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Distance makes the hearts grow stronger

No distance is too far for the two loving hearts

If the love is true, 

the distance is just the power of making people grow.

As the metro pulled out of the station, the man wrote "I love you" on the window. His girlfriend left on the platform, and still gazed into his eyes. It was always not easy to say goodbye for them, especially the following flashbacks after separation.

In the patients at our fertility center, some couples are living apart by necessity. Their husbands could be in the army, fisherman, or overseas businessman. The wives need to face the daily challenges bravely and maintain their home fully.

She was 37 years old and married her husband 7 years ago. They had no children yet. Before visiting us, she had tried IVF three times and undergone several embryo transfers at the other clinics. The ending of this journey seemed still unclear. The doctor arranged the hormone tests of AMH (as an index of ovarian reserves), Prolactin (PRL), and Thyroid stimulating hormone (TSH), to evaluate her body status.

Her PRL value was higher than the reference, suggesting that it might interferes the ovulation. Usually, the elevated PRL could be found in the women with breast feeding. However, the PRL could also increase in the women lack of sleep or under stress. The elevated PRL causes hypogonadism, possible anovulatory, and a decrease in menstruation.

The doctor gave her some medications for the hyperprolactinemia, and subsequent IVF treatment. With a declined AMH value as 1.63 ng/ml, the individualized controlled ovarian stimulation protocol was designed. Since her and her husband lived apart, the doctor planned the strategy of egg collection to fit their schedule. The capacity of female eggs are highly correlated with the maternal age. Therefore, the doctor recommends them to collect at least 15 eggs to increase the possibility of success pregnancy. If she would like to have two children, more eggs could be required.

Entering the IVF cycle again made her feel lonely and stressful. After work, she took the bus from Keelung to Hsinchu, and walked to our clinic. The commuting would take three hours every time. Thus she visited us late, and was always the last one at the clinic suite. The obvious exhaust and anxiety showed on her face. She was afraid that she could not catch the lastest bus up. We all knew that it was such a difficulty to her.

Five mature eggs were collected in the first cycle. In this egg retrieval, the doctor found some unsynchronized follicles with small size. Thus she went through the subsequent duoble-OPU to get the surplus eggs. Until she had 8 eggs, her and her husband decided to give a first try.
Her husband came to our clinic for sperm collection and then the embryologists thawed her eggs to perform the following fertilization. They got 2 blastocysts and transferred the one grading as 5AB freshly.

She got pregnant by this good blastocyst!

Although this journey was hard to her, she insisted to continue. With such a brave heart, she is ready to be a mother.
Stork Fertility Center Stork Fertility Center Author

Does the mild stimulation improve embryo euploid rate in diminished ovarian reserve women?

The psychological and financial burden of IVF increases while the ovarian function declines.

If the frequency of injection decreases, would the patients still have enough embryos for transfer?

Women with diminished ovarian reserve (DOR, which was defined as Anti-mullerian hormone < 2 ng/ml and Antral follicle count ≦ 5 here), are confronted with insufficient ovarian reserve. Although controlled ovarian stimulation (COS) is an efficient treatment for infertility, it involves costly injections for the purpose of retrieving more oocytes during cycle. In order to evaluate the efficiency of different ovarian stimulation protocols in DOR patients, the chromosome constitution identified by using NGS platform was used as a parameter for assessing the embryo quality.

During January 2015 to June 2016, 52 patients (mean age: 38.1 years) with AMH < 2 ng/ml and AFC≦5, were randomly assigned to undergo strong stimulation (long-acting r-FSH and short-acting r-FSH with daily injections), or mild stimulation (short-acting r-FSH with every-other-day injections), or mini stimulation (clomiphene citrate only or natural cycle). A total of 139 embryos from 86 IVF/PGS cycles were biopsied on culturing day 5 or 6, and then analyzed on NGS platform (Miseq®).

Compared with strong stimulation group, mild and mini stimulation groups result in fewer retrieved oocytes per cycle. (Strong:6.1# Ovum; Mild:4# Ova; Mini:1.9# Ova). Moreover, studied patients with advanced maternal age (≧38ys) undergoing mini stimulation showed a tendency to possess more embryos available for biopsy in total retrieved oocytes (Mini: 64.4% v.s. Strong: 35.9%). And the euploid rate of mild and mini stimulation groups were higher than that of the strong stimulation group (Mild plus Mini: 27.6% v.s. Strong: 20.8%). It is known that the euploid rate decreased with increasing maternal age, and mini stimulation seems to have the potential to improve the euploid rate in the patients with DOR.

The preliminary data suggests that different ovarian stimulation strategies could affect the number of retrieved oocytes and chromosomal abnormality of embryos. A friendly ovarian stimulation strategy should concern both the efficiency and the feeling for patients.
Stork Fertility Center Stork Fertility Center Author