<超級考古題系列 – 如果卵巢是一個銀行，妳還剩多少存款？

先別說這個了，妳聽過AMH嗎？>

各位好

小弟鍵盤婦產科 - 威廉氏後人

.

今天我要說一個很老的話題：”AMH”

他重要到我要把他歸類到超級考古題系列中。

.

我知道大部分的人都已經耳熟能詳

甚至曾經面對著自己的AMH報告而獨自在深夜裡哭泣。

-

但我發現還是很多人搞不太清楚

所以我決定專門寫一篇文章來介紹它。

也希望這篇文章能讓更多的人

更了解自己的身體。

-

AMH，抗穆勒氏管荷爾蒙

他是一個很神秘的物質。

在我們還是胚胎的時候

AMH的分泌抑制了胚胎期的女性生殖器官雛型 (穆勒氏管)

也讓人性別分化成男性。

-

但上面這段完全不是我們今天的重點。

-

AMH在成年女性身上

由濾泡中的顆粒細胞所分泌。

因此，AMH的指數與卵巢中的濾泡數目呈線性關係。

-

我知道在座各位的數學都不是太好，

可能聽不太懂什麼叫做線性關係。

.

簡單來說

AMH就是代表著濾泡的數目。

AMH高，表示濾泡多。

AMH低，表示濾泡少。

就這麼簡單。

-

AMH為什麼那麼重要 ?

因為它很準確。

.

而且AMH不受月經週期影響

不論在月經的哪一天去抽

指數都相當的穩定。

-

AMH是目前現階段存在的所有卵巢剩餘功能的評估中

最簡單、最準確、最不受到其他因素干擾的一個項目。

-

其他常用的項目還有很多

常用的如第三天的FSH，

但FSH可能受到荷爾蒙藥物的影響而造成數字上的改變。

.

另外如基礎濾泡量，

但需要月經第二天去照陰道超音波檢查，較為費時費工。

而且每個週期間差異較大。

-

因此，AMH變為現代不孕症一個絕對必要的檢查項目之一

其重要性不輸給男生的精蟲分析。

-

不了解精蟲狀況怎麼判讀的請去複習：

超級考古題系列4 – 我先生這樣正常嗎？ 精蟲狀況與相對應的治療標準

https://www.facebook.com/williams.li.31/posts/243958666163831

-

一個男生還有多少隻會動的精蟲？

一個女生還有多少顆能夠用的卵子？

我想這絕對是我們需要知道的。

-

以上都是基本觀念

以下開始講兩個我今天要講的重點。

-

首先

我曾在DHEA那一篇文章中介紹過

-

沒聽過的麻煩複習：

DHEA :

https://www.facebook.com/mrwilliams999/posts/253659251886125

-

卵巢剩餘功能不佳的人建議吃 DHEA

而什麼樣的人叫做卵巢剩餘功能不佳呢？

-

根據歐洲生殖醫學會訂定的波隆那標準 (Bologna criteria):

卵巢剩餘功能不佳的因子為：

1. 高齡(>40)、或者其他卵巢傷害的病史 (如卵巢手術、化療、電療等等)。

2. 在標準刺激下，過去取卵的數目小於或等於3顆。

3. 基礎濾泡量小於5-7顆 或 AMH < 0.5-1.1 ng/ml

以上 三者有其二

就是卵巢剩餘功能不佳的族群。

-

從這個定義中可以發現AMH的準確性與重要性。

它能夠身為”卵巢剩餘功能不佳”的因子中，唯一的抽血項目。

不是FSH，不是LH，不是雌激素，更不是黃體素

而是AMH。

-

另外，

從試管嬰兒的經驗當中

我們也能夠以AMH的數值去準確預測妳可能的取卵數目。

-

在一篇2013年的研究中

文章一共分析了60位即將進行第一次試管療程的患者

分析她們的AMH與最後的取卵數目。

這些患者都是使用標準刺激療程

而並非所謂的微刺激療程。

.

實驗的結果

再次證實了AMH的數值與取卵數目的線性關係。

AMH越高，取卵數越多

AMH越低，取卵數越少

而這個線性關係的斜率，大約是1/3。

-

也就是說

以AMH數值的3倍

幾乎能夠準確預估妳的取卵數目。

-

AMH = 0.7 的人，取2顆

AMH = 1 的人，取3顆

AMH= 2 的人，取6顆

以此類推。

-

至於妳的年紀，幾個卵，能有多少懷孕機率

這個關係圖我在之前的文章已經說明過了。

如果沒有印象的歡迎再次復習：

<41 - 40 ≠ 40 - 39 : 凍卵到底要幾顆才夠?>

https://www.facebook.com/williams.li.31/posts/231605554065809

-

從7月恢復門診開始到今天

陸陸續續我開出了大概一百張的AMH檢驗單。

結果也是幾家歡樂幾家愁。

從 0.00 到 15 以上的都有。

-

當看到妳的AMH的數字時

先想想妳現在的年齡

再看看妳先生的精子的狀況

然後跟妳先生坐下來好好想想

下一步應該怎麼走。

-

以及

也要好好想想

妳還有多少時間可以 try & error?

-

以上

一些淺見

提供參考

參考資料： Association between AMH, oocyte number and availability of embryos for cryopreservation in IVF. In Vivo. 2013 Nov-Dec;27(6):877-80.

-

“逝去的AMH，如同妳逝去的青春。失去了，就不會再回來了。”

By Mr. Williams

-

~鍵盤婦產科 威廉氏後人~

臉書蒐尋 : 鍵盤婦產科 - 威廉氏後人

粉絲專頁 : https://www.facebook.com/mrwilliams999

網誌連結 : https://mrwilliams999.blogspot.tw

-

<超級考古題系列 – 如果卵巢是一個銀行，妳還剩多少存款？

先別說這個了，妳聽過AMH嗎？>

各位好

小弟鍵盤婦產科 - 威廉氏後人

.

今天我要說一個很老的話題：”AMH”

他重要到我要把他歸類到超級考古題系列中。

.

我知道大部分的人都已經耳熟能詳

甚至曾經面對著自己的AMH報告而獨自在深夜裡哭泣。

-

但我發現還是很多人搞不太清楚

所以我決定專門寫一篇文章來介紹它。

也希望這篇文章能讓更多的人

更了解自己的身體。

-

AMH，抗穆勒氏管荷爾蒙

他是一個很神秘的物質。

在我們還是胚胎的時候

AMH的分泌抑制了胚胎期的女性生殖器官雛型 (穆勒氏管)

也讓人性別分化成男性。

-

但上面這段完全不是我們今天的重點。

-

AMH在成年女性身上

由濾泡中的顆粒細胞所分泌。

因此，AMH的指數與卵巢中的濾泡數目呈線性關係。

-

我知道在座各位的數學都不是太好，

可能聽不太懂什麼叫做線性關係。

.

簡單來說

AMH就是代表著濾泡的數目。

AMH高，表示濾泡多。

AMH低，表示濾泡少。

就這麼簡單。

-

AMH為什麼那麼重要 ?

因為它很準確。

.

而且AMH不受月經週期影響

不論在月經的哪一天去抽

指數都相當的穩定。

-

AMH是目前現階段存在的所有卵巢剩餘功能的評估中

最簡單、最準確、最不受到其他因素干擾的一個項目。

-

其他常用的項目還有很多

常用的如第三天的FSH，

但FSH可能受到荷爾蒙藥物的影響而造成數字上的改變。

.

另外如基礎濾泡量，

但需要月經第二天去照陰道超音波檢查，較為費時費工。

而且每個週期間差異較大。

-

因此，AMH變為現代不孕症一個絕對必要的檢查項目之一

其重要性不輸給男生的精蟲分析。

-

不了解精蟲狀況怎麼判讀的請去複習：

超級考古題系列4 – 我先生這樣正常嗎？ 精蟲狀況與相對應的治療標準

https://www.facebook.com/williams.li.31/posts/243958666163831

-

一個男生還有多少隻會動的精蟲？

一個女生還有多少顆能夠用的卵子？

我想這絕對是我們需要知道的。

-

以上都是基本觀念

以下開始講兩個我今天要講的重點。

-

首先

我曾在DHEA那一篇文章中介紹過

-

沒聽過的麻煩複習：

DHEA :

https://www.facebook.com/mrwilliams999/posts/253659251886125

-

卵巢剩餘功能不佳的人建議吃 DHEA

而什麼樣的人叫做卵巢剩餘功能不佳呢？

-

根據歐洲生殖醫學會訂定的波隆那標準 (Bologna criteria):

卵巢剩餘功能不佳的因子為：

1. 高齡(>40)、或者其他卵巢傷害的病史 (如卵巢手術、化療、電療等等)。

2. 在標準刺激下，過去取卵的數目小於或等於3顆。

3. 基礎濾泡量小於5-7顆 或 AMH < 0.5-1.1 ng/ml

以上 三者有其二

就是卵巢剩餘功能不佳的族群。

-

從這個定義中可以發現AMH的準確性與重要性。

它能夠身為”卵巢剩餘功能不佳”的因子中，唯一的抽血項目。

不是FSH，不是LH，不是雌激素，更不是黃體素

而是AMH。

-

另外，

從試管嬰兒的經驗當中

我們也能夠以AMH的數值去準確預測妳可能的取卵數目。

-

在一篇2013年的研究中

文章一共分析了60位即將進行第一次試管療程的患者

分析她們的AMH與最後的取卵數目。

這些患者都是使用標準刺激療程

而並非所謂的微刺激療程。

.

實驗的結果

再次證實了AMH的數值與取卵數目的線性關係。

AMH越高，取卵數越多

AMH越低，取卵數越少

而這個線性關係的斜率，大約是1/3。

-

也就是說

以AMH數值的3倍

幾乎能夠準確預估妳的取卵數目。

-

AMH = 0.7 的人，取2顆

AMH = 1 的人，取3顆

AMH= 2 的人，取6顆

以此類推。

-

至於妳的年紀，幾個卵，能有多少懷孕機率

這個關係圖我在之前的文章已經說明過了。

如果沒有印象的歡迎再次復習：

<41 - 40 ≠ 40 - 39 : 凍卵到底要幾顆才夠?>

https://www.facebook.com/williams.li.31/posts/231605554065809

-

從7月恢復門診開始到今天

陸陸續續我開出了大概一百張的AMH檢驗單。

結果也是幾家歡樂幾家愁。

從 0.00 到 15 以上的都有。

-

當看到妳的AMH的數字時

先想想妳現在的年齡

再看看妳先生的精子的狀況

然後跟妳先生坐下來好好想想

下一步應該怎麼走。

-

以及

也要好好想想

妳還有多少時間可以 try & error?

-

以上

一些淺見

提供參考

參考資料： Association between AMH, oocyte number and availability of embryos for cryopreservation in IVF. In Vivo. 2013 Nov-Dec;27(6):877-80.

-

“逝去的AMH，如同妳逝去的青春。失去了，就不會再回來了。”

By Mr. Williams

-

~鍵盤婦產科 威廉氏後人~

臉書蒐尋 : 鍵盤婦產科 - 威廉氏後人

粉絲專頁 : https://www.facebook.com/mrwilliams999

網誌連結 : https://mrwilliams999.blogspot.tw

-

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