訂做優生寶寶

歷史上的今天

• 2015: 次世代定序試管嬰兒台灣已上路 了！NGS 全世界第一個NGS次世代試管寶寶，在2013年7月誕生於美國費城， 她是一個37歲不孕症，在美國做了很多次試管嬰兒都失敗，最後做了次世代定序試管嬰兒胚胎切片，前提是送到英國牛津大學， 由Dagan Wells 威爾斯操刀，發報告回美國，告知哪一個胚胎是正常，植入一個胚胎生下一個寶寶叫大衛里維， 在2014年12月份使用ILLUMINA公司所製造的次世代定序機器Ion PGM，由義大利羅馬GEMONA團隊，進行45個案例次世代定序試管嬰兒研究，證實獲得理想的懷孕率64%、活產率，62%的成功率，平均植入1.1個胚胎， 據暸解次世代定序在台灣也在進行當中， 重點在於設計，在於KNOW HOW 並不在於儀器， 空有儀器沒有人才參加分析設計，這是一台機器，就是一台機器，就像妳買一台新的賓利車不會開，那妳買來就只能純欣賞，不能開上路，不能享受開好車的快感，又不是蓋棉被純聊天？ 目前台灣次世代定序試管寶寶的進度呢？ (1)已進入臨床測試階段。 (2)已進入設計探針階段。 簡而言之就是已經有儀器，而且已經在設計階段，設計探針，所以我說台灣的次世代定序基因NGS，新基因定序試管嬰兒應該為相去不遠。
• 2015: 博元婦產科胚胎快篩qPCR-"新鮮"胚胎植入，妳可以不用做羊水穿刺！CCS qPCR 很多高齡病人做了一次、兩次、三次試管嬰兒，好不容易懷孕了， 但因為年紀大， 懷到16週羊水穿刺染色體報告發現是唐氏症， 不得不含淚悲傷的把小孩子中止妊娠， 我們知道16週、17週的中止妊娠是很殘酷、很殘忍的， 而且是不堪回憶的， 它必須要用一個導尿管放到子宮裡面，經卵巢外的引產extra ovary induction ， 有時候 引產一天、有時候兩天、有時後三天，甚至失敗還要剖腹， 這樣的經驗還˙要再一而再、再而三的重演嗎？ 可以不必要!! 因為經由胚胎qPCR篩檢， 沒有唐氏症風險的胚胎植入子宮， 這個時代已經來臨，尤其是 博元婦產科的qPCR胚胎切片， 篩檢染色體不帶唐氏症風險的胚胎植入子宮， 就可以免去羊水穿刺的風險， 記得曾經有一條轟動全台灣的新聞，那是一個母親節前一個禮拜， 一個傷心的老媽媽哭訴的說：她的女兒好不容易懷孕，去做羊水穿刺，沒有想到感染，外孫子沒了甚至女兒也沒了， 等於一屍兩命， 使得那一陣子大家對羊水穿刺聞之而色變， (1)羊水穿刺有風險， (2)高齡懷孕也有唐氏症的風險， 這兩個風險可以藉由胚胎切片，經由確定健康胚胎再植入子宮， 而且可以一條龍試管嬰兒，我們從打排卵針胚胎切片篩檢出健康的胚胎植入子宮， 不用冷凍胚胎苦苦的等報告，而且又便宜、又快速，這個時代已經來臨， 所以胚胎快篩是： (1)免去羊水穿刺感染的風險。 (2)免去高齡懷孕懷了唐氏症，又要傷心墮胎引產的風險。 何樂而不為！ 彰化博元婦產科 提供抽母血或將取代羊水穿刺！ 一滴血取代一支針 羊膜穿刺奪命？一滴血取代一支針 : 1名45歲的陳小姐，因不孕症進行試管嬰兒，成功懷雙胞胎，她堅決不願意做風險高的羊膜穿刺，而改選擇一滴血篩檢胎兒染色體。婦產科醫師蔡鋒博表示，此方式稱為NIPT，只採一滴血，非侵襲性，無細菌感染的風險，準確性近百分百，可以順利檢出母血篩檢第13、18、21對染色體的情況。為了幫這1名不孕症已經11年的患者一圓生子夢，蔡鋒博醫師幫她進行子宮鏡、子宮內膜刺激術與試管嬰兒療程，因為年紀的因素，在子宮內植入4個胚胎，其中2個胚胎著床，懷孕成功。但是，因已經45歲，原以為又得面臨羊水穿刺以進行胎兒染色體檢查的壓力，所幸蔡鋒博醫師建議她使用一種安全性高的NIPT檢驗。 羊膜穿刺奪命？一滴血取代一支針 : 1名45歲的陳小姐，因不孕症進行試管嬰兒，成功懷雙胞胎，她堅決不願意做風險高的羊膜穿刺，而改選擇一滴血篩檢胎兒染色體。婦產科醫師蔡鋒博表示，此方式稱為NIPT，只採一滴血，非侵襲性，無細菌感染的風險，準確性近百分百，可以順利檢出母血篩檢第13、18、21對染色體的情況。為了幫這1名不孕症已經11年的患者一圓生子夢，蔡鋒博醫師幫她進行子宮鏡、子宮內膜刺激術與試管嬰兒療程，因為年紀的因素，在子宮內植入4個胚胎，其中2個胚胎著床，懷孕成功。但是，因已經45歲，原以為又得面臨羊水穿刺以進行胎兒染色體檢查的壓力，所幸蔡鋒博醫師建議她使用一種安全性高的NIPT檢驗。 http://eladies.sina.com.tw/getnews.php?newsid=93884 中天新聞》做羊膜穿刺3/1000流產 不做1/700唐氏症 nipt cti http://www.youtube.com/watch?v=p8PkoSyboc0 <iframe width="420" height="315" src="//www.youtube.com/embed/p8PkoSyboc0" frameborder="0" allowfullscreen></iframe> https://tw.news.yahoo.com/%E7%BE%8A%E8%86%9C%E7%A9%BF%E5%88%BA%E5%A5%AA%E5%91%BD-%E6%BB%B4%E8%A1%80%E5%8F%96%E4%BB%A3-%E6%94%AF%E9%87%9D-103609084.html http://n.yam.com/top1health/healthy/20140509/20140509283929.html http://www.top1health.com/Article/18623 【華人健康網 記者黃曼瑩／台北報導】 2014年5月9日 18:31 華人健康網粉絲團 高齡產婦懷孕過程可說是步步驚心，為了確認腹中胎兒是否有唐氏症的疑慮，而採取羊膜穿刺，但是，不幸的是，台中市1名老師，竟於羊膜穿刺手術檢查術後3天因細菌感染導致敗血症，母子雙亡。婦產科醫師表示，目前可以「一滴血取代一支針」的方式，避免類似細菌感染失去寶貴生命的遺憾再發生！ 一滴血檢測唐氏症3點注意，孕婦最好體重不要超過80公斤。 1名45歲的陳小姐，因不孕症進行試管嬰兒，成功懷雙胞胎，她堅決不願意做風險高的羊膜穿刺，而改選擇一滴血篩檢胎兒染色體。婦產科醫師蔡鋒博表示，此方式稱為NIPT，只採一滴血，非侵襲性，無細菌感染的風險，準確性近百分百，可以順利檢出母血篩檢第13、18、21對染色體的情況。 為了幫這1名不孕症已經11年的患者一圓生子夢，蔡鋒博醫師幫她進行子宮鏡、子宮內膜刺激術與試管嬰兒療程，因為年紀的因素，在子宮內植入4個胚胎，其中2個胚胎著床，懷孕成功。但是，因已經45歲，原以為又得面臨羊水穿刺以進行胎兒染色體檢查的壓力，所幸蔡鋒博醫師建議她使用一種安全性高的NIPT檢驗。 什麼是NIPT檢驗？方式為採取孕婦靜脈血10ml，分離血漿中的DNA，利用新一代DNA定序技術進行高通量定序，進行生物資訊分析，從中即可得到胎兒的遺傳信息。 1.孕婦最好體重不要超過80公斤。媽媽體重太重的話，血液中胎兒DNA就會被稀釋，影響準確性。 2.孕婦如果懷多胞胎要另外解釋。 3.孕婦超過10週以上就可以抽血。一般建議12-18周做此檢測，主要是因若孕周較大的孕婦出現陽性結果，可能會錯過羊水穿刺或是臍血穿刺確認的最佳時間，甚至終止妊娠困難。 蔡鋒博醫師表示，羊膜穿刺有千分之一到千分之三，可能出現感染、流血、流產、破水等風險，但是進行一滴血檢測唐氏症，完全沒有副作用，目前報告是可測出13、18、21對染色體的情況。但事實上，所有的染色體通通可以看的到。彰化博元婦產科 提供抽母血或將取代羊水穿刺！ 一滴血取代一支針
• 2015: 新撲滿試管嬰兒是什麼？？？ 41歲婦產下龍鳳胎 　​彰化博元婦產科​累積胚胎儲卵子 高齡不孕者福音
• 2015: 迷思！李祖寧：打排卵針更年期早到
• 2015: 神經垂體錯置 少女無法登大人
• 2015: 快篩胚胎 生個健康寶寶不是夢
• 2015: 罹多囊性卵巢症 門診五年增3倍
• 2015: 縮時攝影挑胚胎 助孕資優娃娃 --中視新聞CTV報導彰化博元婦產科院長蔡鋒博醫師
• 2015: 撲滿試管嬰兒 40歲婦產下龍鳳胎 博元婦產科累積胚胎高齡不孕者福音-台視新聞
• 2015: 打排卵針　更年期會提早來?--蘋果日報訪問醫師蔡鋒博
• 2015: 選擇健康胚胎最best好的策略！ccs best qpcr 目前"台灣一般"的試管嬰兒中心，選擇胚胎植入的方式有： (1)光學顯微鏡下看哪一個胚胎外觀比較漂亮，第3天看8A，第5天看囊胚，看碎片，這有一些比率會被騙。 (2)用TimeLapse embryoscope縮時攝影的紀錄看胚胎成長的日記。 (3)胚胎切片冷凍等報告a-CGH，這費用很高，而且要冷凍，而且要一定的胚胎數 量才能切片，幾乎全部都是冷凍。 (4)以上3個方法組合，比如1+3或2+3。 全世界愈來愈多的證據顯示，囊胚期胚胎切片所做出來的報告，發現胚胎的外觀真的有時會騙人， 博元婦產科也發現 外觀真的的胚胎，竟然基因染色體的報告是異常， 當然胚胎分裂的速度也是一個關鍵， 囊胚期胚胎形成的速度也是一個關鍵， 有些第5天胚胎就孵化了， 有些甚至第6天胚胎才孵化或甚至不孵化， 這些其實都可以參考， 但真正重要的仍然是胚胎基因染色體整倍與不整倍， 但是這種檢查的方法，又有很多的選擇platform： (1)FISH:螢光原位雜交染色法。 (2)aCGH基因晶片分析。 這些方法目前台灣試管嬰兒中心都有在進行，但都要冷凍胚胎苦等報告 有沒有不冷凍新鮮胚胎植入呢？有！ 打針, 取卵, 胚胎切片， qPCR 快篩, 胚胎報告出爐， 當天或隔天植入新鮮的胚胎， 免冷凍、免冷凍花費， 免癡癡的等待，一氣呵成當媽媽！ 我們稱之為一條龍試管嬰兒， 這個檢查的平台就很重要，我們稱他為 胚胎快篩qPCR， 以美國紐澤西團隊RMANJ 博元婦產科為典型例子， 應該是比較合乎人性，便宜、價格親民，懷孕率高選擇˙胚胎的方式。
• 2015: 博元婦產科 胚胎快篩染色體CCS不必冷凍胚胎,如王寶釧苦守寒窰18年等報告！qPCR CCS 新鮮胚胎植入的 "7大" 理由，根據RMANJ紐澤西團隊斯考特Scott的論述，在生育與節育期刊提出 7大鐵證 ，證明進行CCS不用冷凍胚胎，新鮮胚胎植入就大可進行，理由有： (1)因為CCS的正確性和有效性可以大幅提高成功率和胚胎著床率。 (2)提高試管嬰兒成功率是最大的考慮，而胚胎染色體異常比率從25%增加到40歲之後的85%，這使得更需要做CCS。 (3)因為CCS的費用實在是很昂貴，也因此能夠讓病人少錢就是一個patient center care，因此是不是能夠減少病人冷凍胚胎的費用呢？ (4)使用CCS可以減少多胞胎的比率，因為染色體正常就可以進行單一胚胎植入，進行BEST也就是所謂的囊胚期染色體正常單一胚胎植入。根據研究單胞胎和雙胞胎小孩子的體重，單胞胎會比雙胞胎增加650公克。 (5)冷凍胚胎其實是不可以不用的，因為有CCS之後會有單一胞胎植入，單一胚胎植入之後會有冷凍胚胎，這個冷凍胚胎的對象是染色體正常的胚胎。 (6)有一些病人並不能從CCS得到好處，只有部分的病人，比如根據RCT三份的研究發現，如果說打針病人年紀大，取卵數少，AMH低,或者是形成囊胚期胚胎率低，這個做CCS並沒有得到好處。 (7)能夠進行CCS一定要： 1.進行囊胚期胚胎培養、 2.能夠進行胚胎切片、 3.能夠進行快速冷凍的方法。 因此這三大要件都存在的實驗室，才能夠進行CCS新鮮胚胎植入，並不是每一家試管嬰兒中心都有這3個技術這個能力，因此他提出因為有這個7大理由的時機已經成熟， 也因此 進行胚胎全基因放大檢測胚胎的染色體， 進行胚胎的植入"新鮮"胚胎植入，妳不必再冷凍胚胎苦苦等報告了，這一份的學士論文是登在生育與節育期刊2014年9月份。 參考： Comprehensive chromosome screening with synchronous blastocyst transfer: time for a paradigm shift* Recently, the nature of assisted reproductive technology (ART) laboratory investigation has been shifting. Tradition- ally, it has focused on optimizing the culture milieu or assur- ing fertilization; now, a variety of new technologies are available to assess the reproductive potential of individual embryos. Perhaps most prominent has been the resurgence of embryonic aneuploidy screening. The validation of 24-chromosome testing platforms has led to a variety of studies demonstrating higher implantation and delivery rates. These findings are now translating to changes in the para- digm of ART practice. Caution is prudent in times of change, and methodical analyses are needed. Evaluation logically focuses on efficacy in terms of enhanced implantation and delivery rates. Other factors, such as safety, cost, and accessibility also deserve thoughtful consideration. Evaluations of these endpoints should take into account the caliber of the data supporting the ‘‘new paradigm,’’ in parallel with the data supporting the current ‘‘standard of care,’’ and both should be evaluated with the same level of rigor. Several investigators have recently expressed concerns about the implementation of comprehensive chromosomal screening (CCS) in clinical practice. Fortunately, an ever- growing literature is available to provide clinicians and scien- tists with the information they need to evaluate many of the critical issues. Some of the major issues and questions include: 1. Efficacy of 24-chromosome embryonic aneuploidy screening. Multiple studies provide class I data demon- strating higher implantation and delivery rates following 24-chromosome aneuploidy screening. In distinct contrast to fluorescent in-situ hybridization-based preimplantation genetic screening studies in which every randomized controlled trial (RCT) showed either no improvement or active detriment, every RCT involving 24-chromosome screening has demonstrated benefit (1–3). 2. What magnitude of improvement in clinical outcomes is necessary to justify screening? Answering this question inevitably involves a subjective decision that will be made by patients after counseling by the clinicians caring for them. Given that aneuploidy rates vary from 25% in women in their late twenties to 85% for those in their mid-forties, the opportunity for enhancing outcomes will be greatly affected by the age of the female partner and her intrinsic ovarian responsiveness. It is unlikely that im- provements will be made in direct proportion to the aneu- ploidy rate, as many other factors affect delivery rates. Women with high embryonic arrest rates are unlikely to attain the full benefit of screening. Still, the magnitude of the enhanced outcomes seen in the RCTs is substantial. 3. The cost of CCS may be burdensome. Although substantial costs are associated with CCS, even in proportion, they are * This is an open access article under the CC BY-NC-ND license (http:// would appear that this type of screening is appropriate creativecommons.org/licenses/by-nc-nd/3.0/). 660 VOL. 102 NO. 3 / SEPTEMBER 2014 lower than the costs of additional ART cycles. A definitive cost-effectiveness study has not been published to date. Although enhanced delivery rates should translate to fewer treatment cycles, that question must await more detailed analyses before conclusions may be drawn. Additionally, savings attributable to decreased pregnancy losses and the care provided to ongoing aneuploid gestations would need to be considered. Given that, and the impact on transfer or- der discussed below, it is unlikely that cost effectiveness will limit implementation of embryonic aneuploidy screening. 4. Implementation of CCS may actually increase the risk for multiple gestations unless transfer order is reduced. That very fact has already been established in a randomized controlled trial (2). In fact, it is a mathematical certainty. As implantation rates increase, if there is no decrease in transfer order, then multiple gestation rates will inevitably rise. However, it is not reasonable to assume that transfer order would remain the same. For the first time, there are class I data demonstrating eSET after CCS is as effective as double-embryo transfer of unscreened embryos (2). All prior RCTs comparing elective single-embryo transfer (eSET) versus double-embryo transfer found poorer per- transfer outcomes with eSET. If CCS is used, that is no longer true. Equivalent delivery rates are maintained while virtually eliminating the risk of twins. The paradigm using CCS and eSET produced an average gain in birth weight of approximately 650 grams. No other single intervention in obstetrics has produced such a dramatic enhancement in birth weight, which is known to be highly correlated with the health of the child. Of course, the transfer of two screened embryos would further increase pregnancy rates, but at the cost of quite elevated twin rates; thus, it should be discouraged. Armed with these data, utilization of eSET in our program has risen from less than 6% to approximately 60% over a 4-year interval. 5. Embryo cryopreservation is essential to the application of CCS. This is an excellent point, as it is true in many, but not all, programs. Analyses can be completed in as little as 4 hours, and several programs now have testing labora- tories within their facilities. However, that may not be necessary. Data from RCTs demonstrate equivalent deliv- ery rates following the transfer of fresh or vitrified CCS screened blastocysts (2). Furthermore, data now demon- strate meaningfully better obstetrical outcomes in concep- tions following the transfer of cryopreserved embryos. 6. Some subpopulations may not benefit from aneuploidy screening. The studies to date have focused on infertile normal responders. No class I data address the impact of CCS in women who are low responders or have recurrent pregnancy loss. An RCT to determine the impact of CCS in women at risk for low response to gonadotropin stimu- lation has been registered (NCT01977144) and is currently underway. Within the general ART population, individuals who might typically be considered candidates for two- embryo transfer should be offered CCS. Given that the eSET rate was 8.8% in the recently released 2012 Society for Assisted Reproductive Technology (SART) data, it Fertility and Sterility® for very large numbers of patients. Even those patients who desire eSET attain increased delivery rates if the euploid embryos are selected for transfer. Although many of these patients already have excellent delivery rates, it is difficult to imagine a scenario in which the in- creases in implantation rates seen in the RCTs done to date would not be a compelling reason to screen. 7. The need to culture to the blastocyst stage to safely biopsy embryos increases the number of futile cycles because of embryonic arrest prior to blastulation. This issue is extremely important and represents a widely held belief,
• 2015: CCS不必冷凍胚胎,如王寶釧苦守寒窰18年等報告！qPCR CCS 新鮮胚胎植入的 "7大" 理由，根據RMANJ紐澤西團隊斯考特Scott的論述，在生育與節育期刊提出 7大鐵證 ，證明進行CCS不用冷凍胚胎，新鮮胚胎植入就大可進行，理由有： (1)因為CCS的正確性和有效性可以大幅提高成功率和胚胎著床率。 (2)提高試管嬰兒成功率是最大的考慮，而胚胎染色體異常比率從25%增加到40歲之後的85%，這使得更需要做CCS。 (3)因為CCS的費用實在是很昂貴，也因此能夠讓病人少錢就是一個patient center care，因此是不是能夠減少病人冷凍胚胎的費用呢？ (4)使用CCS可以減少多胞胎的比率，因為染色體正常就可以進行單一胚胎植入，進行BEST也就是所謂的囊胚期染色體正常單一胚胎植入。根據研究單胞胎和雙胞胎小孩子的體重，單胞胎會比雙胞胎增加650公克。 (5)冷凍胚胎其實是不可以不用的，因為有CCS之後會有單一胞胎植入，單一胚胎植入之後會有冷凍胚胎，這個冷凍胚胎的對象是染色體正常的胚胎。 (6)有一些病人並不能從CCS得到好處，只有部分的病人，比如根據RCT三份的研究發現，如果說打針病人年紀大，取卵數少，AMH低,或者是形成囊胚期胚胎率低，這個做CCS並沒有得到好處。 (7)能夠進行CCS一定要： 1.進行囊胚期胚胎培養、 2.能夠進行胚胎切片、 3.能夠進行快速冷凍的方法。 因此這三大要件都存在的實驗室，才能夠進行CCS新鮮胚胎植入，並不是每一家試管嬰兒中心都有這3個技術這個能力，因此他提出因為有這個7大理由的時機已經成熟， 也因此 進行胚胎全基因放大檢測胚胎的染色體， 進行胚胎的植入"新鮮"胚胎植入，妳不必再冷凍胚胎苦苦等報告了，這一份的學士論文是登在生育與節育期刊2014年9月份。 參考： Comprehensive chromosome screening with synchronous blastocyst transfer: time for a paradigm shift* Recently, the nature of assisted reproductive technology (ART) laboratory investigation has been shifting. Tradition- ally, it has focused on optimizing the culture milieu or assur- ing fertilization; now, a variety of new technologies are available to assess the reproductive potential of individual embryos. Perhaps most prominent has been the resurgence of embryonic aneuploidy screening. The validation of 24-chromosome testing platforms has led to a variety of studies demonstrating higher implantation and delivery rates. These findings are now translating to changes in the para- digm of ART practice. Caution is prudent in times of change, and methodical analyses are needed. Evaluation logically focuses on efficacy in terms of enhanced implantation and delivery rates. Other factors, such as safety, cost, and accessibility also deserve thoughtful consideration. Evaluations of these endpoints should take into account the caliber of the data supporting the ‘‘new paradigm,’’ in parallel with the data supporting the current ‘‘standard of care,’’ and both should be evaluated with the same level of rigor. Several investigators have recently expressed concerns about the implementation of comprehensive chromosomal screening (CCS) in clinical practice. Fortunately, an ever- growing literature is available to provide clinicians and scien- tists with the information they need to evaluate many of the critical issues. Some of the major issues and questions include: 1. Efficacy of 24-chromosome embryonic aneuploidy screening. Multiple studies provide class I data demon- strating higher implantation and delivery rates following 24-chromosome aneuploidy screening. In distinct contrast to fluorescent in-situ hybridization-based preimplantation genetic screening studies in which every randomized controlled trial (RCT) showed either no improvement or active detriment, every RCT involving 24-chromosome screening has demonstrated benefit (1–3). 2. What magnitude of improvement in clinical outcomes is necessary to justify screening? Answering this question inevitably involves a subjective decision that will be made by patients after counseling by the clinicians caring for them. Given that aneuploidy rates vary from 25% in women in their late twenties to 85% for those in their mid-forties, the opportunity for enhancing outcomes will be greatly affected by the age of the female partner and her intrinsic ovarian responsiveness. It is unlikely that im- provements will be made in direct proportion to the aneu- ploidy rate, as many other factors affect delivery rates. Women with high embryonic arrest rates are unlikely to attain the full benefit of screening. Still, the magnitude of the enhanced outcomes seen in the RCTs is substantial. 3. The cost of CCS may be burdensome. Although substantial costs are associated with CCS, even in proportion, they are * This is an open access article under the CC BY-NC-ND license (http:// would appear that this type of screening is appropriate creativecommons.org/licenses/by-nc-nd/3.0/). 660 VOL. 102 NO. 3 / SEPTEMBER 2014 lower than the costs of additional ART cycles. A definitive cost-effectiveness study has not been published to date. Although enhanced delivery rates should translate to fewer treatment cycles, that question must await more detailed analyses before conclusions may be drawn. Additionally, savings attributable to decreased pregnancy losses and the care provided to ongoing aneuploid gestations would need to be considered. Given that, and the impact on transfer or- der discussed below, it is unlikely that cost effectiveness will limit implementation of embryonic aneuploidy screening. 4. Implementation of CCS may actually increase the risk for multiple gestations unless transfer order is reduced. That very fact has already been established in a randomized controlled trial (2). In fact, it is a mathematical certainty. As implantation rates increase, if there is no decrease in transfer order, then multiple gestation rates will inevitably rise. However, it is not reasonable to assume that transfer order would remain the same. For the first time, there are class I data demonstrating eSET after CCS is as effective as double-embryo transfer of unscreened embryos (2). All prior RCTs comparing elective single-embryo transfer (eSET) versus double-embryo transfer found poorer per- transfer outcomes with eSET. If CCS is used, that is no longer true. Equivalent delivery rates are maintained while virtually eliminating the risk of twins. The paradigm using CCS and eSET produced an average gain in birth weight of approximately 650 grams. No other single intervention in obstetrics has produced such a dramatic enhancement in birth weight, which is known to be highly correlated with the health of the child. Of course, the transfer of two screened embryos would further increase pregnancy rates, but at the cost of quite elevated twin rates; thus, it should be discouraged. Armed with these data, utilization of eSET in our program has risen from less than 6% to approximately 60% over a 4-year interval. 5. Embryo cryopreservation is essential to the application of CCS. This is an excellent point, as it is true in many, but not all, programs. Analyses can be completed in as little as 4 hours, and several programs now have testing labora- tories within their facilities. However, that may not be necessary. Data from RCTs demonstrate equivalent deliv- ery rates following the transfer of fresh or vitrified CCS screened blastocysts (2). Furthermore, data now demon- strate meaningfully better obstetrical outcomes in concep- tions following the transfer of cryopreserved embryos. 6. Some subpopulations may not benefit from aneuploidy screening. The studies to date have focused on infertile normal responders. No class I data address the impact of CCS in women who are low responders or have recurrent pregnancy loss. An RCT to determine the impact of CCS in women at risk for low response to gonadotropin stimu- lation has been registered (NCT01977144) and is currently underway. Within the general ART population, individuals who might typically be considered candidates for two- embryo transfer should be offered CCS. Given that the eSET rate was 8.8% in the recently released 2012 Society for Assisted Reproductive Technology (SART) data, it Fertility and Sterility® for very large numbers of patients. Even those patients who desire eSET attain increased delivery rates if the euploid embryos are selected for transfer. Although many of these patients already have excellent delivery rates, it is difficult to imagine a scenario in which the in- creases in implantation rates seen in the RCTs done to date would not be a compelling reason to screen. 7. The need to culture to the blastocyst stage to safely biopsy embryos increases the number of futile cycles because of embryonic arrest prior to blastulation. This issue is extremely important and represents a widely held belief,
• 2015: 訂做優生寶寶計畫！限100名額，請來電：04-7260678 查詢
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• 2015: 為什麼RMANJ紐澤西團隊直接跳過a-CGH！偋棄a-CGH不用! a-CGH的好處是：它很敏感精 準， 但壞處也是它太過敏感精 準， 使得很多胚胎正常它誤判為不正常。 他們有一個對比研究是: 針對qPCR和SNP，和a-CGH去對照， 結果發現胚胎明明染色體正常， 但是a-CGH判斷為染色體為不整倍的 ，反觀qPCR和SNP判斷為染色體是正常ˇ的，那原本是一個染色體正常的胚胎， 因為a-CGH判斷為染色體不正常， 妳就不敢植入，是不是少一個成功的機會， 少一個誕生在人間的試管寶寶呢？ 這可以解釋為什麼美國紐澤西團隊他們直接跳過a-CGH， 而偋棄a-CGH不用， 而直接從SNP,qPCR實時間定量的多重酶聚合反應SNP， 跳到次世代定序NGS， 他們沒有把腳步停留在a-CGH， 是不是代表a-CGH檢查胚胎是不那麼實用， 不那麼合適， 不那麼適用於病人， 或會誤"丟"胚胎！
• 2015: 美女妳需要冷凍卵子嗎？CRYO EGG 多位女明星冷凍卵子經過報導推波助瀾，使得冷凍卵子好像是像背LV變成一股時尚， 但美女妳需要冷凍卵子嗎？ 美國SI生殖醫學會提出警告，雖然冷凍卵子是現在已臨床可運用， 但冷凍卵子真正用到的機會不大， 而且會讓女人誤以為自己多大年紀不管幾歲都可以生小孩， 基本上每一家試管嬰兒中心都有能力可以冷凍卵子， 但問題就要有： (1)實用性、 (2)經濟性，同時年齡幾歲冷凍也很重要，愈年輕冷凍幫忙愈大。 研究發現低於38歲的冷凍卵子，在解凍之後都有不錯的存活率， 受精卵也大概在6、7成， 但著床率都只有掉到20%至30%左右， 當然如果算比較好的胚胎， 多放幾個會增加懷孕率，在不考慮胚胎切片的情況下， 冷凍卵子和冷凍臍帶血是一樣的議題， 冷凍了到底用不用的到？ 還是只是買個心安、買個保險？ 多少的冷凍臍帶血還再凍在那裡，每年繳冷凍費用， 美女妳要冷凍卵子前先想一想， 再想一想美國生殖醫學會提出來的建議，冷凍卵子會讓婦女誤會以為年紀多大都可以生孩子，使得生育年齡往後延，這將帶來風險。
• 2015: 避孕器「翹班」 婦女不知懷孕
• 2015: 次世代定序試管嬰兒台灣已上路 了！NGS 全世界第一個NGS次世代試管寶寶，在2013年7月誕生於美國費城， 她是一個37歲不孕症，在美國做了很多次試管嬰兒都失敗，最後做了次世代定序試管嬰兒胚胎切片，前提是送到英國牛津大學， 由Dagan Wells 威爾斯操刀，發報告回美國，告知哪一個胚胎是正常，植入一個胚胎生下一個寶寶叫大衛里維， 在2014年12月份使用ILLUMINA公司所製造的次世代定序機器Ion PGM，由義大利羅馬GEMONA團隊，進行45個案例次世代定序試管嬰兒研究，證實獲得理想的懷孕率64%、活產率，62%的成功率，平均植入1.1個胚胎， 據暸解次世代定序在台灣也在進行當中， 重點在於設計，在於KNOW HOW 並不在於儀器， 空有儀器沒有人才參加分析設計，這是一台機器，就是一台機器，就像妳買一台新的賓利車不會開，那妳買來就只能純欣賞，不能開上路，不能享受開好車的快感，又不是蓋棉被純聊天？ 目前台灣次世代定序試管寶寶的進度呢？ (1)已進入臨床測試階段。 (2)已進入設計探針階段。 簡而言之就是已經有儀器，而且已經在設計階段，設計探針，所以我說台灣的次世代定序基因NGS，新基因定序試管嬰兒應該為相去不遠。
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