Good blastocysts are far more precious than diamonds! If you wanna continue to collect good eggs to form good blastocysts, it will take longer. After all, the older you get, the condition of the eggs will only get worse...

A Birthday gift giving back to the future!

"I make that as a birthday gift to myself. Thanks to the advanced modern medical technology, I can freeze my fertility at this age and have a hold of my future."

I did not plan to have any children at first. I enjoy the time with myself and my freedom. That was me a few years ago. But people change, especially when you are at your most vulnerable moment when you are sick. Someone in the family got sick, everyone in the family is called up to help. That's when I realized you can never have enough family members. 

This is the moment when my thought of freezing my eggs appears. Your child is not necessarily staying with you the whole life. But it is always nice knowing that you have a family that cares about you. Raising a child is not an easy task in 2020, as well as having pets or keeping myself warm. 

The thought planted in my head for so long, it finally sprouted. I turned 39 this year, is the same age that my mother gave birth to me. Time is flying. I realize that I have to take some action! I studied a lot online and found Stork Fertility Center's website. They have detailed blog posts and graphics at a glance. Suddenly I apprehend that the quality of your eggs is tile with your age.  

When I realized that I am competing with time, I started doing research comparing different hospitals and fertility centers. I finally chose Stork Fertility Center. They specialize in infertility and fertility preservation. Their treatment plan aimed at achieving "4- F". Fewer blood tests, fewer ultrasound exams, fewer injections, fewer clinic visits. That's a big attraction for me as I can not get away from work that often.

I make that as a birthday gift to myself. Thanks to the advanced modern medical technology, I can freeze my fertility at this age and have a hold of my future. Some might say that you might never use those eggs. Why bother to spend all that money on that? I think egg freezing is like time traveling. When you are planning for a family maybe five years later, you will be thankful that you made the right decision. Time is irreversible, no matter how much money you own. A word before is worth two behind.

Stork Fertility Center's team is very professional and helpful throughout the treatment. They helped me to arrange the time so that I won't have to take so many off from work. In the end, I only take one day off for surgery day. The blood tests, ultrasound, and clinic visits were all arranged at mine non-working hours. They have their application. It shows your itinerary daily by just one click on your phone. And the surgery took only 10-15 minutes. The operation room's ambiance is warming, not like any other hospital. You feel comfier with the cozy atmosphere and friendly staff. 

Egg freezing is like insurance. You will feel safer after having one. This is probably the most meaningful birthday gift that I ever had. 

Note : 

1. Stork Fertility Center offers "4-F" treatment. Fewer blood tests, fewer ultrasound exams, fewer injections, and fewer clinic visits. The treatment is done with a minimum of two clinic visits. Just like our case above, taking only one day off from work! Before anyone knows, you already finished the treatment!  

2. The case froze ten mature eggs at her first treatment. 

Doctors suggest that the number of frozen mature eggs in each age group is different. It is related to age. With higher age, comes with a higher chromosome abnormal rate. Egg freeze treatment is suggested before age 35. The pregnancy rate and live-birth rate are relatively better. 

3.The recommended number of mature eggs for cryopreservation for bringing a baby home at different ages is as follows:

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Infertility is still a problem with a high prevalence rate in the world at the moment. Infertility affects about 8-12% of couples at reproductive age, and even affects up to 30% of the population in some areas. Statistics show that among married women, the incidence of primary infertility varies in women at different ages. For 15-34 years old women is about 7.3-9.1%, 35-39 years old about 25%, and 40-44 years old is about 30%.

There are many causes of infertility, among which male factors account for about 26%; female abnormal ovulation functions account for 21%, fallopian tube problems account for 14%, endometriosis accounts for 6%, dyspareunia account for 6%, cervix problems account for 3% and other unknown causes account for 28%.

Clinical statistics show that approximate 15-25% of women have experienced miscarriage. Most of the miscarriages occurred before 10 weeks of pregnancy, mainly due to chromosomal abnormality. However, "Recurrent Pregnancy Loss (RPL)” is a different disease. Recurrent Pregnancy Loss is defined as having more than two miscarriages. Among them, about 5% of women have experienced miscarriages two times, and only 1% have experienced more than three times.

There are many causes of Recurrent Pregnancy Loss, including genes, age, antiphospholipid syndrome (APS), thrombophilias, hormone or metabolic disease, infection, autoimmunity, sperm quality, lifestyle and other issues. Here we mainly include three articles with representative clinical treatment guidelines (2017 European Society of Human Reproduction and Embryology, ESHRE; 2013 American Society for Reproductive Medicine, ASRM; and 2011 Royal College of Obstetricians and Gynaecologists, RCOG) to integrate and discuss factors and treatment guidelines of Recurrent Pregnancy Loss.

Infertility patients with recurrent pregnancy loss have always been a huge challenge in the field of reproductive medicine. Experts have been finding the factors that may cause recurrent pregnancy loss, and actively want to increase the success rate of pregnancy. Among the factors, thrombosis and autoimmunity are two important factors of infertility. We now pursue evidence-based medicine and require evidence in every decision making, however each patient is an independent individual.

Under evidence-based and precision medicine, how should we strike a balance to find out the real causes of each infertility patient and seek the best treatment strategy?

Facing each client's condition cautiously, actively observing the treatment process, finding the best treatment policy and humbly consulting experts in various fields are the directions we strive for. Only in this way can we have the chance to break through the dilemma of reproductive medicine.

Oocytes are extremely delicate cells. During the process of Vitrofication, to avoid causing damage of the organelles, cell membrane and spindle, the osmotic pressure and temperature are required to be maintain.

Besides, freeing the oocytes at the correct timing not only can avoid harming the spindle but also enhance the survival rate of thawed oocytes. As oocytes freezing becomes a popular option for single unmarried women, embryologists are also eager to know the “tips” regarding the usage of needle and protocol.

In 2019 conference of Taiwanese Society for Reproductive medicine, a reproductive center reported there result of thawing oocytes of 63 clients from 2018 June to 2019 February.

Their research focused on the following factors which might affect the outcome of oocytes thawing:

1. Age

2. Time from trigger of ovulation to oocytes freezing

3. Appearance of the oocytes during the process of temperature balancing.

4. Duration of temperature balancing.

Age

The total number of thawed oocytes from 63 clients is 463. They grouped their clients into 3 groups according their age. The result shows that the difference of post-thaw survival rate of each group has no statistic difference.

Table 1. Post-thaw Survival Rate in Different Group of Age

Time from trigger of ovulation to oocytes freezing

To understand if the duration from trigger to oocytes freezing would affect the result of survival rate, they separate the results into 4 groups including <38 hours, 38-39 hours, >39 hours and in vitro maturation (IVM). The result shows that the survival rate of mature oocytes is about 97-100%, and has no difference in different time groups. However, if the oocytes haven’t matured when retrieved, the survival rate with decrease to 71.43%.

Figure 2. Post-thaw Survival Rate in Different Group of duration from trigger to oocytes freezing.

Appearance of the oocytes during the process of temperature balancing

The purpose of temperature balancing is to enforce the exchange between water molecule and cryoprotectant, which can avoid the formation of ice crystal during the process of sudden temperature drop. The ice crystal might harm the oocytes and further affect the survival rate. When the oocytes encounter the cryoprotectant with higher osmoic pressure, the oocytes will shrink and become 3 different formations as shown in Figure 3. The 3 different formations are shrinking to a ball shape(A), shrinking to a wavy shape(B) and irregular shrinking(C). According to the previous research, A is consider the oocytes with better quality.

However, the statistic shows that, there are no significant difference in 3 groups, which also imply that other factors might acquire to take into concern.

Figure 3. Appearance of the Oocyte During the Process of Temperature Balancing

Table 4、Post-that survival rate according to the appearance during the process of temperature balancing.

Duration of temperature balancing

Embryologists can justify if the water molecule has exchanged completely or not by observing the appearance of oocytes during the temperature balancing. After the oocytes re-swollen, dehydration and freezing process could be proceeded. The standard of re-swollen time is around 12-15 minutes. Although the time of re-swollen might be shorter in realistic, the time of re-swollen is not affective to the post-survival rate also.

Figure 3. Survival rate of different duration of temperature balancing.

Coincidentally, Stork Fertility Center also published a similar research in 2019 ASPIRE. However, our result is slightly different from the previous research. Our subject is to determine whether the time of oocytes freezing is relevant to the pregnancy rate when using GnRH as the trigger. We back tracked 396 cycles and 7224 oocytes from our oocyte recipient program in 2017 Oct to 2018 Oct. 3313 out of 7224 oocytes were frozen 38 hours after trigger. 3911 oocytes were frozen over 40 hours.

As shown below, the outcome of using oocytes frozen 38 hours after trigger are slightly better. The benefits are shown especially in survival rate and good blastocyst rate with significant difference.

We also further compare the conception outcome by using two group of oocytes. The result shows that the pregnancy rate and the implantation rate are not relevant to the time from trigger to oocyte freezing, which indicates that there’s no need to underestimate the potential of the blastocyst no mater it’s from which kinds of oocytes.

Oocyte freezing service is one of the greatest promise we made for our clients. Therefore, we always discretely preserve the precious oocytes of our clients. For higher age, diminished ovarian reserve and lower oocytes mature rate clients, we will check the spindle additionally before freezing the oocytes.