The Key for Implantation - Endometrium Thickness 

In IVF, we’ve been discussing the ideal thickness of endometrium for implantation.

Besides, is the criteria the same for both fresh blastocysts and frozen-thaw blastocysts implantation? Will it be the same? We did not have many studies on the above issue.

This September(2018), Human Reproduction, a research team from Canada, using the database of local IVF treatment, analyzed over 40 thousand implantation cycles of both fresh blastocysts transfer(BT) and frozen-thaw blastocysts transfer (FBT).

A result had been found: Clinical pregnancy and live birth rates decline as the endometrial thickness decreases below 8 mm in BT and below 7 mm in FBT cycles.

As shown in the study,in the BT cycle, the pregnancy rate for endometrium thickness ≥8mm is 43.2%, the abortion rate is 22%, the live birth rate is 33.7%. Comparing to the statistics of thickness.

In FBT, the pregnancy rate of endometrium thickness≥7mm is 38.3%~38.4%, the abortion rate is 26~28.4%, the live birth rate is 27.4~28.4%. Comparing to the statistics of thickness.

To conclude, the indicator of endometrium thickness for implantation are as following: 

Fresh blastocysts transfer: ≥8mm

Frozen-thaw blastocysts transfer: ≥7mm

With a good uterus environment, comes with a better clinical outcome. Good things are worth waiting for.   

REF:

Hum Reprod. 2018 Sep 17. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: ananalysis of over 40 000 embryo transfers. Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N.

We lost our daughter on the day before Christmas Eve and could not fall asleep in the following 7 days . One Day, at 2 AM, I bought a magazine at 7-11, went to McDonalds and then ordered a cup of coffee. That was a quiet early morning; nobody was on the street. It made me felt like I was the only person in the world. After two weeks, my husband and I went back to work, because we shouldn’t stay at home and keep thinking about our baby daughter. Both of us are over 40 years old. Our Families, friends and doctors all told us " May her rest in peace, both of you need to let it go and move on." We try to make a new life, we scheduled to travel or be volunteers. One year passed, both of us still felt upset. So we made a decision: to make a IVF baby. In the  following two years, we had done IVF for 3 times. However, all of them were failed. because the reasons might be our eggs were fewer quantities, poor quality, no fertilization and abnormal development. As a result, our doctor told us no oocytes that they found via Ultrasonic and even told us to give up. That day I cried a lot, and told my closed friend. She mentioned about "egg donation". I did hear it before, but didn't understand it at all. However, I kept these words “egg donation” in my mind.

To maintain the success rate of artificial reproductive and to lower the rises of multi-birth. Countries have been giving out guidelines at numbers of blastocysts for implantation, which provides for different reproductive centers. How many should we transfer to provide the most genuine help? 


"The doctor told me that transferring 2-3 blastocysts are good enough, but my husband wants to do all 4 that all we have, as the previous 3 went through PGS were abnormal..." When I got your call, I can feel your worries, hopeless, hesitating, wanting to talk to someone.

one is the success rate of IVF, the other one is chances of having multiple births, how can we find the balance? From the perspective of modern artificial reproductive, the goal is to bring a healthy baby back home asap. 
Multi-pregnancy pregnancy bears high risks for the mother and the baby as well, including premature birth, gestational diabetes, pre-eclampsia, fetal underweight, etc., and there are risks in fetal reduction surgery.

To maintain the success rate of artificial reproduction and reduce the risk of multiple births, countries have begun to set guidelines for the fertility centers, suggesting the number of blastocysts for implantation.
How many should we transfer? How can we provide the most substantial help?

European countries set a guideline for themselves considering the number of implants, blastocysts grading, age, and other parameters.
According to the Taiwanese Society for Reproductive Medicine (TSRM), the suggested number of blastocysts for implantation are as follow. For blastocysts with normal PGS result, transferring one will be enough. 




Strok Fertility Center collected the four-year data from 2013.-2017.01, there were 2,857 thawed blastocysts implantation cycles, which were divided into five age groups according to the TSRM index. The average number of implants was 1.65 vs. 1.82 vs. 1.97. Vs. 1.98 vs.1.00; and multiple birth rates were 16.1% vs. 15.2% vs. 9.9% vs. 4.7% vs. 0.3%.


We measured the live birth rate data from the period of 2013.01-2015.12. There were 1,842 thawing implantation cycles, and the average number of implantation is 1.70 vs. 1.80 vs. 2.01 vs. 1.96 vs. 1.00. As for the live birth rate was 52.9% vs. 48.8% vs. 33.6% vs. 17.5% vs. 43.0%.


"Transferring a normal blastocyst, giving you a healthy baby" has always been our biggest goal. As we mentioned at the beginning, the client was facing a predicament that all the blastocysts were abnormal and cannot be implanted. 
Although she was 37 years old and the prevalence rate of embryo abnormality is high, I still did not recommend that she transfer all the rest four unexamined blastocysts. 

After listening to my analysis of the pros and cons, she thanked me happily. It seemed to help the client to clear her thoughts. I believe that no matter what the final decision is, she will be okay.


Reference: 
1.Clinical data by Stork Fertility Center
2.TSRM guideline (2016）

















Andi's word

1. The abnormal rate of the 37-year-old group woman is about 46.2% based on the PGS(preimplantation chromosome screenings)  test of 2,980  of blastocysts. However, according to the study of the relationship between
the result of transfer a single embryo with normal chromosome and the grading of blastocysts that published by our center in 2017, not every blastocyst is suitable for PGS, and the blastocyst with poor grades are more vulnerable even if the test results show that the chromosomes are normal. Result in a lower pregnancy rate.



2. The Taiwanese Society for Reproductive Medicine (TSRM) introduced a guideline based on the "maternal age", "with or without chromosome screening" considering the clinical data of local fertility institutions.
the success rate of transferring a blastocyst with normal chromosomes is about 60%, but it is true that not every blastocyst is suitable for biopsy and examination. As the way of cultivation might be different at each different institution (eg. splinter culture vs blastocyst stage culture), blastocyst parameters are different (pollardization time, appearance grading), different personal experiences (implanted several times, maternal environment), it is not the best way to apply one single fixed formula to each case.
The primary purpose of Personalized Precision(PP-IVF) is to provide tailor-made medical assistance that best meets the needs of the individual.

We have to keep a balance of the pregnancy rate and the risks of multi-birth. 
Other than adjusting the number of blastocysts for implantation, "immune system screening", " hysterosalpingogram (HSG) ", " Hysteroscopy ", and "ERA (Endometrial Receptivity Array)” etc. are also factor that might affect the bedding. We no longer just transfer with few blastocysts, we transfer the right one at the right time in the right place! 

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I am a woman who has gotten primary ovarian insufficiency, so I stopped having a menstrual cycle since I was in high school. I have to take pills to make my menstrual cycle regular. Thus, I started my infertility treatment immediately after I got married. However, I did not get any oocyte that could be used for my IVF treatment after several times doing the OPU (Oocyte pick-up) surgeries. After all of these treatments, I decided to do IVA (In Vitro Follicle Activation) test to know how many oocytes that I still have. The final test result is that I do not have any oocyte or follicle in my ovarian, and it also means that I don’t have any opportunity to use my own egg having a baby. Therefore, using an oocytes bank is my new hope to have a baby.

At first, we did some research online. My husband and I only found information on oocytes bank in the U.S., but price of these treatments were way too high than we originally expected. In the same time, my original clinic in Japan recommended us to go fertility center in Taiwan. After couple days discussion, my husband and me realize that we could do the oocyte bank in Taiwan, and the price of oocyte bank in Taiwan is more affordable than if we go to the U.S.. Also, the distance from Japan to Taiwan is much closer than from Japan to The U.S.. My original clinic in Japan introduced us to two fertility centers in Taiwan. At First, my husband and I had hard time to make a choice for these two fertility centers in Taiwan, so we e-mailed both of them in the same time. These two fertility centers were replied our question kindly and quickly. Eventually, we choose Stork Fertility Center because most Taiwanese to go here to do IVF or do oocyte bank. Even though another fertility center is more famous in Japan and we can find a lot of information online, we still believe that only local people know these fertility centers better than foreigners like us who from Japan.
   
In the beginning of September, we went to Stork fertility center first time. We took bus from Taiwan Taoyuan International Airport to High Speed Railway Taoyuan station for 15 minis, and we spend another 10 minis for taking High Speed Railway from Taoyuan to Hsinchu. The last step is that Taking a Taxi from High Speed Railway  Hsinchu station to Stork fertility center for 15 minis. When we arrived stork fertility center, and we saw a giant and elegant building in front of our face. If people do not know this building is a fertility center, people may think this building is an art museum. This how amazing that building is. Also, their staffs open the door for you, when you into lobby. I never see any clinic has this kind of service which is like you check in to a hotel.

Finally, we saw the person who was kept sending email with me is our Japanese consulter, Celine. She is a woman who looks very kind and outstanding. She helped us to figure out how to arrange some instruments of law for applying to the oocyte bank, and went to bank to exchange money. The most important thing is that stork fertility center will pay all of the taxi fees for their customers. Also, we have to exchange a large amount of money. It really makes feel safer and sweet that Celine can go to the bank with us. Especially, she found a bank which had a better exchange rate for Japanese to Taiwan currency. When we finished all of paper work for some instruments of law, we still had couple hours waiting for our first visit with deputy superintendentsur. Thus, Celine asked us if we want to have a dinner first, then she print out a map to us, and recommend us a famous local restaurant. Although this restaurant can’t speak Japanese, it still was a great experience to have such tasty food and experience Taiwanese culture.

The deputy superintendent in Stork fertility center can’t speak Japanese, but the first visit with deputy superintendent still was great because Japanese consulter will help translate very thing what deputy superintendent said to us. The Deputy superintendent patiently answer our questions and told to my husband and I that “ I think you will have your baby this year”. This sentence really cheers me up a lot, and helps me use a positive attitude to face the unknown future. Moreover, I noticed that the equipment are better and newer than Japan clinic during the tests. After these tests, we told our conditions to Japanese consulter because under reproductive law in Taiwan, oocyte receiver can’t know how oocyte donor look or any information of this oocyte donor.

When we got all of paper work and tests done, and there were a lot of Taiwanese patients in the waiting area. I recognized that no matter what country you go, there are always a lot of people who have infertility problems. Also, we make sure that the Stork fertility center is very famous and popular in Taiwan. Before we left Stork fertility center, my husband and I went to visit their room which is for foreigners. It is very clean and cozy, just like a deluxe hotel. It’s price for one night also a little bit high as well. Stork fertility center also help us to find a taxi to go Hsinchu train station, and we do not have to pay any fee for this ride.

After we back to Japan one month later, we received a message that they found a oocyte donor from Stork fertility center. However, this donor is not too fit with our expectation, so we decided do a one more round for pair up a new donor. Two weeks later, they found another donor for us, and my husband and I agreed with this donor. Therefore, this all pair process only took around one and half month. This is much faster than I thought. In the end of November, oocyte donor complete OPU (Oocyte pick-up) surgery. During this time, Celine kept updating every single detail of that oocyte bank process. Sometimes, I asked something is not that relate to this oocyte bank, Celine still answered my question very soon and accurate.

The Day Came that I do BT(Blastocyst Transfer). The Deputy Superintendent showed me the photo of that blastocyst before we start to do that surgery,and He told me that the process of thaw blastocyst is good. A minute later, Deputy Superintendent said this BT(Blastocyst Transfer) is going very well, and I still can’t believe that how soon that deputy Deputy Superintendent complete this surgery. Then they moved me to a quiet room for recover, and the staff also prepare a meal as my lunch. It really makes me feel warm and sweet. Two later, I did the blood test in Japan clinic told me that you are pregnant. From the first visit to I'm pregnant, my husband and me only spend four months. I would never believe everything will be that easy to happen.

After 10 months and 10 days, I have my own child, and my family. Even though I took a lot of convoluted path before I want to Stork fertility center, I hug my lovely daughter now. Before I see my daughter, I was worried about my daughter is not look like me. If she is not look like me, do I still love her without any question? However, I see my daughter at first sight. I know these worries are not necessary. I certainly sure I will love her, my daughter forever. Thanks so much to Stork Fertility center for bringing this amazing happiness to me, and also thanks Celine who is our Japanese consulter during this time. Choosing Stork fertility center is the most important choice in my life, and it is the most correct one as well.


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1. Having the blood test on the first day to third day of our period, and it can be used as an indicator to evaluate the "ovarian reserve".

When FSH is above than 10, it is more predictive.
However, 75% of women's ovarian reserve has declined, and this hormone is still within the normal range.
Once it is detected that this hormone has risen, it is usually too late.

AMH is expressed by granulosa cells of the ovary during the reproductive years. It declines with age and oocytes. Due to its high sensitivity, stability and low volatility, it has become the most important indicator for assessing the ovarian reserve.
1. As the age increases or ovarian reserve begins to decline, AMH will become lower and lower.

However, don't just trust the clinical values, because these indicators or the results of the test only present the status of the current ovarian function, rather than predicting the outcome of pregnancy. As long as we grasp the prime time of pregnancy and do not give up easily, I believe that the happiness in the future will not be too far away. 





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