风采杂志-拒绝童婚

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林韵璇医生专访:不孕与助孕疗程 8TV

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The Reality of IVF

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Many couples choose their Fertility doctors because of their preference towards a characteristic of the doctor, however, many more choose to undergo their IVF treatment under a doctor or a centre because of the perceived success rates of the doctor or a centre. A published survey in the UK revealed that success rate of a centre or a doctor is the key determining factor for the decision of going through IVF in a particular Fertility Centre.

 

Therefore, all IVF doctors and centres strive very hard to increase the success rates of their patients. We emphasize on the patients’ lifestyle and age, in hope to get them to come at a younger age and in a better state of body fitness, so that we can obtain better eggs and sperms and hence make better embryos. We improve our laboratory environment and technology to mimic the uterus environment to yield a better fertilization and growth rate. We pat our own shoulders when we produce good quality embryos. And then we transfer the good looking embryos into the uterus and we wait……

 

10-12 days later, we either rejoice with the patient for a positive result, or we put on a very sad and sorry face to deliver the bad news

So what happened in between the time after we put those embryos back into the uterus until the time we test for pregnancy?   The answer to this is that nobody knows.

As doctors we placed the embryos back, and nobody actually knows when and how the embryos get implanted, and what determines whether the embryos will get implanted or not.

This is the Holy Grill of the science and wonders of IVF

Many people had tried various things, complete bed rest, baby aspirin, steroids, hanging the legs up and etc etc etc.

Studies after studies failed to show any good recommendation on what we should do to improve the implantation rates. Some people believe that by performing a Pre-implantation Genetic diagnosis (PGD) can improve the implantation rates. There is some logic behind this: by selecting the normal chromosomal embryo to put back into the uterus, the chance of implantation increases. However, years had gone by with such a practice being implemented in some centers and there is only a marginal increment in pregnancy rates.

A recent study conducted at KL Fertility Centre (Monash IVF, KL) showed some interesting data.

We looked at all the women going through one IVF and divide them into 3 different groups by age.

Women who are under the age of 35 have 60% chance of getting pregnant during the fresh cycle when we put back the embryos into their uterus.

If they do not get pregnant during the first round and have good embryos which can be frozen and to be used in a later date, the chance of them getting pregnant by replacing 1-2 frozen embryos is around 60%.

By the time this group of women exhausted all their embryos which were produced by ONE IVF treatment, the likelihood of them having at least one baby is around 80%.

This translates that 4 out of 5 couples who are under the age of 35 will get pregnant with just ONE IVF attempt.

The success rate is about 60% in women between the age of 35-40 with the same trend observed.

Even for the group of women who are in the range of over 40 years of age, the success rate is close to 30%.

This certainly have a significant impact on the way we think….we now know that the chance of pregnancy is extremely good by just having ONE IVF without even having to subject the embryos to expensive and potentially hazardous pre-implantation genetic testing.

 

The key thing is to just keep moving on!!!!!

 

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The History of Monash IVF in Malaysia

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Some of my colleagues and friends were curious: how did my life change after the IVF unit I was working at became part of Monash IVF, one of the oldest and prestigious IVF in the world?

I must admit that I was very proud to be one of the members of such distinguished establishment. I started working at KL Fertility Centre way before this unit merged with Monash IVF and I was here to witness this transition and was feeling very blessed to be involved in the whole journey.

First and foremost, let us look through the history of Monash IVF and how this humble little unit had made such significant impacted to the world of IVF:

With over 40 years of experience, over 20,000 babies and pregnancy rates among the best in the world, Monash IVF is the leading fertility research and treatment centre in Australia. They continue to achieve many world firsts in IVF and related technologies since the work of their pioneers who achieved the first IVF pregnancy in the world in 1973. Amazingly, 12 out of the first 15 IVF babies in the world are Monash babies. Some of the team’s groundbreaking achievements of Monash IVF include:

(1)World’s first IVF pregnancy in 1973. This was the first time scientist had proven that conception can be achieved outside human body and the resulting embryos can be placed back into the womb and resulted a pregnancy. However, this pregnancy ended with an ectopic and had to be terminated. Following this breakthrough, the Cambridge group in the UK used the similar technique to achieve the first IVF life birth. Louise Brown was the first baby born through IVF.

(2) World’s first microinjection (ICSI was developed as a result of this work) in 1980

(3) World’s first frozen embryo birth in 1984

(4) World’s first frozen embryo twins in 1985

(5) World’s first donor egg baby in 1983

(6) World’s first pregnancy and birth from a sperm retrieval operation for azoospermia in 1986

(7) Australia’s first surrogate birth

(8) Australia’s first open testicular biopsy twins

(9) Australia’s first blastocyst baby

Having boasted so much on the history of Monash IVF, so what does it mean to the unit I am working at? How does it change my life for the better? how does it assist me in helping my patients to improve their chance of pregnancy? I asked myself the same questions as the unit was going through the process of merging. Then came 1st of January 2013, the truth unveil itself.

(1) Improvement in recording, reporting and self-auditing for Quality Control

The unit was required to do thorough reporting on monthly basis. The Head Quarters in Australia requires us to report every cases of Fertility Treatment (IUI, IVF, ICSI) and to report the statistics of our success rates. The Headquarter pay meticulous attention to the success rates of the unit and will flag up unusual occurrences and this is most important for our quality control.

(2) Setting standards

Another important aspect of Monash IVF’s involvement in our daily practice is to standardize our practice and to set standards on the process of performing IVF, including the patients’ treatment cycle as well as the standard of the laboratory. This is to ensure that our standard of care is comparable to the standard of care in Australia.

(3) Technology transfer especially for the embryology laboratory

Regulation and transfer of technology for the embryology laboratory is one of the key component of involvement Monash IVF. The chief scientific director, Dr Tiki Osianlis from Monash IVF came and spent some time in our laboratory to look through the laboratory workflow and process. Her enthusiasm and her professionalism was inspiring and encouraging for our embryologists. Her continuous involvement includes supporting our embryologists with the latest information and technology to further improve the performance of of laboratory.

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Dr Tiki Osianlis (middle) with our embryologists

(4) Research

Monash IVF had been and is still actively involved with Research in Human Reproduction. Many current technologies involved in IVF today was the result of research of yesterday by a group of researchers from Monash IVF. Some of the key research areas we are involved in can be found under this link: http://monashivf.com/category/research-and-education-foundation/research-interests/ Some of the recently completed research by Monash IVF can be found under this link: http://monashivf.com/category/research-and-education-foundation/completed-projects/

(5) Sharing of information and scientific data

Our direct link with Monash IVF provides us with an excellent opportunity to be involved with research. As a centre located in the heart of South East Asia with heterogeneous group of patients from various ethnicity, KL Fertility Centre serves as an excellent partner in providing scientific data to further strengthen the power and significance of the study.