Checkups for Infertility couples
6/30/2020 05:43:00 AM- Female
Hysteroscopy (H-scopy)
Purpose:
H-scopy uses a hysteroscope to examine if the uterus and uterine lining are normal. There is a direct correlation between the condition of the uterus and embryo implantation.
Procedure:
Patient will be asked to lie on her back on the examination table with feet raised and supported by stirrups, similar to a pap smear or vaginal exam. An optical instrument connected to a video unit with a fiber optic light source is inserted to check the conditions of the uterus.
If only a simple examination is required, there is no need for anesthesia. The whole process takes about 3 mins, after which, the patient is asked to rest for another 30 mins. For further examination and operation, anesthesia will be administered and the process will take about 5 mins. Resting period is an additional 1-2 hours.
Patient will be asked to lie on her back on the examination table with feet raised and supported by stirrups, similar to a pap smear or vaginal exam. An optical instrument connected to a video unit with a fiber optic light source is inserted to check the conditions of the uterus.
If only a simple examination is required, there is no need for anesthesia. The whole process takes about 3 mins, after which, the patient is asked to rest for another 30 mins. For further examination and operation, anesthesia will be administered and the process will take about 5 mins. Resting period is an additional 1-2 hours.
When to test:
Best time to test is after the last menstrual cycle and before ovulation takes place for the next cycle. If it is a regular cycle of 28 days, the best time will be in the morning of the 7th to 11th day.
Cervical cultures
Purpose:
Inflammation of female genital tract includes viginitis, cervicitis, salpingitis and pelvic inflammatory disease (PID). Chronic inflammation may cause endometirum polyp(s), tubal adhesion, obstruction and/ or hydrosalpinx, etc. Bacteria, Chlamydia trachomatis and human papillomavirus (HPV) are 3 most common pathogens.
Inflammation of female genital tract includes viginitis, cervicitis, salpingitis and pelvic inflammatory disease (PID). Chronic inflammation may cause endometirum polyp(s), tubal adhesion, obstruction and/ or hydrosalpinx, etc. Bacteria, Chlamydia trachomatis and human papillomavirus (HPV) are 3 most common pathogens.
Auto-immune system
Purpose:
Through blood tests, we can determine whether patients' immune system is normal or not. Some patients' immune system will attack embryo after implantation, which will affect its bedding procedure or even cause miscarriage.
Through blood tests, we can determine whether patients' immune system is normal or not. Some patients' immune system will attack embryo after implantation, which will affect its bedding procedure or even cause miscarriage.
We suggest blood tests if you have any of the following symptoms :
1. infertility with unknown reason, advance age, premature ovarian failure, constitution allergy
2. Recurrent miscarriage or habitual abortion ※Def : ≥ 2 miscarriages within AP20wks
What items are included in the blood test ?
1. Anti-Thyroglobulin antibody (ATA)
2. Anti-Thyroid peroxidase antibody (Anti-TPO)
3. Anti-Extractable nuclear antigen antibody panel (Anti-ENA)
4. Anti-Thyroglobulin antibody (ATA)
5. Anti-Thyroid peroxidase antibody (Anti-TPO)
6. Anti-Extractable nuclear antigen antibody panel (Anti-ENA)
7. Anti-Phospholipid antibody (APS)
-Anti-b2 glycoprotein IgG/IgM (B2GP)
-Anti-cardiolipin IgG/IgM (ACA)
-Lupus anticoagulant
Blood test for
couples’ chromosome
Based on
stats, over 70% of spontaneous abortion are related to abnormality of fetus’
chromosome. It is important to check for couples’ chromosome if you have any of
the following symptoms:
- Infertility with unknown reason, poor sperm quality, azoospermia
- Fail implantation with accumulated 4 GBR or 2 blastocysts with normal
chromosome
- Recurrent miscarriage or habitual abortion
※Def
: ≥ 2 miscarriages within AP20wks
- Male
For patients that cannot find sperm at multiple sperm analyses, doctor collect the first will collect urine sample after ejaculation, to eliminate the possibility of obstructive azoospermia. After that, blood tests are suggested to evaluate patient’s spermatogenesis.
How to read the reports?
Dysfunction of hypothalamus or pituitary gland (lack of hormone to produce sperm)
|
Blood test
results
|
Low in FSH & LH
Low in Testosterone High in PRL |
|
Treatment
|
Treat with injections (retain
hormone supplies)
Treat with medicines Transfer to oncology after Docotr`s evaluation |
Dysfunctional testiculus
|
Blood test
results
|
High in FSH & LH
Testosterone normal or lower than average High in PRL |
|
Treatment
|
Treat with injections + MESA /TESA
IVF with donated sperm Treat with medicines |
Ductus deferens blockage
|
Blood test
results
|
Normal in FSH & LH
Normal in testosterone |
|
Treatment
|
MESA
/TESA
|
Based on
stats, over 70% of spontaneous abortion are related to abnormality of fetus’
chromosome. It is important to check for couples’ chromosome if you have any of
the following symptoms:
- Infertility with unknown reason, poor sperm quality, azoospermia
- Fail implantation with accumulated 4 GBR or 2 blastocysts with normal
chromosome
- Recurrent miscarriage or habitual abortion
※Def
: ≥ 2 miscarriages within AP20wks
Endometrial Receptivity Array (ERA)
6/24/2020 02:02:00 AM
Have you ever heard
the phrase of personalized precision IVF?
Nowadays, the
individualized medication is more prevalent.
Embryo implantation is a highly complex process
incorporating with a healthy embryo, a receptive endometrium, and a molecularly
communicative dialogue in between. Until 2016, Stork Fertility Center has
comprehensive applied individualized
COS, IMSI/ICSI, blastocyst culture, PGS/PGD, donor
gametes, and frozen
embryo transfer for
the cases with specific indications. Moreover, all patients would be requested
to take the hysteroscopy, hysterosalpingograrphy, and cervical
bacteria culture before
entering the transfer cycle. However, still, some patients failed after couples of transfers.
Why?
Except for the quality of embryos and the physically
normal observation of uterus and endometrium (EM) through ultrasound, a hidden
culprit must exist in between—the dialogue for permitting implantation.
Actually, the human endometrium is a dynamic tissue, which undergoes changes
during multiple levels in a menstrual cycle. The changes in histological markers,
biochemical markers, molecular markers, and transcriptomics (Omics) have been
reported in the previous articles. Generally, the period of EM receptivity is
known as the "window of implantation, WOI," which opens during the cycle day 19 or 20
and remains open for 4-5 days. During WOI, the EM becomes functionally
competent for the embryo implantation.
Using the assisted statistical tool, principal
component analysis (PCA), hundreds of transcriptome (gene expression) during
different phase of EM (proliferative [PE], early secretory [ESE], mid-secretory
[MSE], and late secretory [LSE]) could be analyzed and clustered into four
groups: proliferative, pre-receptive, receptive, and post-receptive.
Through
examining these transcriptomes in EM biopsies from different people, several
studies found that the WOI is not fixed, as was believed before. It means that
a fixed transfer protocol to all the patients could not be applicable. Thus
several clinical approaches for detecting the receptivity of EM tissue were
developed recently, and the endometrium receptivity array (ERA) was one of
them. The ERA was used to analyzed the expression of 238 genes in an EM biopsy
obtained from either an HRT or natural cycle. After priming of progesterone in
an HRT or of LH in a natural cycle, the EM would be biopsied and analyzed. If
the result showed receptive, transferring embryo at the same time in another
cycle would be recommended. If the result showed non-receptive, transferring
time would be adjusted according to the expressions of pre- or
post-receptivity.
Based on the clinical trial of IGENOMIX, a leading team of reproductive genetics in Spain,
around 30% in the population had a WOI which is not located in the general
frame (P+5 or LH+7), and four-fifths of these non-receptive are pre-receptive
(80%). The introduction of ERA has been reported to solve the problem in part
of patients suffering from repeated implantation failure, and thus to increase
the success rate in IVF.
At Stork
Fertility Center, the indications for ERA is as below:
A. Repeated implantation failure after undergoing hysterosalpingogram, hysteroscopy
and autoimmune examinations.
B. Repeated failures after transferring four Day 5 blastocysts graded over BB
in accumulationThe 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”.
C. Repeated failures after transferring two euploid
blastocysts in accumulation
D. Elderly women over 43 years old.
The pregnancy rate of transferring a good blastocyst with
PGS+ERA can reach 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”.
Basic Examination
6/11/2020 02:31:00 AM
To realize the cause of
infertility, we suggest both of the spouses undergoing the following basic
examinations:
Preparation for a newborn
The process of pregnancy creates the
strongest bonding of mother and baby. Women’s body is designed as a palace
welcoming the new birth. The most important 3 factors of a pregnancy are:
ovaries, fallopian tube and uterus.
FEMALE
FEMALE
Hormone Study
To estimate the rate of potentially
successful pregnancy and if there are any hormonal imbalanaces that causes
infertility.
3 indexs of ovarian function:
3 indexs of ovarian function:
1.
Prolactin (PRL)
Secreted by pituitary gland, PRL is considering as antagonist of hormone
regarding the growth of follicles. Therefore, higher PRL level would inhibit
the ovulation, and leads to infertility.
2.
Thyroid-stimulating hormone (TSH)
Secreted by anterior pituitary, higher TSH is usually associated with
hypothyroidism. Since the structure of TSH is similar to ovulation related
hormone such as LH and FSH, higher TSH would also affect the function of
ovarian.
3.
Testosterone
Excessive androgenic hormone due to PCOS or congenital adrenal hyperplasia
would lead to female infertility.
Ovarian Reserve Examination
The number of oocytes of a female is
fixed after birth. There are about a million of primary oocytes on both sides
of the ovaries. As getting older, the number of oocytes would decrease
gradually. By taking a blood draw, ovarian reserve examination allows us to
realize the ovarian function, which also can be interpreted as a reference for
the following treatment.
2 Major Index of Ovarian
Reserve：
- Anti-Mullerian hormone
(AMH)
AMH, secreted by follicles, is the
most important index of the ovarian function. AMH由level would be lower as the number of follicles decline.
The correlation between AMH and age：
Age
|
25↓
|
35y
|
38y
|
40y
|
43↑
|
|
AMH
|
International
Facilities
|
above 6
|
4
|
3
|
2
|
1
|
Stork Fertility Center
|
above 6
|
2.2
|
1.3
|
0.9
|
0.7
|
|
2.
Follicle Stimulating Hormone (FSH)
FSH is one of the
hormone that stimulate the maturation of follicles. Secreted by pituitary gland,
FSH is also an ovarian reserve index. To rule out the fluctuation, FSH is
suggested to test on day 1-3 of the period and repeated for 2-3 times. When FSH>10
mIU/mL, the ovarian function is considered as hugely decline. (Note：For patients who
have done the ovarian surgery or endometriosis, FSH would not be able to
represent the ovarian function)
Antral follicle counts (AFC)
AFC is examined on day 1-3 of the
period by ultrasound.
Hysterosalpingography(HSG)
Fallopian tube is the spot where the sperm meet the oocyte. Therefore, the
patency of the fallopian tubes is important for the following treatment. Intrauterine
Insemination(IUI) and Timed Sexual Intercourse(TSI) are both applicable if the
fallopian tubes are patent. However, if
there are obstruction or hydrosalpinx in the fallopian tubes, the chances of
ectopic pregnancy would increase. Also, the embedding of the embryo would be
affected because the inflammatory fluid may flow into the uterus. The best
solution of patients with blocked fallopian tubes is to undergo a Salpingectomy
and IVF.
HSG is an X-Ray test to examine the condition
of the fallopian tubes and uterus to determine if there are any blocked tubes,
abnormal uterine structures or growths. It’s recognized as a simple, convenient
and with 80%-90% accuracy.
HSG
must be conducted after
menstrual period and before ovulation. If cycle is regular (28 days), it is
best to conduct the HSG on the 7th -11th day of the cycle. If doing the HSG
after day 11 is inevitable, contraception measures must be fulfilled throughout
the cycle in case of pregnancy.
The test is usually done in 5-10 minutes, and the doctor will explain the result on the same day.
The test is usually done in 5-10 minutes, and the doctor will explain the result on the same day.
Transvaginal Sonography(TVS)
Sonography (sona) is used to check the
interval reproductive organs for any abnormalities, including the cervix,
uterus, ovary and endometrium lining. It is also used to estimate ovulation
period and measure uterine wall thickness.
Period
|
Examination
|
Purpose
|
Day 1-3
|
Size of follicles and
ovaries
|
Ovarian function
assessment
|
Day 12
|
Number and size of the
follicles
|
Prediction of
ovulation
|
Day 12
|
Endometrium thickness
|
Environment of embryo
embedding
|
No discharge
|
Structure and size of
uterus
|
Environment of embryo
embedding
|
The
sona technician will cover the probe with a condom and gel, and then, insert it
into the vagina slowly. The probe sends out sound waves, reflecting body
structures to the computer, creating pictures. The procedure would take about 3
minutes.
MALE
Semen Analysis
Semen Analysis
Semen Analysis is done according to 2010 WHO regulations in order to test the forward motility, quality and quantity of sperm collected.
·
Total
Sperm number: >39 millions/ ejaculate
·
Total
Motility: >40% motile
·
Progressive
Motility: >32% with forward motility
·
Sperm
Morphology: >4% normal forms
※ The formation of sperm cells requires
72-75 days. The quality of sperm is easily
influenced by external factors, such as: change in seasons, temperature, body
condition and living standards. Handling of semen sample is delicate.
It is not suggested
to rely on the results on the first testing due to above possible factors
affecting the result. It is better to undergo at least 2-3 examinations.
When could I have the sample collected?
Make an appointment with the fertility center after consultation with the doctor. Please avoid sexual intercourse for 2-7 days prior to the intended day for sample collection.
Make an appointment with the fertility center after consultation with the doctor. Please avoid sexual intercourse for 2-7 days prior to the intended day for sample collection.
Where to do the
examination?
At Stork Fertility Center – We will arrange a private and cozy room for you.
Please collect the sample into a sterilized cup we provided by masturbating.
At your own place - By masturbation, collect the ejaculated sperm in the sterilized cup. Within 60 minutes from time of ejaculation, retrieved sperm sample must be submitted to the clinic. Ideal temperature for transporting sample is around 25℃.
At your own place - By masturbation, collect the ejaculated sperm in the sterilized cup. Within 60 minutes from time of ejaculation, retrieved sperm sample must be submitted to the clinic. Ideal temperature for transporting sample is around 25℃.