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.

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.


Not many countries in Asia allow oocyte donation, such as Japan, China (including Hong Kong and Macau), Singapore, and Philippines. Thus more and more overseas patients came to Taiwan for the oocyte donation program. To provide more information to the patients who needs donated oocytes, the Stork Fertility Center held an orientation in Fukuota, Japan, on 6th, November, 2016. 



Until 2016, Seventy-five fertility centers in Taiwan provides the oocyte donation program. Among them, the Stork Fertility Center had our own oocyte bank, which can be immediately used after appropriate matching process. The majority of oocyte recipients were from mainland China, including Hong Kong and Macau, and the second was from Japan.

The first orientation was held in the Grand Hyatt Hotel of Fukuota, since most Japanese patients were from there. In the future, the orientation would be held in Tokyo (April, 2017) and Osaka (August, 2017). By the interactions with the audience, we can understand the patients' real needs and expectations.


The past records of Stork Fertility Center showed that half of patients can achieve successful pregnancy after the first cryotransfer, and around 90% of patients can achieve successful pregnancy after the second cryotransfer. The oldest case was a 62-year old woman.

After the orientation, the team also had a birthday party for the patients' IVF babies. The superintendent of Stork Fertility Center, Dr.Lai, said that," our goal is to help the couples who need baby to start a family, no matter how difficult it is."




The advantages of SFC donor/recipient program:

1. Only two steps in Taiwan:


2. High quality and sufficient donor bank:
 - 4 blood types: A/B/O/AB
- Complete health evaluation: psychological consultation, genetic screening, infection disease screening, and ovarian function tests
3. Professional and Personal consulting agent
 - English/Japanese/Cantonese
4. Hospitality and Transportation
 - Airport transportation (optional)
- Hospitality in Stork Fertility Center (optional)
More info:


Tuesday, November 8, 2016

The secret of age—maternal age and embryo aneuploidy


The chromosomal abnormality (aneuploidy) rate increases with maternal age.


By analyzing with next-generation sequencing, more precise information can be obtained.

Preimplantation genetic screening (PGS) is an examination to screen the embryos with abnormal dosage of chromosomes (aneuploid) in the IVF realm, and it is strongly recommended to the women with advanced maternal age or undergoing recurrent miscarriage. By excluding the aneuploid embryo transfer, the success rate of IVF can be significantly improved.

The newly released platform of comprehensive chromosome screening (CCS) in 2014 is next-generation sequencing (NGS). The PGS/NGS have better resolution to detect the low-rate aneuploiy in the embryo biopsy, and the low-rate aneuploidy is known as the pure mosaicism (diploid and aneuploid mixture). By using high-resolution Next-generation sequencing (NGS) to analyze the relationship between maternal age and blastocysts as different ploidies in preimplantation genetic screening (PGS) in 1736 embryos, the result was shown as below,



(The involved embryos were from women aged 21 to 46 years and biopsied on Day 5 and 6: 363 embryos from egg donors (20.9%), and 1373 from non-donors (80.1%). The PGS/NGS includes whole-genome amplification and following sequencing (Miseq®). The copy number variation was analyzed by BlueFuse Multi® software. Absolutely aneuploid was defined as over 50% of aneuploidy, and low-rate aneuploid as between 20% to 50%, and absolutely euploid as under 20%.)

Every woman can always keep one secret—the secret of her age. However, the women can choose not to speak out her age, but can't choose to hide her age. The human body can release one's age by many ways, including the ovarian reserve, hormone levels, and the aneuploid rate of her embryos. The aneuploid rate of each age was shown as below,


Of absolutely aneuploid rate, the percentage continuously increased with the maternal age. The embryo aneuploidy showed lowest in women aged 26 to 29 years and dramatically increased in women over 34 years by non-linear (R2=0.815) and linear regression analyses (R2=0.849), respectively.

The aneuploid rate of embryo increases with maternal age. It is because that the incidence of meiotic errors during the oogenesis is significantly higher in older women, and the main causes to the anomalies are nondisjunction and anaphase lagging. Intriguingly, the mosaicism rate (combining the abnormal mosaic and pure mosaic) remains constant among each age span (around 25%).


 The actual mechanism of mosaicism has not been validated, and it is believed to relate with the mitotic errors during the first three cell divisions. The main causes of these errors might be the culture condition (varied dramatically in the different labs) or male factors (post-zygotic errors).




Conclusively, the aneuploid rate significantly increases with the maternal age in women over 34 years and is lowest at age spanning 26 to 29 years; the mosaicism rate stays constant at each age span (around 25%). The results reflects that the embryo aneuploidy are mainly due to meiotic errors affecting by maternal age, but the embryo mosaicism are mostly caused by mitotic errors, which occur during the post-zygotic stage and do not relate to the maternal age.

References:
Munné S, Grifo J, Wells D. Mosaicism: "survival of the fittest" versus "no embryo left behind". Fertil Steril. 2016;105:1146-1149.
Data were analyzed from the Stork Fertility Center and released in the annual meeting of 2016 Taiwan Society of Reproductive Medicine.

Thursday, October 20, 2016

A home-run and an additional Y chromosome









The result of pregnancy test made her extraordinarily happy — 100% positive. 




However, the following amniocentesis report turned her down immediately...


A real story was shared by the doctor of Stork Fertility Center.






She made an appointment for saying good-bye to me. The entire IVF progress was filled difficulties. And just like another temptation to her, God gave an additional Y chromosome to the transferred embryo. Although the risk existed, she decided to continue the gestation. She said,

"I prayed for a Y chromosome, but He gave me two. "



Tuesday, October 11, 2016

The last four tubes of frozen sperms



How to grasp the last chance? 

In a frustrated manner or an optimistic manner? 

A real story was shared by the doctor of Stork Fertility Center.



"For everything there is a season, and a time for every purpose under heaven: a time to be born, and a time to die; a time to plant, and a time to pluck up what is planted..." ~ Ecclesiastes 3, Bible.

As the King Solomon said, there is a beginning and an ending in everything, including the human body. However, most of us are not ready to face the end.

I met this couple at the clinic suite in a beautiful day.