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As possible advantages of the use of the PICSI we could talk about the following:
- It is a complete, accurate and alternative sperm selection method. Complete because the sperm sample to be used for PICSI has already been improved with techniques such as Swim-up or Gradient; precise because the basis of the technique involves molecular components and alternative because it represents a different option to other means of sperm selection.
- It seems to be associated with a reduction in the abortion rate: the different studies state that the use of PICSI does not increase the live birth rate compared to the use of ICSI but reveal that there is a lower abortion rate in the PICSI group. Why is it that if it reduces abortions it is not found in the studies that it increases the live birth rates? Because this decrease in the abortion rate is so low that in studies it has no influence on live birth rates.
- It is an objective and simple method that does not require much experience to develop, unlike ICSI where there is a subjective component in the choice of sperm to microinject.
The best option to achieve a pregnancy after having had a tubal ligation is to resort to in vitro fertilization (IVF). Another possible option would be to try to repair the fallopian tubes by an operation called tubal reanastomosis, i.e. joining the ends of the cut tubes together again.
Ovarian hyperstimulation is characterized by an increase in the size of the ovaries. In the most severe cases there may be sudden changes in body fluids, with fluid leaking out of the blood vessels into, for example, the abdominal cavity.
In this type of situation, it is always recommended to avoid physical exercise and sexual relations. The main reason will be to avoid possible ovarian torsion. This consists of a complete or partial rotation of the ovary on its supporting elements, with the consequent loss of its blood supply. The fact that the ovary is larger than usual is a risk factor for this type of incident.
In fact, after carrying out an in vitro fertilization, even if there is no ovarian hyperstimulation syndrome, sexual relations are not recommended until some time has passed, as to a greater or lesser extent, the ovaries will always be larger than usual due to the growth of multiple follicles, and therefore, an increased risk of ovarian torsion.
Most chronic diseases will be at risk of worsening during pregnancy, so close monitoring before, during and after pregnancy will be essential.
In some cases, pregnancy may even be contraindicated because of the risks to the mother.
There are two groups of patients in whom a deficit of the LH hormone may prevent proper follicular development:
- Women over 35: As the years go by, the LH produced by the body is less powerful and the LH receptors are less functional.
- Women who, in spite of having good ovarian reserve parameters, have shown a low response in a previous ovarian stimulation cycle. One of the causes, among others, that can provoke this unexpected low response is a genetic variant of LH that makes the hormone biologically inactive. Thus, if we measure the LH levels in the blood they will be normal, but the hormone will not be able to exert its function.
These are the patients in whom it will be necessary to add LH activity in ovarian stimulation, since they do not have enough endogenous LH to complement FSH in folliculogenesis.
Firstly, it is necessary to define very well what these spermatozoa obtained from the testicle are going to be used for and what type of azoospermia we are talking about.
In cases of secretory azoospermia, as it is more difficult to obtain sperm, microinjection can be attempted even if the number is very low, always informing the patients of the prognosis. There is no defined minimum number of sperm but there must be at least two or three times the number of oocytes to be microinjected to ensure a certain margin of safety. Normally, freezing samples in these cases is very difficult due to the shortage.
In contrast, in obstructive azoospermia, the scenario is usually different. Embryologists assess that the concentration of sperm present is as before, 2-3 times more than the number of oocytes to be microinjected, and if the sample has a higher concentration it can be frozen for future use. As long as the sample can be frozen, it will be the most convenient to avoid future surgeries if the in vitro fertilization treatment fails.
In the treatment of frozen embryos, oocyte or embryo donation, when carried out in a substituted cycle (with medication) the hormonal secretion of the ovary must be simulated. In this way, treatment is initiated with the patient's period and estrogens are added in tablets or patches to promote endometrial growth. Normally, a control ultrasound is performed after 10-12 days to check this growth. If the appearance is trilaminar and the thickness is above 7-8 mm, the endometrium is considered to be ready for the embryo transfer. For this, progesterone should be added as many days before the embryo to be transferred. Both hormones (estrogen and progesterone) must be maintained at least until the day of the pregnancy test and if it is positive, the first weeks of gestation will be maintained.
The cause of Kallman syndrome is genetic, with different genes involved. Therefore, there is no cure as such. Treatment consists of exogenously giving the body the hormones it needs for proper pubertal development. In women estrogens are administered and in men testosterone, in both cases they will be maintained indefinitely.
In addition, if there comes a time when the patient wishes to have children, the hypothalamic pituitary gonadal axis must be activated with medication. GnRH or FSH and LH can be administered to activate the ovaries and testicles.
Serological study of hepatitis B, hepatitis C, HIV and syphilis should be performed prior to any treatment.
This aims to avoid transmission between partners, from mother to fetus and even contamination in the laboratory with possible infection of the staff of the same or other uninfected partners.
Today there is still much ignorance as to what factors affect fertility. For example, when a male has a seminogram and it is altered, most of the time we will not know the cause.
Just like food, life habits such as exercising and not consuming toxins are very important for reproduction. We know that environmental factors can also affect, although we are not yet sure how they all affect each other.
A rise in temperature maintained in the area of the external genitalia of males can be one of the causes of poor semen quality. In this sense, laptops can be affected when used on the lap. Studies in urology describe that with more than 10-15 minutes of computer use in the lap, scrotal temperature increases considerably and this can cause problems in sperm production. Therefore, it is recommended that computers are used on the table so that this potentially damaging temperature increase does not occur.
Ideally, fetal DNA testing should be the method used in all pregnant women. However, most health care providers only cover the costs for high-risk patients.
In general, we could say that this test would be especially recommended in the following groups of women:
- Women who underwent first trimester screening and are considered high-risk patients(≥1/270)
- Women who presented aneuploidies in chromosomes 21, 18 or 13 in their previous pregnancy.
- Women who are pregnant at ≥ 38 years.
Fertility, among other things, depends on the health of each person, so food is one of the most important bases before and during pregnancy.
It is advisable to follow a healthy and varied diet. The Mediterranean diet is ideal for this, as it provides the necessary nutrients for a healthy lifestyle. In addition, you can eat as many times a day as necessary, but taking into account the appropriate amounts for each person.
Estrogens are the hormones produced by ovaries. A very low level of estrogen is usually found in a case of non-functioning ovaries (in cases of ovarian failure, menopause, etc.). The consequences of having a very low level of estrogen are the same as during menopause (vaginal dryness, decreased libido, etc.).
In a woman's normal menstrual cycle, for two or three days there is a low level of oestrogen (the first few days of menstruation) but the oestrogens quickly start to rise, until they reach a maximum, when ovulation occurs.
A woman is considered to have POF if she has deteriorated ovarian function under 40 years of age. Some time ago this was also known as early ovarian failure or early menopause. However, these terms are not entirely accurate, because at menopause there is a total or almost total depletion of the ovarian reserve, so menstruation disappears completely. In early ovarian failure patients may continue to ovulate occasionally.
50% of the testosterone in a woman's body comes from the conversion of other androgens, while the other 50% is produced directly in the ovary and the adrenal glands in equal parts.
Specifically, women produce between 0.1 and 0.4 mg of testosterone daily, while men produce between 5 and 7 mg daily.
99% of a woman's testosterone is bound to a protein called sex hormone-bound globulin (SHBG), which does not allow it to function. Therefore, only 1% of testosterone will be in free form and may have an effect on the body.
As menopause approaches, there is a decrease in androgen levels. However, the ovaries of menopausal women will continue to produce testosterone constantly.
In addition to menopause, other situations that may decrease androgen concentrations include anorexia nervosa, medications such as contraceptives (due to increased SHBG concentrations), HIV, bilateral oophorectomy (surgical excision of both ovaries), and endocrine pathologies such as a failure of the adrenal glands or hypopituitarism.
On the contrary, there are circumstances in which higher levels of androgens are observed, such as polycystic ovary syndrome (PCOS)
Testosterone is sometimes used in assisted reproduction in an attempt to improve the response in women with low egg reserves.
Testosterone or DHEA pre-treatment appears to be associated with better live birth rates, although the quality of evidence is moderate.
FISH is a cytogenetic analysis technique that allows the identification of sperm chromosomes in an ejaculate or testicular biopsy sample. It determines the chromosomal endowment, expressing the percentage of spermatozoa that present alterations.
Usually 5 chromosomes are analyzed, 13, 18, 21, X and Y, as they are the most frequently affected chromosomes that can give rise to viable gestations. However, this study can be extended to other chromosomes.
Multiple indications have been proposed for performing sperm FISH, including repeated miscarriages, implantation failure, advanced paternal age, history of chemotherapy treatment, seminal alterations, infertility of unknown origin, genetic anomalies, etc. However, not all of them are linked to a high percentage of patients with an altered FISH.
There's quite a bit of controversy about that. In general, there is no clear evidence that time-lapse incubators improve success rates. However, there are studies that claim that more embryos will be able to reach the blastocyst stage due to better culture conditions and that higher gestation rates can be achieved by better embryo selection.
The first incubators for embryo culture were large and the embryos of all patients were stored in the same space. Therefore, when a patient's embryos had to be removed for microscopic viewing or transfer, the temperature and gas conditions were temporarily altered, and this could affect all the embryos.
More recently, "benchtop" or "sandwich" type incubators have been developed. These have individualized compartments for each patient, so that opening one does not affect the others. In addition, the culture conditions are much better than with the first incubators, as they work at low oxygen pressures, so they imitate the conditions of the human body much better. The difference between these incubators and the Embryoscope® or other types of time-lapse incubators is that they do not have a built-in camera, so if you want to monitor the development of the embryos you need to remove them from the incubator to look at them under the microscope.
Ovaleap's main advantage is its administration device.
In a recent study, 402 patients from different countries were surveyed to evaluate what they considered to be the most important characteristics of devices for self-administration of medication in assisted reproduction treatments. Of the 6 most valued characteristics, Ovaleap has the device with the highest number of them, 5 in total (type of device: multi-dose pen, with dial-back function, possibility of increasing the dose in small amounts, release button for injection and visibility of the remaining medication in the cartridge).
Only the Puregon device outperformed it in one feature, the daily injection volume, being 0.18ml while with Ovaleap it is 0.25ml.
The implant is a long-lasting, but reversible method of contraception. It has a contraceptive efficacy of 99.95% and a single implant can last up to 5 years.
It is a small metal device, which is placed under the skin of the arm. It works thanks to the hormonal release of gestagens that will inhibit ovulation. It is true that women can witness changes in the amount and duration of their periods, there are even women who will not have menstruation during its use.
Once it is removed, the contraceptive effect disappears quickly and the ovulatory cycles will continue in a normal way, so it does not affect fertility at all.
It is always one more tool that will provide us with more information. This technique allows us to select chromosomally normal embryos and, therefore, increases the pregnancy rate for each embryo transferred and reduces the risk of miscarriage.
Yes, HPV is not a contraindication for pregnancy or assisted reproductive techniques, as long as the virus has not caused any injury to the cervix, vagina or external genitalia. For this reason, all women undergoing treatment will be asked for a Pap smear beforehand. If any lesion is present, we will have to wait for it to resolve, but if the HPV is present and the Pap is negative and there are no lesions, we will be able to go ahead with the process without any problem. The woman will just have to follow her usual check-ups.
Normally, pregnancy follow-up after IVF is exactly the same as a spontaneous pregnancy, but it must be kept in mind that many of the women who undergo assisted reproduction treatments are over 35 and even 40 years old. In other words, the risks derived from chromosomal alterations will be increased. Nowadays, thanks to prenatal blood diagnosis techniques in the first weeks of pregnancy, we can detect chromosomal alterations even before performing the first trimester ultrasound. We will recommend this type of analysis to older women who have achieved pregnancy with their own eggs.
Ovarian insufficiency or ovarian failure is the condition suffered by young women, under 42 years, with malfunction of the ovary due to low ovarian reserve.
All women lose proper ovarian function at some point in their lives, since the ovary is endowed with follicles (which inside have eggs) that are going to decrease throughout our lives, and are not going to regenerate again.
If exhaustion comes at 48 years, it is not a problem, and menopause occurs naturally.
However, in other women, there may be ovarian depletion at a young age. If it is accompanied by alterations in the pattern of the menstruational cycles, an early ovarian failure will occur. If, on the other hand, there are no alterations in the menstrual pattern, it will be called occult ovarian failure.
If the woman has regular cycles, requesting the Antimullerian Hormone is enough for us to know how her ovarian reserve is. However, if the cycles are irregular, we will need to request other hormones such as FSH, LH, estradiol, or prolactin to know the cause: polycystic ovary syndrome, menopause, hyperprolactinemia, etc. In all cases, we will also ask for thyroid hormones, as it is important to check that the levels are normal for fertility and pregnancy.
Pelvic inflammatory disease is a pathology that is diagnosed by the presence of clinical compatible with it: fever, pelvic pain and the finding in the cervical culture or culture of endometrial aspirate bacteria that produce this pathology, such as gonococcus or chlamydia, among other things.
The most sensitive diagnostic test is laparoscopy, but in the vast majority of cases the diagnosis of pelvic inflammatory disease is made without having to resort to it. Blood tests are performed to determine the degree of infection, leukocytosis, as well as cultures with swabbing to detect bacteria that may cause this disease.
The duration of artificial insemination is usually about 5 minutes if there is no problem. After the process, the patient will rest for 20-30 minutes and then leave the clinic with the instructions until the day of the pregnancy test.
Rest after insemination is not obligatory, as no evidence exists that it improves the pregnancy rate.
Turner syndrome is one of the most common chromosomal abnormalities in humans, and represents an important cause of early menopause. It is caused by the total or partial loss of one of the X chromosomes (women usually have 2 X chromosomes).
The vast majority of women with Turner syndrome will be sterile due to ovarian failure. However, there is a small percentage of women (about 5%) who will be able to achieve natural gestations. It will be more likely if you have had spontaneous menstruations or if you have a mosaic Turner syndrome (when some cells have one X chromosome and two other X chromosomes).
Some adolescent women or Turner mosaics will have enough ovarian function to respond to ovarian stimulation and may vitrify oocytes to become mothers later or perform in vitro fertilization. However, the vast majority of women with this chromosomal alteration will have to resort to ovodonation.
In addition, for these women there is an increased risk of aortic dissection during pregnancy and postpartum, which will require a complete medical evaluation before seeking gestation, paying special attention to cardiovascular and renal function.
Only in a minority of cases of salpingitis does peritonitis or pelvic abscess develop, manifesting itself with more intense pain and general symptoms such as fever. If this degree is reached, surgery is sometimes necessary to cure the disease, and the tubes and even the ovaries have to be removed.
In the most severe cases, the process can extend to other abdominal organs such as the liver or even pass into the blood (sepsis), posing a risk to the woman's life.
There are several causes that can cause us not to ovulate. One of the most common is Polycystic Ovary Syndrome, a benign condition that affects many young women. It consists of an endocrine disorder that does not allow correct ovulation.
There could also be anovulation of hypothalamic or pituitary cause, such as intense physical exercise, low weight, etcetera. Other hormonal alterations such as alterations in thyroid hormone (TSH) or prolactin, can cause ovulation not to occur properly.
Advanced age would also be a cause why, in spite of having periods, in many cycles ovulation does not occur regularly.
There are several types of analogs, which differ by small variations of components of the molecule. These would be leuprorelin acetate, triptorelin, nafarelin, buserelin, and goserelin. There are several presentations (daily, monthly, quarterly ...), indicating at each time the most appropriate for the effect you want to achieve. Each type of analog also has its route of administration, which may be subcutaneous, intramuscular, or intranasal.
It has not been demonstrated that any of the agonists marketed is superior to another, although the subcutaneous route provides constant bioavailability and little variation between patients, while intranasal or inhalation absorption may be more variable.
Ovitrelle is a hormone called chorionic gonadotropin. It is administered to induce ovulation in those women who do not ovulate spontaneously or after ovarian stimulation as part of an assisted reproduction treatment.
Depending on the bioavailability of the drug, its half-life is 30 hours, after which most of it will be eliminated from the body. However, there may be interference in blood and urine tests up to 10 days after administration, which may lead to false-positive pregnancy tests. It is important that patients are warned to always take a pregnancy test at least 11 days after Ovitrelle has been administered.
Cancer treatment may occasionally require removal of the ovaries or administration of chemotherapy or radiation therapy. This often results in a loss of fertility. However, in many situations, with adequate planning it will be possible to preserve the fertility of these patients so that they can become mothers in the future. The most important thing in this sense is to consult a fertility specialist as soon as the malignant pathology is diagnosed.
Although there exists different studies that relate an advanced age with fertility problems, actually it is still unclear.
In the testicle, sperm production is a permanent process, contrary to what happens in with egg production in females. This is the reason why, freezing sperm as a preventive measure is not so useful as in the case of egg freezing, since egg quality and quantity decreases from age 35 onwards.
Unless there exists a disorder that affects sperm production, in the case of cancer patients who are going to undergo chemotherapy or radiotherapy, or if the man undergoes some kind of surgery (such as in the case of vasectomy), freezing sperm for the future is not required.
The triple test or triple screen is a universal test that is done in all women when they are pregnant, particularly around week 12 of pregnancy. It pays special attention to the risk of Down's syndrome in the fetus by combining two markers from the first trimester ultrasound with two hormones examined in pregnant women (BHCG + AFP) along with her age.
In case your OB/GYN refers you directly to invasive tests (amnio test or chorionic villus sampling) because you've been pregnant before and chromosomal abnormalities were detected in the fetus, then a triple test would be unnecessary.
Yes, although the chances are quite low.
When we classify embryos according to their quality at the lab, we do so by evaluating their implantation potential, that is, trying to "guess" which ones have greater chances for attaching tot he uterus, and which don't. C and D scored embryos are embryos of moderate-to-low quality, which means that a C or D scored embryo has a reduced chance of implantation if compared to a B or A scored embryo. In any case, however, whenever we select an embryo for the transfer, it's because it has been observed that its implantation potential is a good one.
There exist no differences between a natural pregnancy and a pregnancy that has been achieved using reproductive technologies such as IVF. After the embryo transfer, fetal development will be the exactly the same.
Neither the risk of malformations nor the risk of miscarriage increase when using a fertility treatment. Some studies have discovered a slightly higher risk of preterm birth or low birth weight. Anyway, these complications do not seem to be directly linked to the use of fertility treatments, but with the cause of infertility: women aged 40 or older, uterine anomalies and other pathologies... This type of pregnancies must be monitored very closely.
The number of embryos to transfer to a patient is not dependent on the technique performed for the genetic analysis of embryos, but on the stage, quality, and particularities of each patient. Preimplantation Genetic Diagnosis is usually performed in cases of advanced maternal age (aneuploidy screening) or when there exist severe genetic pathologies (in many cases, present in the woman). In both situations, a multiple pregnancy would be contraindicated.
So, given all these circumstances, doctors usually recommend Single Embryo Transfers (SETs).
Follicular puncture or oocyte retrieval is a mild procedure that involves little risk of complications.
The most severe risks that can occur during or after this procedure are damage to pelvic organs (intestines, bladder...), bleeding, or infections. These complications are very rare, as it is an ultrasound-guided procedure, which means that the gynecologist can monitor the sites being approached.
Other side effects, though less severe, include dizziness and vomiting due to anesthesia, or abdominal pain during the first days after the procedure.
ICSI or Intracytoplasmic Sperm Injection is a type of In Vitro Fertilization that is used to fertilize the egg cell. With ICSI, the sperm cell is selected and injected within each one of the eggs collected.
Unanimously recognized indications of ICSI include:
- Severe male infertility: a single sperm per egg cell is enough
- Previous fertilization failure using conventional IVF
- Issues with the oocytes: poor-quality eggs may compromise sperm penetration into the egg cell
- Techniques that involve isolating the egg from the cells that surround it (egg donation, preimplantation diagnosis...)
The treatment to follow varies depending on whether it is a fresh embryo transfer (after an IVF cycle) or a frozen embryo transfer.
With fresh embryos, patients follow a hormonal treatment based on applying injections to stimulate the ovaries during 10 days approximately. After retrieving the eggs, the patient starts taking progesterone vaginally or subcutaneosly.
With frozen embryos, patients have to prepare during 2 weeks with estrogens (in patches or tablets). Depending on the day of the embryo transfer, progesterone may be prescribed as well. In some cases, the patient follows a natural cycle, without using estrogens.
Seminal quality can also be evaluated by studying the genetic content of spermatozoa. First, we can study DNA integrity, which is fundamental to obtain correct embryonic development. However, sometimes it is fragmented. The fragmentation test evaluates the percentage of fragmented spermatozoa in the ejaculate.
On the other hand, we can study if the sperm have a correct chromosomal content through the FISH study (5 pairs of chromosomes are evaluated) or Chromosperm (a general chromosomal profile is evaluated). An ejaculate with a high percentage of chromosomally altered sperm could generate a greater number of aneuploid embryos.
Hydrocele is the accumulation of fluid between one of the layers of the testicle (vaginal tunic) and the scrotum of one or both testicles. It can be congenital (affects babies at birth) or acquired, i.e. secondary to infections, trauma, tumors, surgeries on the testicle, etc.
In most cases the hydrocele is presented as an inflammation of the testicle, not painful or causing mild discomfort. In itself, it is not a cause of sterility but certain cases, such as those caused by an infection, can reduce the reproductive capacity.
Anti-Müllerian hormone is produced by the ovary, and its blood levels are an indicator of a woman's ovarian reserve.
To ensure everything works as expected, we recommend that the first measurement is done from age 20 and not later than age 30. By doing this, if a woman has a diminished ovarian reserve at a young age, she would have time to decide whether she wants to have a baby now or cryopreserve some eggs to become a mother in the future.
There are no concrete actions to increase sperm volume. The right thing would be to redirect the question towards: how can semen quality be improved?
Seminal characteristics are specific to each male. However, there are certain factors that can modify the quality of the semen, causing it to increase or decrease.
Factors that diminish seminal quality are: tobacco, alcohol, drugs, a bad diet, a very stressful life rhythm, continuous and direct exposure to radiation or chemical agents harmful to health.
In order to improve seminal quality the right thing is to lead a healthy way of life:
- Balanced and healthy food (encourage the regular consumption of foods rich in antioxidants)
- Maintain an adequate weight (excess weight is negative for seminal quality)
- Maintain a low-moderate stress level
However, there are pathologies such as agenesis of vas deferens, infections in glands such as seminal vesicles or prostate, etc. that can reduce the volume of an ejaculate, and therefore it is very important to consult a specialist.