1, Dr. Kuang, hello: I am your patient XXX couple, I am sorry to bother you on the weekend, now scheduled for egg retrieval on Monday, but the male semen examination, less sperm, inactive, positive mycoplasma, is taking azithromycin, Xuanju capsules, erectile dysfunction, the treatment process, while the chromosome report is not out, at this time to retrieve eggs and sperm to grow blastocysts, will not affect the quality of embryos? I don’t need to know the efficacy of these treatments for men. If the chromosome report is not available, will there be any adverse consequences in the future if there is any abnormality? If it doesn’t matter, then what is the point of such treatment and examination? Please reply, thank you. I was not supposed to bother you with these questions, but I got nothing but impatient faces from your assistants, and nothing was expressed or mumbled. I think maybe there are too many patients and the work pressure is too much! As the head of the center, you should also be working to improve the attitude of medical services while constantly improving your technology, otherwise you would be too busy to ask questions like this. In addition, a word of caution: the market of the United States produced more than three hundred Brevic, your hospital opened the Italian-made Brevic to sell one thousand five, huh…
Answer.
(1) male treatment can not improve the outcome of your husband’s sperm need to do IVF.
(2) there is no male treatment methods to improve the genetic traits of sperm, that is, if the seed has some kind of genetic defects, such as AZF gene deletion, all the current treatment can not improve. Some patients with male infertility can be well fertilized by microinjection techniques, but repeated IVF cannot get good embryos. The fundamental reason is that the sperm has some kind of intrinsic defect, and the current technology cannot find this factor and cannot treat it.
3) Mycoplasma is a conditionally pathogenic bacteria, widely present in the human body, and a positive mycoplasma has no clinical significance if it is not combined with other inflammatory conditions. Moreover, mycoplasma is sensitive to azithromycin and can be easily cleared. Antibiotics are contained in the sperm processing fluid and embryo culture fluid, and even without treatment, mycoplasma is killed by antibiotics in embryo culture.
4) The detection rate of chromosomal abnormalities in patients with oligospermia is relatively low. In order not to delay your treatment and reduce your repeated trips to the hospital, you were given a cycle before the chromosome report came out, also for your consideration. Because we don’t do fresh embryo transfer here, you will definitely see the chromosome report before the transfer. If you are not comfortable with this, we suggest you not to retrieve eggs this time.
5) It’s not up to you, me or the hospital to decide about the price of the medication. You can totally go to the US to buy the medication, just like some people go abroad to buy ipnone 5 or LV faux leather bags. Of course you can also go to the United States to do in vitro fertilization, where the mouth is sure to make you satisfied
2, can we call on each attending doctor to open a WeChat ah? The attending doctor actually knows more about the patient’s situation and can communicate in time if he has questions.
Answer.
Each doctor in the assisted reproduction department of the Ninth Hospital has a homepage, and it is more convenient to contact your doctor in charge. Doctors are also people, to eat and sleep, there are wives and children, also have to wash clothes and cook. As the director, I can only ask them to do a good job for 8 hours, and not to interfere with things outside of 8 hours. It is not possible to demand too much. These doctors in the Ninth Hospital are already very dedicated, work very hard, never have holidays, no annual leave, can not give them more code. Even animals need to rest, let alone people!
3. Ovarian perforation is not recommended for patients with polycystic ovary syndrome.
Surgical treatment is not recommended. Ovarian perforation is not effective in treating PCOS and does not restore normal ovulation in a lasting way. What is more serious is that ovarian perforation uses electrocautery rods to cauterize the ovaries, the amount of heat and the number of electrocoagulation cannot be accurately estimated because the reserve follicles in the ovaries are very sensitive to thermal damage, so many patients will have early menopause after ovarian perforation and the infertility treatment will be more difficult. There is also ovarian perforation that destroys the smooth surface of the ovary, which means that the ovarian peritoneum is incomplete, which is a factor in the occurrence of periovarian adhesions that cause infertility. Simple polycystic ovary syndrome is only an ovulation disorder, which should be treated with ovulation promotion. The key is that the doctor should have good ovulation promotion techniques, and simple ovulation disorders are easily treated. If you don’t get pregnant after three ovulation cycles, you need to check carefully for other infertility factors, especially how about the condition of the fallopian tubes. If the fallopian tubes are normal, the male partner has normal semen and does not get pregnant in six ovulation cycles, artificial insemination should be done.
Due to the popularity of laparoscopy, more and more patients are undergoing ovarian surgery through laparoscopy, such as ovarian chocolate cyst debridement, ovarian simple cyst debridement, ovarian teratoma debridement, etc. Very unfortunately, many of them have ovarian atrophy and functional decline after ovarian surgery, which makes subsequent infertility treatment more difficult and less successful. Therefore, women of childbearing age should be very careful in deciding to have ovarian surgery and avoid ovarian surgery whenever possible. If ovarian surgery must be done, it is recommended to consult an IVF doctor before the surgery and to do fertility preservation if necessary, i.e. to save the embryos before the surgery and transfer them when conditions permit after the surgery. Shanghai Jiu Hospital can retrieve eggs at all periods of the menstrual cycle, so there will be no delay in the procedure.
4. Causes and treatment of amenorrhea in 18-year-old girls after two periods.
Cycle therapy first to prevent atrophy of the reproductive tract. Estrogen and progesterone cycle therapy sometimes induces the hypothalamus-pituitary-ovary to establish a normal positive and negative feedback mechanism to establish a normal menstrual cycle mechanism. If you can get your period with progesterone, it means there is no major problem with your uterus. When you have fertility requirements, ovulation promotion treatment.
5.Should women with low ovarian reserve take DHEA?
DHEA is scientifically known as dehydroepiandrosterone sulfate, which is an androgen. There are a few foreign reports on the use of DHEA in women with low ovarian reserve, but the sample size of these reports is relatively small and the studies are not conclusive, so there is no conclusion that DHEA can improve ovarian responsiveness. However, for some reason, women with low ovarian reserve all over the world look forward to DHEA as a miracle cure, imagining that their ovaries will return to the level of a young girl. In fact, this is not possible!
In fact, there has been a long history of research on the use of androgens for low ovarian response, including oral androgens, patch androgens, androgen gels, and various other dosage forms and various androgens, all of which have not clearly concluded that they can improve the ovulatory response of women with low ovarian reserve.
As a result of DHEA abuse, there have been an increasing number of clinical side effects: endocrine disorders such as menstrual cycle disorders, decreased menstrual flow, and multiple ovarian cysts. Long-term use of androgens can also lead to feminine masculinization: increased darkening of the beard, enlargement of the pubic empire, breast atrophy, hoarseness, etc.
In patients with low ovarian reserve, the most important thing is to use natural cycles or lightly stimulated ovulation strategies, not to look for magic pills to bring back youth or turn back the clock, which is impossible to do!
The mechanism of ovarian failure is that the reserve follicles in the ovaries are reduced, the reserve follicles cannot be regenerated, the reserve follicles die at a fixed rate and the woman becomes menopausal when the reserve follicles die out. Therefore, there is no drug that can increase the reserve of the ovaries. At present, we mainly use natural cycles and mild stimulation to do IVF for women with low ovarian reserve, as long as we get good embryos, the transfer success rate is still very high. We do not recommend DHEA in Shanghai Jiu Hospital
6. In early 2011, we found a sharp decrease in menstrual flow and found out that there was a tendency of premature ovarian failure; after that, the effect of traditional Chinese medicine was not good, in which the FSH was high and low. In March 2012, when we went to Beihang Hospital to prepare for IVF, the FSH rose to 17. After the first failed IVF, acupuncture treatment plus DHEA, the FSH was adjusted back to 10.80, but in December, we entered the short program in haste and the second failed IVF.
Treatment status.
The first IVF in June this year, long protocol (gonafen + urea + Dafilin), when FSH soared to 17, 7 follicles were monitored, only one egg was retrieved and did not develop into a fertilized egg; in December, FSH was adjusted to 10.80, 5-6 basal follicles, was added to the short protocol (gonafen + urea + Sikai), the result was only 4 when monitored, 6 eggs were retrieved, 1 degenerated, 5 One of them was not fertilized after maturation. She is 39 years old and will soon be 40.
Medical history.
I have been married for many years and never wanted to have a child, nor did I conceive naturally. after returning to China, I found signs of premature ovarian failure and changed my mind, only to find out later that my husband’s semen could only be ICIS. more than a year has passed and two IVF attempts were unsuccessful.
How would like to be helped.
I am now working in Beijing, but I really want to come to consult the feasibility as soon as possible, can I make an appointment online to register? I came to Shanghai specifically. I can transfer my job to Shanghai and specialize in treatment. The two IVFs at Beihang Hospital were very physically damaging and I heard that micro-promotion or natural cycles are more applicable. When the second IVF failed, my husband shed tears to the nurse, which in itself made me very sad.
Dr. Kuang, thank you for your reply. Forgive me for wasting your time by asking general questions, but I finally learned yesterday that the only egg that was barely raised did not fertilize, so I got emotional. I have put together the following questions and I wonder if you could take a little more time to answer them for me, which is naturally very, very important to me. Thank you in advance.
1) Is it possible to avoid taking raw eggs with microfertilization?
The fact that all the eggs in this IVF were raw has something to do with luck and the hospital. I had one more egg per month in my natural cycle, but the IVF results were also very poor, which was a big blow to me physically and psychologically.
(I forgot to mention that everything is normal except for my advanced age and high FSH, but I have no choice but to deal with my husband’s problem)
2) I just had an egg retrieval, do I have to take a break? Acupuncture, DHEA, Maca?
I know age is not forgiving and I don’t dare to waste a day. There is an acupuncture team for premature ovarian failure at BCMU that has been effective in treating me. I will restart acupuncture when I am emotionally calmed down. Do I still need to take DHEA? I have heard that royal jelly causes cancer, not too bold, and what about maca? I swim and exercise at the same time, not much, two or three times a week.
This egg retrieval was very painful, with diarrhea for many days and vague ovarian pain, perhaps because I went to work a few hours after the retrieval and didn’t take care of myself with a full diet.
3) How can I be sure to get your number? Or, will you be working on December 31 (Monday)?
The registration at Beijing hospital is very scary, so I am worried that I will make a special trip from Beijing to Shanghai and not be able to get your number without any problems. The reason why I worked a few hours after the egg retrieval was also a no-brainer. My husband is now starting his own business and I am the only source of financial support for the family and need to have money set aside for IVF. This is a very difficult period in my life with my husband.
4) My case is special (egg production problem) and time is tight. Is it possible to take up private time in case there is no guaranteed consultation time in the hospital?
The first IVF failure also lies in the fact that no eggs were retrieved, about only one was taken out and barely raised to maturity, but failed to fission. The previous monitoring was good, there were 7 of them and several were growing well. I asked several doctors at the third hospital and their records were incomplete, they only said they monitored 4 and also said they were growing well, they retrieved 6, but 5 of the eggs were raw. Maybe I should have thought of delaying for one more day or taking a little more hCG. my experience at the NBH made me desperate to find a doctor who was at least willing to read through my medical history and customize a plan based on my real situation. I am too old to delay any longer. If there is no daily limit at the Ninth Hospital – I can’t imagine it a bit. If there is no way I can pay more and take up your private time at least for the initial consultation or to set a plan? I’m really sorry to be so reckless in making such a request.
I was really scared by my experience with the NPHC. My American gynecologist family doctor who has been exceptionally good to me for over 10 years was always pushing me to have children at the time, but I didn’t listen to him. When I went to him for my last checkup in 2009, I found out that he was much older and I was very sad. There are good doctors in China that I have met, such as my current acupuncturist.
5) Or, can you recommend a hospital that will take me in and treat me well? The US and UK are fine.
I have a general agreement with my company that I can transfer to Shanghai, if needed. However, I am a US national and was thinking of going to CCRM for IVF with Dr. Schoolcraft, but this failure has made me worried about the results of IVF. Personally, I have long wished for a technique similar to microfacilitation or natural cycles, but at the time I did not research much and did not know that Jiu Hospital already had this service and was the best in China.
Hi, I am now almost confirmed as a patient with oocyte maturation disorder, and it may be genetic and severe. Can you tell me if the quality of eggs produced by micro-promotion is better for similar patients? (It may be genetic. The first two times, most of the eggs were produced only at the GV stage, and probably at the M1 stage individually. (3 eggs were retrieved the first time, 6 the second time). If I am at an advanced age like I am today and time is of the essence, will the number of eggs produced with micro-promotion be lower? Can the number perhaps increase the chances of IVM (that technique of raising eggs)? Can I borrow eggs from the hospital? I am a US citizen. I can borrow blind, but I do need to know the health and education of the person, etc. I am sure I will try one last time to conceive with my own eggs before borrowing. I am looking forward to hearing from you as the egg production techniques and lab conditions are critical to me and I am on a tight schedule. Thank you very much. Dr. Kuang, I have confirmed that I am a patient with oocyte maturation disorder, almost all of my eggs were raw in both retrievals, and I am of advanced age. Because of the suspected genetic problem, the key is the quality of the laboratory; and can the quality of the micro-promotion be slightly better? The quantity will be reduced. My last two times were mostly in GV stage and less in M1 stage. Thanks a lot.
ANSWER.
Before you give yourself this diagnosis, you need to get one thing clear: can your eggs get to MII stage in vitro after removal, if they can, your diagnosis is not valid, if they can’t mature in vitro, your diagnosis is right, it is an enzyme deficiency that is currently untreatable. Also you said that almost all of your eggs are raw, if one is mature, you cannot diagnose egg maturation disorder. I did encounter several cases of egg maturation disorder in my 17 years of experience, and these were characterized by disrupted menstruation, similar to the manifestations of polycystic ovary syndrome, and no matter what ovulation protocol was used, all the eggs obtained were immature, some stalled in the GV stage, some in the MI stage, and were not able to mature in vitro. If the eggs you obtained in your first cycle did mature in vitro, you can rule out If the eggs you get in the first cycle do mature in vitro, you can rule out impaired egg maturation. We have had many cases where we were unable to get mature eggs at outside hospitals, but later got mature eggs and became pregnant at KCRC, so the ovulation method has a lot to do with the maturation of the eggs.
Your ovarian response does not match your FSH level, and it is doubtful if the hormone test is accurate. Ovulation should put getting quality eggs first, not chasing quantity. Getting a bunch of useless eggs is not as good as getting one good egg. I am too uneducated to advise you as to which elixir MACA is. The natural cycle, mild stimulation technique has a different hormonal environment than a down regulation cycle, so the quality of the eggs you get may be different. You can only know if you try and there is no guarantee that you will have good results. You only have to look at the article on the front page to know about the registration. As a result, I got 3 eggs using luteal phase ovulation in the ninth hospital, 2 of which were mature eggs. It shows that different ovulation protocols have different effects on the maturity of the eggs. Unfortunately, these 2 eggs did not turn out to be good quality embryos
7. I am constantly asked about checking for closed antibodies. There is no evidence that closed antibodies are related to embryo implantation failure, so we do not recommend this test. From our experience in treating repeated implantation failures, there has not been a single case where the successful treatment was related to the intervention of closed antibodies (husband lymphocyte injection). As a responsible doctor, please understand that we will not recommend tests and treatments that do not make sense.
8. There are two cases of low menstruation: (1) abortion, tuberculosis, inflammation has damaged the endometrium and is an organic lesion. (2) Non-ovulatory menstruation, the cycle can be normal, but there is no ovulation. Ovulation monitoring should be done. If the lining is still thin before ovulation, the lining is organically injured, and hysteroscopy and treatment are needed.
9. Why do I need IVF for severe endometrial injury?
Progesterone rises after ovulation in natural cycle, and the endometrium cannot grow after progesterone rises. Hormone replacement can be considered to prolong the proliferative phase and promote endometrial growth through long-term estrogen stimulation. We were the first to find that vaginal phentermine is 22 times higher than oral blood levels, and by vaginal phentermine you can stimulate endometrial growth with a small amount of estrogen in an efficient and prolonged manner, and wait for the endometrium to exceed eight millimeters for frozen embryo transfer. So IVF before hormone replacement to freeze embryos well is a must. For patients with severe endometrial damage, our treatment strategy is: egg retrieval, embryo freezing, hysteroscopy to adjust endometrial blood supply, hormone replacement to stimulate endometrial growth, and frozen embryo transfer.
10. Safety of progesterone during pregnancy
Patients constantly ask whether progesterone during pregnancy is safe. Currently we are using Duffetone and vaginal progesterone which are both approved progestins for use during pregnancy. Duffetone is the trans structure of natural progesterone and has been used during pregnancy for decades and millions of cases have proven that Duffetone is safe during pregnancy. Vaginal progesterone is a natural progesterone, as is injectable progesterone. Twenty years ago, it was thought that progesterone could cause female fetal masculinization, but numerous subsequent studies have proven that natural progesterone is safe during pregnancy and has nothing to do with female fetal masculinization, and these studies have become conclusive. Progesterone is now widely used during pregnancy, from early pregnancy to prevent miscarriage to middle pregnancy to prevent premature birth, progesterone has definite efficacy.
11.About sperm deformation rate
The fifth edition of the World Health Organization semen analysis standard is now adopted, and the definition of sperm malformation is more stringent, but we have noticed in clinical practice that the sperm malformation rate has little relationship with the fertilization rate and embryo quality of in vitro fertilization. More data are needed to show the relationship between the new criteria and the spontaneous pregnancy rate and miscarriage rate. Our observed results of sperm malformation rate have little relationship at least with the outcome of in vitro fertilization.