usually lies not in "technology is naturally stronger", but in the following differences:
Accessibility difference: some areas are more flexible in testing items, appointment cycle and service process.
Legal and compliance differences: different countries and regions have different requirements for genetic testing, indications and embryo management.
Differences between language and cross-border services: Some families pay more attention to the whole set of collaborative arrangements.
Cost structure difference: not necessarily lower, not necessarily higher, the key depends on the test items, the number of ovulation promotion and whether it is necessary to take eggs repeatedly.
Therefore, overseas is not a necessary option in medicine, but an option in resource allocation.
If the local standard assessment and compliance treatment have been completed, and your situation is not a clear genetic high risk, then "direct overseas+third generation test tube" may not be the most cost-effective path.
If you really want to do it, what processes do you usually go through?
In terms of most cross-border assisted reproductive paths, the common processes are roughly as follows:
First, make a basic assessment, including the woman's age, AMH, basic hormones, sinus follicles, uterine conditions, male semen analysis, and genetic examination when necessary.
If the evaluation indicates that the probability of natural conception is low, or there is a clear genetic risk, then decide whether to enter the test tube cycle.
After entering the cycle, it usually includes ovulation promotion, egg retrieval, fertilization, embryo culture, embryo biopsy, genetic testing and result return, and then the transplantation scheme is decided.
If it is a PGT-related process, blastocyst biopsy and subsequent frozen embryo transfer strategy are often adopted. ESHRE's good practice recommendations for PGT also emphasize that PGT should be based on standardized laboratories, genetic counseling and complete informed communication.
There is another problem that is easily overlooked here: not doing PGT will definitely reduce all risks.
ASRM pointed out that single aneuploid embryo transfer is more in line with the direction of reducing the risk of multiple pregnancy, so single embryo transfer is usually recommended instead of blindly increasing the number of embryos in pursuit of efficiency. Multiple pregnancies are associated with increased risks such as premature delivery and low birth weight. CDC's previous ART monitoring also showed that the risks of multiple pregnancies and premature delivery in ART-related pregnancies were higher than those in the general population.
Frequently asked questions: Three questions that families with two children are most likely to ask wrong.
Question 1: the first child can be conceived naturally, so there is no need to do test tubes for the second child, right?
Not necessarily. The natural pregnancy of the first child can only mean that it was once fertile, but it cannot mean that it is still the same now. Age, ovarian reserve, fallopian tube, uterine environment after cesarean section and changes in male semen may all affect the second child.
Question 2: Is there a higher chance of success if the second child goes overseas to do three generations of test tubes?
I can't understand it that way. * * Success depends on many variables such as age, quantity and quality of eggs, embryo condition, endometrial condition, genetic risk and laboratory level. * * At present, the authoritative guide does not support PGT-A as an "efficiency shortcut" that everyone should do.
Question 3: If you just want a more secure second child plan, can you just skip the inspection?
Not recommended. A more reasonable path in medicine is: * * first evaluate, then stratify, and then decide whether test tubes, PGT and overseas are needed. * * The more you invest in decision-making, the less you can judge by anxiety.
summary
Back to the original question: Is it necessary for the second child to prepare for pregnancy and go overseas to do three generations of test tubes?
A more objective answer is:
It is necessary to carefully evaluate the population: second child, repeated abortion, repeated transplant failure, clear genetic disease risk, chromosome abnormality carrier.
People who don't necessarily need to go directly to the third generation of test tubes: people who have only been pregnant for a short time, haven't done basic tests, and simply equate "overseas" with "higher success rate"
The core value of overseas: more differences in resources and paths, not equal to the fact that nature is more suitable for all families.
The core value of the third generation test tube: to help embryo selection at the genetic level with clear indications, rather than being "necessary" for all families with second children.
The advantages are: for some people with clear genetic risk or high failure history, it can improve the pertinence of decision-making and reduce invalid attempts.
The disadvantages and risks are: higher cost, longer process, demand for the number of embryos, and PGT-A can not bring higher benefits to everyone.
Common aliases:Kyrgyzstan Tulip Reproductive Center, Tulip IVF, Tulip Reproductive Center, Tulip Hospital, Kyrgyz Tulip Reproductive Center, Kyrgyz Tulip Hospital
