Archive for June 2018

Third generation IVF Plus- Personalized Precise Implantation

Maybe you've been there, the transfer failed over and over again. Even with PGS, still get nothing. If someone tells you that with a good blastocyst and transfer at the right time. Pregnancy rate will rise to 80 %, Do you believe it?

Timing! Is either too early or too late, like a boy and a girl meeting at wrong timing─no good will come of it. It's hard to develop into a zygote (2PN) if the post-thaw mature oocytes form the oocyte bank fertilized at an improper time. That's why we use polscope to observe whether oocytes are fully expended or not. So we can perform fertilization accurately. Making post-thaw embryos have same fertilization rate and blastocyst rate as the fresh oocytes. However, is there a precise implantation timetable for bedding, as known as the WOI(window of implantation)?

Miss G, 43-year-old, from Beijing, picking up 6 oocytes at her last operation, transferring 3 early-stage embryos, but still didn't get pregnant. She came to our center looking for donated-oocytes. Then we quickly matched a donor with 12 mature oocytes for her. The post-thaw survival rate was 100% and thankfully 11 fertilized egg were cultured into blastocysts. With lots of confidence and expectation, two blastocysts was transferred. However, we didn't win the battle. In the next month, we repeated the process. β-HCG topped at 126 and dropped. Those oocytes quality was good as donors were in their twenties. Theoretically, the pregnancy rate could have been up to 90% by transferring 4 blastocysts in total. But the devils was in the details, we suggested her to take ERA(Endometrial Receptivity Array), nevertheless, she wanted to give it another shot before ERA.

https://www.e-stork.com.tw/images/180515_body.jpg

After taking a three-month break, transferring 2 blastocysts still bring us nothing. I called her after the pregnancy test result was released, but her husband lost all his faith, and planned to go all the way to the U.S, exploring for another clinic. I said give it a chance to the ERA! The ERA report indicated that the best bedding time would be at 144 hours after the progesterone infiltration. We did the first 3 implantation wrong. But with two blastocysts , precise implantation, and hallelujah, the β-HCG value went up to 1,989. She rejoiced in her pregnancy hood.

For the longest time, doctors has been using their experiences, transferring blastocyst(s) after giving progesterone for 5 days(120±3hrs). But after the long-awaited 15 days and still have only one line on the pregnancy test, yet don't know why? "Probability" or "abnormal chromosome of blastocysts" are the only comfort words to appease clients.

Indeed 60~70% of implantation failures are due to a chromosome abnormality, even some survive from the first round. Miscarriages are more likely to happen within 3 months, only a few exceptions will be given birth, eg. down syndrome babies. We recommend PGS for clients to avoid history repeats itself. Even though with the precise selection, transferring good blastocysts for few times and still get nothing ? What happened?

37-year-old Miss L, from Taiwan, had to abort because she was carrying a down syndrome baby. This time she asked for PGS. For the first oocyte retrieval, we picked up 10 oocytes and created 4 blastocysts. 2 out of 4 had normal chromosome, we transfer 1 blastocyst but failed. The second time, we transferred 1 blastocyst again but failed again. She thought that ERA was unnecessary due to past experience of natural pregnancy. With no normal blastocyst left, we had to operate again to pick up more oocyte. This time, 14 oocytes and cultured 6 blastocysts. We examined 4 blastocysts with PGS, only 1 of them is normal. For caution’s sake, we arranged ERA. Surprisingly, the WOI is also 144 hours after the progesterone infiltration. According to the result, with a normal blastocyst, precise transfer, β-HCG reaches 7,294! Hooray!

People become irrational when they losing faith, folk remedy, DHEA, Q10, inositol(vitamin B8), melatonin, vitamin D3… they eat at all they can, feeling like it is better than just doing nothing. On the other hand, the minority who still believe in science throw themselves to immunotherapy, even with normal immune index, human Immunoglobulin(IVIG) and heparin are injected as a drowning man will clutch at a straw. However, the result of spending more money is still the same, the truth has not been revealed yet.

Think about it! What else is unknown in reproductive sciences? Did we miss something between PGS and immunologic rejection? The blastocysts with normal chromosome will be accepted by the uterus no matter in what kind of circumstances? Other than having an ideal thickness of endometrium lining(10±1mm). Does everyone have the same scheme of progesterone infiltration?

The brand new ERA is to analyze the expression levels of the 236 genes from the endometrium cells. An informatic predictor is used to determine how long does progesterone infiltration take. That will lead us to the best bedding time. We call that "personalized precise implantation"

Since the technology was introduced in 2015, more than 40,000 big data have been accumulated so far, showing that up to 28.6% of the implantation time was wrong. That means, with only the doctor's experience, ¼ of the time is wrong.

More than 40% of our clients are from overseas. Many of them travel around, visiting several clinics. Various doctors, multiple implantation, but with the same result─still not pregnant. Most of these clients’ ERA result is different than others’, progesterone infiltration takes 12~24 hours longer. A very few of them takes 12~24 hours less. Usually, it takes only one implantation to get pregnant after adjusting the progesterone infiltration time. Only a handful need to take further treatments due to the immune system problems. We suggest her finishing ERA first to avoid wasting valuable time and embryos on the wrong way. Regard it as an upgraded version of the third generation of IVF (IVF 3.0+).

Trust Sciences! Trust Genetics! The pregnancy rate of transferring a good blastocyst with PGS+ERA can reach at 80%. On the other hand, 10~20% increase compared to those with PGS, only 60~70%. This is the Third generation IVF Plus: “precise selection + precise implantation”.

1. Miss G, from Beijing, IVF with donated oocytes

Implantation results are as follows: