Oocyte Freezing – A Friend from Shanghai
11/29/2019 08:32:00 PM
Oocyte Freezing – A Friend from Shanghai
Becoming a bride and becoming a mother are two important life events for women. However we cannot predict future. When will we fulfill our dream? When can we meet Mr. Right? Why not embrace the freedom of uncertainty? Oocyte freezing is a good choice for us to free ourselves.
By Dr. Stork Lai
Engagement is a promise to get married.
Oocyte freezing is insurance for having a baby in the future. Becoming a bride
and becoming a mother are two important life events for women. To whom will you
reach out your hand for such important events?
We have a lot of clients from oversea. Clients
from Mainland China are lesser. But it’s increasing these two years. Most of
them are “high difficulty” cases. For example, primary ovarian insufficiency, habitual abortion, genetic disease
and fail for a lot of times. However, there was no one from Mainland China came
for oocyte freezing program. And she became the first one.
I met her
last March. She came with her friend. They met each other when they studied in
Europe. This Taiwanese friend froze her eggs few months earlier, because she
had goals to reach at the time. After freezing, her future seems to be full of
hope, which made her felt great and wanted to share with her friend and leaded
to our first oocyte freezing client from Mainland China.
It’s easier
when you have a friend accompany with you. After first consultation, she
brought back all the injections needed in the program. I designed the simplest
stimulated protocol for her. Which not only can minimize the time she came to
Taiwan but also retrieve more oocytes. Moreover, in order to avoid ovarian hyper
stimulation syndrome, I choose to use GnRHa as trigger injection.
We met
for the second time on the ninth day of her period. She came for ultrasound and
blood test and get total 19 follicles. Two of them are large, six in medium
size. The others are small ones. Because the growing speed of the follicles
were faster than expected, we do oocyte retrieval two days earlier than my
original plan. We got 22 oocytes in total. Exclude one bad quality oocyte and
two immature
ones, 19 mature oocytes were frozen.
Life is full of uncertainty. When will we
fulfill our dream? When can we meet Mr. Right? Why not embrace the freedom of uncertainty?
And try to do what you can do for your future self. She only came to Taiwan two
times and stay for about a week. Except came for following check up shortly,
she was traveling Taiwan for most of her time. Experience beauty of nature and
exotic culture.
Can oocyte freezing bring blessing and good
luck? I received a box of delicate wedding cake a few days before. The familiar name printed on the card
surprised me. She studied in America and had a great job after graduate.
However, she hadn't get married. And came for oocyte freezing around 40 years
old. And after two years, she finally met the one she wanted to walk down the
aisle with. She is the first one who get married after oocyte freezing. I'm so
happy for her.
Before
oocyte freezing, there are three questions I will ask. "Do you have a
boyfriend that you are considering marry him?","Will you get married
within 2 to 3 years?", "How many children do you want after you get
married?". I've ask her before. Although the answer was no, she finally
found the one, which makes me very happy.
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WhatsApp：The Depressing “8 accidents” of IVF Treatment
11/29/2019 02:46:00 AM
What is the most depressing part of IVF?
For younger women with abundant ovarian reserve, the process would be smoother.
Usually, 1-2 times oocyte retrievals are highly possible to create a baby.
However, for women over age 38, there might be numerous obstacles.
Age> 38 and AMH< 2 are 2 indicators
of “Diminished ovarian reserve”.
The following situations are “8 accidents” we
concluded from our previous experience.
Bad response
|
For example: We saw 5 small follicles on
D1-3 of the patients’ period. However, the number of follicles decrease after
stimulation. The primary reason of this situation is the bad quality of
follicles which are not able to proceed developing.
|
Earlier ovulation
|
The ovulation should occur at 36-40 hr
after trigger. However, if the ovulation occur earlier then we expect, we
might not be able to extract the oocytes when operation performing.
|
Empty follicle
|
Usually, there would be an oocyte inside
a follicle. However, in some cases, there might be no oocyte in the follicle,
which we called a “empty follicle”.
|
Low good oocytes rate
|
The good oocytes rate for women under age
35 is over 70%. For women over age 40, the good oocytes rate is lower than
50%. Even worse, some of the oocytes might be defective for insemination.
|
Low fertilization rate
|
The overall fertilization rate is about
70%. However, for some cases, the fertilization might be lower than we
expect.
|
Abnormal fertilization
|
The fertilization might turn out to be
3PN or other abnormality.
|
Not dividing
|
95% of the fertilized eggs would go on
cell division. However, some of them might not undergo cell division.
|
Stop developing
|
The normal embryos will divide in 15-17
hours. The embryo should acquire 6-8 cells after 3-day culture. However, the
embryo might stop developing during the culture, which will end up no embryo
for further transfer or freezing.
|
How to prevent these 8 accidents?
Bad response
|
Planning the PP-IVF (Personal Precision
IVF), such as mild stimulation, natural cycle or D-OPU.
|
Earlier ovulation
|
The time point of trigger is different
depends on the age. For women under age 40, we only trigger when the
follicles are bigger than 17 mm. For women age under 40, we would adjust the
trigger at 15-17 mm follicles size. Since the follicles walls of older women
are less flexible (might rupture when the size is 20 mm), we can use the prostate
gland inhibitor (anal suppositories) to prevent the rupture at 8-14 hrs prior
to the oocyte retrieval.
|
Empty follicle
|
There might be truly no oocytes in the
follicles. Otherwise, the time point and the method of trigger might also the
reasons of empty follicles. In this case, we can try adjusting the time or
the gesture of the trigger.
|
Low good oocytes rate
|
The oocytes would be observed by
embryologist after the operation. Those defective oocytes are neither
predictable nor not able to undergo fertilization. What we can do is to keep
collecting more oocytes with good quality.
|
Low fertilization rate
|
The low fertilization rate is related to
the quality of sperm and oocyte. The quality of the oocytes is depending on
the age, when is unalterable. What we can try is using microscopy with higher
resolution (6300X IMSI) to choose sperms with better quality.
|
Abnormal fertilization
|
Usually, for those who have fewer
oocytes, ICSI is used as the first priority method of fertilization. The cause
of this situation are mostly the chromosomal abnormality of the oocytes. What
we can do is to keep collecting more oocytes with good quality.
|
Not developing
|
The cause of this situation is more
related to the quality of the oocyte. What we can do is to keep collecting
more oocytes with good quality.
|
Stop developing
|
From the genetic aspect, the better
embryos have higher possibility to keep developing. The abnormal embryos would
be naturally eliminated and often stop developing at D3-4 of the culture. What
we can do is to keep collecting more embryos with good quality.
|
Under which circumstances should I consider using
oocytes from younger donor?
According to our statics, for women at age
43, it might take 120 oocytes to successfully bring back a baby. The live birth
rate each oocyte retrieval and transfer is only 3.5%. Under these conditions,
do you still have the courage to keep going? If the answer is uncertain, maybe
you can start considering the oocytes recipient program.
We suggest women with
the following conditions to consider using oocytes from the donor:
1.
Women older than 43 years old.
2.
Continuously getting empty
follicles for 3 times oocytes retrievals.
3.
Continuously getting 0 oocytes
for 3 times oocytes retrievals.
4.
Continuously having 0 embryos
for further transfer for 3 times.
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