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cutecutetown


男爵府

積分: 9231


1#
發表於 10-2-12 11:02 |顯示全部帖子
Being in the ivf field for >10 years, I hope to help in a discussion format any of your questions or concerns with my relevant scientific knowledge and experience.

Please also let me declare that any of my sharings and discussions here whatsoever are based on my own personal views and opinions; and therefore, my discussions and I in this discussion blog do not represent my employer or my center.

Any of your postings can be in Chinese or English. My response will mostly be in English.

Have a successful Year of the Tiger!
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cutecutetown


男爵府

積分: 9231


2#
發表於 10-2-18 17:50 |顯示全部帖子
To answer your first question, there could be many reasons to why embryos stop developing. Some of the more common ones include:
(1) the embryo itself may be genetically abnormal;
(2) there may be a problem in the activation of the embryonic genome;
[generally speaking, < 8-cell embryo is still relying on proteins orginating from the egg which it is derived; embryo with 8 or more cells will make its own proteins]
(3) suboptimal culture conditions.

My answer above somewhat addresses your 2nd question. Besides, some doctors believe milder stimulation may help. The recruitment of another cohort of eggs, i.e. starting a new cycle, may give a totally different picture compared to the previous cycle. However, if embryo quality is consistently poor, it is better to talk to your in-charge doctor and also the ivf lab to come up with the best solution.

原帖由 parker123 於 10-2-14 12:39 發表
Hi,

do you know the reason why the embryo stops development starting day 3 (2 only 7 cells and 6 are arrested with 4 cells in day 5) and how to improve the quality of embryo (if any) ? Thanks
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cutecutetown


男爵府

積分: 9231


3#
發表於 10-2-19 13:01 |顯示全部帖子
It will be nice if you can talk to your doctor or the lab people (embryologists). They are the ones who know your embryo stage and quality.

In my lab, we do not freeze poor-quality embryos. Embryo freezing is for the benefit of the patient so that she does not have to go through another new stimulation cycle in order to have an embryo transfer.

My opinion is that you should not give up your frozen embryos.

原帖由 Happyeverafter 於 10-2-18 21:39 發表
Hi Cutecutetown,

Your information sounds very professional.

I did ivf last month but failed. I am wondering whether it was due to failure to implant or quality of the embryos. Is there a way to find ...
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cutecutetown


男爵府

積分: 9231


4#
發表於 10-2-19 13:11 |顯示全部帖子
Generally, maintain a healthy lifestyle is the key to everything. e.g. eat healthy meals, exercise moderately, sleep well, know how to relax or relieve stress.

Doing what you believe in moderation is important. It makes you happy and confident about yourself. I do not believe very much in chinese medicine; however, I do not see it will hurt either. My suggestions will be, if you see a chinese medicine dr, try to limit yourself to only the healthy herbs. I will avoid anything with unknown medicinal ingredients.


原帖由 MusicTV 於 10-2-19 02:41 發表
Will you suggest any preparation before ivf treatment, such as visit chinese dr, drink more milk and the like? thanks!

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cutecutetown


男爵府

積分: 9231


5#
發表於 10-2-19 13:22 |顯示全部帖子
Hi parker123,

1) Can be from father or mother, or both, or de novo (new) from imperfect cell division.

2) Sorry, my answer was somewhat simplified in my last reply. You cannot take more proteins to help your eggs or embryos.
The DNA, or the genes, are the blueprint, and there are other things that make the necessary proteins based on this blueprint. At a molecular level, a lot of events need to be coordinated to have this activation of the embryonic genome.

原帖由 parker123 於 10-2-19 08:58 發表
Hi cutecutetown

I have some further questions
1). Is the genectic problem due to a male or female factor or both?

2) can I take up more protein during eggs stimulation to solve or prevent the embryo ...
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cutecutetown


男爵府

積分: 9231


6#
發表於 10-2-19 17:46 |顯示全部帖子
That depends on what disabilities we are talking about. I think people mainly worry about (1) mental retardation (2) major physical disabilities.

There are a number of reviews on this subject which I have read some but not all. My own interpretation is that when the naturally-conceived bb has an overall abnormality/disability rate of ~2-3%, ivf or icsi bb has a rate of ~4-5%. I have not read enough about iui bb, so I can't really share any rate with you here.

However, please keep in mind that because these are ivf/icsi bb, we tend to follow-up on every little detail. For naturally-conceived, we don't follow every bb and rely on voluntary reporting. Also, some believe that infertility may have genetic components to it; and therefore, it can pass onto the offspring (bb). Or think from another end, if there is no ivf/icsi, these bb may not even be here.

It probably gets down to the real question - if we have trouble conceiving naturally, what are the risks and how much of the risk can we take?

原帖由 Sonatina 於 10-2-19 16:29 發表
我好想知ivf的bb會否較iui或自然懷孕的bb容易出現先天性缺陷?
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cutecutetown


男爵府

積分: 9231


7#
發表於 10-2-20 09:51 |顯示全部帖子
A quick note for Happyeverafter, the difference is somewhat more than 1%, and it really depends on what kind of abnormality. However, many people view the risk as "doubled".[2% x2=4%]
Instead of putting everything in a calculable number, I would say the risk is slightly increased, although it is still very low.

Also, consider that ivf itself requires time and more medication compared to iui; the egg retrieval procedure is also invasive. Sometimes couples somewhat forget that the women need to go through some risks themselves before achieving the goal.


原帖由 Happyeverafter 於 10-2-19 17:56 發表
My husband kept telling me that the abnormal rate for IVF is much higher than IUI. That was the reason why I did 5 IUI but all failed. Finally, I decided to take the risk and did ivf. After all, we ar ...
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cutecutetown


男爵府

積分: 9231


8#
發表於 10-3-1 17:51 |顯示全部帖子
My pleasure, thanks for your support :)

There are 7 licensed centers in HK providing IVF/ICSI services. For those interested, this is the website to begin: http://www.chrt.org.hk/

I don't have the general figure for the whole HK, but in my lab, the overall success rate for women under 35 is >40%. There are other factors that may affect success rates, one of which (as you mentioned) is the number of previous attempts.

And yes, although success chance is lower when attempts increase, it is not uncommon for some to finally "bingo" on their 3rd or 4th attempt. I had personally handled a case who didn't get pregnant until her 11th attempt. A little extreme, but do consult your IVF doctor (MD) for professional advice.


原帖由 dolphindor 於 10-2-28 15:44 發表
Hi Cutecutetown
Thanks for starting the thread and it's very informative

I would like to ask, in general in HK or in your particular lab, what's the success rate for IVF for women under 35?

Also, ar ...
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cutecutetown


男爵府

積分: 9231


9#
發表於 10-3-3 11:24 |顯示全部帖子
To my understanding, DHEA may be prescribed to those who have aged ovary; could be a woman of an older age, or a younger woman but having poor ovarian response to stimulation. The logic behind is to try to improve the number of eggs. Whether that may help with egg quality or not I don't have much experience.

If you have had failed IVF(s) before due to poor ovarian response, you may talk to your doc to see if he/she agrees DHEA may help. If he/she has already suggested to you, my opinion will be to follow his/her advice. I did look up some published literature but no clear conclusion can yet be drawn.


原帖由 little_icy1 於 10-3-3 09:24 發表
Hi cutecutetown,

Please share your experience if DHEA can help the poor response patient to improve their no. of egg and quality. Any experience in your lab ?
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cutecutetown


男爵府

積分: 9231


10#
發表於 10-3-3 18:12 |顯示全部帖子
Hi little icy,

Knowing your age and assuming your FSH is still <10, it seems to me that you still want to try IVF one more time but worry about having very few eggs and another unsuccessful outcome.

I won't discourage you from pursuing another IVF if you choose to do so, because I have many cases which are very similar to you in terms of age, FSH, and few eggs. Statistically, the pregnancy chance is still present, although much lower than the younger, good-response group.

With your new IVF cycle, you will probably continue to have very few eggs. DHEA will not do a miracle by giving you 15-20 eggs, however, it won't hurt to ask your doc about DHEA and if it may be useful in your case.

Usually I worry more on the emotional side of the women because some of them are really stressed even before starting and the "guilt" carries forward even after a negative pregnancy test. I know the result means a lot but at the same time it is not the end of the world. There are other options available as long as your mind stays open.

In the mean time, live healthy to keep your body in a good condition and good luck in whatever choice you make :)



原帖由 little_icy1 於 10-3-3 14:18 發表
Hi cutecutetown,

Thanks for your advice.

I had done 4 times of ivf in PWH few years ago. At that moment, I was 35 and the FSH was not high as 7.7 (LH was 2.43) on day 3. However, I only got few ...
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cutecutetown


男爵府

積分: 9231


11#
發表於 10-3-4 15:13 |顯示全部帖子
Hi little icy,
With the advanced age issue, I suspect you may not be accepted anywhere to the public queue. If you would like to try private (I hope you are financially OK), then PWH may be a good choice because it has your past records and you are familiar with the place. I know their private clinic is relatively more affordable compared to some 'famous' private hospitals.


原帖由 little_icy1 於 10-3-3 19:42 發表
Hi cutecutedown,

Thank you for your encouragement to me on my rough road.

Yes, I don't have great expectation on this attempt but at least giving myself one more chance. I hope a private doctor c ...
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cutecutetown


男爵府

積分: 9231


12#
發表於 10-3-4 16:53 |顯示全部帖子
I am so sorry to hear about your experience. If you will be starting another cycle anywhere, feel free to ask any question here. I will try to help you the best I can. Good luck!

原帖由 little_icy1 於 10-3-4 15:54 發表
Hi cutecutetown,

I had tried 3 times in private queue & 2 times in public queue in PWH. The 1st attemp in public queue was changed to iui as my poor response to the HMG. So I had spent much money i ...
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cutecutetown


男爵府

積分: 9231


13#
發表於 10-3-4 17:03 |顯示全部帖子
Hi Kandice,
I am sorry to know about your miscarriage. Please take care of your well-being before worrying about other things. I hope you get good support from your husband and close relatives.

To answer your question, 流產 happens in natural conception too, and no particular reason can be found in most cases. If you or your family do not have a history with genetic diseases, you do not need to worry about the later use of your frozen embryos.


原帖由 Kandice 於 10-3-4 16:03 發表
你好，我1st ivf失敗了，上星期7周檢查時照不到心跳(stop growing)，下星期check多次後便決定用藥還是手術流產。請問:

-今次是胚質素的問題嗎?如果是，那我的雪胎質素會相若嗎?我怕再放雪胎也會有同樣經歷

-embyo stop gro ...
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cutecutetown


男爵府

積分: 9231


14#
發表於 10-3-5 09:48 |顯示全部帖子
jamie mama,
I think your doc's suggestion was for you to receive in vitro fertilization (ivf) instead of other simpler treatment such as IUI, which means the treatment will be more elaborate in terms of time and costs.

As for your hubby's sperm quality, I am not sure where he had his semen analysis and the standard being used in that particular lab. Nowadays, especially if you are ok to pay that little extra and understand the extra manipulation on your eggs, you may request ICSI to be done regardless of sperm quality. Very generally speaking, if a sperm sample is of good enough quality for IVF, by doing ICSI may not add extra benefit.

To share with you my experience in the lab, if on the day of egg retrieval the sperm sample is suboptimal (the sperm may not fertilize the eggs by conventional IVF), I will definitely inform the doc and he/she will check with the patient(s) to come to an agreement to use ICSI instead. Most patients will agree; but believe it or not, it happened once in my entire career that the couple did not agree and the lab could only do IVF.


原帖由 jamie_mama 於 10-3-4 20:45 發表
cutecutetown,
thank you very much for your sharing. Just want to ask you about the successful rate of IVF and ICSI. My hubby's sperm count and mobility is not up to standard, but the doctor just s ...
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cutecutetown


男爵府

積分: 9231


15#
發表於 10-3-12 12:43 |顯示全部帖子
平常心 la, wish you luck with the remaining embryos.

原帖由 Kandice 於 10-3-12 11:34 發表


Thank you for your reply!我會好好照顧自已的了。我和老公的家族沒特別的問題，希望下次無太大問題，不過亦不敢抱太大期望，希望越大失望越大，平常心好了，哈哈! ...
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cutecutetown


男爵府

積分: 9231


16#
發表於 10-3-12 15:47 |顯示全部帖子
Hi Junly,
Some labs thaw ("dissolve"?) embryos on the day of transfer and some thaw one day before. In general, embryos frozen on day-2 or day-3 are thawed the day before transfer and cultured overnight; this will help the lab to assess the embryo growth. Embryos/blastocysts frozen on day-5 or day-6 are thawed on the same day, but some labs may thaw them the day before transfer. Blastocysts often look "collapsed" upon thawing and may re-expand in a few hours (an imaginative way to describe it is that a collapsed blastocyst is like a raisin/dried-up grape; when it re-expands, it will resume its grape appearance.)

Other than considering when to thaw, another important point to a successful frozen embryo transfer is to have a synchronized endometrium. Both the embryos and the uterus need to be at the right timing. This timing is taken into consideration when embryos are thawed for transfer.

原帖由 junly 於 10-3-12 13:29 發表
Hello cutecutetown

Is it a normal practice for IVF lab to dissolve frozen embryo at the day of embryo transfer? Can the successful chance be improved if the lab can have one or two days observation ...
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cutecutetown


男爵府

積分: 9231


17#
發表於 10-3-15 17:51 |顯示全部帖子
Dear Sally,
Did your "new" doctor suggest you to do IVF? Simply based on your age (relatively young) and your husband's sperm quality being ok, I think you should have a good chance with ivf.
However, your doctor may or may not require you to have a laparoscopy to investigate the inside of your tummy or areas around your ovaries. Some blood tests may also be required. If you decide to do ivf, come to this blog and others to see people's sharing of their experience. They all help by giving you ideas what to do or how it is like.
Good luck :)

原帖由 sally2009wong 於 10-3-14 22:50 發表
Hi cutecutetown,

Thanks for your help.

I am 33 years old, i have been trying to have baby for 4 years and have tried 4 times iui with different doctors in the past 2 years...all the doctors conclud ...
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cutecutetown


男爵府

積分: 9231


18#
發表於 10-3-16 13:47 |顯示全部帖子
Hi Sally,

OHSS certainly sounds scary, but with your age and no previous ivf done before, I think your doctor hopefully won't start you on a high dose of drugs. This is a very small risk, but slightly higher in PCOS patients; however, the doctor will keep you under his/her monitoring more regularly (as compared to iui) and he/she will adjust the medication during the ovarian stimulation process.

There is really nothing you can do to prevent OHSS. If you are still super worried about it, discuss with your doctor; let him/her see your concerns. I think most of the specialists are experienced enough and your previous iui records may also help your new doctor in deciding the right dosage for you.

Sorry I don't quite get what you mean by "seeing Chinese doctor to get warmed up"? Do you have cold feet or something? Regular exercises help, so will eating well (and healthy), no smoking, no second-hand smoke, getting quality sleep....all these do not just help with fertility but a better self. So, good luck and keep a relaxed and open mind :)


原帖由 sally2009wong 於 10-3-15 18:32 發表
Dear cutecutetown,

That is what the doctor said, he also suggested to go for IVF, and indeed, I am very concerned about the OHSS...how often it happens? what is the %/ chance of getting an OHSS?

I a ...
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cutecutetown


男爵府

積分: 9231


19#
發表於 10-3-16 14:04 |顯示全部帖子
Hi mschu,

Your doc is right, there is no such thing as an endometrium being too thick for smooth implantation.

The wall of the uterus builds up and gets shed every month, that's why women have periods. As long as you are menstruating regularly, it is not a worry unless your doctor tells you otherwise.

Your last iui cycle was totally independent of your egg retrieval yesterday. The size of your follicles (17mm, 18mm) in your last iui had nothing to do with your uterine wall. The same reasoning applies to your ivf cycle. And when you do ivf, the process you have been through is closely monitored by your doctor. If your uterus is an issue for implantation, your doctor will advise you other alternative.

So, your eggs should be fertilized today; any news? Wish you some good-quality embryos. Relax and be happy to wait for the embryo transfer procedure. Good luck!



原帖由 mschu 於 10-3-15 19:10 發表
Hi cutecutetown

I just had my eggs extracted today. My question concerning ivf is as follows:

On the last ultrasound scan on last Saturday, I was told my uterus wall was 16.5mm thick. I then asked ...
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cutecutetown


男爵府

積分: 9231


20#
發表於 10-3-16 16:29 |顯示全部帖子
It is quite common that sperm from TESE are not motile. A sperm that does not "swim around" may not be dead. There are ways in the lab to find sperm that are alive and these living sperm will be used during ICSI.

When living but immotile sperm of TESE is used for the ICSI procedure, fertilisation rate may sometimes be lower; however, as long as there are fertilised eggs and embryos for transfer, there is always a chance for pregnancy.

Success rate varies due to a lot of reasons or combinations of reasons, quoted percentages are often drawn from statistics and may not fit your particular case. At least to me, each couple is unique. Because your doctor lets you go ahead with IVF+ICSI even after your husband's TESE, that means you have a chance. Stay positive! You can always share your experience or doubts here if you feel lost.


原帖由 玫瑰野獸 於 10-3-15 20:34 發表
我先生有無精症,上月做左TESE, 胚胎專家係組織中抽左D SAMPLE只係找到兩三隻不動精蟲, 而家到我打針做IVF+ICSI, 用不動精蟲做ICSI係咪好難成功架?
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