Get Answers from Fertility Madrid
The production of antisperm antibodies (ASA) can occur in the male and/or in the female. In the male, it is due to a disruption in the blood-testis barrier that brings the sperm inside the testicle into contact with blood antibodies. In the female, it is thought to be due to damage to the wall of the genital tract that allows the presence of AAEs primarily in the cervical mucus.
These AAE can cause decreased sperm motility, or agglutination of sperm, as well as molecular damage that prevents fertilization or produces altered embryonic development.
As for treatment, corticosteroids were positioned as the first therapeutic step since they improved sperm quantity and motility, although their efficacy in increasing the number of gestations was doubtful. It seems that artificial insemination with or without corticosteroids improves the possibility of gestation, but it is IVF that achieves the highest pregnancy rates, and is the main therapeutic option for women with the presence of ESA.
The EndomeTRIO test is used to find out more about the patients' endometrium. It is a complete analysis of endometrial health that includes the following tests: ERA, EMMA and ALICE.
The ERA test analyses endometrial receptivity, the EMMA test analyses endometrial microbiota to increase reproductive success and the ALICE test detects the bacteria that cause chronic endometritis.
Numerous studies show the importance of a good endometrium as one of the fundamental keys to assisted reproduction treatment, as it is known that 20% of infertility is due to an endometrial factor.
Both techniques are reproductive technologies, and as such, we cannot say that one is better than the other. Actually, it depends on the diagnosis of each couple.
In the case of conventional IVF, we put the oocyte in contact with a determined concentration of sperm, so that the sperm itself fertilizes the egg, which resembles natural fertilization to a large extent.
In many cases, sperm quality is altered, in which case using the sperm won't be possible. In such situations, we use ICSI. It consists in microinjecting the sperm, which is subjectively selected by the embryologists, into the oocyte.
When a man is affected by HIV, the first thing we would do is wash the semen sample, which removes the seminal plasma, so that the sample contains spermatozoa only. Thanks to this technique, we are able to remove the virus from semen samples. After the washing, we examine the sample to detect copies of the virus using the PCR (Polymerase Chain Reaction) test. If the PCR is negative or the number of copies is low, the sample can be used for a fertility treatment. In this cases, we recommend patients to choose ICSI, as a sperm washing affects the sperm count and motility.
To calculate the gestational age we look at the first day of the last menstrual period. We will be able to confirm with more certainty the gestational age by means of the ultrasound scan of the 12th week.
In in Spain, the medication needed for your IVF treatment is covered by the social security only when the whole treatment is also covered in the same way. If you attend a private assisted reproduction clinic you will have to pay for the medication.
In the US, health insurance rarely covers the costs of the medication and you will have to pay for them.
In the UK, the NHS may cover part of the cost of the medication, but only if the treatment is being paid for by the NHS. If you are receiving private treatment then you will have to pay them separately.
When a woman takes an ovulation test and the result is negative, she may think that something is not right and/or that she has problems ovulating. However, a negative ovulation test can also be due to the following reasons:
- The woman has done the test with the first urine of the morning, or without following the instrucitons correctly.
- The patient has tested too far in advance of the LH peak (e.g. patient with long cycles).
- The LH peak can be short (2 hours) and when the patient tested, it was too late for the test to be positive. It is therefore advisable to do it twice a day.
- The sensitivity of the test used is low and does not detect the specific LH peak of the patient.
Yes, alterations in the cervical mucus can are a common cause of female infertility. The cervical mucus is a secretion produced before ovulation and it disappears after the woman ovulates. It has a sticky texture, and its mission is to pave the way for sperm. It is, in fact, a good indicator of female fertility.
Puerperal fever is defined as the presence of a temperature higher than 38ºC from 24 hours after delivery until six weeks later.
In most cases, these infectious processes are limited by the use of antibiotics (in the order of 7-10 days) that limit the situation. In some cases it is necessary to complete the treatment surgically, as in the case of mastitis with an aspiration curettage, or with the drainage of the surgical wound of the cesarean section or the drainage of a breast abscess in the case of mastitis.
The triple screening does not represent a diagnosis but is a statistical test based on biochemical markers present in maternal blood that establishes a risk index.
It does not provide information on the actual condition of the baby but is based on a simple calculation of probabilities.
Toxoplasmosis is a protozoan called toxoplasma gondii that can affect the newborn through the transplacental route. Depending on the stage at which the infection occurs, so will be its consequences.
If a woman becomes infected with toxoplasmosis during pregnancy, the more advanced the pregnancy is, the more likely it is that the infection will be transmitted to the fetus.
However, if the parasite is transmitted during the first trimester of pregnancy, the consequences are more serious.
Transmission can be prevented by following simple hygiene and dietary guidelines during the months of pregnancy.
Yes, it should be performed on all pregnant women between 24-28 weeks of gestation.
This test is an analytical test, which is a screening test for gestational diabetes mellitus. It evaluates carbohydrate metabolism by testing blood glucose.
Spotting is very common in the first trimester of pregnancy. Any spotting in the first trimester is considered a threat of miscarriage.
Spotting can be due to different causes. The most important thing to do is to see your gynecologist to find out the origin of the spotting. Possible causes include hematoma, low insertion placenta, polyp in the cervix, etc.
The ideal is to consult a doctor. A urine culture should be performed and if it is positive, antibiotics should be started. With the result of the urine culture, check whether the germ is sensitive or not to the antibiotic.
If the urine culture is normal but the patient has urinary symptoms, treatment should also be given.
Any urinary tract infection in a pregnant woman should be well treated to avoid possible complications.
From 12 weeks the sign of the genital tubercle can be seen. From the 16th week onwards, the male and female genitalia can be visualized as long as the fetus is well-positioned.
According to the SEGO (Spanish Society of Gynecology and Obstetrics) along with other gynecological societies worldwide, the first regulated or official ultrasound of pregnancy should be done between 12 and 14 weeks, at which time the correct dating of the pregnancy is performed, to see if the growth that is observed in the ultrasound coincides with that which marks the date of the last menstrual period. In addition, a first study of fetal morphology is performed and very important ultrasound markers such as the nuchal fold are measured, which combined with other analytical tests (PAPPA and BHCG) allow estimating the statistical risk of genetic disease such as Down Syndrome or Edwards' Syndrome.
Both are invasive prenatal diagnostic techniques. The gynecologist should be the one to indicate when to perform one or the other depending on the gestational age.
The earliest is a chorion biopsy, which can be performed between the 10th and 14th week of pregnancy. The risk of miscarriage is 7-8%. It is performed by removing a small sample of chorionic villi.
Amniocentesis can be done between 16-18 weeks of pregnancy. It is performed by extracting amniotic fluid. The risk of miscarriage with this technique is 0.6 and 1%.
Both present a risk of natural termination of pregnancy.
Triple screening is done to all pregnant women nationwide, both in the public and private health system. It is usually done in the 10th week of pregnancy.
It is a statistical computer program that combines ultrasound data with biochemical data (BHCG and PAPP-A) and patient data (age, smoking).
It provides the pregnant woman with a statistical value that informs of a risk. It has a sensitivity of 80 to 85%.
Childbirth preparation courses usually begin around the 6th - 7th month of pregnancy, although they can be started in the first trimester of pregnancy.
They consist of a theoretical part and a prenatal gymnastics part.
Most couples decide to take a course of 6/8 sessions during the last months of pregnancy.
Absence of fetal movements for more than 4 hours despite stimulation.
It is recommended to go to the emergency room for an ultrasound.
It cannot be avoided, since in many cases it happens even with a controlled pregnancy and normal laboratory tests.
There are two types of in vitro fertilization techniques; IVF itself and intracytoplasmic sperm microinjection. The main indication for IVF is a motile sperm count above 3 million. Therefore, any semen sample below this count will be indicative of ICSI (severe male failure).
Other possible indications for ICSI would be a previous IVF fertilization failure, semen samples with teratozoospermia or patients requiring preimplantation genetic diagnosis treatment.
There is a consensus among the Spanish Fertility Society and experts in Reproductive Medicine in our country to set an age limit of 50 years to start an Assisted Reproduction treatment.
In order to be able to treat a woman of this age, she must be in optimal health, without any pathology that could complicate gestation.
One of the possibilities within the Informed Consent is to donate your embryos to another patient/s for reproductive purposes. These embryos become part of the Centre's own embryo bank. The donation of embryos will be made by the Centre to the recipient patient/couple, who will be reminded of the free, secret and anonymous nature of embryo donation and its nature as a voluntary, altruistic and disinterested act. Likewise, in your case, you will not be able to know to whom the embryos have been donated.
Endometrial scratching is a relatively new, simple technique that provides good results in assisted reproduction techniques.
It is applied mainly in patients diagnosed with recurrent implantation failure to improve the reception site of a new embryo.
The objectives of endometrial scratching are:
- To produce a small lesion in the endometrium that causes growth factors, hormonal and chemical factors to be released, so that the newly growing endometrium becomes more receptive.
- Potential activation of molecular/genetic factors involved in implantation that would not be activated in a normal transfer.
At present, scratching is considered to be a good solution for patients with previous implantation failures in order to increase their gestation rate, although there is still no evidence for its routine recommendation.
Childbirth preparation courses usually begin around the 6th-7th month of pregnancy, although they also can be started at the first pregnancy trimester.
They consist of a theoretical part and a prenatal gymnastics part.
The most common decision of couples is to carry out a course of 6/8 sessions during the last months of pregnancy.
Natural double ovulation is studied by the rate of spontaneous twin pregnancies that occurs in 1 out of 80 pregnancies.
In Spain the incidence of multiple ovulation in women is approximately 1.25%. However, there are countries, such as Nigeria, where the incidence is higher and others, such as Japan, where it is lower.
An episiotomy is a minor surgery that may result in the following complications:
- Enlargement of the cut, into the vagina including the anus- rectum.
- Bleeding or bruising.
- Infection, due to the fact that many bacteria live in the genital area.
- Painful cicatrization: the points that are applied for the closure "pull" and bother the patient.
- Dyspareunia: pain during sexual intercourse time after complete healing.
Listeriosis is caused by Listeria monocytogenes, which is transmitted through contaminated food and causes fever and a flu-like illness.
The most frequently contaminated products with which the pregnant woman must take special care are precooked meat, unpasteurized milk and/or dairy products, and shellfish.
It is recommended to cook raw foods of animal origin (meat, fish...) at high temperatures (> 50ºC) and avoid drinking milk without heat treatment. Carefully wash raw foods (vegetables, fruits...). Wash hands after handling raw food and wash kitchen utensils after handling raw food and before using cooked food.
Do not mix raw and cooked or ready-to-eat foods in the refrigerator and clean the refrigerator often.
Once opened, do not store too long cold cuts that require storage in the refrigerator (ham, turkey sausage, pork tongue, gelatin...).
Food leftovers and ready meals should be carefully reheated (> 50°C) before consumption.
A classification of breast cancers is based on the receptors it expresses. Three main receptors are studied: ER or estrogen receptor; RP or progesterone receptor; and HER2.
Triple negative breast cancer is cancer in which the hormone receptors, estrogen and progesterone receptors, and HER2 are negative.
Consequently, this type of cancer is more resistant to pharmacological treatment as it does not respond to hormone therapy (such as tamoxifen or aromatase inhibitors) or to therapies aimed at HER2 receptors, such as Herceptin (generic name: trastuzumab), with other treatments such as surgery (lumpectomy or mastectomy), radiotherapy and other chemotherapies other than Herceptin taking on special importance.
About 10-20% of breast cancer cases are triple negative, and due to their resistance to treatment they are also more aggressive.
Tokophobia is defined as the irrational fear of pregnancy and childbirth. Like any other phobia, it can be treated by putting yourself in the hands of the right specialist. Psychological help, understanding of the couple and family support are essential to overcome it.
Gonadotropin-releasing hormone (GNRH) is a hormone released by neurons in the hypothalamus in a pulsatile form. It stimulates the release of gonadotropins (LH and FSH) by the adenohypophysis.
This hormone is rapidly metabolized and for this reason cannot be quantified in the blood.
Placenta previa is a pregnancy problem in which placenta grows in the lower part of the cervix causing a complete or partial obstruction of its opening.
The main symptom is sudden painless vaginal bleeding. It is detected by ultrasound, which shows the position of the placenta.
It is convenient to have an exhaustive ultrasound control in these cases in order to avoid premature birth.
Sometimes it may be necessary to perform an emergency caesarean section.
The probability of being pregnant is minimal, as decapeptyl is a medication that inhibits ovulation at a central level, making it virtually impossible for ovulation to occur.
The ideal thing would be to do an ultrasound scan to confirm that there is no pregnancy.
In couples with a good prognosis, that is, under the age of 37, with a normal sperm sample, we recommend 4 IUI attempts before moving on to IVF. In the case of single women or donor insemination cycles, up to 6 attempts are recommended. It depends on the clinical history of each patient, though.
A HSG is a type of x-ray examination that aims to examine the presence of pathologies in the uterine cavity, and well as tubal patency. It is recommended to evaluate potential causes of primary sterility. It involves inserting a cannula until the entrance of the uterus, through which a special radio-opaque contrast material dye is inserted. The contrast material dye will fill in the cavity and the tubes. Then, a series of x-rays will be done to detect potential abnormalities or blockages in the different structures. It is a simple procedure that is typically done in the first 10 days of the cycle. During its performance, the woman may feel period-like symptoms. Hospitalization is not required, and its duration ranges between 15 and 30 minutes approximately.
A therapeutic abortion is a type of abortion that is performed for medical reasons. Common basic medical causes include:
- In case a pregnancy is a life-threatening condition for the mother.
- To protect the physical and/or mental health of the mother.
- When there exists risk of birth defects or genetic disease.
- In multiple pregnancies, it is possible to perform a selective reduction or multifetal pregnancy reduction (MFPR) to a number of fetuses that removes serious risks and makes the pregnancy a viable one.
- When there is a serious risk for the life of the developing baby, either because there exists a malformation, or because there is a high risk of being born dead (stillbirth) or death right after being born
Klinefelter syndrome or 47,XXY is a genetic abnormality that occurs as a consequence of an incorrect division of homologous chromosomes during meiosis, which give raise to the gametes of one of the parents. It can also occur during the first divisions of the zygote.
Males affected by it suffer from hypogonadotropic hypogonadism, gynecomastia, learning disabilities, and infertility. It is the most common genetic disease in males. Some men, however, do not have symptoms, and they don't know that they have this condition until they are adults and have infertility issues.
An egg is the female reproductive cell, which is fertilized by the male reproductive cell, that is, the sperm. Gametes are haploid cells (23 chromosomes), that is, they have half the number of chromosomes than other cells, which are diploid (46 chromosomes). The fusion between both reproductive cells (male and female) gives raise to a zygote (diploid cell, 46 chromosomes), in which we can find a female pronucleus (23 chromosomes) and a male pronucleus (23 chromosomes).
Hypospadias is a birth defect that affects male babies. With this conditions, the urinary meatus is located in a place other than the external urethral orifice, such as the scrotum. There exist various types of hypospadias, from mild to most severe.
The fact that a woman has had repeated miscarriages in the past has nothing to do with the day of the embryo transfer. In most of the cases, it is associated with the chromosomes of the embryos. Keeping this in mind, ideally the best treatment option in these cases would be IVF with PGD (Preimplantation Genetic Diagnosis). With PGD, we examine 6-8 cells of each embryo. It allows us to find out which embryos are genetically norma and which don't.
By blastocyst culture we refer to keeping the embryos in the incubator until day 5-6 of development, that is, until they reach blastocyst stage. By doing this, we perform a much more thorough embryo selection process. The fact they they are capable of making it to blastocyst means that they have a greater implantation potential, as it was able to stay longer in the lab. Pregnancy success rates depend on age, though.