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Fertty International Support Group

Fertility Support Group
This clinic is part of the Fertility Support Group Program.
1. Health Center approved by the Spanish Ministry of Health - License number (CNN): 09080122792. Registration Code of Health Centres, Services and Establishments of the Department of Health (Government of Catalonia): E08629688

Get Answers from Fertty International

Is tubal ligation dangerous for women?
By Dr. María Arqué. Last Update: 06/25/2020

Tubal ligation is a permanent method of contraception in which the fallopian tubes are cut, tied, or blocked to prevent pregnancy. The procedure itself has no consequences for the woman's menstrual cycle.

However, since tubal ligation is an operation under anesthesia that involves incision of the abdomen, there are some risks associated with the surgical intervention:

  • Damage to intestines, bladder, or major blood vessels
  • Reaction to anesthesia
  • Inadequate wound healing or infection
  • Continuous pelvic or abdominal pain
  • Failure of the procedure, resulting in unwanted future pregnancy

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Is Gonal the same as Ovitrelle?
By Dr. María Arqué. Last Update: 06/25/2020

No. Gonal and Ovitrelle are fertility drugs with different functions and different mechanisms of action.

Gonal consists of recombinant FSH (follitropin alpha) and is used to promote the growth of follicles during ovarian stimulation. Ovitrelle is a drug that contains the recombinant hCG hormone (r-hCG) and is used in the vast majority of assisted reproduction treatments. It involves a single injection that induces the final follicular maturation after controlled ovarian stimulation, both in artificial insemination (AI) and in vitro fertilization (IVF).

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Is IVF possible in cases of leukocytospermia?
By Dr. María Arqué. Last Update: 06/25/2020

Leukocytes or pyrocytes are generally scarce in the seminal fluid or even absent. However, if there is a large number of these cells, it could be an indication that there is an infection. This high presence of leukocytes is known as leukospermia, leukocytospermia or pyospermia.

It is common to observe some of them in semen samples when seminograms are performed. However, when they are in an abnormally high concentration (over 1 million leukocytes per ml according to WHO definition), it can compromise male fertility because it increases oxidative stress and causes a worsening of seminal quality, as it can affect sperm concentration. The presence of leukocytes in sperm can cause temporary sterility.

For this reason, in cases where leukospermia is detected, specific treatment is needed to resolve this sterility and prevent it from having a negative impact on the result of in vitro fertilization or becoming permanent.

Can I have sex as a low responder in ovulation induction?
By Dr. María Arqué. Last Update: 06/25/2020

In the event that ovarian stimulation has been performed to perform an in vitro fertilization treatment and that, due to the low ovarian response, the treatment has been canceled, there is the possibility of converting it back into artificial insemination or scheduled reports, provided the following requirements are met:

  1. Sufficient semen quality for the possibility of pregnancy
  2. Having one fallopian tube
  3. monofollicular ovarian response or a maximum of 2 follicles: if there are more than two follicles that have grown (> 15 mm) and have unprotected sexual intercourse, there is a risk that all these oocytes will be fertilized and that there will be multiple gestation. For this reason, if more than two follicles have grown, it is recommended to avoid unprotected sexual intercourse.
Is there any food that improves astenozoospermia?
By Dr. María Arqué. Last Update: 06/25/2020

Asthenozoospermia is an alteration of the semen that refers to mobility problems in sperm.
If the man has a high percentage of sperm with mobility problems, it is difficult to achieve pregnancy naturally. Therefore, an assisted reproduction technique is usually necessary.

As for treatment options, there are the following:

Diet and lifestyle
It is recommended to lead a healthy lifestyle and avoid toxic habits (tobacco consumption, alcohol, etc.) which may affect the overall quality of sperm, including sperm mobility. This can be of great help in case of mild or light asthenozoospermia. In addition, we recommend the consumption of a vitamin supplement that has antioxidants to stimulate sperm mobility.
Pharmacotherapy
There are some medications designed to improve sperm quality that can help reduce sperm mobility problems. However, this will only be effective in mild cases of male infertility in sperm.
Severe or severe asthenozoospermia is difficult to improve with any of these treatments. In these cases, it will be necessary to use assisted reproduction techniques to achieve pregnancy.
Is Turner syndrome hereditary?
By Silvia Fernández Fernández. Last Update: 06/11/2020

Turner syndrome is a chromosomal disorder characterized by the total or partial loss of one of the sex chromosomes in the female gender. Therefore, the karyotype of these women will be 45.X0 instead of the normal karyotype which is 46.XX. It is not known whether the cause may be due to meiotic problems (formation of the oocytes in the mother) or mitotic problems (division of the cells in the embryo).

This is why women with Turner syndrome are more likely to have children with Turner syndrome or other genetic disorders, because the segregation of their chromosomes occurs in an unbalanced way.

Why does teratozoospermia cause fertility problems?
By Silvia Fernández Fernández. Last Update: 06/11/2020

Teratozoozpermia is an alteration that affects the male semen in which the vast majority of spermatozoa have an abnormal morphology. The bad morphology of the sperm may be due to defects in their head, middle piece, or tail. These abnormalities prevent the sperm from fertilizing the egg. This is why it is one of the most common causes of male infertility.

What is the purpose of menopur in fertility treatments?
By Dr. María Arqué. Last Update: 05/25/2020

Menopur is a drug used in assisted reproduction techniques for controlled ovarian stimulation.

It is a highly purified menotropin (human menopausal gonadotropin, HMG-hP), with follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity. Human chorionic gonadotropin (hCG), a hormone naturally present in the urine of menopausal women, is the major contributor to the LH activity of this drug.

When compared with recombinant gonadotropin products, no differences in safety, purity, or clinical efficacy have been observed.

For embryo adoption, where do embryos come from?
By Dr. María Arqué. Last Update: 05/25/2020

Embryos for embryo adoption come from other couples who have already completed their reproductive project and who have donated their surplus embryos so that other couples can have children.

These embryos may come from donor eggs or from the woman's own eggs, in which case she must have been under 35 years old when the ovarian puncture was performed. The sperm can come from the man himself or from a sperm donor.

Moreover, as per Law requirements, the parents of the donated embryos must not have any known infectious or genetic disease.

Is it possible to achieve pregnancy with oligoasthenozoospermia?
By Dr. María Arqué. Last Update: 05/25/2020

Oligoasthenozoospermia is a cause of male infertility in which two seminal parameters are affected: sperm’s concentration and motility.

We talk of oligoasthenozoospermia when concentration is below 15 million per ml and when there are more than 60% of sperm with altered motility.

Therefore, oligoasthenosperma is considered to be a combination of the oligozoospermia and asthenozoospermia disorders, which aggravates men’s sterile situation.

Achieving a natural pregnancy by men with oligoasthenozoospermia is complicated, although not impossible. If pregnancy was not achieved, couples affected by this pathology should resort to in vitro fertilization (IVF) techniques in order to become parents.

Basically, there are two suitable treatments for these patients: Intra-uterine insemination (IUI) in cases of discreet oligoasthenozoospermia or IVF/ICSI for patients with moderate or severe oligoasthenospermia.

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What are the causes of altered sperm morphology?
By Dr. María Arqué. Last Update: 05/25/2020

Teratozoospermia is the alteration of sperm morphology, either by presenting defects in their head, intermediate piece, or tail.

According to the World Health Organization (WHO) criteria for 2010, a man has teratozoospermia when more than 96% of his spermatozoa have a strange or abnormal morphology.

There are several causes that provoke alterations in morphology and there are not always easy to diagnose, such as genetic alterations, chemotherapy, testicular disorders, unhealthy lifestyle habits, seminal infections, or pathologies like diabetes mellitus, meningitis, etc...

Some of these factors can cause reversible teratozoospermia, which disappears when the fever, infection, or periods of stress are reversed.

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What information does the Anti-Müllerian hormone analysis provide?
By Dr. María Arqué. Last Update: 05/25/2020

Anti-Müllerian hormone is produced by the preantral and antral follicles of the ovaries throughout a woman's reproductive life.

Specifically, responsible for synthesizing it are the granulosa cells that surround the egg. The measurement of AMH in blood indicates approximately the quantity or number of eggs a woman has, i.e. her ovarian reserve. To complete the information on the ovarian reserve it is necessary to perform a transvaginal ultrasound with an antral follicle count.

It is important to remember that both the AMH and the antral follicle count are quantitative markers and do not provide us with information about egg quality. The parameter that best correlates with the quality of the oocytes is the woman's age.

Which assisted reproductive treatment is best for a 40 years-old woman?
By Dr. María Arqué. Last Update: 05/13/2020

Women are born with a limited number of eggs and do not produce new ones throughout their lives. There is a gradual decline in the quality and quantity of the eggs over time, with the decline becoming more pronounced after the age of 35. From the age of forty onwards, a high percentage of the eggs present alterations in quality, which explains the greater difficulty in achieving a pregnancy and the greater risk of abortion. In women over 40, the assisted reproduction treatment with the highest success rate is egg donation. However, each case must be individualized, and in women with good ovarian reserve and no other infertility factors besides age, there is also a good chance of success with an in vitro fertilization with their own eggs.

Whom will the sperm donor look like in artificial insemination for female couples?
By Dr. María Arqué. Last Update: 05/13/2020

In artificial insemination treatments with donor sperm, the selection of the donor is carried out seeking the maximum phenotypical and immunological similarity with the recipient woman. In most centers, in cases of female couples, the physical characteristics of both are taken into account for the selection of the most suitable donor.

Is it normal for a 23-years old girl to have AMH levels of 1.2 ng/mL?
By Dr. María Arqué. Last Update: 05/13/2020

An antimullerian hormone value of 1.2 ng/ml in a 23-year-old woman would be considered within the range of normal. However, to get a more accurate idea of the woman's ovarian reserve, it would be necessary to complete the study with a transvaginal ultrasound with an antral follicle count, which should be equal to or higher than 8 to be considered normal. Antimullerian hormone and antral follicle count are quantitative markers of ovarian reserve, and age remains the best prognostic factor for egg quality. That is, two women with the same anti-Mullerian hormone and antral follicle count results may have very different reproductive outcomes depending on their age.

Which assisted reproductive treatment provides the highest success rate?
By Dr. María Arqué. Last Update: 04/07/2020

The assisted reproduction treatment with the highest probability of success would be the one indicated as the most appropriate for each clinical case. In absolute terms, egg donation would be the treatment with the highest success rate, but that does not mean that it is the necessary or indicated treatment for all cases. For this reason, proper diagnosis and good therapeutic guidance are crucial to the success of the assisted reproduction procedure.

What can happen if hCG is administered too late?
By Dr. María Arqué. Last Update: 04/03/2020

HCG is a hormone that is administered 36 hours before egg collection. In some cases, a GnRH analog is administered instead.

These hormones are responsible for facilitating the final process of oocyte maturation and ovulation. It is crucial to administer these hormones at the time indicated by your assisted reproduction specialist, as doing so too early could cause premature ovulation, therefore preventing oocytes recovery when performing the egg collection.

Administering the trigger injection too late could lead to a lack of maturation of the oocytes, which leads to a lower oocyte recovery rate (because part of these cumulus-oocyte complexes will still be adhered to the follicle wall, and therefore will not be recovered in the egg collection) and that the collected oocytes will probably be immature and not suitable thus to be used for the treatment.

Why is age such an important factor in a woman's fertility?
By Dr. María Arqué. Last Update: 04/03/2020

We women are born with all the oocytes we will have for life. A process of natural loss of the quantity and quality of oocytes occurs throughout life. This decrease in the quantity and quality of the eggs is more pronounced after 35 years old.

For this reason, after the age of 35, the chances of pregnancy decrease and the probability of miscarriage increases.

What are the causes of testicular factor male infertility?
By Dr. María Arqué. Last Update: 04/03/2020

There are numerous factors that can cause male infertility as they affect the production and maturation of sperm in the testicles themselves. These lead to low sperm concentration, low sperm mobility, changes in sperm morphology or failure to produce sperm.

The most common causes of male infertility due to the testicular factor include high testicular temperature, toxins, chromosomal defects or testicular diseases.

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What day is best for embryo transfer? the 3rd or 5th day?
By Dr. María Arqué. Last Update: 04/03/2020

Embryonic development in the first few days of the embryo's life is very fast. The embryos that follow a normal development, on the third day of life have about 8 cells and, on the fifth day of life, they are already a structure called a blastocyst, which has more than 200 cells, with an internal cell mass (the part that will form the baby) and a trophectoderm (the part that will form the placenta) already defined.

During this development process, a first selection already occurs in the laboratory itself, since not all embryos reach the blastocyst stage. In fact, some embryos that show good characteristics on day 3 do not reach day 5 (they are blocked or their quality is not good enough).

In this sense, we have more information on embryo quality on the 5th day of development and we can better select which embryos are most likely to give an evolving pregnancy. For this reason, the current trend in most assisted reproduction centres is to transfer on the fifth day of development.

Can I have Ovarian Hyperstimulation Syndrome in a frozen embryo cycle?
By Dr. Juan José Espinós Gómez. Last Update: 03/26/2020

No, it's not possible. Embryo cryotransfer is performed in an asynchronous cycle not stimulated with gonadotropins. It can be done with natural cycle in women with very regular periods or with cycles substituted with female hormones.

In case of a substituted cycle, the treatment consists of the administration of an estrogen in the first phase and the association of an estrogen and progesterone in the second phase. Both substances prepare the endometrium for implantation, but have no effect on follicular growth or ovulation. In fact, during a substituted cycle the ovary is slowed down by the effect of the hormones.

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