< 不孕越久的人,無論是要自然懷孕還是做試管,懷孕率都越低 >
各位好
小弟威廉氏後人 - 李毅評醫師
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這是一位40歲的患者,小渟。
備孕超過8年
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AMH 5.0,月經還算規則,
超音波下子宮卵巢檢查都正常
雙側輸卵管都正常
精子檢驗也都正常
子宮腔檢查也都正常
就是傳說中的什麼都正常的不孕症患者
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然而
檢查什麼都正常的小渟
備孕了足足八年都沒有懷孕過
在這中間
她曾找過其他醫師做過三次的人工授精
前年也在台北另一家大醫院做過一次試管
上一次試管取卵13顆,
養到第三天就新鮮週期植入2顆,但很遺憾沒有成功
後來剩下的胚胎養到囊胚,
共得到4顆囊胚,品質中等到中上
但很遺憾,解凍胚胎植入還是都沒有成功。
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針對這類型找不到原因的不明原因不孕者患者
其實這類型患者的內心是萬分的痛苦
由於什麼問題都沒有
所以會一直質疑自己為什麼不懷孕
通常也都會有再試試看的想法
這是無可厚非,合情合理的想法
但是
如果過去8年
一共96個週期
都不曾懷孕過
第97個週期,
自然懷孕機率當然還是很小。
如果自然懷孕很容易
又怎麼會過去96個週期都不成功呢?
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事實上,
根據統計
超過80%的夫妻
在備孕的前六個月就順利懷孕了
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也就是說
不明原因的不孕症
往往不是沒有原因
更不是單純運氣不好
而是有個潛在的、但很困難檢查出來的問題
而這樣的問題
有時候,在做療程的中間
才會浮現。
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後來
小渟選擇來找我做第二次的試管療程
這次我取了15顆卵
共8顆受精,培養到囊胚的有7顆。
品質BB x 4, CC x 3。
我們可以發現
小渟的胚胎
有受精的幾乎都到了囊胚 (囊胚率87.5%)
遠遠超過平均的囊胚率50%。
也就是說
她的胚胎是很正常的
問題卡在不容易受精這個過程
受精率僅53.3%,
另外,胚胎的培養非常順利
所以問題也可能出現在內膜。
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內膜的問題 + 受精的問題
這在一般的傳統檢查是完全無法發現的
只能從人工三次沒成功猜測受精可能有問題而已
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這一次
小渟在我這邊植入了兩顆解凍胚胎
都是4BB等級
懷孕指數1700多
看來又是一對雙胞胎報到了。
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小渟的故事非常值得我們思考
如果備孕很久很久都沒成功
就算夫妻兩人檢查都完全正常
找不出任何原因
再不斷嘗試的自然懷孕率又到底有多少呢?
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根據過去的研究
美國生殖醫學會在1978年就發表過
針對不孕的時間越長的人
接下來再試的自然懷孕率越低
不孕 <2年的:懷孕率22.8%
不孕 2-4年的:懷孕率10.3%
不孕 4-6年的:懷孕率9.2%
不孕 >6年的:懷孕率2.2%
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這樣的結果
在試管嬰兒療程也有完全相同的結論
針對平均年齡34.7歲的婦女做分析
不孕1-2年的:試管懷孕率34.3%
不孕3-4年的:試管懷孕率21.8%
不孕 >4年的:試管懷孕率9.1%
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也就是說
針對這些不孕時間越長的患者
他們背後潛在的原因可能越多
絕對不是單純機率就可以解釋的了。
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參考資料:
1. Fertility And Sterility Vol. 30, No.4, October 1978 , the duration of infertility: an important datum for the fertility prognosis of men with semen abnormalities
2. Gynecologic Endocrinology and Reproductive Medicine , 04 January 2019, Only women’s age and the duration of infertility are the prognostic factors for the success rate of natural cycle IVF
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“找原因固然重要,但如果妳怎麼找都找不到原因的時候,或許,只能在治療中再去尋找原因了。又或許,再也不需要知道到底什麼原因了,就像故事中的小渟一樣。”
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~ 威廉氏後人 - 李毅評醫師 ~
臉書蒐尋 : 威廉氏後人 - 李毅評醫師
粉絲專頁 : https://www.facebook.com/mrwilliams999
網誌連結 : https://mrwilliams999.blogspot.tw
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同時也有1部Youtube影片,追蹤數超過2萬的網紅賓狗單字Bingo Bilingual,也在其Youtube影片中提到,— 陪賓狗錄 podcast — 歡迎來訂閱我的節目《聽新聞學英文》 https://open.firstory.me/user/bingobilingual/platforms 【今天會學到的單字】 Fertility rate 生育率 fertility 生育的能力 Have an impa...
infertility rate 在 Garage+ Facebook 的最佳解答
#StartupGlobalProgram #OpenHouse
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infertility rate 在 我的ivf试管婴儿の日记 Facebook 的精選貼文
从老公的角度看试管婴儿疗程
当一对夫妻要做 #IVF试管疗程时,做丈夫的应该用什么态度来面对?常常有网友告诉我说,我的老公精子不好,可是他还是不能戒烟戒酒,好不配合。要知道,不孕症不只是女人的责任,男人也是有责任。这篇文章,是以男人的角度出发,里面分享身为丈夫应该如何帮助太太一起度过疗程,文章是英文内容,是奥莉爸爸写的,奥莉爸不会中文。分享给大家😊
IVF Journey, A Husband’s Perspective
Hi all, before reading further I would like to say this is NOT an instruction or tips for IVF and hopefully readers will understand my poorly written English. This is my journey as a father of the IVF baby girl. Why am I sharing all this? It is because my wife had a Facebook page of her IVF journey at https://facebook.com/ivfjourney2015/ and she told me that majorities (not all but most) feedback indicate husband not supportive enough to commit into a journey of IVF. I’m not a true supportive husband either, least I made up my mind to make it happen.
Let’s start with “Why IVF?”
We went for a fertilization test and results with;
Husband: Teratospermia (Human language, sperm is weak for fertilization process)
Wife: Unexplained infertility (I think this is easy to understand, there is for the confirming reason for this result and we don’t go for further test after it because it will consumes too much time and money)
We married and planned to have children late 2011, both our ages were 37 in 2015 because of late marriage. My wife introduced IVF because she does not want to give up and feels regretful in future and so do I. Maybe because I did too many regretful things in the past, now I do not want this happened to my wife. At least I do it better then ignoring it.
Preparation for IVF
Financially, I know it will involve amount of 20k – 30k “Ringgit Malaysia” in the whole process depending on the situation and this is only one chance for me. I don’t have the money for a second attempt because I need to allocate funds for delivery if success.
Mentally, I do some studies/research on IVF. The whole journey took 50 days and in one of the process my wife needs to do a self-injection daily. I quickly asked my wife “Daily injection?! Do I need to fetch you to clinic daily to do this?” She answered “No, we need to do this ourselves”. A final question from me going to be “How?!” After we sat down and discuss, we comes into conclusion and I will do the injection for her. This was the most painful and nervous moment I ever experience by poking a needle to my wife’s belly EVERYDAY!
Lifestyle, 6 months earlier. My wife told me the NO’s, NO alcohol NO smoking NO midnight wandering NO stress. I said, I will fly up to the skies like butterfly if I able to do all the NO’s. It’s like a mission impossible. How can a man like me not go out to social with friends without alcohol and smoke? The joke was sleeping early! You want me to social with my friends in breakfast or lunch time? At this time, she softly said “I really wants to have a cute baby in future, it looks more like a family. Furthermore, I don’t want to have regretful moments in future”. All these words came out of my love (wife), her words melted in my heart deeply. I told her “Ok, we will go for it BUT you will need to promise me ONE IMPORTANT thing. No matter the process success or not we only have one attempt we need to accept the truth and live happily without regret in future.” she agreed.
Commitment, this is not some empty promise. I made a huge commitment to change my lifestyle into zero alcohol, tobacco and lesser stress. If comparing the pain and suffers my wife will take in this journey e.g., injection, medication effects, hormone changes and all the effects from pregnancies to delivery, mine looks more alike small potatoes (looks much more simple). Trust me guys, don't compare it, if you do and more likely you're going loose badly. For the sake of making a better future, I had fulfilled this commitment.
IVF Journey Phase 1 “Unskilled Husband Injection”
Day 1, doctor consults us for Buserelin injection. I need to inject this medication into my wife's belly each day sharp at 8AM. The nurse had guided me side by side to do the first injection.
Day 2, I started my first injection to my wife's belly without anyone guiding beside. Feels a bit nervous because this time I'm doing it all by myself. I try to hum some music to distract my wife's from looking at the needle while injecting but still she is looking at it.
Day 3 - Day 15, sometime the injection hurting and causes bleeding/bruise to her. I need to find a new spot to inject every time and sees her bruise makes my pain in the heart too. My injection skills improved dramatically. She even told me that she doesn't feel pain like the beginning stages.
Day 16, follow up 2nd checkup. Doctor said, everything goes smoothly and added another medication to inject called Gonal-F to take home and start injecting on day 23. This message never surprises me because I've been told earlier, but just that the price to pay for this medication is quite costly.
Day 17 - Day 22, nothing much on these days and we just stick on the plan as usual.
IVF Journey Phase 2 “Stressful Night”
Day 23, Gonal F injections start today. This needle doesn't look same as those earlier, it comes with medication in it and look like a pen.
Day 24 - Day 26, side effects of the Gonal F medications started. My wife is feeling irritation at the injection site, fullness, bloating and tenderness in the lower abdomen due to the increasing size of the ovaries. Her mood changes dramatically as I can tell, but she endures it and tell me she can handle it.
Day 27, follow up 3rd checkup. Doctor said wife has eggs total of 12 and is ready for Transvaginal oocyte retrieval "Human language, Egg retrieval" at day 31.
Day 28 - Day 29, final injection of Gonal F. At day 29 night, I inject Ovidrel to wife belly to that causes the growth and release of a mature egg (ovulation) for day 31.
Day 30, resting whole day. Finally, we had a day without injection and worrying about holding any needles. Today we wondering about the egg growth, not knowing will the eggs grow more or still the same amount of 12.
Day 31, egg retrieval. 8 egg success retrieves and I give out my sperm for oocytes selection on the same day. Wife given cyclogest for oval protection after the egg retrieval.
IVF Journey Phase 3 “Hopeful Embryo Culture & Embryo Transfer”
Day 32 - Day 35, rest at home. We had pillow talk every night concerning about the growth of an embryo. We also look at sample growth stages of an embryo from the web to see what the current growth stage is.
Day 36, another hopeful and nervous morning. Doctor tells us the result of embryo culture as below;
Total Embryo Retrieve: 8
Embryo Qualified for ICSI: 6
Embryo Success until Cleavage Stage (Day 2 – Day 4): 3
Embryo Success until Blastocyst Stage (Day 5): 2
Embryo Qualified / Recommended for Transfer: 1
Both our eyes looked at each other, knowing only 1 Blastocyst Embryo available to transfer and doctor tell the same after it. I really do not know how to express both our feelings into words here, as we expected to have at least 2 Blastocyst out of 8 embryos and only left 1. We both agreed to proceed this only 1 Blastocyst transfer as this is the only choice we had. It's more likely walking on a 100ft tall string with no supports mission, a single error will fail the mission.
After the transfer process, wife given a room to rest for few hours. A nurse came and give us adjunctive medications, injections and advice while resting at room.
IVF Journey Phase 4 “The Final Moment of IVF”
Day 37 - Day 49, after the transfer. This period is known as 2WW (2 Weeks Wait) with adjunctive medications, injections and be very careful. I just let her sleep/rest more on the bed, I served her every meal in the room. We're also nervous and curious about pregnancy results on day 44, we tested with cheap pregnancy tester and get got a double line on it and we do have a little hope and joy with this result. On day 47, again we test, but this time with expensive pregnancy tester and the results double line again! We're so hopeful and happy at this moment. We really hope this result is true until the next checkup.
Day 50, final checkup. My wife goes for the hCG test by giving a sample of blood, we waited 2 hours for the results. While waiting, nurse guide us to a room to rest. Wife slept and I sat beside concerned on the hCG test results. 2 hours later, the doctor invited us to look for him. Before doctor speaks, while we are sitting down, my wife's eyes were starring in the hCG results number and she spotted the hCG number is 452. She smiles happily while doctor tells her "You are pregnant and congratulations! Come back after 2 weeks to scan for baby heartbeats. And please go out to the counter and ring the bell!”
Just Sharing My Thoughts
By all means, I’m not bragging about my success. I would like to say if anyone is planning on IVF, teamwork is very important and husband play a very important role to increase the success rate. Sometimes, I do feel like a spectator than a participant myself because I never experience any of the medical exams but this is not true. Every injection I put on her belly, I feel the pain in my heart as bad as she has on the belly. Ok, nothing much to share in this IVF journey and next time I might be sharing another journey as a Father! Here is my little baby girl Facebook page奥莉 Olivia Baby - 梁童心心 https://fb.me/oliviababylove if you wish to see her growth updates.
End.
#ivf #ivfmalaysia #ivfjourney #baby #alphafertility
infertility rate 在 賓狗單字Bingo Bilingual Youtube 的精選貼文
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【今天會學到的單字】
Fertility rate 生育率
fertility 生育的能力
Have an impact 有影響
Do sth of one’s own free will 自願、非遭強迫的
On the other hand 另一方面(副詞片語)
infertile 不孕的
fertile 有繁殖力的;土壤肥沃的
Be faced with 面臨(常常可以接 crisis)
infertility crisis 不孕危機
sperm concentration 精子濃度
decline 減少
excessive 過度的
drinking 常常指飲酒
fall into a category 屬於什麼範圍
in one’s control 由誰可以掌控的
Adverse 不好的;不想要的
adverse effect 不好的效果;不好的影響
副詞 adversely affect,帶來負面影響
reproductive health 生殖健康
Pan 平底鍋
Water-repellent jacket 防水外套
cosmetics 化妝品
testosterone 睪固酮
interfere with 干涉;干預;(負面)影響
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infertility rate 在 Infertility statistics 2021: How many couples are affected by ... 的相關結果
How common is infertility? · An estimated 15% of couples will have trouble conceiving. (UCLA Health, 2020) · Globally, 48.5 million couples ... ... <看更多>
infertility rate 在 Infertility - WHO | World Health Organization 的相關結果
2020年9月14日 — In the male reproductive system, infertility is most commonly caused by problems in the ejection of semen (1), absence or low levels of sperm, ... ... <看更多>
infertility rate 在 FastStats - Infertility - CDC 的相關結果
Infertility ; Percent of women aged 15-49 with impaired fecundity, by parity: 0 births: 13.8%; 1 or more births: 13.1% ; Percent of married women aged 15-49 with ... ... <看更多>