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Ovaries Reserve

AMH

Anti-mullerian Hormone (AMH) is a hormone that  represents a female's ovarian reserves which are closely related to the female's fertility.

AMH's current clinical application:

  1. Assessing ovarian reserve of reproductive age

  2. Assessing the potential of fertility

  3. Predicting the risk of early ovarian failure

  4. Predicting polycystic ovary

  5. Evaluating IVF effectiveness in stimulating ovulation

  6. Evaluating IVF success rate 

  7. Evaluating menopause

  8. Evaluating ovarian damage before and after surgery or chemotherapy

Ovarian Functions

Ovaries provide 2 key functions :

  1. Produce a mature egg for fertilization monthly

  2. Produce estrogen and progesterone that are essential to establish, maintain pregnancy, vital functions and sexual function as well

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There are several ways to determine whether a woman ovulates regularly and produces sufficient amounts of hormones:

  1. Medical examinations:The first step in assessing ovarian health is to receive physical and pelvic examinations and provide medical history.

  2. Menstrual history (the patient’s history well as that of relevant family members)

  3. Medication history:Experience of previous pelvic surgery, history of anorexia or bulimia, health of the adrenal, thyroid, and pituitary glands.

  4. Pelvic ultrasound:A transducer inserted into the vagina sends out high frequency sound waves and then collects returning echoes from tissues in the body. The result image, viewed in real time, shows follicles as well as any problems such as ovarian cysts.

  5. Blood tests

Fertility Check-up

We focus on several examinations that are important for the IVF treatment:

  1. Inquiry of medical history, menstrual and ovulation status, intercourse, infertility treatment records

  2. Physical examinations : examination of uterus, vagina, cervix and reproductive organs

  3. Ultrasound examinations : Ultrasound can be used to observe uterine morphology, endometrium, uterine fibroids, ovaries and ovulation. Recently, ultrasound has been used for vaginal oocytes retrieval and evaluating the endometrium.

  4. Evaluation of ovaries reserve : The evaluation of ovarian reserve is not only an indicator of female fertility, but also related to medicines that doctors choose to stimulate ovulation. We use ultrasound to check antral follicles count and check AMH level to determine what medicines are most appropriate. A good protocol makes the maximum of oocytes yield.

  5. Hysteroscopy examinations : Hysteroscopy uses an endoscope to check the condition from cervix to the uterine cavity if there are uterine flesh, uterine fibroids or endometrial adhesion. We uses soft hysteroscopy which can be performed without anesthesia

  6. Infection check : Syphilis, AIDS and hepatitis, chlamydia and gonorrhea, which are the most common sexually transmitted diseases, should be checked before IVF treatment. Chlamydia infection may be clinically asymptomatic or cause acute pelvic inflammation. Chlamydia infection can cause chronic endometrial inflammation, reduce pregnancy rate, and increase abortion rate. Beside traditional diagnosis of chlamydia infection with cultures, cervical and urethral samples as well as urine sample are used for chlamydia DNAtesting.

  7. Hysterosalpingography (HSG) : It is a uterine and fallopian tube radiography. Before menstruation, injecting the dye into the uterus, then use X-ray to check the permeability of the fallopian tubes, the morphology of the uterine cavity, and congenital uterine anomalies.

  8. Ovulation tests : Many methods are used to check ovulation such as Blood LH and progesterone level increase, basal body temperature (measure 2 - 3 months), cervical mucus, endometrial slice (2 - 3 days before menstruation), and ultrasound tracking.

  9. Hormonal tests : Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, Thyroid-stimulating hormone (TSH).Immunological examinations

  10. Detection of anti-sperm antibodies in women's serum or in cervical mucus. There have been some discussions on autoimmune and infertility. Reports indicate that human leukocytic antigens (HLA) and autoimmune problems have associate with abortion. Further research is needed to clarify the relationship between autoimmune disorder and infertility.

  11.  Post-coital test (PCT) : PCT should be done as close to ovulation as possible and checked 9-24 hours after sexual intercourse. After 2 days of abstinence then have sex in night before the test. Check cervical mucus on its amount, shape and viscosity to see if it is Spinnbarkeit mucus, which is the stretchy, egg white-colored cervical fluids around ovulation.

Genetic Diagnosis

​The genetic codes in DNA produce the necessary proteins for the creatures with correct timing and quantity. Any errors in those processes may lead to changes in proteins and physiological functions, which may cause disease.

 

Genetic disease can be caused by various reasons, such as protein coding,regulation of protein expression as well as the protein-protein interaction. As the human genome has become clearer, many diseases have known to caused bygenetic mutations.

 

Genetic test is a medical test that can identify changes in chromosomes, genes, or proteins. It can confirm or rule out suspected genetic conditions or help determine an individual's chances of having disease based on genetic variation. In cooperation with GGA Corp, HuaYu fertility uses the most advanced molecular medicine technology to provide comprehensive genetic

diagnostic services for patients in need. We aim to reduce major birth defects,early detections and treatments of congenital abnormalities in newborns, and reduce risk of genetic diseases.

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Pre-pregnancy

 

 A person who has a gene mutation in a chromosome associated with a recessive genetic disease is called a carrier. The carriers are usually healthy and normal in appearance. However, carriers have higher chances of giving birth to children with genetic disease if both parents are the carrier of the same disease. The recessive genetic disease is difficult to be discovered through general prenatal testing, so it is often found after birth. Screening can help couples to know whether they have the relevant genetic disease genes and the risk of having offspring with genetic disease.

 

Who needs genetic diagnosis?

 

  1. Who want to know if you are a carrier of recessive genetic diseases

  2. Family members with history of genetic disease

  3. Close consanguinity couples

  4. Who are planning for pregnancy

  5. Sperm or egg donor

 

 

 

Embryo Biopsy

 

Preimplantation genetic target for aneuploidy (PGT-A) or Preimplantation genetic diagnosis (PGD) is to perform genetic analysis on embryo. It is done by embryo TE cells biopsy under microscope. The purpose of PGT-A is to increase implantation rate. It is suggested for elder women, recurrent embryo implantation failure, recurrent abortion, and severe male infertility.PGD is used to avoid transmission mutation gene(s) to the next generation.

 

 

 

Days of Embryo biopsy TE cells biopsy is preferred in blastocyst stage (Day 5) but it is also possible to do blastomere biopsy in morula stage (day 3-4) or polar body from eggs after meiosis.

 

 

 

Controversy

 

The statistical results of PGT-A / PGD are controversial, mainly because whether the biopsy method and freezing/thawing affect the subsequent development of the embryo, which is a problem that cannot be fully resolved at present. However, many studies suggests that embryo biopsy can increase embryo implantation rate, increase the pregnancy rate per cycle, and reduce the self-abortion rate.

 

 

 

After Pregnancy

 

After detecting the fetal heartbeat, HuaYu will refer you to a well-qualified Ob/GYN! During pregnancy, you can do genetic diagnosis on the fetus to ensure the baby's health.

 

Amniocentesis is a technique used to extract amniotic fluid for genetic test because amniotic fluid contains fetal cells. There are different detection methods can be performed to check the fetal development and health. The following are common tests:

 

 

 

Karyotype analysis The chromosome karyotype analysis is to detect 23 pairs of chromosomes by dye staining and use the microscope to identify whether the number of chromosomes is abnormal, and whether there are structural abnormalities such as large fragment deletion or non-equilibrium chromosomal translocation. The chromosomal abnormalities of three times the number of chromosomes is quite common in elderly maternal, such as Down's disease (trisomy 21), Edward's disease (trisomy 18), Patau's disease (trisomy 13) and so on.

 

 

 

Amniotic fluid chromosome microarray (amniotic fluid genetic chip) Amniotic fluid genetic chips are analyzed using DNA hybridization. By applying high density of probes, smaller fragment deletion / duplicate diseases can be detected, such as chubby willy syndrome, angel syndrome, DiGeorge syndrome, cat cry syndrome, etc. However, the cost of the genetic chips are higher than the karyotype analysis. Since it is impossible to distinguish the imbalanced chromosomal translocation or other structures anomalies with gene chip, both karyotyping and amniotic fluid chips have their own merits and cannot be replaced by each other.

 

 

 

Non-invasive fetal chromosome test (NIPT)

 

Studies have shown that fetal DNA can be detected in pregnant women's venous plasma. Non-invasive fetal chromosome test (NIPT) technology can accurately detect fetal DNA information contained in the plasma from maternal venous blood and use next-generation sequencing technology and bioinformatics methods to accurately detect whether the fetus has a chromosomal disease.

 

 Applicable to :

  1. Elder female

  2. Pregnancy serum screening for suspected fetal abnormalities

  3. Ultrasound examination of fetal abnormalities

  4. Chromosome karyotype analysis

  5. People with certain genetic diseases or congenital abnormalities

  6. Multiple spontaneous abortion

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