Taiwan IVF Specialist Infertility Treatment_2023.02 Ver.

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Causes of Infertility

Common

Causes

• Ovarian Related Factors

• Fallopian Tube Related Factors

• Other Uterine Factors

• Other Female Factors

• Endometriosis

• Penis Related Factors

• Testicular Related Factors

• Vas deferens Related Factors

• Immunity Factors

• Other Factors

Unknown Causes

4.4%

General Examination

Blood Test (Hormonal Study)

• Anti-Mullerian Hormone （AMH）

• Reproductive Hormones （FSH、LH、E2）

• Prolactin （PRL）

• Thyroid-Stimulating H （TSH）

• Androgen （EIA/LIA）

Transvaginal Ultrasonography (TVS)

Hysteroscopy

Hysterosalpingography (HSG)

Semen Analysis (SA)

Advanced Examinations (by doctors’ recommendation)

Examination of Immunology

Carrier Genetic Test (CGT)

Hyaluronan-Binding Assay (HBA)

Sperm DNA Fragmentation Analysis, Oxidative Free Radical Content, Mitochondrial Function Analysis

EndomeTRIO Examination （EndomeTRIO）

• Endometrial Receptivity Analysis （ERA）

• Endometrial Microbiome Metagenomic Analysis（EMMA）

• Analysis of Infectious Chronic Endometritis（ALICE）

Details of Infertility Examinations

Semen Analysis (SA)

Abstinence for 3 days before the test.

It is recommended to maintain a daily routine 2-5 days before the test. Avoid smoking, drinking, excessive intake of caffeine and hormone medicines.

Hyaluronan-Binding Assay (HBA)

It can predict sperm performance and fertilization potential. As the sperm approaches to the "zona pellucida" of the ovum, the acrosome region of the sperm head secretes enzymes that allow the sperm to penetrate the ovum shell for fertilization.

• Those who have failed IUI multiple times.

• Those who have undergone IVF treatment but unable to get pregnant.

• Those with normal semen analysis values but unable to get pregnant.

Sperm DNA Fragmentation Analysis

Chances of miscarriage could be affected by sperm DNA fragmentation. Sperm DNA Fragmentation Analysis can be considered if all other indexes are normal but infertility or miscarriage persist.

Application: Watch this to understand the sperm crisis!

Details

Examinations

Transvaginal Ultrasonography (TVS)

Ultrasound is used to examine uterus structural abnormalities and to monitor follicle growth, endometrial thickness, fibroids, chocolate cysts, and endometriosis.

Ovarian follicles

Uterine cavity

Application

2D Ultrasound

• Amount and shape of follicles.

• Anteverted or retroverted uterus.

• Endometrial thickness.

• Routine gynecological examination.

• Females preparing for pregnancy.

4D Ultrasound

• Amount and shape of follicles.

• Each follicle is marked with a different color.

• Shape of uterine cavity.

• Surrounding tissue of the uterus.

• Females with known ovulation problems.

• Females with suspected structural abnormalities of the uterine cavity.

Hysterosalpingography (HSG) Reservation required.

From the end of menstruation to the day of ovulation, a radiocontrast agent is injected through the cervix, and X-ray photography is used to check whether the fallopian tubes are unobstructed. This can also help to observe the adhesion around the fallopian tube fimbria, to determine whether there are lesions, hydrops, and whether the uterus is congenitally deformed.

Infertility Examinations

Hysteroscopy Reservation required.

Hysteroscopy can find lesions in the uterine cavity and diagnose uterine diseases such as: endometrial polyps, uterine adhesions, uterine septum, uterine fibroids, and endometrial inflammation, etc.

When is the best time for hysteroscopy?

After menstruation ends and before ovulation, it is about day 7 to day 11 of the menstrual cycle.

Is anesthesia required for hysteroscopy?

With a flexible hysteroscope, anesthesia is not necessary during the procedure.

When is it unsuitable for hysteroscopy?

• When bleeding is heavy, the imaging is unclear and cannot be examined.

• When there is inflammation in the pelvic cavity. This is to avoid a more serious infection.

• During pregnancy. This is to avoid affecting the fetus.

Are there any side effects from hysteroscopy? Is bleeding normal?

• The complication rate of hysteroscopy is very low (the incidence rate is about 0.05% to 1%), and possible complications include uterine perforation, allergy, infection, or hyponatremia.

• It is normal to experience slight vaginal bleeding after a hysteroscopy.

Let's see if the embryo's bed is ready.

Carrier Genetic Test (CGT)

CGT is a pre-pregnancy genetic test for hereditary diseases that only requires a blood draw. It is used to check if a couple is likely to pass a genetic disorder on to their children. Through WES analysis, more than 2,200 monogenetic disorders such as cystic fibrosis, spinal muscular atrophy, and fragile X syndrome can be detected. According to the test results, you can choose to conceive naturally or undergo IVF treatment to screen out healthy embryos through PGT-M (PGD), thereby reducing the risk of giving birth to a baby with genetic abnormalities.

One in 100 live births has monogenic disorders.

Golden age of female fertility

• 21 to 25 years old is the peak of a female’s reproductive period.

• 30 years old If you have not been pregnant for a year, infertility examinations are recommended.

• 35 years old If you have not been pregnant for half a year, infertility examinations are required.

• 37 years old Please take an infertility examinations.

• 38 years old Please undergo infertility examinations and actively receive treatments.

AMH

AMH, short for Anti-Müllerian Hormone, is secreted by immature follicles in the ovaries. It is the indicator of ovarian reserve. Ovarian function is the key factor affecting pregnancy, therefore AMH level is an important indicator for predicting the success rate of IUI and IVF treatments.

The overall condition needs to be evaluated along with other blood test results.

The AMH test is not affected by menstruation and can be tested at any time.

Reference for 35 years old females:

AMH <2

AMH 2-5

AMH >5

Premature ovarian failure (POF)

Normal

Possible be Polycystic Ovary Syndrome (POS)

POS requires a comprehensive evaluation and diagnosis by infertility physicians.

Golden period for natural conception

Taking the 28-day menstrual cycle as an example, ovulation occurs on the 14th day of the menstrual cycle. Ovum can live for about 24 hours after being released, while sperm can live for 2-3 days in a woman's body. Therefore, 3 days before and after ovulation are often referred to as the golden period for natural conception.

Ovulation Prediction:

• Vaginal Ultrasonography

• Ovulation Prediction Strips

• Basal Body Temperature Recording

• Vaginal Discharge Observation

Ovulation Tips

8 Ways to keep your ovum healthy

TSI is divided into oral and injection ovulation stimulants. For the drug method, ovulation drugs are used to stimulate the ovaries to accelerate the growth of follicles, and then use ultrasound to observe the size of the follicles to determine whether HCG injection is needed. Finally arrange the time and frequency of intercourse. Doctors will also prescribe progesterone to help eliminate uncontrollable factors.

Take supplements as instructed by your doctor.

Timed Sexual Intercourse (TSI)

Things both husband and wife should know when preparing for pregnancy

Pre-pregnancy Health Check

Avoid conditions that may have been overlooked but could affect the fetus.

Develop Exercise Habits

Obesity can lead to abnormal ovulation and spermatogenesis. Moderate exercise can enhance the body's metabolic function and increase the chance of conception.

Balanced Diet and Supplements

Both men and women need balanced diet and may take supplements with female and male fertility vitamins.

Maintain positive emotions and release pressure

Negative emotions and pressure could lead to ejaculation disorders, abnormal ovulation, loss of libido, sexual dysfunction and other problems that cause infertility.

Avoid alcohol, tobacco and drugs

These will affect the production and maturation of sperm and ovum.

Five Supplements for Healthy Ovum

Improves ovum quality and ovarian function.

Helps ovum maturity and increases fertilization and pregnancy rate.

Improves irregular ovulation, helps early embryo development.

Improves ovum quality, reduces miscarriage rate in women at advanced maternal age.

Improves follicle development, ovum quality and ovarian function.

The dose required for each person is different and if you have any specific conditions, please consult your doctor before taking it.

Supplements for Healthy Sperm

Supplements with glutathione, zinc, selenium, Q10, folic acid, arginine, and other nutrients can help maintain sperm quality.

Take Mediterranean diet for 90 days can increase your chances of getting pregnant!

Watch the video to learn how to take care of your ovum from diet!

Graphic explanation, professional physician, nutritionist.

Normal IVF

4th Generation IVF (with PGT-A)

Donor Egg IVF

Five Don’ts after implantation!

"Don’t" do strenuous exercise, overwork or heavy lifting.

"Don’t" have sexual intercourse after implantation and the first three months of pregnancy.

"Don’t" be anxious, stay happy and healthy.

"Don’t" take baths or hot springs to avoid difficulties in embryonic development.

"Don’t" squat for a long time, or force your abdominal muscles.

Age

Reproductive function declines.

Fallopian Tubes Factors

Bilateral tubal obstruction or edema.

Ovulation Factors

Anovulation, polycystic ovary syndrome and ovarian hyporesponse.

Male factors

Abnormal sperm, anti-sperm antibodies, and azoospermia.

Unknown factors

After the infertility examination, the couple showed no abnormalities in anatomy and reproductive function, but they were still unable to conceive naturally.

Other factors

Recurrent miscarriage Couples with known chromosomal abnormalities or genetic disorders.

First Generation IVF

Place sperm and ovum in the same medium in which the sperm and ovum can be fertilized naturally .

Application

• Those with blocked fallopian tubes

• Those with endometriosis

• Those who are infertile due to secretion abnormalities

Men with low sperm count may lead to IVF failure.

Second Generation IVF

Intracytoplasmic Sperm

Injection (ICSI): the embryologist will operate the retrieved germ cells under a microscope, stabilize an ovum with a specific stabilizer, and draw a sperm with a needle. Then the needle is inserted through the ovum's zona pellucida and cell membrane, and the sperm is released into the egg's cytoplasm.

Application

• Infertile men

Those with low sperm count, lack of motility, and azoospermia

• Those with abnormal hyaluronan binding assay results

Third generation IVF : PGT-A

In combination with the second-generation IVF technology and Preimplantation

Genetic Testing for Aneuploidy (PGT-A), the third generation

IVF technology focuses on chromosome analysis before embryo implantation. When the cultured embryo developed to the 5th-6th day (blastocyst stage), 5-10 cells of the trophectoderm on the periphery of the embryo are taken out by embryo biopsy, and a molecular diagnostic method is used to check whether there are a full set of 46 chromosomes. After confirming that there is no abnormality, the healthy embryo will be implanted. Our PGT-A adopts advanced next generation sequencing (NGS) technology, which can provide fast, high-accuracy, and high-resolution chromosome analysis.

Application

Couples with the following conditions are recommended to take PGT-A to increase pregnancy rate.

• Women over 38 years old

• Those who have recurrent miscarriage

• Those who have failed embryo implantation multiple times

• Those who try to avoid fetal chromosomal abnormalities

• Those who have failed IVF multiple times

• Those with abnormal number of chromosomes or chromosomal trans locations in their family history

• Procedure of the Third Generation IVF (PGT-A)

Start the course of IVF.

Perform embryo biopsy to take out a small amount of trophoblast cells.

Retrieve ovum and sperm.

Use those cells for chromosome tests.

Perform fertilization in the laboratory and culture embryos.

Choose embryos with normal number of chromosomes for implantation.

Continue to culture embryos for 5-6 days to form blastocyst stage embryos.

Generation IVF : Embryoscope Time-Lapse System

Embryo's Mansion

Lee Women's Hospital has more than five embryo incubators. Different from traditional incubators, the Timelapse embryo incubator is equipped with 24-hour high-resolution monitoring, allowing it to determine embryo development status quickly and accurately. It can provide more objective and accurate information when screening high-quality embryos suitable for implantation.

Advantages of the Time-Lapse

System

High Resolution Photography and Microscopy

Environment

Monitoring

None

The door needs to be opened during observation

Temps, humidity, and pH will be affected during observation

1~2 times a day, only the static growth of the embryo can be observed.

Important developments

Observing 1~2 times a day, not all can be seen.

Yes

The door doesn’t need to be opened during observation

Temps, humidity, and pH remain stable

Shooting once every 10 minutes, continuous observation for 24 hours, the dynamic growth of embryos can be observed.

Observing 144 times a day, all can be seen and recorded.

Traditional Embryo Incubator

Time-Lapse Embryo Incubator

Fourth generation IVF: AI Embryo Selection System

In the past 40 years, Lee Women's Hospital has accumulated more than 30,000 IVF babies across 36 countries. With an embryonic pattern database and professional AI embryo selection technology, we can increase the success rate of IVF!

Our research published on ESHRE has won Best Paper Award from Taiwanese Society for Reproductive Medicine!

Effectively increase the chances of pregnancy

Spindle View Positioning Technology

The spindle apparatus is the heart of the ovum. Normally, the spindle apparatus will not be dislocated, but it tends to be displaced more frequently in elderly women or patients with premature ovarian failure, so the spindle apparatus may be damaged during sperm injection. The spindle view positioning technology is used to accurately determine the position of the spindle apparatus and avoid damage to ovum during sperm microinjection. According to clinical statistics, when this technique is applied to elderly women or patients with premature ovarian failure, the insemination rate increases to over 85%!

The Witness System is like the facial recognition system of sperm and ovum.

When a container is replaced, the data is automatically imported into the new container to reduce manual proofreading errors.

After the medical records of IVF patients are archived, the data of both husband and wife will be automatically imported into the Witness System.

During oocyte retrieval and implantation, the patient's identity will be confirmed by her chip bracelet.

During the IVF treatment process, all relevant containers are affixed with exclusive identification chips.

Providing a sense of security for exhausting IVF couples.

If an unpaired sample is placed in the working area, an alarm will be triggered immediately.

Know more about Witness system

With the change of environment and the increasingly serious pollution of environmental hormones, people's demand for reproductive medicine is getting higher and higher. Countries around the world continue to innovate and develop reproductive technology, and Taiwan's IVF technology has reached the No. 1 position in Asia and No. 2 in the world. This is based on the efforts that Taiwan's medical research team has invested in this field 40 years ago.

Professor Maw-Sheng Lee has been devoted to the research of reproductive medicine since 1980, and he has led the laboratory and physician team to continuously study and cooperate with European, American and Japanese teams to develop new cutting-edge reproductive technologies. Since the birth of the first IVF baby in 1987, Professor Lee's team has broken many records with leading technology, of which 5 cases were the first of its kind in Asia, establishing the team's position in the field of reproductive medicine.

In 2018, NHK from Japan visited Lee Women’s Hospital.

In 2019, Lee Women's Hospital hosted the IVF World Expo.

With two world records and contributing a number of reproductive technologies to Taiwan, Dean Maw-Sheng Lee was awarded the National "2nd Class Professional Medal" by the Ministry of Health and Welfare in 2014. At that time, very few physicians could receive this honor. The government also thanks Dean Maw-Sheng Lee for devoting his 40 years of brilliant achievements in reproductive medicine!

In order to provide more comprehensive medical services, the Lee Women’s Clinic expanded to a hospital in 2016. It is also the only maternal and child hospital in Taiwan that specializes in infertility. Lee Women's Hospital has been improving its technology and continuously developing the best solutions. We participate in ESHRE and ASRM every year to publish the latest research results, and almost 350 papers are published yearly in leading international reproductive journals. It is in line with international medical technology and continues to rank among the best in the world. So far, more than 25,000 IVF babies have been born at Lee Women's Hospital, and their parents come from 36 countries around the world!

The unveiling ceremony of Lee Women's Hospital was held in 2016. The national evaluation of the hospital was passed in the same year.

Lee Women's Hospital has accumulated nearly 40 years of clinical experience in infertility treatment. All the way from consultation to precise personalized medicine and implantation, we will ensure the best possible care for our patients.

TAF-certified medical-grade

Guinness World Records

With clinical expertise and the TAF-certified medical-grade （ISO

15189）embryo testing laboratory, we provide safe and accurate reproductive medicine services.

In 2011, 1232 IVF babies gathering breaks Guinness World Records !

Vice President Chung-Yi Chen carefully examined the patients.

Our hospital has developed a the fourth-generation IVF and AI big data deep learning process that provides innovative and unique embryo selection technology that chooses embryos with the best development status. We create personalized and precise treatment courses, so that the pregnancy success rate is better than that of Europe and the United States.

Our hospital has developed the fourth-generation IVF and AI big data deep learning process that provides innovative and unique embryo selection technology that chooses embryos with the best development status. We create personalized and precise treatment courses, so that the pregnancy success rate is better than that of Europe and the United States.

The Embryoscope time-lapse system is the most powerful tool for AI embryo selection technology!

Dr. Chun-I Lee was invited to participate in the online ESHRE. He shared and discussed the breakthrough of AI embryo selection patent technology.

Director Jun-Jia Huang, performs ICSI in the Reproductive Research Laboratory.

The birth of every new life represents a new inheritance, and we will continue passing on the torch.

In the future, we plan to build a well-established education hospital to strengthen medical services and let the experiences of Lee Women’s Hospital continue to be passed on. By the hands of God, we wish to make life better. May Lee Women’s Hospital help you to fulfill your dream. The successful couple brought their baby to thank Dean Lee.

Dean Professor Maw-Sheng Lee

PhD in Obstetrics and Gynaecology, Toho University, Japan / Postdoctoral Researcher, University of Pennsylvania / Professor of the Department of Medicine, China Medical UniversityProfessor of the Institute of Medicine of Chung Shan Medical University / Hospital Evaluation Committee Member of the Ministry of Health and Welfare

Vice President Dr. Chung-Yi Chen

Attending Physician of Endovision Center of Kawasaki Hospital in Japan / Attending Physician of Reproductive Center of FreeUniversity in Belgium / Attending Physician of BounHall IVF Center in UK

Director of the Genetic Center Dr.Chun-I Lee

Physician, Department of Reproductive Endocrinology and Infertility, National Taiwan University Hospital / Assistant Professor, Department of Obstetrics and Gynecology, Chung Shan Medical University / Ph.D., Institute of Medicine, Chung Shan Medical University

Director of the Reproductive Medicine Center Dr. Pin-Yao Lin

Director of the Department of Reproductive Medicine, Kaohsiung Chang Gung Memorial Hospital / Ph.D., Institute of Medicine, Chung Shan Medical University

Department of infertility Dr. Tzu-Ning Yu

Attending Physician, Reproductive Medicine Center, Taipei Medical University Hospital / Doctoral Program of Institute of Medicine, Chung Shan Medical University / MSc., Biochemistry Institute, National Yang Ming University

Attending Physician of Infertility Dr. Ting-Feng Wu

Attending Physician of Dept. of Obstetrics and Gynecology, Chung Shan Medical University Hospital / Fellow of Div. of Reproductive Endocrinology and Infertility, Dept. Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital / Resident doctor of Dept. of Obstetrics and Gynecology, Chung Shan Medical University Hospital / Bachelor of Medicine, Chung Shan Medical University

Chromosomal Inheritance Laboratory Team

Anesthesiologist team

Reproductive Research Laboratory Team

Genetic Diagnosis Laboratory Team

Fourth Generation IVF : AI Embryo Selection System

Implantation success rate can be raised from 50% to 70% by AI embryo selection

Accumulated over a hundred million of image data analysis

Embryo time-lapse technology can observe the dynamic changes during embryo development to predict whether the embryo may have the risk of chromosomal mutations, and find better quality embryos to improve pregnancy rate

Excellent master and doctoral team

The medical team has 6 experienced infertility doctors

The laboratory team consists of 5 PhDs., 12 Masters and 5 Bachelors.

Among them, there are 4 senior embryologists with over 20 years of experiences

High accuracy examinations

Lee Women's Hospital has three professional laboratories

Genetic Diagnosis Laboratory

Reproductive Research Laboratory

Chromosomal Inheritance Laboratory

Developed precise examination technology, no embryo delivery is needed

Lowered the risk of embryo delivery

Inspection results with high accuracy

Design precise treating strategy

Medical Laboratory

TAF certified genetic diagnosis laboratory

Certified by ISO 15189

Examination and technology are guaranteed

Professional technology & great value equipment

Identification for ovum and sperm

Witness Electronic Pairing Verification System

Precise implantation

Spindle View Positioning Technology

Embryo luxurious mansion

Time-Lapse Embryo Monitoring System

Raise the pregnancy rate of infertile patients

TAF certified NGS Technology: PGT-A

Genetic testing for monogenic disorders

PGT-M Preimplantation Genetic Testing for Monogenic disorders

Intelligent selection of high-quality embryos

AI embryo selection

Identify the cause of male infertility

Specialized semen testing equipment and professional analysis technology

An advanced maternal age couple conceived healthy twins from D6 embryos!

What is a mosaic embryo? Can a mosaic embryo be implanted?

Hysteroscopy (HSG)What is it?

How does HSG help with IVF treatment?

What are the causes and treatments of infertility caused by fallopian tube obstruction?

Is it a good idea to accept donor eggs if repeated IVF fails at advanced maternal age?