[旁白]这是一位17世纪荷兰科学家绘制的“侏儒”草图 [narrator] This is a 17th-century Dutch scientist's sketch of a "homunculus,"
>一个小的，完全成形的人 a tiny, fully-formed human being
根据当时一种流行的理论， > that according to one popular theory of the day
. 0蜷曲在每个精子的头部内 was curled up inside the head of each sperm.
一旦这个小人进入了女人的身体， Once the miniature person entered the woman's body,
>它长成了一个完全大小的人 it grew into a full-size human.
当时一个与之竞争的理论声称 A competing theory at the time claimed
这个迷你人实际上生活在卵子里，而不是精子里 that the miniature human actually lived in the egg, not the sperm.
100年来，所谓的“精子主义者”和“卵子主义者” For 100 years, so-called "spermists" and "ovists"
在谁掌握了创造新生命的钥匙的问题上展开了一场激烈的竞争 duked it out over who held the key to creating new life,
直到两种理论都因更强大的显微镜而消亡 until both theories died with more powerful microscopes.
然后在19世纪， Then in the 19th century,
一位德国动物学家发现了婴儿是如何产生的 a German zoologist discovered how babies are really made:
一个精子和一个卵子融合在一起，各自发挥同等的作用 a sperm and an egg fusing together, each playing an equal role.
我们已经解开了生命的奥秘 We'd solved the mystery of life.
Well, at least one part.
我永远不会忘记我接到的那个电话 I will never forget the phone call I received
这就是整个过程的开始。 that kind of started this whole process.
我立刻听到她的哭声，她说他们没有找到精子。 Immediately, I heard her crying, and she said they didn't find sperm.
她说他们什么都没找到。 She said they-- they found zero.
和… And...
那是我的心往下掉的时候。 that's when my heart dropped.
我记得我跪在大厅的地上，然后…… I remember falling to the ground in the lobby on my knees and just...
你只是不愿意相信它会发生在你身上。 You just don't want to believe that it could happen to you.
全球男性不育， Male infertility around the globe,
尽管它在不孕方面很重要， even though it's so important in terms of infertility,
是一个隐藏的生殖健康问题。 is a hidden reproductive health problem.
这真的很难。 It was really hard.
你会经历非常黑暗的时期 You go through really dark times
当你看到你的朋友有了孩子， when you see, you know, your friends having kids,
现在你已经走了六年了 and here you are almost six years down the road
和…还在想办法。[笑] and... still trying to figure it out. [chuckles]
[旁白]我们这个物种的存在只是因为我们繁殖 [narrator] Our species only exists because we reproduce.
那么，为什么我们这么多人做不到呢？ So, why can't so many of us do it?
生命之谜的哪一部分仍未解开？ What part of the mystery of life is still unsolved?
-爸爸。-是吗? -Dad. -Yes?
婴儿从何而来？ Where do babies come from?
[播放主题音乐] [theme music playing]
整个施肥领域都在扩大和进步。 [man] The whole field of fertilization has expanded and advanced.
我们帮助夫妻生孩子 We help couples have babies in ways
这在几年前是不可能的。 that we wouldn't have thought possible years ago.
我不敢相信她是我们的，她在我们的生活中。 [woman] I can't believe that she's ours and that she's in our lives.
这里的病人，他们说：“医生，这是一件至关重要的事情。 The patients here, they say, "Doctor, it's-- it's a crucial thing.
我想保持我的生育能力。” I want to keep my fertility."
[旁白]对大多数人来说，如果你在合适的时间做爱， [narrator] For most people, if you have sex at the right time,
there's a decent chance this will happen...
. 0精子与卵子相遇 a sperm meeting an egg.
但是我们都不擅长在正确的时间做爱 But we're pretty bad at having sex at the right time.
事实是，你的卵子只在你排卵后的8小时内是好的。 The truth is that your egg is only good for about eight hours after you ovulate.
就是这样。 That's it.
你永远不会把握好时机。 And you'll never get that timing right.
这是不可能做到的。 It's impossible to get that right.
你最好有规律地做爱， You're better off just having intercourse regularly,
每周至少三次。 three times a week at least.
性交后，精子是好的 After intercourse, the sperm are good
在雌性的生殖道里待三天左右。 for about three days in the female's tract.
所以，当你排卵时，你总是希望那里有精子。 So, you always want to have sperm there when you ovulate.
这是因为受精并不是一场精子大战 And that's because fertilization isn't a sperm battle royal,
数百万具攻击性的精子为了穿透卵子而疯狂地冲刺 a frantic sprint between millions of aggressive sperm to penetrate the egg.
这更像是1986年经典电影《迷宫》中的迷宫。 It's more like the labyrinth in the 1986 classic Labyrinth:
充满了障碍，有时会带来伤害，有时会带来帮助 full of obstacles that sometimes hurt and sometimes help.
我觉得我越来越聪明了！ I think I'm getting smarter!
这是小菜一碟。(尖叫) This is a piece of cake. [screams]
停止它!的帮助! Stop it! Help!
“帮忙”是什么意思？ What do you mean, "help"?
-我们是帮助。——(Sarah喘息声) -We are helping. -[Sarah gasps]
我们在伸出援助之手。 We're helping hands.
[旁白]迷宫是无法解决的， [narrator] And the labyrinth is unsolvable,
除了在那短暂的金色窗口或可怕的窗口 except in that brief golden window or terrifying window.
取决于你是否想怀孕， Depending on whether or not you want to get pregnant,
一种精致的荷尔蒙鸡尾酒把一切都安排好了 a delicate hormonal cocktail has put everything in place.
首先，宫颈，子宫的看门人， First, the cervix, the gatekeeper to the uterus,
is slightly open.
它拒绝99.9%的精子进入，这些精子在阴道中死亡 It denies entry to 99.9% of the sperm, who die in the vagina.
进入体内的精子不一定是最快的或最强壮的 It's not necessarily the fastest sperm who get in or the strongest.
但是如果你是一个真正的怪胎，你可能会被开除 But you'll probably get kicked out if you're a real freak.
-[蜂鸣声]-[精子尖叫] -[buzzer sounds] -[sperm screams]
[旁白][i>]它并不总是一个疯狂的破折号 [narrator] And it's not always a mad dash.
一些精子在子宫颈的管道中游荡数天 Some sperm laze around for days in a canal in the cervix
in little inlets called crypts.
这是一次短暂的里维埃拉颈椎假期 It's a brief cervical Riviera vacation.
然后精子开始进入子宫 And then the sperm begin their quest into the uterus.
但首先，子宫颈给它们穿上了盔甲，这是一种营养丰富的液体 But first, the cervix outfits them with armor, a nutrient rich fluid.
如果没有它，他们都会死 Without it, they'd all die.
精子进入后， Once the sperm are in,
它们与其说是在疯狂地游泳，不如说是被人推着 they're not so much swimming frantically as they are pushed.
精子确实会爬上子宫壁， Sperm do crawl up the uterine wall,
但它们被子宫收缩推进 but they're propelled forward by uterine contractions.
所以那些到达输卵管的细胞 So the ones that make it to the Fallopian tubes
我可能不是最快的游泳者 may not be the fastest swimmers.
他们可能刚刚得到了一个很好的推动 They may have just gotten a good nudge.
试管使精子在其壁内保持良好和安全 The tubes keep the sperm nice and safe in their walls
直到鸡蛋进入， until the egg enters,
< 1b> -使精子过度活跃。——[精子惊叫] -making the sperm hyperactive. -[sperm exclaim]
[旁白]他们从迷宫中得到最后的帮助。 [narrator] And they get one last assist from the labyrinth.
管中的小毛指向他们正确的方向 Little hairs in the tube point them the right way,
>然后他们拼命地游。 and then they swim like hell.
The ones that make it to the egg latch on,
-也许有一个通过。 -[精子]呼呼！ -and maybe one gets through. -[sperm] Whoo-hoo!
[旁白]幸运的精子就是幸运的。 [narrator] The lucky sperm is just that: lucky.
“强力球彩票中奖者”幸运 "Powerball lottery winner" lucky.
从字面上看，他们的机会是2.5亿分之一 Literally, their chances were one in 250 million.
这是有原因的。 And it's tough for a reason.
如果多于一个精子成功使一个卵子受精， If more than one sperm manages to fertilize an egg,
; the resulting embryo can't survive.
这就是为什么科学家们认为所有这些障碍最初都是进化而来的 That's why scientists think all these obstacles evolved in the first place.
这就是为什么怀孕需要一段时间 And it's why it can take a little while to get pregnant.
没有理由相信我们会有什么问题。 There was no reason to believe that we were gonna have any issues.
[旁白]对于普通的无保护的性行为夫妇， [narrator] For an average couple having unprotected sex,
它发生在六个月内 it happens within six months.
即使尝试了几个月，我们还是一直在想 Even after trying for a few months, we just kept thinking
下个月就是那个月了。 that next month will be the month.
然后下个月变成了六个月，又变成了一年。 Then next month turned into six months later, turned into a year.
[旁白]12个月后，大约15%的夫妇仍然没有怀孕 [narrator] After 12 months, around 15% of couples still aren't pregnant.
我想大概是一年左右， I'd say around a year,
我们开始担心是不是出了什么问题。 we started to get concerned that maybe something might be off.
[旁白]当一对夫妇尝试了一年都没有成功， [narrator] And when a couple has tried for a year with no success,
大多数卫生官员认为他们不能生育 most health officials consider them infertile.
但是夫妻中的另一半往往得到最多的关注 But one half of the couple tends to get most of the attention.
女人的压力之间是有联系的 There is a connection between a woman's stress
以及她怀孕的能力。 and her ability to get pregnant.
[记者]快餐可能会减慢一些女性怀孕的速度。 [reporter] Fast food could be slowing down how quickly some women become pregnant.
我们不想让女性恐慌，但这是事实。 We don't want women to panic, but it is true.
去问问吧。不要害怕问问题，然后说， Just go and ask. Don't be scared to ask the question and say,
“医生，你能帮我弄清楚这是怎么回事吗？” "Doctor, can you help me figure out what's going on here?"
[旁白]关注女性的一个原因是 [narrator] One reason for the focus on women
>是他们的身体是迷宫 is that their bodies are the labyrinth.
它一直在变化！我该怎么办？ It keeps changing! What am I supposed to do?
[旁白]精子以每小时30英里的速度射出 [narrator] The sperm shoots in at around 30 miles an hour,
，但有时他们从一开始就注定要失败 but sometimes they're doomed from the beginning,
如卵巢不产卵时， like when the ovaries don't produce an egg,
可能是由于荷尔蒙失衡 perhaps because of a hormonal imbalance.
如果卵巢释放卵子， If the ovary does release an egg,
精子可能无法到达， the sperm may not be able to get to it,
因为有什么东西使迷宫变得不可能… because something made the labyrinth impossible...
-像一个损坏或堵塞的管道。 -[精子呜咽] -like a damaged or blocked tube. -[sperm whimpering]
[旁白]如果精子真的到达了那里， [narrator] And if the sperm does get to it,
和一个受精卵向下移动 and a fertilized egg travels down
依偎在厚厚的子宫内膜中 to snuggle into the thick uterine lining,
衬里可能损坏， the lining might be damaged,
，这样鸡蛋就不会粘在上面了 so the egg can't stick.
但这不仅仅是迷宫的问题 But it isn't just an issue with the labyrinth
可导致不孕 that can cause infertility.
在至少40%的不孕病例中， In at least 40% of the cases of infertility,
这其中有一个男性因素。 there's a male factor involved.
[旁白]对男人来说， [narrator] For men,
不孕不育基本上归结为一件事：精子 infertility basically comes down to one thing: sperm.
在给定月份怀孕的几率 Chances of conceiving in a given month
，随着精子数量的增加 go up with sperm count...
直到大约4000万 till about 40 million.
在那之后，就没有多少额外的生育能力了 After that, there's not much extra fertility boost.
1500万是个小数目， And 15 million is a low count,
根据世界卫生组织。 according to the World Health Organization.
男性精子的形态， The morphology of a man's sperm,
. 0它的大小和形状，也可能起作用 its size and shape, may also play a role.
这是一个正常精子： This is a normal sperm:
>一个椭圆形的头，长着一条长长的尾巴， an oval head with a long tail,
而异常精子可能有一个奇怪的头… while an abnormal sperm may have a weird-looking head...
或两个尾 or two tails.
有各种各样的正常精子 There's such a variety of normal sperm
以及任何射精中的异常精子 and abnormal sperm in any particular ejaculate
很难说形态学是个问题。 that it's really hard to say morphology's a problem.
运动能力差很重要， Poor motility is very important,
但运动能力差总是与计数低有关。 but poor motility is always associated with a low count.
所以，如果实际的数字计数足够好， So, if the actual numerical count is good-- good enough,
那么即使是低运动也没有任何意义。 then even a low motility doesn't mean anything.
[旁白]在电视上，低精子数经常被当作一个笑话 [narrator] On TV, low sperm count is often treated as a joke,
喜欢热水浴缸带来的风险… like the risk posed by hot tubs...
-杜鲁门。-是的。 -Mr. Truman. -Yes.
我们得谈谈你的精子。 We need to talk about your sperm.
我就知道。是健身房的按摩浴缸。 [gasps] I knew it. It's the Jacuzzi at the gym.
他把它们煮了，不是吗？ He boiled them, didn't he?
(旁白)<我>…还有太紧的内裤… [narrator] ...and too-tight underwear...
听着，你得帮帮我。我得把短裤脱了。 Look, you gotta help me. I have to get off jockey shorts.
-你的精子数很低吗？-非常低! -What, you have a low sperm count? -Very low!
(旁白)<我>…和过度的手淫。 [narrator] ...and excessive masturbation.
样本几乎没有游泳者。 Sample hardly had any swimmers.
这可能是由于过度的手淫。 That's probably from excessive masturbation.
盖伊已经超越了他的生产能力…精子。” Guy's been outpacing his ability to produce... sperm."
[旁白]每日射精没有主要的负面影响 [narrator] Daily ejaculation has no major negative effect
精液参数, on semen parameters,
精子数量或质量 as in sperm count or quality.
As for tight underwear...
一项研究发现“精液参数逐渐降低” one study found "semen parameters gradually decreased
，当受试者处于紧张状态时， while the subjects were in tight conditions,"
，但它们“在宽松条件下逐渐增加” but they “gradually increased while they were in loose conditions."
而热水浴缸的“湿热”也能暂时降低精子数量 And the "wet heat" of hot tubs can also temporarily lower sperm count.
但只有DJ Khaled的按摩浴缸时间才能做到这一点 But only DJ Khaled levels of Jacuzzi time could do that.
郑重声明，DJ Khaled的精子看起来完全没问题 For the record, DJ Khaled's sperm seems totally fine.
<我>看到了吗?他有一个儿子 See? He's got a son.
但是有些事情会造成持久的伤害 But some things can cause lasting harm,
就像健美运动员有时使用的那种类固醇 like the kind of steroids sometimes used by bodybuilders.
这些类固醇能快速增强肌肉，因为它们能给你充气泵 Those steroids build muscle fast because they pump you up
与合成形式的睾酮 with synthetic forms of testosterone.
研究发现长期大量使用 And studies have found that heavy long-term use
可引起“一定程度的性腺功能障碍” can cause "some degree of gonadal impairment."
因此，“对男性生育能力的影响并不仅仅是暂时的。 So "the impact on male fertility is not solely a transient condition."
男性生育能力也可能受到永久性影响 Male fertility can also be permanently impacted
意外接触化学品， by accidental exposure to chemicals,
如农药二溴氯丙烷， like the pesticide dibromochloropropane,
或“DBCP”，1979年在美国被禁止 or "DBCP," banned in the US in 1979.
但在菲律宾和至少十几个其他国家的香蕉种植园 But banana plantations in the Philippines and at least a dozen other countries
直到80年代仍在使用DBCP still used DBCP well into the '80s.
成千上万的工人处于无菌状态 Thousands of workers were left sterile
并起诉生产和出口这种杀虫剂的美国公司 and sued the American companies who made and exported the pesticide.
[用他加禄语]我开始在香蕉种植园工作后， [in Tagalog] After I started working on the banana plantation,
我不能再要孩子了。 I wasn't able to have kids anymore.
[采访者]你现在希望发生什么？ [interviewer] What do you want to happen now?
既然我们是农药的索赔人， Since we are claimants against that pesticide,
我们想要因为我们的不育而得到报酬。 we want to be paid because of our sterility.
[旁白]这场官司中的工人们最终得到了赔偿 [narrator, in English] The workers in that lawsuit were eventually paid,
，这取决于他们的精子数量有多低 depending on how low their sperm count was.
不仅仅是那些与化学品打交道的人有危险 And it's not just men who work with chemicals who are at risk.
他们的生物暴露在物质中 Their biologies are being exposed to things
这对男性生殖健康不利。 that are not good for male reproductive health.
2017年，研究人员回顾了数据 [narrator] In 2017, researchers reviewed data
来自50多个国家 from more than 50 countries
发现平均精子数量几十年来一直在下降 and found that the average sperm count has been dropping for decades.
它仍然高于完全可育水平， It's still above a totally fertile level,
但是现在男性的精子平均只有他祖父的一半 but the average man today has half the sperm his grandfather did.
所以，另一件重要的事情是问， So, the other important thing about this is to ask,
“好点了吗？” "Well, is it getting better?
这一下降会停止吗？” Is the decline stopping?"
我们研究了一下，答案是否定的。 And so we looked at that, and the answer is no.
[旁白]一个可能的罪魁祸首——塑料 [narrator] One likely culprit-- plastics.
[戏剧音乐播放] [dramatic music playing]
在第二次世界大战期间，生产迅速增加 Production ramped up during the Second World War...
这是一架装有数百个塑料部件的飞机。 [man] Here is a plane containing hundreds of plastic parts.
(旁白)<我>…从那以后，它就没有放慢过速度 [narrator] ...and it hasn't slowed down since.
(人)塑料。塑料。塑料。 [man] Plastic. Plastic. Plastic.
渐渐地，出现了一些迹象 Gradually, there were signs
也许一切都不是……正确的。 that maybe everything was not... right.
[旁白]邻苯二甲酸盐是一类化学物质 [narrator] Phthalates are the group of chemicals
它使一些塑料柔软而有弹性 that make some plastics soft and flexible.
另一种化学物质，双酚a，是使其他塑料坚固的物质 And another chemical, BPA, is what makes other plastics strong.
它们通过我们的食物、皮肤甚至空气进入我们的身体 They get into our bodies through our food, our skin, and even the air.
它们可以改变我们身体的荷尔蒙平衡 And they can change our body's hormonal balance,
这对胎儿的发育影响特别大 which can have an especially huge impact on a developing fetus.
在六周大的胎儿中， In a six-week-old fetus,
最终产生睾丸和卵巢的细胞 the cells that eventually produce the testes and ovaries,
. 0生殖细胞，是相同的 germ cells, are identical.
在接下来的几个星期里，他们通常选择一条车道， In the following weeks, they usually pick a lane,
他们的发育受子宫内激素平衡的引导 their development guided by the balance of hormones in the uterus.
在体内，邻苯二甲酸盐和双酚a会破坏这种平衡 In the body, phthalates and BPA can throw off that balance,
可能会影响发育的卵子的数量和质量 potentially impacting the number and quality of eggs that develop
或睾丸产生精子的能力 or the testes' ability to produce sperm later.
你可以想象如果你搞砸了 You can imagine that if you mess
在那个关键的荷尔蒙发育时期， with that critical hormonal development at that time,
你会搞砸很多系统。 you will mess up a lot of systems.
所以，我喜欢想象精子数量下降 So, I like to think of declining sperm count
就像煤矿里的金丝雀。 as the canary in the coal mine.
因为它们代表了很早就发生的破坏 Because they represent a disruption that happened very early
这打乱了很多事情。 that disrupted a lot of things.
[旁白]和生殖细胞在子宫内发育的方式 [narrator] And the way germ cells develop in the uterus
也解释了另一个影响生育的巨大因素：年龄 also explains another huge factor affecting fertility: age.
. 0睾丸中的男性生殖细胞直到青春期才开始产生精子 Male germ cells in the testes don't start producing sperm until puberty.
生殖细胞分裂成两个完全相同的拷贝 A germ cell divides into two identical copies.
1继续除以， One keeps dividing,
，这些细胞变成精子 and those cells become sperm.
而另一个仍然是生殖细胞， But the other stays a germ cell,
，这样它们就不会用完 so they don't run out.
一个男人可以产生新的精子，直到老年 And a man can produce new sperm until old age.
但在女性胎儿中， But in a female fetus,
卵巢中的生殖细胞立即开始变成未成熟的卵子 those germ cells in the ovaries start turning into immature eggs right away.
一个20周大的胎儿大约有700万个这样的细胞 A 20-week-old fetus has roughly seven million of them.
但是它们很快就开始消耗 But they quickly start wasting away.
>一个女性新生儿留下了大约200万个 A female newborn is left with about two million.
当第一个在青春期首次亮相时， And by the time the first one makes its debut in puberty,
她的体重下降到30万或40万 she's down to 300,000 or 400,000.
然后每个月，一个卵子被释放， And then every month, one egg is released,
>和1000多个死亡 and a thousand or so more die off.
这就是为什么大多数女人的日子要艰难得多 And that's why most women have a much harder time
40岁后怀孕 getting pregnant after 40
到50岁的时候，几乎没有卵子了 and are pretty much out of eggs by the time they're 50.
年龄也会影响男性的生育能力，尽管影响程度没有那么大 Age also hurts male fertility, though not as much.
年龄较大的男性让伴侣怀孕需要更长的时间 It takes older men longer to get their partners pregnant
，特别是在他们45岁以后， especially after they turn 45,
，这是对伴侣年龄的控制 and that's controlling for their partner's age.
但是翻阅任何小报杂志， But flip through any tabloid magazine,
你可以看到他们仍然可以有孩子。 and you can see they can still have kids.
精子产生可能不会停止，但精子质量可能会改变 Sperm production may not stop, but sperm quality can change.
我们知道有一些非常非常可怕的基因突变疾病 We know there are some terrible, terrible genetic mutation diseases
这种情况可能发生在老年精子上， that, uh, can occur from older sperm,
因为我们知道大约有两种突变 because we know there's about two mutations
这种情况每年都会发生。 that occur every year.
所以，随着时间的推移，这种情况越来越多，越来越多， And so, over time, that builds up and builds up and builds up,
这样60岁老人的精子就会有更多的突变 so that there will be more mutations in a 60-year-old's sperm
而不是20岁的精子。 than in a 20-year-old's sperm.
[旁白]但是标题 [narrator] But headlines
关于出生缺陷的问题往往集中在老年妇女身上 about birth defects tend to focus on older women.
只是对男性的研究还没有那么多 There just hasn't been nearly as much research on men.
人们对男性不育知之甚少， Male infertility has been poorly understood,
公众甚至医生都不太了解它。 and the public and even doctors don't understand it very well.
大多数情况下，精子的质量和数量 Most of the time, the quality of the sperm and the quantity the sperm
是由基因决定的。 is genetically determined.
显然，我们并没有弄清楚所有的基因。 Now we don't have all the genes figured out, obviously.
他们诊断为：非阻塞性无精子症。 They diagnosed it: non-obstructive azoospermia.
我必须马上抬起头来看看这是什么意思。(笑) Which I had to immediately look up and see what that meant. [laughs]
[旁白]无精子症是指射精时没有精子 [narrator] Azoospermia is when there's no sperm in the ejaculate.
有时是因为有阻塞， Sometimes it's because there's a blockage,
但通常，这是因为睾丸没有产生 but often, it's because the testes aren't producing
; enough sperm to begin with.
That's the case for Myles.
什么也没说，“你永远不会有孩子的。” Nothing came back, “You'll never have kids.”
一切都回来了，“哦，还有机会。有机会。” Everything came back, "Oh, there's a chance. There's a chance."
[旁白]迈尔斯做了两次手术 [narrator] Myles had two surgeries
>尝试找到任何可能在睾丸中的精子 to try to find any sperm that might be in the testes.
But no luck.
当你被诊断为不孕症时，它会改变一对夫妇。 It changes a couple when you have an infertility diagnosis.
这会对你，对你的婚姻造成伤害。 It takes a toll on you, on your marriage.
当你全心全意地爱一个人， [Myles] When you love somebody with all your heart,
但你不能给他们想要的…… but you can't give them what they want...
第二次手术后我就崩溃了。 I was pretty destroyed after the second surgery.
治疗无精子症的药物真的不多。 There really isn't a lot of things that treat azoospermia.
[旁白]几个世纪以来， [narrator] For centuries,
因为生育研究主要集中在女性身上， because fertility research has focused on women,
，所以有生育治疗， so have fertility treatments,
在迷宫中找出如何绕过不同的障碍。 figuring out how to get around different obstacles in the labyrinth.
无论如何，你不会 You don't, by any chance,
你知道这个迷宫的路吗？ know the way through this labyrinth, do you?
谁,我吗?不，我只是条虫子。[笑] Who, me? No, I'm just a worm. [chuckles]
（叹气）我必须解开这个迷宫。 [sighs] I have to solve this labyrinth.
一个捷径是让精子跳过子宫颈 [narrator] One shortcut is to let the sperm skip the cervix
通过将它们直接放入子宫，称为“宫内人工授精” by putting them directly into the uterus, called "intrauterine insemination."
后来，科学家们开发了治疗 Later, scientists developed treatments
，从迷宫中移除更多的障碍， that removed more barriers from the labyrinth,
刺激卵巢产生卵子的药物， drugs that stimulate the ovaries into producing an egg,
手术以清除输卵管阻塞 surgery to remove blockages in the Fallopian tubes.
然后在1978年，我们想出了如何完全跳过迷宫的方法 Then in 1978, we figured out how to skip the labyrinth entirely.
你即将看到一个历史性的诞生 [man] You are about to see a historic birth
在体外受精之后。 following in vitro fertilization.
[旁白]这个成就是如此具有历史意义 [narrator] The achievement was so historic,
整个分娩过程是应英国政府的要求拍摄的 the entire birth was filmed at the British government's request.
[男]心音和肺音都正常。 [man] Heart sounds and the lung sounds are normal.
-[婴儿啼哭]-[男子]可爱的粉红色。 -[baby wailing] -[man] Lovely pink color.
皮肤下面有很多脂肪…… Plenty of fat underneath the skin...
好成熟的宝贝。 Good mature baby.
[旁白]In vitro fertilization来自拉丁语“In glass”， [narrator] In vitro fertilization comes from the Latin "in glass,"
，又称"IVF " otherwise known as "IVF."
医生通过阴道从卵巢取出卵子 A doctor retrieves an egg from the ovaries through the vagina
，然后在实验室与精子混合 and then mixes it with sperm in a lab.
然后将受精卵直接植入子宫 The fertilized egg is then implanted directly into the uterus.
另一个重大突破发生在20世纪90年代：< i> And another major breakthrough happened in the 1990s:
. 0“胞浆内单精子注射”或ICSI "Intracytoplasmic sperm injection" or ICSI.
通过使用一个精致的空心针， By using a delicate hollow needle,
医生现在可以取出单个精子并将其植入卵子 doctors can now pick up a single sperm and implant it into the egg.
我说的不是500万、5万、1000或100万…… I'm not talking about five million, or 50,000, or 1,000, or 100...
如果他有两个、三个或一个精子，我们就能找到， If he has two or three sperm or one sperm, we can find it,
我们可以把它直接注射到卵子里， and we can inject it directly into the egg,
你的怀孕率正常。 and you have a normal pregnancy rate.
[旁白]我们已经绕过了迷宫， [narrator] We'd gotten around the labyrinth,
，但一对夫妇仍然需要找到精子 but a couple still needs to find that sperm.
把孩子给我。 Give me the child.
我想一定会有办法的。 I figured there had to be a way somehow.
所以，我从一开始就做了研究。 So, I had done research from the start.
她遇到了一个不太常见的程序， [narrator] And she came across a less common procedure,
，可能定位精子 which could potentially locate sperm
. . . that the other surgeries might have missed.
她说，“会是一万三千美元，也许吧， She's like, "It's gonna be $13,000, and it's a maybe,
我们已经被拒绝过两次了。” and we've already been told no twice."
我说，“哇。” And I was like, "Wow."
我知道，在这一点上，这是最后的欢呼。 I knew, at this point, it was the last hurrah.
如果，如果我们有坏消息，那就完了。 If-- If we got bad news, that-- that was it.
但是，嗯，你知道，我也是，乐观主义的缩影。 But, um, you know just, I'm also, like, the epitome of optimism.
所以，我说，“哦，是的，我们会想办法的。这会成功的。” So, I was like, "Oh, yeah, we'll figure it out. This is gonna work."
[旁白]所有这些技术也打开了可能性 [narrator] All this technology also opens up the possibility
对于双方都有卵子的夫妇来说，生物学上的亲子关系 of biological parenthood for couples where both partners have eggs
或双方都有精子，而对于没有伴侣的人 or both partners have sperm, and for people without a partner.
为人父母的面貌正在发生变化 A changing face of parenthood is emerging
随着越来越多的女性使用体外受精 as more women are using in vitro fertilization
成为单身母亲。 to become single mothers.
约瑟夫·蒂托在肯尼亚通过代孕成为父亲的旅程 Joseph Tito's journey to fatherhood via surrogacy in Kenya
吸引人们注意的是不同的方式吗 is drawing attention to the diverse ways
人们可以选择生孩子。 in which people may choose to have children.
我们可以从一个女人身上取出卵子， We're able to take the eggs from one woman,
用捐赠者的精子使它们受精， fertilize them with the donor's sperm,
并转移到她的同性女性伴侣身上。 and transfer them into her same-sex female partner.
我们都以自己的方式创造了她。 We both participated in our own ways in creating her.
这是扎卡里。我是大卫， This is Zachary. This is David,
我们很高兴来到这里。 and we are very happy to be here.
——(人)嘿!-嘿,扎卡里。 -[man] Hey! -Hey, Zachary.
[旁白]但是这项新技术并没有保证 [narrator] But the new tech doesn't come with a guarantee.
例如，试管婴儿（IVF）的成功在很大程度上取决于卵子的年龄 For example, IVF's success depends a lot on the age of the eggs.
对于35岁以下的女性，29%的时间有效 For women under 35, it works 29% of the time.
对于40至42岁的女性，成功率约为十分之一 For women 40 to 42, the success rate is around one in ten.
使用年轻时冷冻的卵子，成功的几率会增加 The chance of success goes up when using eggs frozen at a younger age.
但根据一项研究， But according to one study,
最大限度地提高成功几率的真正方法是冷冻大量的卵子 the real way to maximize the chance of success is to freeze a ton of eggs.
对于大多数女性来说，40岁， For most women, 40,
，这通常需要几轮鸡蛋提取 which would usually require several rounds of egg extraction
再加上几个月的激素注射，这会对身体造成伤害 and months of hormone injections, which can take a physical toll.
虽然你可能不知道在社交媒体上看广告， Though you may not know that looking at ads on social media,
来自精品创业公司的20多岁女性的需求 from boutique startups urging women in their 20s
</i bbb . 0作为一种保险政策，冷冻他们的卵子 to freeze their eggs as an insurance policy.
有人将冷冻卵子与巴西莓碗的成本进行了比较， One compared egg freezing to the cost of an acai bowl,
>好像这个过程和任何健康趋势一样容易接受 as if the procedure was as easy to buy into as any wellness trend.
我认为它被商业化是很不幸的。 I think it's unfortunate that it's become commercialized.
所以，有很多非常恶劣的市场营销正在进行。 So, there's a lot of really kind of atrocious marketing going on.
因为它不能保证任何事情。 Because it's not a guarantee of anything.
[旁白]但是有一种很有希望的新疗法 [narrator] But there's a new promising therapy
这可以帮助更多的女性超越她们的生物钟 that could help even more women transcend their biological clocks:
不是冷冻卵子，而是冷冻卵巢的一部分 not freezing their eggs, but freezing a piece of their ovaries.
(机器转动) [machine whirring]
这最初是为癌症患者开发的， [narrator] This was originally developed for cancer patients,
，其卵巢可被化疗或其他治疗破坏 whose ovaries can be destroyed by chemotherapy or other treatments.
所以，我们冷冻卵巢组织，几天之内， So, we freeze the ovarian tissue, and within a matter of days,
他们可以开始他们的癌症治疗。20年后…… they can start on their cancer treatment. And then 20 years later...
[旁白]组织被移植到死亡的卵巢上， [narrator] The tissue is transplanted onto the dead ovary,
，不可思议的是，移植组织 where incredibly, the transplanted tissue
开始像自己的新卵巢一样运作 starts functioning like its own new ovary.
你瞧，她们开始排卵了， And lo and behold, they start ovulating,
她们不需要体外受精就能自然怀孕。 and they get pregnant spontaneously with no IVF.
[旁白]截至2016年， [narrator] As of 2016,
通过卵巢组织冷冻出生84例， 84 babies had been born through ovarian tissue freezing,
三分之二未体外受精 two-thirds without IVF.
医生们希望有一天这能成为一种主流疗法 And doctors hope that one day this could be a mainstream therapy.
当每项新技术时 And while each new technology
>正在帮助越来越多以前不能怀孕的人怀孕 is helping more and more people conceive who couldn't before,
. . . some are always left out.
作为一个渴望成为母亲的黑人女同性恋， As a black lesbian woman who desperately wants to be a mother,
我不得不去看，“保险能提供什么？” I've had to look at, like, "What does insurance provide?"
这要花多少钱？这对我来说到底有多容易理解？” How much money is this going to cost? How accessible is this really for me?"
[旁白]在大多数国家， [narrator] In most countries,
单轮试管受精将花费数千美元 a single round of IVF will run thousands of dollars,
，许多人需要多次才能工作。 and many people need multiple rounds for it to work.
这是一个非常昂贵的过程， It's a very expensive procedure,
而我们谈论的是黑人女性在一美元中只赚64美分。 and we're talking about black women only making 64 cents on the dollar.
[旁白]一些国家可以禁止某些群体接受体外受精 [narrator] And some countries can ban certain groups from getting IVF
或其他生育治疗 or other fertility treatments.
因为这些不仅仅是医疗程序， Because these aren't just medical procedures,
他们挑战传统的家庭观念 they challenge the traditional idea of family.
请记住，卫生官员长期以来对不孕症的定义是 Remember, health officials have long defined infertility
表示无保护的性行为一年之后不能怀孕， as an inability to get pregnant after one year of unprotected sex,
这显然不适用于单身女性 which obviously doesn't apply to single women
对于很多LGBTQ夫妇来说，这是一个很好的例子 or a lot of the LGBTQ couples.
在法国，单身女性的道路是一个障碍赛。 [in French] The route for single women in France is an obstacle course.
我们没有得到满足，因为到目前为止这都是非法的。 We're not accommodated because it's been illegal up until now.
你必须出国。你得研究一下诊所。 And you have to go abroad. You have to research a clinic.
[旁白] 2017年，一些医生改变了定义 [narrator, in English] In 2017, some doctors changed the definition
到一个人生育能力的损害 to an impairment of a person's capacity to reproduce
作为个人或与他或她的伴侣 either as an individual or with his or her partner."
这可能会导致更广泛的治疗途径 Which may lead the way to broader access to treatments.
毫无疑问，更多的研究和新发现将带来希望 And no doubt, more research and new discoveries will offer hope
. . . to more people who long for a biological child.
如果是好消息，冰箱里就有一瓶香槟， We had a bottle of champagne in the fridge if the news was good,
我们可能会把它砸了 uh, and we probably just would have smashed it
如果是坏消息，就在地板上。 on the floor if the news was bad.
我们接到医生的电话， So, we get the call from the doctor,
他只是说：“嘿，你们最近过得怎么样？” and he literally just said, "Hey, you know, how have you guys been?"
然后是，“我有好消息要告诉你。” And then it was, "I got some good news for you."
我们都倒在地上哭了。我不—— And we both fell to the floor in tears. I don't--
我是说，那只是… I mean, it was just...
那可能是我一生中最美好的时刻之一。 it was probably one of the best moments of my entire life.
试管受精还有很长的路要走。 We still have a very long road ahead of us with IVF and everything.
而且，我们希望我们的财务状况能稳定下来 And, um, we're hoping to have our finances in place
10月份出去约会，希望能怀孕。 to go out in October and hopefully get pregnant.
九月。九月。 -September. -September.
(两个笑) [both chuckle]
[播放主题音乐] [theme music playing]