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 oocytes 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)

Monday, April 24, 2017

The best is yet to come

She was always gentle to the medical team.

Behind the smiling face,

We all knew the disappointments and frustration.

In the past six months,

No embryos were available for transfer.

A woman is born with a limited number of oocytes which gradually diminishes by age. It is an irreversible process. As the maternal age increases, both the quantity and quality of the oocytes decrease. Accordingly, the live birth rate in women over 40 years is under 10%, since the aneuploid rate of oocyte is quite high.

She was a 45-year-old woman from Taiwan countryside, undergoing IUI five times and IVF twice. Still, no good news released. When she came to our clinic at the first time, she was arranged to take the oocyte-retrieval after two days for the observed dominant follicle. Unluckily, it was an immature oocyte. Since then, the fertility specialist recommended the natural-cycle IVF to her because of the declined ovarian function. No additional stimulation injections or oral alternatives were administrated, and supremon nasal solution was used as the trigger. From February to July in 2015, she visited the clinic almost every week, but no available embryo was collected.

She was always gentle to the medical team. Behind the smiling face, we all knew the disappointments and frustration. She told the doctor that she probably could not realize her dream. The fertility specialist encouraged her that there is not an only way to be a mother, and suggested her thinking about oocyte donation program.

Owing to the bountiful supply of oocyte bank at Stork Fertility Center, the matching process only took two months. In September of 2015, nine available blastocysts were derived and cryopreserved. Following with hysterosalpingography, hysteroscopy, and cervical bacteria culture, the doctor checked her uterine environment through several examinations. After the first cryotransfer, the beta-HCG showed negative. Her doctor ordered an auto-immune testing, and transferred her to the related specialists for further immune treatment.

In March of 2016, she took the second cryotransfer. The result was still upset. Why? Why? Why? She continuously asked the doctor and herself. Her specialist asked several questions about her life style after embryo transfer: 

Her family owned a small business in Yilan. She needed to help and stand for a long time for the daily works. Although the doctor concerned the derived pressure to uterus, she refused to take a rest after transfer. The medical team did not give up and continue to convince her. Finally, she decided to grasp the chance. 

The third cryotransfer was in July of 2016 after she arranged the backups for her family business. The fertility and immune specialists adjusted the post-transfer medications for her. She took two weeks for resting after the transfer and stayed at Hsinchu until the pregnancy test released. The beta-HCG showed positive this time, and the fetal heartbeat was detected after another three weeks later.

She was very happy and careful, coming back for the prenatal checks and related immune exams. In the 14 weeks of gestation, the non-invasive prenatal testing (NIPT) showed normal. Now, she was waiting for her healthy newborn.

Her autologous-IVF records were as follows,

And, her outcomes of donated oocyte derived embryos were shown,

Monday, April 17, 2017

I feel bloated—ovarian hyperstimulation syndromes (OHSS)

Ms. Helen started appointments with me since last year. She has been married for two years without preventing pregnancy, but still no good news released. By several examinations, I found that she has some features of polycystic ovarian syndromes.

Compared to the average age of entire IVF cases, Helen was still young, and she would not like to jump into the assisted reproduction technology too fast. Hence she tried clomiphene citrate several times in timed sexual intercourse (TSI) program. Unfortunately, it did not work. For some cases, clomiphene citrate could have adverse effect on the endometrial thickness, and thus the embryo implantation may fail. Concerning this point, we discussed about the mild stimulation injections (recombinant rFSH) in intrauterine insemination program.

As expected, the response of Helen's ovaries to the injections was good. With lower dosage, both the size of follicles and blood estrodial level were steadily increased. Since higher risk of ovarian hyperstimulation syndromes (OHSS) in the IUI cases was well known, I used the GnRH agonist to trigger and gave a complete consultation to Helen and her husband before the insemination. 

Three days after insemination, Helen came back to the clinic and felt very uncomfortable. Her belly seemed obviously bloated. Through abdominal ultrasound observation, the image showed that around 2000ml of ascites accumulated there. I arranged the laparocentesis to drainage the fluid and appropriate albumin/electrolyte supplements through intravenous infusion. Sooner after, her bloating symptom was relieved. Another three days later, I saw Helen's belly accumulated 2000ml of ascites again, and she underwent the similar treatment. In the last three weeks, repeated bloated and laparocenteses filled in Helen's daily life. And also, we found that Helen got twins in her uterus. 

Helen is a typical type of OHSS.
The actual mechanism of OHSS remains unclear. Generally, it was believed to the consequence of interactions among progesterone, estrodial, beta-HCG, and vascular endothelial growth factor (VEGF). Increased concentration of the above hormones induces elevated vascular permeability. Both the fluid and related contents (albumin, electrolytes) flow out of the vessels, and then accumulate at the chest, abdomen, or lymphatic system. Thus a serial of symptoms is derived.

Common signs of OHSS include abdominal bloating, nausea, decreased urine output, and so on. According to the size of enlarged ovaries and the volume of ascites, it can be categorized as follows,

Wednesday, March 22, 2017

ERA program (ERA procedures)

One step to start a family--

When to eat progesterone, transfer...and more!  

IGENOMIX, a leading team of reproductive genetics in Spain, has developed ERA to analyze the gene expression of endometrial tissue. This method helps us determine if the endometrium presents the ideal condition for implantation of embryo (WOI, window of implantation), and thus pregnancy rate would be improved.

Friday, March 17, 2017

Follow your dreams, they know ways.

Using the donated eggs or struggling with my declined ovaries made me confused on this journey.

I slowed down, and heard the voice in my heart,

"What do you really want in the very beginning?"

"Having a child, my Lord."

"Just follow your dreams, they know the way."

In the summer of 2015, I got an email overseas. 

This mail was from Hong Kong, and also the first connection between she and me. She was my first "pen-pal" at the Stork Fertility Center, but not the first overseas friend here. 

Our dean always said that there were four stations during the journey of having babies. Each person gets on the different trains in different times, at different places. The speed, the duration, and the starting/ending time are different as well. Ideally, this journey would be better at the age under 35 years. The second one was at the age between 35 and 37 years. Then it was at the age between 38 and 40 years. The last train was at the age over 40 years. On the last train, the cost was high and the duration was pretty long, but terminal became uncertain.