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Quality and quantity , Guide for transferring blastocysts

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.

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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[Patient Testimonial] advanced maternal age with Egg Donation

My baby just finished his milk; and now he was sleeping in my wife arms while I was writing our story. My wife held my hand and gave me a lovely smile. This simple happiness made me so happy. However, this simple happiness was hard to come by.
My wife and I were considered as late marriage. After marriage, having a child was not our top priority because we were concerned about work, life, and dream more. Around 7 years ago, by seeing friends and colleagues sharing their happy family life with their children, suddenly I felt it’s time to have a child. I discussed with my wife and realized that actually my wife had been thinking about having a baby for a long while, but she never told me because she chose to support and respect my decision. Therefore, we started to trying, completing our physical checkup, taking Chinese-medicine therapy, exercising, adjusting daily diets and living...etc. However, my wife didn't get pregnant. About 3 years ago, we accepted the treatment of IUI, but it didn't work out. We were so disappointed, but we still believe we should try our last chance, IVF.

I still could remember the day we went to see our doctor, it was on February, 2016, it was still cold in Hong-Kong. We met the doctor of Reproductive Medicine from Hong-Kong. He told us" Look at the number of the chart. Because of your age, success rate of IVF is still very low. To be honest, I would like to suggest you not to waste your money on this valueless treatment. Nevertheless, if you still insist on trying, I will try my best to help you. " We appreciated the meaning of doctor's truth and we felt hopeless after the appointment.

We didn’t say any words on the way home; we could not stop crying when we were home. I still remembered that heartbreaking feeling. We decided to have one last treatment of IVF in Hong-Kong. After that, we experienced 4 months treatment: medicine, injection, ova harvest ...etc. Finally, we collected 3 eggs, but only one egg grew up to day 3. We transferred the embryo without knowing the quality of the embryo because they didn't explained it. It had a fair knowledge of consequence, my wife didn't get pregnant. We accepted the result with peace and calm this time.

We didn't give up! And Keeping trying to find hope and success. Suddenly, we have found many research paper all mentioned about "44 years old" is a boundary lines to accept the suggestion of egg donation. What a coincidence, that's also my wife's age of that year. That was the first information regarding egg donation. Therefore, We did lots of search and also knew Stork Fertility Center which is the top of this field, and then we registered for consulting.Soon, the consultant of Stork Fertility Center reached us, answered us all the question of regarding egg donation with detail patiently. So that we made decision right away. Based on the Tawianese law, In order to have the IVF treatment in Taiwan, we needed to prepare the document for proofing our legal marriage. We spent a little long time with it. However, thanks to the consultant's assistant, we had our all paper works ready.
Maybe we've got many frustration in Hong-Kong. “So that we looked so tired while arrived Stork Fertility Center.” For that reason, we looked listless when we first time met Doctor Wang. However, Doctor Wang's profession and confidence that gave us a lot of hope.  Also he gave us detail explanation on our report of physical checkup, which let us know we still have some positive side. After that, we've stayed couple days in Taiwan. We went to Pingxi for sky lanterns. Wishing for good luck, we left the words "Wishing for a baby boy and making us happily after".I thought the God heard our wishes, we found the right girl for egg donation. We trusted this team so much, so we didn't take long time to make decision on each step and also believe in Stork Fertility Center would help us pick the best option. For example, there was quality issue on my sperm, after reviewing my physical checkup. Therefore, they suggested the best way for us is using fresh sperm instead frozen sperm to get the good blastocyst. The only thing I needed to do was an extra trip to Taiwan. Everything went so well and showed all suggestions Stork Fertility Center made were so right. We got many good blastocysts. Also we took their advice to transfer one blastocyst that professional team chosen. After transferring, we went back to Hong-Kong waiting and waited for good news.

We really appreciate all the assistant from Stork Fertility Center. Without their support, we wouldn’t have such hopeful treatment on IVF.Eventually, we would like to tell our anonymous egg donator: “Thank you so much for everything. What you did was so meaningful for us. Your sweet heart made our wishes come true and also gave us a completed family. We wish you live happily ever and after.”

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