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Fertility and Reproductive Medicine: National Taiwan University Hospital

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The Fertility and Reproductive Medicine Center at National Taiwan University Hospital (NTUH) includes a multidisciplinary team of specialists in fertility, rehabilitation, genetics, and urology, as well clinical nurses and technicians that provide comprehensive fertility treatment.

NTUH focuses on academic research and clinical practice including oocytes cryopreservation, pre-implantation genetic diagnosis (PGD), assisted reproductive technology (ART), ovulation monitoring, embryo implantation, polycystic ovary syndrome (PCOS), ovarian hyper-stimulation syndrome (OHSS), intra-cytoplasmic sperm injection (ICSI), endometriosis and fertility-related surgery. Research in these areas has been published in word-class medical journals and put into clinical use to the benefit of patients.

As a leading research medical facility, the center has nearly 30 years of experience and the pregnancy and live birth success rates are above the world average, with more than 7,500 cases resulting in healthy infants. Many patients from the United States, Canada, Japan, Hong Kong, China, Malaysia, The Philippines, and Mongolia seek fertility treatment at NTUH.

Fertility Preservation

The cryopreservation of oocytes contributes significantly to oocyte donation and the preservation of fertility, which provides opportunities to women who wish to defer pregnancy or those who stand to lose ovarian function due to surgery, chemotherapy or radiotherapy.

In the past, frozen oocytes had poor survival rates. Those that did survive often were not able to be fertilized. The meiotic spindle may be damaged during the thawing process.

With regards to the meiotic spindle, NTUH demonstrated that by using vitrification with human oocytes, the survival rate is above 90 percent. The restoration of meiotic spindles is related to the post-thaw incubation. The rate of fertilization.

As a leading research medical facility, the center has nearly 30 years of experience and the pregnancy and live birth success rates are above the world average.

of oocytes and embryonic growth can be increased in three hours of incubation. The results were published in “Human Reproduction” magazine.

Taiwan’s first in-vitro fertilization (IVF) baby using a frozen oocyte was born at NTUH, in 2002, a breakthrough in fertility treatment. In 2007, the team wrote a chapter on oocyte cryopreservation for Vitrification in Assisted Reproductive Technology, edited by professors Liebermann and Tucker.

Fertility preservation procedures help cancer patients and women who want to defer pregnancy to retain their oocytes, and then successfully give birth later in life.

Pre-implantation Genetic Diagnosis (PGD)

Avoiding a fetus with congenital anomalies and ensuring the birth of a healthy infant are important objectives of reproductive medicine. The traditional prenatal genetic diagnosis includes Chorionic Villus Sampling (CVS) and Amniocentesis. Once a genetic disease has been detected, an induced abortion places tremendous pressure on both the mother and her family. To avoid an abnormal fetus and pregnancy termination, Preimplantation Genetic Diagnosis (PGD) is a technique to examine the embryo prior to implantation, and can be used to screen for a specific genetic disease or chromosome abnormality.

Pre-implantation diagnosis of the embryo requires only a few cells for genetic analysis, but the experimental operation needs to be precisely controlled to provide an accurate diagnosis. NTUH employs the whole genome amplification method to simultaneously diagnose the thalassemia gene and HLA genes, while avoiding mutual interference.

Traditional embryo biopsy takes a 6-8 cells during the developmental stage and trophectoderm biopsy takes 5-10 cells from the trophoblast. In order to increase the accuracy of pregnancy diagnosis, the NTUH team developed a blastocyst biopsy.

The advantage of a blastocyst biopsy is not to provide more cells for a more accurate diagnosis, but allow for the development of embryos to the balstocyst stage, which have more potential for successful implantation.

After the blastocyst biopsy is completed, the specimen is sent to the laboratory for genetic diagnosis. An embryo preserved through vitrification ensures the specimen has sufficient time to be analyzed, contributing to a comprehensive and accurate diagnosis.

When the results become available, the healthy embryo will be unfrozen and implanted. This method can prevent ovarian hyper-stimulation syndrome in women with too many follicles, and increase safety and successful pregnancy rates for those who have a poor endometrium condition.

Recent PDG achievements include:

• 2008 – Helped a couple to have a healthy and HLAmatched baby girl by applying PGD techniques to the

IVF process, the first such case in Asia.

• 2010 – Performed the first successful PGD in families with genetic hearing impairment.

• 2012 – Completed Asia’s first successful case of PGD using blastocyst biopsy and array comparative genomic hybridization for women who suffer recurrent miscarriages caused by chromosomal translocation.

• Blastocyst biopsy and vitrification effectively diagnosed pre-implantation genetics in monogenic diseases. The diagnostic rate increased from 71-90 percent. The pregnancy rate was 64 percent.

Intra-cytoplasmic Sperm Injection (ICSI)

With severe semen abnormalities, such as low sperm count, decreased sperm motility, or abnormal shape of the sperm, the infertility rate is low and there may even be fertilization failures when performing IVF. Intra-cytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm-related infertility problems.

Although ICSI has been effectively used to enhance the fertilization phase of IVF by injecting a single sperm into a mature egg, recent efforts have been directed toward increasing the efficiency and efficacy of ICSI. The NTUH team has developed a method for dissecting a sperm tail at the tip that can be easily and quickly performed and does not damage the centrosome of the sperm. This outstanding research finding was published in “Human Reproduction” magazine in 1996.

Ejaculatory dysfunction, poor sperm motility, and infertility are common problems for men with spinal cord injury (SCI).

The majority with SCI require some form of ART to become biological fathers. NTUH team has advocated a protocol of using electro-ejaculation and systemic ART including IUI and ICSI; surgical retrieval with vassal aspiration; cryopreservation of sperm; the addition of pentoxifylline for immotile sperm during ICSI; and sperm donation.

The team of physiatrists, urologists, and gynecologists attains a high efficiency and efficacy for pregnancy and may reduce risks and complications from repeated electro-ejaculation or surgeries. This exceptional  research finding was published in “Archives of Physical Medicine and Rehabilitation” magazine in 2003.

Reproductive medicine and ART has already been developed to an advanced state in Taiwan. In the future, besides a continued focus on refining ART techniques to increase the success rate through reproductive research, additional focus in clinical practice will be put on patient safety, friendly treatment processes, and meeting individual patient needs.

International Patient Services

To meet the special needs of international patients, NTUH established an International Medical Service Center (IMSC).

English-speaking staff assists patients at registration and during consultations. Designated personnel assist at the laboratory and pharmacy to eliminate language barriers. Patients visiting the Fertility and Reproductive Medicine Center are escorted by IMSC staff to a lounge located in a private area.

The cozy and comfortable clinic reduces patient anxiety and offers personalized service. Overseas patients often remark that the level of service at the clinic is even superior to what is found in the United States because patients are escorted and assisted by English-speaking staff members from the time they enter the door until they pick up their medication.

Patient Spotlight

Liza is a successful career woman from Manila, the Philippines. She and her husband had been trying to have children for more than five years. They had tried various infertility treatments, but all proved unsuccessful. From a close friend, Liza learned that the Fertility and Reproductive Medicine Center at NTUH had a very high success rate and that charges were reasonable compared to other clinics offering similar services in Asia.

Liza does not speak, read nor write Chinese, nor had she ever visited Taiwan. She was referred to IMSC, where staff helped Liza find a convenient and reasonably priced hotel to stay throughout her treatment. IMSC staff accompanied her through a series of consultations, examinations, and laboratory tests. They also helped arrange for Liza’s husband to come to Taiwan later. During the course of her treatment, IMSC staff showed Liza the famous night markets, various shopping centers, and tourist attractions of Taipei.

After implantation of the fertilized eggs, Liza and her husband returned to their home country. Several weeks later, Liza informed IMSC staff that she was pregnant with twins. Liza and her husband are happy to have realized their dream of children. This might never have happened without the help of NTUH.

The NTUH team has developed a method for dissecting a sperm tail at the tip that can be easily and quickly performed and does not damage the centrosome of the sperm.

Patients utilizing the fertility clinic, or any other clinics at NTUH, can expect high quality care. To ensure a safe environment for treatment and medical workers and to further enhance the quality of healthcare, NTUH received Joint Commission International (JCI) accreditation, in 2010, for meeting international standards for patient care and organizational management.

In 2013, JCI adopted a new set of standards for academic medical center hospitals. NTUH was accredited under the new JCI standards, in April 2013. NTUH has served expatriates and diverse group of international patients. Highquality, efficient, and reasonably priced medical service has gained a high level of customer satisfaction and recognition.

With an increasing number of international patients traveling to the hospital for medical treatment, NTUH has become a recognized medical tourism destination in Asia.

About the Author

Shee-Uan Chen, M.D., is a professor and attending doctor at National Taiwan Univiersity Hospital, where he is the director of the Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, in Taipei, Taiwan. His research interests include clinical and basic reproductive medicine, cryopreservation of oocytes, embryos and ovarian tissue and pre-implantation genetic diagnosis.

He has had many research papers in reproductive medicine in recognized medical journals. He is a reviewer and member of the editorial board of several international journals, and has been an invited speaker on topics in reproductive medicine.

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