積少成多(儲蓄式，撲滿)試管嬰兒add

2014.12.19
積少成多(儲蓄式，撲滿)試管嬰兒add 積少成多試管嬰兒的概念是來自於歐洲最大一家試管嬰兒中心西班牙IVI試管嬰兒中心，他們針對卵巢功能退化進行新的一個做法:累積兩次取卵數目，來進行合併兩次卵子植入胚胎的試管嬰兒，稱之為累積卵子:卵巢功能退化的求子新策略! IVI試管嬰兒中心得到一個很高的成功率，幾乎快要只做一次取卵新鮮胚胎植入成功率的兩倍，算起活產率大概是1.5倍，(Cumulative LBR/patient was statistically higher in the LR-Accu-Vit group (36.4%) than the LR-fresh group (23.7%) )這個論文發表在2012年RBO醫學期刊，這是一個著名的線上不孕症醫學期刊， 博元婦產科在2013年台灣生殖醫學會(TSRN)發表:積少成多:卵巢功能低下求子新策略初步報告，與會人士的矚目，在這個論文報告裡面累積了5個成功案例，年紀是24、34、37、40、41都累積兩次試管嬰兒取卵，AMH有人低於0.14、0.59、08、0.71、0.99這五人經由博元婦產科的積少成多(儲蓄式，撲滿)試管嬰兒協助都已經成功懷孕生產，尤其是那個41歲卵巢功能低於0.14的個案，我們一開始要她借卵生子，她堅決不借卵，後來還是成功生龍鳳胎(見他送來油飯的嬰兒照片及台視新聞報導博元婦產科的論文) 對於卵巢功能低下我們可以使用DHEA、使用生長激素，但其實效果都不彰，博元婦產科花了很多時間和人力做了全面回顧了全球的卵巢功能低下求子策略研究報告裡面，發現其中積少成多(儲蓄式，撲滿)試管嬰兒是最快最有效的，當然病人比較辛苦，但與其把錢花在生長激素，或者說要吃半年的DHEA，增加的卵子數目恐怕都不夠每個月卵巢自己閉鎖(atresia)的量約一千顆卵子，一個女人一個月至少有一千個卵子閉鎖(atresia)，所以如果要累積或堆積增加取卵數，來增加懷孕率，與其是吃各式各樣藥(目前有證據力的只有DHEA)去增加取卵數，我們不如取出卵子來累積多一點，這個概念很像你去銀行儲款，或者儲蓄或存錢在撲滿的概念，日積月累積少成多， 相信博元婦產科累積少成多(儲蓄式，撲滿)試管嬰兒，或積少成多試管嬰兒、或儲蓄式試管嬰兒、或撲滿式試管嬰兒，至少在台灣地區是一個創新的做法，對於卵巢功能退化，老化退化，低下的病人，如果累積足夠的胚胎用最新的第3代基因晶片定量PCR試管嬰兒，找出正常染色體的胚胎，更是如虎添翼，胚胎切片全基因篩檢，目前已經進入全基因放大檢測，可以全面看到染色體、包括24個染色體，也就是1到22號染色體，加上XY染色體，可以找到接近近乎正常染色體的胚胎，如果植入兩個胚胎到子宮那根據美國紐澤西李察醫師團隊發表在2013年9月的論文高達84.7%的活產率如果放三個呢?豈不是接近百分百? http://www.youtube.com/watch?v=ozT3cLAR22U http://www.ttv.com.tw/102/08/1020826/102082646655012.htm 參考文獻: Reprod Biomed Online. 2012 Apr;24(4):424-32. doi: 10.1016/j.rbmo.2011.12.012. Epub 2012 Jan 8. Accumulation of oocytes: a new strategy for managing low-responder patients. Cobo A1, Garrido N, Crespo J, José R, Pellicer A. Author information Abstract Accumulation of oocytes from several ovarian stimulation cycles is currently possible using novel vitrification technologies. This strategy could increase the inseminated cohort, creating a similar situation to normoresponders. This study included 242 low-responder (LR) patients (594 cycles) whose mature oocytes were accumulated by vitrification and inseminated simultaneously (LR-Accu-Vit) and 482 patients (588 cycles) undergoing IVF/embryo transfer with fresh oocytes in each stimulation cycle (LR-fresh). Drop-out rate in the LR-fresh group was >75%. The embryo-transfer cancellation per patient was significantly lower in the LR-Accu-Vit group (9.1%) than the LR-fresh group (34.0%). Live-birth rate (LBR)/patient was higher in the LR-Accu-Vit group (30.2%) than the LR-fresh group (22.4%). Cumulative LBR/patient was statistically higher in the LR-Accu-Vit group (36.4%) than the LR-fresh group (23.7%) and a similar outcome was observed among patients aged ⩾40years (LR-Accu-Vit 15.8% versus LR-fresh 7.1%). The LR-Accu-Vit group had more cycles with embryo cryopreservation (LR-Accu-Vit 28.9% versus LR-fresh 8.7%). Accumulation of oocytes by vitrification and simultaneous insemination represents a successful alternative for LR patients, yielding comparable success rates to those in normoresponders and avoiding adverse effects of a low response. The accumulation of oocytes from several ovarian stimulation cycles is currently possible with the aid of novel vitrification technologies. This strategy could be useful for low-responder patients, contributing to increase the inseminated cohort and creating a similar situation as in normal responders. According to the results presented herein (higher live-birth rate per patient treated), this strategy represents a successful alternative for low-responder patients, yielding comparable success rates to those in normal responders and avoiding the adverse effects of a low response.