多囊卵巢症候群個案分享(1)

個案一

年齡：約37歲

病歷：從超聲波檢查中發現兩側卵巢呈多囊泡狀排列，血液荷爾蒙檢查中，LH水平高於FSH水平，被診斷患有多囊卵巢症候群。在34歲時尋求輔助生肓治療，當時輸卵管通暢；而丈夫的精子檢查亦屬正常。結果使用高純度促卵泡素(Pure FSH)注射，在卵泡成熟時行房而成功懷孕。3年後再次計劃懷孕。

治療方法：嘗試注射Pure FSH兩個週期,刺激排卵，結果失敗。在第三個週期先服食糖尿丸，再注射FSH，待卵泡成熟時行房而成功懷有第二胎。

個案二

年齡：35 歲

病歷：嘗試1年(32-35)，只曾向中醫求診。 他們前來求診時，我立即為她做腹腔鏡檢查: 一邊輸卵管閉塞，另一邊雖然沒有閉塞，但有病變。 經過一次IVF，胚胎移植，但可惜胚胎異位。及後我移除患者一邊的輸卵管，再用夾夾着另一邊輸卵管。因為，第一，病變的輸卵管有機會令患者再次胚胎異位，其次，半或完全閉塞的輸卵管，管內的有毒液體亦會影響患者再次成孕的機會。 第二個週期只有四粒卵子(因為年齡問題，所以卵子數目較少)。在32-35時，她“浪費“了寶貴的三年光陰。

治療方法：最後，有3個胚胎培植成功，當中兩粒轉移到患者子宮內。起初兩個胚胎都能發育，但後來只有一個能成功。這是她的照片。

個案三

年齡：女30，男33

病歷：嘗試三年後仍未能成功受孕。女方接受所有檢查後沒有異常，但男方因拒絕檢查，直至三年後嘗試不果，檢查時發現男方的精子有嚴重問題。只能選擇IVF

治療方法：一個IVF 週期後，成功誕下一對龍鳳胎。

教訓: 不要浪費時間等待，及早定期檢查。

參考資料: fertility.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的婦產科醫生查詢，而不應單倚賴以上提供的資料。

Treatment procedures for infertility problem - Intracytoplasmic Sperm Injection (ICSI) (Part 2)

What does it involve?

To start, you will have to take fertility medications to induce ovulation during your cycle before the ICSI because this procedure requires multiple eggs to ensure the success of the treatment.

 

Similar to standard IVF procedures, the mature eggs are collected from your ovaries and you may receive general anaesthesia during the procedure. Meanwhile, your partner will be asked to provide a semen sample. The sperms are then evaluated and the healthiest sperm are selected for the ICSI procedure.

 

After the eggs and sperms are collected, the ICSI process will take place in the laboratory in which the “healthiest” sperm is injected directly into the centre of the egg by an embryologist.

 

Eggs are observed for the following day or so and those that are fertilised and developed properly will then be transferred into your uterine cavity.

 

If the procedure has been successful, your doctor will discuss with you and your partner about the number of embryos to be transferred to your uterine cavity. Your doctor will place a speculum inside your vagina, insert a small catheter through your cervix into your uterine cavity, and transfer the embryos through the catheter. The transfer causes minimal discomfort.

 

You will be asked to do a pregnancy blood test at the clinic about 2 weeks after the embryo transfer. It is not recommended to do a home pregnancy test before that time because some of the fertility medications may lead to false results if the test is performed too early.

 

 

 

 

Advantages of ICSI

ICSI is the most commonly used method to overcome male infertility problems. By selecting one single “healthiest” sperm and directly injecting into the egg, it bypasses the problem of penetration, which may not be easily done by less healthy sperm in a natural environment, thus enhancing the chance of pregnancy. Other benefits include:

l   Most effective procedure for male infertility

l   Overcoming sperm quality problems

 

 

Disadvantages of ICSI

l   Possibility of transmitting infertility to offspring;

l   Technically demanding; and

l   More expensive than IVF.

 

 

 

 

Reference: fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

 

Treatment procedures for infertility problem - Intracytoplasmic Sperm Injection (ICSI) (Part 1)

According to the Hong Kong Council on Human Reproductive Technology, a couple may be classified as "infertile" or "sub-infertile" if pregnancy has not occurred after one year of regular unprotected sexual life. In Hong Kong, an estimated one in six couples has difficulty conceiving due to different reasons.

 

There are many reasons for infertility. Problems affecting male fertility include tubal obstruction or damage, semen abnormality or unexplained infertility while those affecting women include ovulation disorders, endometriosis and unexplained infertility. Age may also be one of the other factors affecting fertility.

 

A Reproductive Technology (RT) procedure means a medical, surgical, obstetric or other procedures assisting or bringing about human reproduction by artificial means. RT treatment may be considered as one of the options to increase the chance of conception. Apart from RT treatment, other methods such as timed intercourse, drug therapy and surgery may be recommended by medical practitioners. You are strongly advised to consult your doctor for the most appropriate and suitable procedures if you intend to go through infertility treatment.

 

 

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a method of gamete micromanipulation where a single sperm is injected into the inner cellular structure of an egg. The resulting embryo will be transferred into woman's womb as in a normal IVF cycle.

 

 

 

 

 

 

 

Reference: fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

 

Kw: ICSI, Intracytoplasmic Sperm Injection, infertility Problems, couples, test tube baby

Treatment procedures for infertility problem - IVF, in vitro fertilization(Part6)

Luteal support

After the embryo transfer, progesterone or hCG supplementation may help maintain your uterine lining (endometrium) to support the implantation and growth of the developing embryo.

 

 

IVF risks

-          Multiple pregnancies: Since each IVF therapy includes 2-3 embryos for implantation, multiple pregnancy may be resulted. Patients should consult their doctors when deciding the number of embryos to be transferred.

-          Ectopic pregnancy: ectopic pregnancy means the embryo is implanted in the fallopian tube, which may develop occasionally during IVF therapy.

-          Drug reaction: some people may be allergic to the fertility medications used in IVF therapy. However, one should be reminded that drug allergy is possible in all treatments.

-          Congenital defects: the risk associated with IVF is low. However, congenital defect is related to multiple factors, including genetic factors, the age of parents, chemical/radiation exposure, etc.

 

 

 

 

Reference: fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Treatment procedures for infertility problem - IVF, in vitro fertilization(Part5)

Step Five - Embryo transfer This involves transporting the fertilized eggs (embryos) back to the uterus using a catheter and ultrasound. It is relatively simple, does not require anesthesia and takes only a few minutes.   Procedure Before the procedure begins, you doctor will consult you and your partner about the number of embryos to be transferred. It is common that several embryos, rather than one, are transferred to your uterine cavity to improve your chances for pregnancy.   To place the embryos into your uterus, a speculum is placed inside your vagina and a small catheter is inserted through your cervix into your uterine cavity where the embryos are placed through the catheter.  You may experience a slight discomfort during this procedure.   Once the embryo has been transferred successfully, you may receive a daily progesterone injection that helps to support the lining of your uterus to improve chances of implantation and maintaining a pregnancy.   Generally, you will know whether the treatment has been successful about 2 weeks after embryo transfer and this is done by a pregnancy blood test at the clinic. It is advised that you should not do a home pregnancy test before that time because some of the fertility medications may produce a false result if the test is conducted too early.     Selection of embryo Till now, there is no accurate method to select the “best” embryo. Selection is performed with bare eye observation only, so experienced embryologist is critical.       Reference: fertility.com.hk   The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Treatment procedures for infertility problem - IVF, in vitro fertilization(Part 4)

Step Three - Egg retrieval

Eggs should be ready to be collected after the completion of ovarian stimulation:

 

 

 

Step Four - Fertilization

It involves placing each egg into a dish with sperms and leaving the fertilized eggs (embryos) to culture in a special incubator where they can develop under an optimal environment.

 

Procedure

Around the time of egg retrieval, the male partner will be asked to provide a semen sample.

The semen is “washed” to remove the seminal fluid from the sperm, which are then incubated with the eggs for fertilization. 

 

On the next day, eggs are checked to see if they are fertilized and the fertilized eggs (embryos) will then be closely examine over the next few days by the embryologist to ensure a healthy development and to find out which embryos have the highest reproductive potential. 

 

Reference: fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Treatment procedures for infertility problem - IVF, in vitro fertilization(Part 3)

IVF Process

Step One - Ovarian Downregulation

This is a preparation procedure that uses medications, such as Gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist to temporarily ‘switch off’ the messages going from the brain (pituitary gland) to the ovaries telling them to produce an egg on a monthly basis.

 

Pituitary gland, which is close to the front of your brain, is responsible for the normal functioning of your ovaries.

 

Suppressing the pituitary gland not only helps in achieving optimum ovarian stimulation, but most importantly it stops your ovaries from releasing premature eggs.

 

Ovarian downregulation is particularly helpful for women who respond poorly, or not at all, to the ovarian stimulating medications and therefore cannot take the full advantage of the IVF treatment. 

 

 

 

Step Two - Ovarian stimulation

This involves stimulating the development and the release of eggs using various infertility medications.

 Infertility medications like gonadotropins will be used to stimulate the growth of the follicles and eggs which will be retrieved for IVF procedure.

Your doctor will monitor you frequently during this time to make sure your follicles are developing properly and to identify the right time for egg retrieval. Once your follicles are developed, your doctor will retrieve the mature eggs.

 

What does it involve?

Your treatment will depend on your specify needs but it generally include following pathway:

 

Are there any restrictions of using hCG injection?
Sometimes hCG injection may be stopped because:

·           A lack of mature eggs for the IVF procedure such that the follicles may not have developed properly

·           Woman ovulates prematurely and the eggs cannot be retrieved

·           Woman develops too many follicles and doctor feels that it would be unsafe to give the hCG injection.

 

How long is ovarian stimulation?

It can be a lengthy process with a lot of your time devoting to attending appointments with your doctor and taking your medications at the right time. The length of ovarian stimulation will depend on your ovarian response during the treatment.

 

Reference: fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.