Saturday, January 1, 2050

IVF in Stork Fertility Center (IVF in Taiwan)

What is IVF?

In Vitro Fertilization (IVF) is an assisted reproductive method wherein oocyte are fertilized by sperm outside of the womb, hence the word in vitro. It involves hormonally controlling ovulation stimulating increased follicle development, transvaginal oocyte retrieval and sperm collection, laboratory incubation for fertilization and zygote implantation into the uterus to establish pregnancy. After sperm retreival and successful fertilization, the embryo is implanted to the mother’s womb. This procedure is also known as Test Tube Baby.

(Know more IVF procedure at Stork Fertility Center)

(Know more donated programs at Stork Fertility Center)

(Know more oocyte-freezing programs at Stork Fertility Center)

Tuesday, January 17, 2017

To have a second child? Preimplantation genetic screening is a good choice

"Excuse me, my oocyte pick-up is done,
 but my husband is still doing the sperm collection. Please tell him that I got to go."

She left in a rush, and I forgot to ask her name.

The day was as hasty as usual, scheduling for retrieval operations and gynecologic examinations. Every consultant at the counter of assisted reproductive technology (ART) department was busy for works, and I was checking the patients' ID and consent forms.

" Excuse me, my oocyte pick-up is done, but my husband is still doing the sperm collection. Please tell him that I got to go." A woman suddenly blocked my view by her hand and left the words. After looking up, I only saw her back, and just thought that I haven't had her name.

Luckily, her unique style impressed my colleagues deeply. It wasn't too difficult to find her name in our patients' list. It was a cute and childish name, which just reflected her personality.

Soon after, her husband finished the sperm collection and gave the sample to ART. He was a prudent man, checking the details of sample and procedure carefully. After understanding the following IVF programs, he gently appreciated the consultant and went to pay fees.

Five minutes later, I picked up an outside call,

"Hello, this is XX's husband. I still have some questions about the embryo culturing. Could I talk to the embryologist, please?" It was his gentle voice. I just wondered why he used the cell phone while still at the fertility center. I grabbed the couple's history notes, and then went to the waiting zone. He had several questions about our embryo culturing. After getting all the answers, he appreciated for the service again.

Finally, all the routines have been completed at the ART. I got some time to recheck this couple's records,

1st reproductive outcome:
OPU x2, MII x14, 2PN (fertilized embryo) x10, good blastocysts x4 > 1st cryotransfer > live birth in 2015

2nd reproductive outcome:
-Prepare to have a second baby (Note: The wife had a quarrel with her husband, since she did not want to take IVF again.)

OPU x2, MII x32, 2PN x24, good blastocysts x10, PGS x8 > aneuploid x5, euploid x3

According to the records, most of her embryos generated from the first IVF cycle this year were grading as BC based on the Gardners' criteria. Concerning the maternal age, the specialist recommended her to take preimplantation genetic screening (PGS) to examine the chromosome aneuploidy. By the note in the record, I understood why the wife just left her husband at the center alone. (Perhaps she thought that one child is enough. Perhaps she had bad memory about the treatment. Perhaps...)

On the day of cryotransfer, I saw her kid when I explained the embryo quality to her. He was a quite pretty boy. However, she was not concentrated on our talk,

"Well, the thawing embryo looks good? Uh huh~"

"What can I do for you? Aren't you ready for the second baby?" I felt quite worried for her, so I asked.

She looked at me deeply, and said in a low voice,

"You don't know. I don't want to be pregnant again. I don't want to be stuck."

"Being parents is tired sometimes. Your first boy looks very cute and strong. I believe that you are good at being a mother." I encouraged her.

"Ummm, one is enough." She still looked a little bit unhappy.

After the cryotransfer, she speeded away as usual, and left her husband to care about the post-transfer medications. Her husband gave me a big smile,

"She is much younger than me. I knew the importance of having siblings during childhood, but she may not get it. Still, I really appreciate her to undergo all the IVF programs. It's not easy."

"Please take care of her body. I hope that she could rest longer after the transfer, and wish you have another cutie."

Fortunately, the beta-HCG value was 9054 mIU/mL. The gentle husband took the prescription to the pharmacy with great joy, and came back to the ART to thank all the embryologists. And the wife was just at the counter to call a taxi.

Although the morphology of her embryos were only graded as BC (median), the PGS helped us to select the embryo with normal chromosome dosage to transfer, and thus increased the success rate. Her total euploid rate was 37.5% (3/8), and it could reflect her maternal age.

Each couple could encounter the similar dilemma about having child (or having a second child). Different thoughts could be from the experiences at our original families. Unceasingly communication and taking more time are the best solutions, and patience is the catalyst.

Thursday, December 22, 2016

If I still have my periods, can I be pregnant?

"If I still have my periods, can I be pregnant?"

It is a common question at fertility centers. The specialist clarified that having periods does not mean having ovulations. Many women with advanced age thought that having periods equals to having potential to be pregnant. The fact is that older the age is, worse the egg quality is. That is why the women with advanced maternal age are harder to be pregnant.

Since the social style and economic environment are changing, more people do not expect to start their family in the early life. Getting married later made the infertility issue become more serious. In Taiwanese records, one seventh couples are suffering with infertility (around 15% of population).

Over half of infertile couples choose to undergo assisted reproduction

According to the Taiwan ministry of Health and Welfare reports, the number of IVF babies increases annually, and it increased twofold in the last decade. Five of every ten infertile couples would choose assisted reproduction programs to have babies including IUI and IVF.

Clinically, abnormal vaginal bleeding or anovulatory menstruation could mislead people to believe they still have potential to be pregnant naturally. Not like normal menstrual bleeding in an ovulatory cycle is a result of progesterone withdrawal bleeding, anovulatory bleeding is commonly caused by estrogen breakthrough bleeding.
The cycle lengths of females with anovulatory menstruation showed different degrees: most have prolonged cycle lengths, but some have regular or even frequent menses (though the amount of fluid is comparably fewer).

To sum up, the irregular menstruation is highly correlated with infertility due to anovulation. The clinical indications of anovulation could be hormone disorders (e.g. PCOS, hyperprolactinemia, thyroid disorders), upstream reasons such as hypothalamic dysfunction, or age issue (e.g. ovulation dysfunction, perimenapause).

In the age issue, women with age at 25 years have highest pregnancy rate; with age over 40 only have half or lower of highest pregnancy rate. Women suffering with infertility problem was around 6% in the group spanning 20-24 years, 9% in the group spanning 25-29, 15% in the group spanning 30-34, 30% in the group spanning 35-39, and 64% in the group spanning 40-44. Beyond 45 years of age, the pregnancy rate of IVF patients were quite low. Thus the most appropriate age of taking IVF program is under 35 years, and the clinical outcomes also displayed more favorable in this group. 


Thursday, December 8, 2016

Hyaluronan(HA) binding assay: a good matchmaker to sperm

For in-vitro fertilization, the oocytes attract the sperms with better maturation status by hyaluronic acid of the surrounding cumulus cells.

In the 2016 annual meeting of Taiwan Society of Reproductive Medicine, Dr. Dionisios Sakkas from Boston IVF center, US, shared his experiences in semen processing and sperm selection,

1. Density:Gradient separation 

2. Surface Charge:Electrophoresis 

4. Motility Characteristics: Microfluidics

5. Membrane Integrity:Hyaluronan(HA)-binding

6. Surgical:MESA/TESE 

Monday, November 21, 2016

International medical service provides more convenience to the patients

To have better medical service than home country, medical tourism has become a more popular word. For example, Asian patients with cancer or cardiovascular diseases would go to Japan or other developed countries for the advanced treatments. In the realm of reproductive medicine, the condition for patients who need donated oocytes is different. Since the law restricted the oocyte donation in Japan, patients must find a solution overseas.

The assisted reproductive technology has been developed around one decade in Taiwan. In 2007, the oocyte donation was allowed in Taiwan by the authority decree, and the oocyte cryopreservation for social reason as well. For patients with authorized marriage certificate, they can take the oocyte-donation program if the wife's ovarian reserve displayed significant diminished, because taking more IVF cycles seems inefficient.