Showing posts with label top8. Show all posts
Showing posts with label top8. Show all posts
IVF in Stork Fertility Center (IVF in Taiwan)
January 01, 2017
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)
Born in 1978 in Manchester, England, Louise Joy Brown – the world’s first IVF baby – is now, in the year 2008, 30yrs old. For the past 30 years since her birth, IVF has helped thousands of couples overcome infertility. Taiwan alone has succesfully produced a few thousand IVF babies. Current statistics show that in Europe, 3 out of 100 newborns are IVF babies; while in Taiwan, the ratio is 1 out of 100.
Stork Fertility Center (Lai’s Ladies Clinic) started to provide IVF procedures to patients in 1992. In 1993, a timeframe of just one year, we announced our very first IVF baby. In the subsequent 14 years of our practice, we have already delivered thousands of healthy IVF babies; with 80-100 successful births per year - a ratio which has been steadily increasing.
(Know more about the history of Stork Fertility Center)
IVF Procedure
IVF involves ovarian stimulation through oral medication or injectibles in order to increase follicle development. Once mature follicle count is ideal, oocyte retrieval is done using a thin, ultrasound-guided needle to harvest egg cells from the ovary under general anesthesia. Sperm is collected, washed and pre-selected.
(Know more about controlled ovarian stimulation)
Follicles stimulation – Oocyte retrieval – Pre-selection and incubation for fertlization – Embryo transfer – Luteal function maintenance – Waiting period for announcement of pregnancy – Embryo implantation in the uterine lining – Pregnancy confirmed – Child birth/ Delivery
(Know more about in-vitro fertilization)
(Know more about preimplantation genetic screening)
(Know more about embryo freezing)
Suitable candidiates for In Vitro Fertilization (IVF)
Couples must be legally married and healthy. Wife should have a normal uterus and husband should have sperm production (low count is acceptable). Couples experiencing any of the below problems can also utilize IVF to assist conception:
1) Both fallopian tubes for the oocyte to travel to the uterus are clogged
2) Mild to moderate emdometriosis
3) Infection of the pelvic area causing internal organ adherence
4) Male factor such as low sperm count, low forward progressive motility, abnormal morphology, azoospermia (no sperms produced)
5) Immune rejection disorder
6) Failure after 3-6 times of undergoing Intrauterine insemination
7) Unexplained infertility
8) Failure to achieve pregnancy even after 2 years of marriage with regular sexual intercourse
9) Above 35 years of age and desiring to conceive
Procedure guidelines and reminders
1) Prior to treatment
Couples should relax, continue with daily activity and exercise, regulate sleep to at least 6-8 hours every night, and make sure there is less pressure or stress in their lives. Trust in the expertise of the physicians and medical staff in the clinic. During the onset of the menstrual cycle, (prior to the desired month undergoing IVF), couples will need to visit the clinic for some preliminary examinations, which will determine which treatment is best based on specific conditions/problems.
2) Inducement of oocyte production and retrieval:
Short method – On the 3rd day of the menstrual cycle, follicle-stimulating hormone (FSH) injections will be prescribed by the doctor. Try to administer on the same time each day for 8 days. Dosages will depend on the individual’s conditions. At 35 years and below, dosage of 225IU FSH per day is normal. (Each injection pen and treatment package usually contains 2500IU)
Afterwards, clinic visits for progress examinations shall be required every 2 days. Usually around the 10th day to 12th day of injections, the oocyte will have matured. The physician shall then recommend the injection of hCG and at around 34-36 hours, oocyte retrieval shall be conducted. Sperm collection is also to be prepared at this time, awaiting the development of the retreived oocyte.
Long method – On the 21st day from previous cycle, the physician shall administer Supremon everyday. Supremon is a kind of medciation that down-regulate pituitary gland. Continue with this injection until the 2nd or 3rd day of the succeeding menstrual cycle. On the 3rd day, a clinic visit is required for blood test and vaginal ultrasound. If everything is in order, FSH shall be administered everyday starting from the 3rd day. Dosage shall depend on the individual’s conditions.
Afterwards, the procedure is the same as the short method above.
3) Luteal function maintenance
The patient needs to be administered a low dosage of hCG on 1st, 4th, 7th day after embryo transfer and supplemented with progesterone untill pregnancy test is done.
4) Ensuring better adherence of embryo to uterine wall
A low dosage of aspirin is prescribed to be taken everyday in order to improve the uterus conditions and blood circulation.
5) From the date of implantation until the announcement date, a period of about 16 days, the patient should refrain from any strenous activities such as extensive housework or stress-inducing work, exercise, sexual intercourse etc.
Pregnancy Rate
Today, undergoing one cycle of IVF yields an average success rate of about 35-40% (World Standards) This means, for every 100 couples, there are 35-40 pairs successfully achieving pregancy. The remaining 60-65% shall need to undergo a second or third cycle. Usually with confidence and patience, success is achieved in the second or third treatment.
Some of the most important consideration in the patients success rate are age, ovary conditions, semen/ sperm quality, embryo quality, the procedure of embryo implantation and health. For example, a 35-year old or below patient’s pregnancy rate is higher then a woman of a more mature age. Implantation of 2 top-quality embryos can increase the success rate to 50-60%.
(Know more clinical outcomes at Stork Fertility Center: oocyte recipient)
(Know more clinical outcomes at Stork Fertility Center: sperm recipient)
Multiple Births
The chance of multiple births with IVF treatment is about 25-30%; with twins being the most common. If the patient has a possibility of developing triplets or more, the physician will recommend a decrease in the number to be carried to term.
Because the Stork Fertility Center has reached world-wide standards, we are exerting our very best efforts to ensure multiple births will be limited to twins at the most to decrease chances of any pregnancy-related complications. Also, we are promoting blastocyst transfer and cryopreservation in order to decrease the rate of multiple births.
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Ectopic Pregnancy (Pregnancy outside the uterus)
Possibility of ectopic pregnancy is around 5% for IVF. In normal/ natural pregnancy, the rate is about 2%.
Miscarriage
Miscarriage chances greatly depends on the age of the patient. The possibility, though, is not more than 20-25%. A more advanced age increases the risk of miscarriage. For 40 years of age and above, the possibility is at 38%.
Psychological Effects
Couples who experience infertility and have been undergoing treatments for a period of time can have increased stress levels due to the pressure, either financially or emotionally. It is recommended for couples to relax and try to decrease their stress levels and try to avoid feelings of sadness, anger or disappointment.
Should any patient require clarifications which will help relieve some of the emotional stress, staff at Stork Fertility Center is more than happy to provide any explanations. The hotline number is +886-3-523-3355 ext. 205. Everyone is welcomed to join the Stork IVF association.
Birth Defects
Reports indicate that there is no correlation between undergoing IVF and increased chances of birth defects or abnormalities. There is no need to worry. It is suggested for patients to undergo amniocentensis and high-resolution ultrasound examinations.
Potential Side Effects to undergoing IVF
OHSS is a possible condition that may arise from taking fertility medications and injections. There is a 5% chance of acquiring mild OHSS, but there is a small percentage (about 1%) that is severe. Severe OHSS cases need to be treated in the hospital.
Symptoms of OHSS may include the following: enlarged ovaries, abdominal bloating and feeling of fullness, nausea, diarrhea, vomiting, less and frequent micturate, excessive thirst, fullness or bloating above the waist/in the chest area, pain, and shortness of breathe.
Symptoms for mild cases of OHSS will dissipate in about 2 weeks so please do not worry too much.
2) Ovarian Cancer
According to some studies, long term usage and administration of fertility medicines and injections may increase the chances of ovarian cancer. This may be caused by long term anovulation of the ovary. However, there is a large percentage of medical practitioners who also feel more studies and tests must still be conducted in order to prove this point.
Hospitalization
There is no need for hospitalization. 4-8 hours after embryo transfer, the patient can go back home. Stork Fertility Center has a pregnancy success rate of 55% without any hospitalization required.
(For oversea customers, hospitalization at clinic is provided)
(Know more about the surroundings of Stork Fertility Center)
Nutrition and Diet
There is no special diet needed. Patients can mostly continue their daily activities, simply avoiding any heavy lifting, strenous exercises and actions/ activities that can cause pressure to the abdominal area (such as: massage, pressing stomach, excessive laughter or nipple stimulation). The most important reminder is to relax and keep an uplifted spirit. Sexual intercourse during this period is also best avoided.
Expenses
One treatment cycle of IVF can cost from NT100,000 to NT150,000; including the fees for injections, ultrasounds, blood tests, oocyte retrieval, embryo transfer and assistance in embryo hatching to improve implantation potential.
If needed, additional special treatments or medications will incur additional costs. For example, cases wherein ICSI, blastocyst culture or emrbyo cryopreservation is performed.
Based on the costs for IVF treatment in Asia, Taiwan is the most cost-effective. Per treatment in China will incur expenses reaching RMB 40,000 and in Hong Kong, costs are in excess of HKD 40,000.
(Know more about the prices of Stork Fertility Center services)
(Know more about the prices of Stork Fertility Center services)
Conclusion
The success rates of IVF and ART treatment nowadays is already high. With patience and willingness to undergo the correct treatment cycles, there is no reason to give up hope of achieveing conception and fulfilling the dream of starting a family. It is important to select a doctor with at least 5 years experience (Medical residency lasts for about 3-4 years + 1 year professional practice). With these factors, it is very optimistic that you will have your own healthy baby soon.
This is the most fervent wish of our team at Stork Fertility Center and our driving force in continuously exerting our best efforts to upgrade our service systems in providing you excellent medical care.
Never say never — Preimplantation genetic screening reveals the quality of embryos
July 05, 2016
Perseverance is the hard work you do
after you get tired of doing the hard work you already did.
One more try is the only shortcut to success.
"Hello, Celine."
I am a Japanese-speaking consultant at Icryobank (Overseas division of Stork Fertility Center). She was my first Chinese-speaking case from Hong Kong. When we first met, she insisted to take the autologous IVF treatment at age 42. We both knew that it would be a long and hard way to go, and many centers would just suggest patients with this age taking the donation program instead of autologous IVF. She did not give up.
Since then, I became her special agent.
Due to the autoimmune problems, she visited Taiwan more than the other overseas cases for additional examinations and treatments.
"Why you not just take both the autoimmune and IVF treatments in Hong Kong? It would be much easier." I wondered.
"I trusted you guys. That's why." she answered simply.
I kept this word in my mind. My team and I understood that how important the word was, and never say never to whom haven't given up.
1
In the first cycle, ten oocytes were retrieved and four of them grew into blastocysts. We biopsied the best three for preimplantation genetic screening (PGS), which we just upgraded it to the high-resolution next-generation sequencing platform. Unfortunately, two were aneuploids, and the last one was failed to be amplified.
2
After one month later, another ten oocytes were retrieved in her second cycle. Again, there were three best blastocysts for the PGS. It still resulted in all aneuploids. I could feel her frustration because I just felt the same. The high aneuploid rate was not surprising at this age, but we just expected to catch the opportunity. Discussing with the fertility specialist, she finally decided to take the donation program if there was still no euploid embryo after the next year.
3
Another month for rest, she came to Taiwan for stimulation again. We talked for a long time to release the burden and anxiety. Eight oocytes were retrieved this time, and two blastocysts were biopsied for PGS. Better than before, one was euploid, and the other aneuploid. She hoped to harvest more.
4
Then in her fourth cycle, only five oocytes were retrieved, and two blastocysts were formed with fair morphology. They were not suitable to be biopsied for PGS. The decline of ovarian function was obvious, and she knew the only euploid embryo might be the last chance.
The only chance was such valuable. Before the embryo transfer, we rechecked every details—the uterus, the fallopian tubes, the immune system, and the endometrium. She spent couple of days for just resting in Taiwan, and updating her feelings with me. I just listened and provided my encouragements.
We kept tight after she back to Hong Kong.
"I am sorry for the bothering, but I felt relaxed when I hear your voice." she said. I was so happy to have these interactions, both phoning and emailing.
When she got "two lines" on her pregnancy test, I received the photo immediately. This was the best Christmas gift for us. She told me that her beta-HCG reached 2433 mIU/mL later.
We kept tight after she back to Hong Kong.
"I am sorry for the bothering, but I felt relaxed when I hear your voice." she said. I was so happy to have these interactions, both phoning and emailing.
When she got "two lines" on her pregnancy test, I received the photo immediately. This was the best Christmas gift for us. She told me that her beta-HCG reached 2433 mIU/mL later.
She taught me what the real perseverance and optimism are. No matter how disappointed the outcome was, she always shared her feelings with a happy face. She said that she appreciated us a lot during these months, but she did not know she had given us something better.
IVF in Stork Fertility Center (IVF in Taiwan)
January 01, 2016What 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)
The very first IVF pregancy was reported in 1978 by Patrick Steptoe (Dept. Of Obstetrics and Gynaecology, General Hospital – Oldham) and Robert Edwards (University of Physiology Laboratory - Cambridge), which resulted in the birth of the world’s first IVF babies. Their success was announced in The Lancet 1978, ii, p.366. In 1981, the Jones Team in Norfolk, Virginia, first American group to use IVF, further improved the procedure and developed their first test tube baby. In Taiwan, the first IVF procedure was in 1985.
Born in 1978 in Manchester, England, Louise Joy Brown – the world’s first IVF baby – is now, in the year 2008, 30yrs old. For the past 30 years since her birth, IVF has helped thousands of couples overcome infertility. Taiwan alone has succesfully produced a few thousand IVF babies. Current statistics show that in Europe, 3 out of 100 newborns are IVF babies; while in Taiwan, the ratio is 1 out of 100.
Stork Fertility Center (Lai’s Ladies Clinic) started to provide IVF procedures to patients in 1992. In 1993, a timeframe of just one year, we announced our very first IVF baby. In the subsequent 14 years of our practice, we have already delivered thousands of healthy IVF babies; with 80-100 successful births per year - a ratio which has been steadily increasing.
(Know more about the history of Stork Fertility Center)
IVF Procedure
IVF involves ovarian stimulation through oral medication or injectibles in order to increase follicle development. Once mature follicle count is ideal, oocyte retrieval is done using a thin, ultrasound-guided needle to harvest egg cells from the ovary under general anesthesia. Sperm is collected, washed and pre-selected.
(Know more about controlled ovarian stimulation)
Depending on the maturity rate of the oocyte, usually within 3-15 hours, the best quality oocyte shall be selected in order to be incubated in the laboratory with the sperm to induce fertilization. These will be closely observed within 15-17 hours in order to check if fertilization is successful. If yes, individual embryos shall be continued to be cultivated into 4-8 cells stage (2nd-3rd day), or blastocyst stage (5th-6th day), then a special designed tube shall be inserted into the inner uterus in order to transfer embryos.
Follicles stimulation – Oocyte retrieval – Pre-selection and incubation for fertlization – Embryo transfer – Luteal function maintenance – Waiting period for announcement of pregnancy – Embryo implantation in the uterine lining – Pregnancy confirmed – Child birth/ Delivery
(Know more about in-vitro fertilization)
(Know more about preimplantation genetic screening)
(Know more about embryo freezing)
Suitable candidiates for In Vitro Fertilization (IVF)
Couples must be legally married and healthy. Wife should have a normal uterus and husband should have sperm production (low count is acceptable). Couples experiencing any of the below problems can also utilize IVF to assist conception:
1) Both fallopian tubes for the oocyte to travel to the uterus are clogged
2) Mild to moderate emdometriosis
3) Infection of the pelvic area causing internal organ adherence
4) Male factor such as low sperm count, low forward progressive motility, abnormal morphology, azoospermia (no sperms produced)
5) Immune rejection disorder
6) Failure after 3-6 times of undergoing Intrauterine insemination
7) Unexplained infertility
8) Failure to achieve pregnancy even after 2 years of marriage with regular sexual intercourse
9) Above 35 years of age and desiring to conceive
Procedure guidelines and reminders
1) Prior to treatment
Couples should relax, continue with daily activity and exercise, regulate sleep to at least 6-8 hours every night, and make sure there is less pressure or stress in their lives. Trust in the expertise of the physicians and medical staff in the clinic. During the onset of the menstrual cycle, (prior to the desired month undergoing IVF), couples will need to visit the clinic for some preliminary examinations, which will determine which treatment is best based on specific conditions/problems.
2) Inducement of oocyte production and retrieval:
Short method – On the 3rd day of the menstrual cycle, follicle-stimulating hormone (FSH) injections will be prescribed by the doctor. Try to administer on the same time each day for 8 days. Dosages will depend on the individual’s conditions. At 35 years and below, dosage of 225IU FSH per day is normal. (Each injection pen and treatment package usually contains 2500IU)
Afterwards, clinic visits for progress examinations shall be required every 2 days. Usually around the 10th day to 12th day of injections, the oocyte will have matured. The physician shall then recommend the injection of hCG and at around 34-36 hours, oocyte retrieval shall be conducted. Sperm collection is also to be prepared at this time, awaiting the development of the retreived oocyte.
Long method – On the 21st day from previous cycle, the physician shall administer Supremon everyday. Supremon is a kind of medciation that down-regulate pituitary gland. Continue with this injection until the 2nd or 3rd day of the succeeding menstrual cycle. On the 3rd day, a clinic visit is required for blood test and vaginal ultrasound. If everything is in order, FSH shall be administered everyday starting from the 3rd day. Dosage shall depend on the individual’s conditions.
Afterwards, the procedure is the same as the short method above.
3) Luteal function maintenance
The patient needs to be administered a low dosage of hCG on 1st, 4th, 7th day after embryo transfer and supplemented with progesterone untill pregnancy test is done.
4) Ensuring better adherence of embryo to uterine wall
A low dosage of aspirin is prescribed to be taken everyday in order to improve the uterus conditions and blood circulation.
5) From the date of implantation until the announcement date, a period of about 16 days, the patient should refrain from any strenous activities such as extensive housework or stress-inducing work, exercise, sexual intercourse etc.
Pregnancy Rate
Today, undergoing one cycle of IVF yields an average success rate of about 35-40% (World Standards) This means, for every 100 couples, there are 35-40 pairs successfully achieving pregancy. The remaining 60-65% shall need to undergo a second or third cycle. Usually with confidence and patience, success is achieved in the second or third treatment.
Some of the most important consideration in the patients success rate are age, ovary conditions, semen/ sperm quality, embryo quality, the procedure of embryo implantation and health. For example, a 35-year old or below patient’s pregnancy rate is higher then a woman of a more mature age. Implantation of 2 top-quality embryos can increase the success rate to 50-60%.
(Know more clinical outcomes at Stork Fertility Center: oocyte recipient)
(Know more clinical outcomes at Stork Fertility Center: sperm recipient)
Multiple Births
The chance of multiple births with IVF treatment is about 25-30%; with twins being the most common. If the patient has a possibility of developing triplets or more, the physician will recommend a decrease in the number to be carried to term.
Because the Stork Fertility Center has reached world-wide standards, we are exerting our very best efforts to ensure multiple births will be limited to twins at the most to decrease chances of any pregnancy-related complications. Also, we are promoting blastocyst transfer and cryopreservation in order to decrease the rate of multiple births.
Ectopic Pregnancy (Pregnancy outside the uterus)
Possibility of ectopic pregnancy is around 5% for IVF. In normal/ natural pregnancy, the rate is about 2%.
Miscarriage
Miscarriage chances greatly depends on the age of the patient. The possibility, though, is not more than 20-25%. A more advanced age increases the risk of miscarriage. For 40 years of age and above, the possibility is at 38%.
Psychological Effects
Couples who experience infertility and have been undergoing treatments for a period of time can have increased stress levels due to the pressure, either financially or emotionally. It is recommended for couples to relax and try to decrease their stress levels and try to avoid feelings of sadness, anger or disappointment.
Should any patient require clarifications which will help relieve some of the emotional stress, staff at Stork Fertility Center is more than happy to provide any explanations. The hotline number is +886-3-523-3355 ext. 205. Everyone is welcomed to join the Stork IVF association.
Birth Defects
Reports indicate that there is no correlation between undergoing IVF and increased chances of birth defects or abnormalities. There is no need to worry. It is suggested for patients to undergo amniocentensis and high-resolution ultrasound examinations.
Potential Side Effects to undergoing IVF
1) OHSS (Ovarian Hyperstimulation Syndrome)
OHSS is a possible condition that may arise from taking fertility medications and injections. There is a 5% chance of acquiring mild OHSS, but there is a small percentage (about 1%) that is severe. Severe OHSS cases need to be treated in the hospital.
Symptoms of OHSS may include the following: enlarged ovaries, abdominal bloating and feeling of fullness, nausea, diarrhea, vomiting, less and frequent micturate, excessive thirst, fullness or bloating above the waist/in the chest area, pain, and shortness of breathe.
Symptoms for mild cases of OHSS will dissipate in about 2 weeks so please do not worry too much.
2) Ovarian Cancer
According to some studies, long term usage and administration of fertility medicines and injections may increase the chances of ovarian cancer. This may be caused by long term anovulation of the ovary. However, there is a large percentage of medical practitioners who also feel more studies and tests must still be conducted in order to prove this point.
Hospitalization
There is no need for hospitalization. 4-8 hours after embryo transfer, the patient can go back home. Stork Fertility Center has a pregnancy success rate of 55% without any hospitalization required.
(For oversea customers, hospitalization at clinic is provided)
(Know more about the surroundings of Stork Fertility Center)
Nutrition and Diet
There is no special diet needed. Patients can mostly continue their daily activities, simply avoiding any heavy lifting, strenous exercises and actions/ activities that can cause pressure to the abdominal area (such as: massage, pressing stomach, excessive laughter or nipple stimulation). The most important reminder is to relax and keep an uplifted spirit. Sexual intercourse during this period is also best avoided.
Expenses
One treatment cycle of IVF can cost from NT100,000 to NT150,000; including the fees for injections, ultrasounds, blood tests, oocyte retrieval, embryo transfer and assistance in embryo hatching to improve implantation potential.
If needed, additional special treatments or medications will incur additional costs. For example, cases wherein ICSI, blastocyst culture or emrbyo cryopreservation is performed.
Based on the costs for IVF treatment in Asia, Taiwan is the most cost-effective. Per treatment in China will incur expenses reaching RMB 40,000 and in Hong Kong, costs are in excess of HKD 40,000.
(Know more about the prices of Stork Fertility Center services)
(Know more about the prices of Stork Fertility Center services)
Conclusion
The success rates of IVF and ART treatment nowadays is already high. With patience and willingness to undergo the correct treatment cycles, there is no reason to give up hope of achieveing conception and fulfilling the dream of starting a family. It is important to select a doctor with at least 5 years experience (Medical residency lasts for about 3-4 years + 1 year professional practice). With these factors, it is very optimistic that you will have your own healthy baby soon.
This is the most fervent wish of our team at Stork Fertility Center and our driving force in continuously exerting our best efforts to upgrade our service systems in providing you excellent medical care.
Are you afraid of testicular sperm extraction (TESE)?
September 02, 2015
Before starting the IVF program, the diagnostic microdissection testicular sperm extraction can improve the success rate of surgical sperm extraction on the oocyte retrieval day. It would be a great news in the couples with azoospermia.
Azoospermia is a severe male factor in the infertility, and the occurrence is around 15% in the infertile men. There are two types of azoospermia,—obstructive and non-obstructive. In the patients with the obstructive azoospermia, the testes are able to produce functional sperms (spermatozoa), but the duct is blocked. In the patients with the non-obstructive azoospermia, the testes are unable to produce functional sperms, and the original cause have not been identified yet in 76% of the patients. The fertility specialist generally recommended these patients to take microsurgical epididymal sperm aspiration (MESA; in the patients with obstructive azoospermia) or testicular sperm extraction (TESE; in the patients with non-obstructive azoospermia) combing with intracellular single sperm injection (ICSI) in the IVF program.
The microdissection testicular sperm extraction (micro-TESE) has the advantages avoiding the damage of testes blood supply or larger trauma. It makes a small incision (4~5cm) on the scrotum to take testes out. After cutting the tunica albuginea along the equatorial plane, the seminiferous tubule can be examined and then be biospied under the operating microscope. If the diameter of a particular seminiferous tubule is over 300μm, the sperm retrieval rate could be significantly increased.
Seminiferous tubule diameter(μm) | >300 |
Sperm retrieval rate(%) | 84 |
However, the micro-TESE may not work in 40-50% of the patients with non-obstructive azoospermia. It could happen that no extracted sperms can be used on the oocyte retrieval day, and the patients must cryopreserve their eggs instead.
Therefore, the diagnostic microdissection testicular sperm extraction (diagnostic mTESE) was developed. The diagnostic mTESE is doing the micro-TESE before the operation on the oocyte retrieval day. By conducting the Touch print smear (TPS), the biopsied sample can be stained to examine the existence of mature sperms with the freezing tissue-processing method. The site of found mature sperms would be recorded as references for the operation on the oocyte retrieval day.
During 2012 to 2014, 152 patients with non-obstructive azoospermia were recruited to evaluate the efficacy of the procedure. In the recruited cohort, the sperm retrieval rate with diagnostic mTESE was 45.3%, and then the rate on the oocyte retrieval day is almost 100%. It strongly proved that an advance diagnostic mTESE could improve the sperm retrieval rate on the oocyte retrieval day. It could prevent the unexpected egg-freezing in the IVF program, and also lessen the psychological stress in the patients.
References:
2015 Symposium, The Taiwanese Association of Andrology
Microdissection testicular sperm extraction:an update. Asian J Androl. 2013 Jan; 15(1): 35–39Give thanks in all circumstances (Egg donation)
August 03, 2015
The 3S women (Single、Seventies [born in the 1970s]、Stuck) are both intelligent and independent. They bravely pursue for excellent success in their career and professions, but always forget to think about their marriage.
—She is a 3S woman and fortunately met the Mr.Right in her forties. Her appearance is still young and beautiful, but the ovaries is becoming to decline.
I married to a Japanese when I was 42 years old. My husband really likes kids and we hope that we could have a baby as soon as possible. But the problem is my age and irregular menses. When the doctor said that my AMH is only 0.16 ng/mL, which is approximate to the value in the menapause period, I started tearing up. Then I went home and tried to calm myself down.
In the next few days, I did so much online works, trying to figure out this problem. I suddenly found that egg donation is the only solution. However, egg donation was illegal in Japan, and thus I turned back to search for this service in my home country, Taiwan. I selected five popular fertility centers in Taiwan and made appointments for all of them. During the long vacation in Japan, I went back to Taiwan to "interview" all the candidates.
Eventually, I was impressed by Stork fertility center and made the decision after discussing with my husband. He came to cryopreserve the semen sample and also was surprised by the museum-like circumstances. He really appreciated that Taiwanese government provides the donation service and expected Japanese government to reconsider this necessity.
We didn't wait our donor for a long time. When I was suffering with my menopausal symptoms, my donor finished her donation program already. We were really grateful to hear that this lovely girl gave us eight embryos with wonderful appearances, frozen in the liquid nitrogen. My thoughtful agent and specialist instructed me step by step, including the exams for fallopian tubes and uterus. We hope that the precious embryo could implant into a cozy environment.
One of the advantages of freezing-embryo was that I could came back to Taiwan when I was totally free from my business. Probably because of the well preparation, I got my positive pregnancy test after the first cryotransfer. In this October, our little baby is coming to join this family, and I am going to celebrate my 44-year birthday as well.
We are lucky to have our own baby that soon. I strongly encourage those women who have a similar ovarian reserve result with mine to be open-minded to egg donation, and then you would enjoy being a mother soon.
Only Two shots!! The application of corifollitropin alfa helps you to have a baby in the IVF treatment.
January 25, 2014
Having an appointment with doctor is not a good memory, because it is always linked with taking bitter medicines, or receiving painful injections. Those amiable nurses always said, "it won't be that dread as it looks. Trust me! It’s nothing more than being bitten by mosquitoes. Ok, take a deep breath...!!" And you have known the result － it was really painful until you pressed the puncture wound for several minutes. Most people couldn't forget the fearsome to take the injections.
However, taking several injections is just the basic tips for the patients who are involved in the program of intrauterine insemination (IUI) or of in-vitro fertilization (IVF). Having one to three shots daily is one of the unbearable things besides waiting for the result of pregnancy test.
The primary follicle stimulating hormone (FSH) injection has been developed in 1950. Because of the unstable extracts, the quality of retrieved eggs was poor and the following results of embryo culturing were generally not good. The first generation of FSH shot was intramuscular injection, and it caused inflammatory reactions quite often. Until 90s, the 100% pure recombinant FSH shots have been released through the rapid growth of genetic engineering. It has not only increased the quality of retrieved eggs and the following cultured embryo, but also provided IVF patients a friendly operative method -- the injection pen. The easier way of taking shots encourages IVF patients to do the injections by themselves for saving the time costs, and the subcutaneous injection relieves the pain as well.
In spite of so many advantages of the recombinant FSH, the frequency of injection still couldn’t be reduced depending on the individual dosage. In 2011, a more advanced recombinant FSH, corifollitropin alfa (Elonva®), has been developed. It has a longer half life but with similar pharmacologic action in human body, which means that only one shot of corifollitropin alfa can stimulate the growth of ovarian multi-follicles for seven days. According to the official protocol, one shot of corifollitropin alfa plus several short-half-life FSH shots and antagonists of pituitary gland are required. But the frequency of injection seems not being reduced quite much.
Maturation rate of retrieved oocytes (MR) | Good embryo rate of Day 3 culture (GER)a | Good blastocyst rate of Day 5 culture (GBR)b | |
Corifollitropin alfa | 72.4% | 60.9% | 59.1% |
Traditional recombinant FSH | 78.5% | 61.3% | 58.9% |
bGBR: Inner cell mass at least > grade B, trophectoderm cell at least > grade C
(based on Gardner grading system)
Retrieving the oocytes with better quality has been a tendency in the IVF realm recently. The quality of oocyte is before the quantity of oocyte. Who said that IVF program equals to so many shots in your life? Two shots are enough!