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PGT is a technique that allows the study of the embryo's karyotype and is indicated for several reasons. One of them is the woman's age. From 38 years of age onwards, we will recommend it after IVF because we know that the rate of chromosomally altered embryos (aneuploid) increases exponentially with respect to younger women and, the older the woman is, the lower the probability of having healthy embryos.
This explains why the probability of pregnancy becomes less and less with the passage of time, just as the probability of miscarriage increases with age.
Yes, endometriosis is a multifactorial disease, where hereditary, immunological and environmental factors make some women more susceptible than others to the disease.
Other related risk factors are:
- Late first pregnancy or no offspring
- Environmental factors: toxins, lifestyle, diet.
- First early menstruation (before age 11 years)
- Late menopause.
- Short menstrual cycles of less than 27 days.
- Heavy or long-lasting menses.
- Menstrual periods.
- Previous pelvic surgery where the uterus is manipulated.
- Underweight or overweight.
- High estrogen levels during cycles resulting in increased hormone exposure throughout life.
- Abnormalities of the reproductive system that hinder the correct release of menstruation.
In addition, there is a hereditary component of endometriosis of 10%, so if there is any case in the closest family, the probability of developing this pathology will be higher.
There are certain signs that may suggest that a woman is not fertile. The first sign is if we have irregular periods or no periods at all. In this case, it is very important to go to the gynecologist to assess the cause of irregular cycles, and discuss the possible impact on fertility, to see if it is advisable, for example, to perform an egg freezing.
There may also be other signs such as very painful periods, dysmenorrhea, which could be associated with endometriosis. In the case of a patient with endometriosis, it is necessary to have regular check-ups with a gynecologist to assess possible treatments and evaluate the ovarian reserve.
In addition, in women who have had pelvic surgeries, or who have fibroids, it is necessary to make a consultation of the possible impact of these processes on future fertility.
On the other hand, in patients with endocrine disorders such as overweight or obesity, thyroid disorders, it is highly advisable to talk to the specialist to assess possible hormonal alterations that may affect the chances of pregnancy.
Finally, those patients who have hirsutism or very marked acne, may also be associated with ovarian hormone alterations that may decrease fertility.
It is very common to go to a first fertility visit after having visited other centres. If you have had tests done at another clinic or have had previous fertility treatments, it is highly recommended that you bring all the reports with you.
The gynaecologist who is an expert in reproduction will be able to know your case in more detail and draw up a better diagnosis and detailed plan if he/she assesses all the tests or reports carried out during the first consultation.
The tests that we consider to be up to date are those less than a year old, but when in doubt it is better to bring everything that has been done previously.
Testicular biopsy is used to obtain sperm when sperm cannot be obtained by ejaculation. It is indicated in cases of azoospermia, when sperm have been obtained without sperm in the semen sample or to achieve pregnancy after a vasectomy.
In cases of azoospermia, sperm will be retrieved if the cause is an obstruction (obstructive azoospermia). In case the problem is in sperm production, if a sperm-producing focus of the testicle is not located, it is very difficult to find sperm in the biopsy as well.
Since the seminal sample does not contain sperm (which is the reason why biopsy is usually indicated), having sexual intercourse before the biopsy will not influence the results of the procedure.
Egg freezing and vitrification are techniques used to preserve eggs for an indeterminate period of time. Until relatively recently, slow freezing was the most commonly used technique, but it has now been replaced by vitrification.
Vitrification and devitrification procedures are standardised processes that allow the risks of survival of both oocytes and embryos to be reduced to a minimum. Although it is true that, as with all assisted reproduction techniques, there are associated risks, reduced to around 3% both in terms of survival and in terms of a decrease in the potential success of the embryos. It is important to bear in mind that the survival of the embryos may be affected by poor handling or acceptance of the oocytes to the cryoprotectants, which may result in the oocytes not being able to survive the technique.
The decrease in survival will be associated with starting the microinjection process with fewer oocytes than those previously vitrified, but those that are able to evolve have gestational success rates similar to those of fresh oocytes.
Apart from the oocyte quality, the usefulness of vitrified oocytes, especially from donors, lies in the possibility of better coordination of the cycle and even the possibility of carrying out the transfer in fresh and natural cycle.
In any case, what is really important is the achievement of a full-term pregnancy, regardless of the fresh or frozen origin of the gametes or embryos.
This technique is recommended for those cases of infertility in which there is a very low concentration of sperm in the male ejaculate. Epididymal sperm aspiration is also recommended for those cases in which there is a complete absence of sperm in the sample (obstructive azoospermia) due to blockage or congenital absence of the vas deferens.
In addition, those men who have previously had a vasectomy, but wish to have children, can also have this procedure performed to obtain sperm.
Whenever sperm aspiration is performed, it must be complemented with ICSI (intracytoplasmic sperm injection) to try to fertilize the eggs.
IVM (In Vitro Maturation) of oocytes is a technique that has been known for more than 20 years, but its clinical application remains very limited. The pregnancy rate results when IVM is applied are still worse than with IVF.
However, there are some cases where IVM can provide advantages over IVF:
- To optimize the performance of patients with low response. There are cases in which women respond less than expected to ovarian stimulation, so there are small follicles that do not grow with medication. These follicles can be aspirated along with the rest of the large follicles on the day of the puncture resulting in obtaining immature oocytes that could be matured in vitro to obtain more embryos after IVF.
- For women to whom the administration of gonadotropins for ovarian stimulation is contraindicated..
- For patients with polycystic ovaries and high risk of ovarian hyperstimulation using gonadotropins.
- For oncologic patients or patients with other pathologies that require urgent fertility preservation.
In the cases mentioned above, IVM is becoming more important, since it would allow us to increase the number of oocytes to be preserved without having to wait longer and without having to undergo more hormonal treatment before proceeding with the treatment of the disease.
No, ovulation induction is the process by which the growth of 1 or several follicles of the ovary is produced thanks to the administration of drugs called Gonadotropins. After this, ovulation is usually triggered in a controlled manner.
Once this ovulation induction has been performed, intercourse can be programmed, that is to say, the couple can be told when ovulation will occur approximately and when they should have sexual intercourse to increase the chances of pregnancy.
Fifty percent of couples who come to assisted reproduction centers have a diagnosis of male infertility, which can be associated with different pathologies, but the most common is seminal quality.
The reasons that affect seminal quality are the age of the male, lifestyle and various pollutants. In the case of pollutants, where we could include pesticides, they involve a toxicity through which these compounds act as hormone disruptors, and can alter both the production of fertility hormones (testosterone, LH, FSH...) and the state of oxidation-reduction that could lead to affectations in terms of concentration, mobility or even DNA. It is important not to automatically associate the use of pesticides with infertility, since the effects would be due to continuous exposure to the appropriate toxicants.
Therefore, we should be aware of the importance of the male in reproductive processes and try to avoid exposure to contaminants that may alter sperm production.
No. The motile sperm count test or advanced semen analysis report is a complementary test to a basis semen analysis that is carried out to confirm the parameters evaluated in the latter. Therefore, the advanced seminogram provides more clinical information.
The survival rate of the devitrified embryos depends on both the viability of the embryo and tolerance to the process, as well as on compliance with the procedures established in the protocols. Therefore, in order to analyze the survival rate, we must understand what vitrification is.
Furthermore, it should be noted that the success of embryo devitrification does not lie in the survival rate of the embryos after the process. What is really important is to achieve results similar to those achieved when using fresh embryos.
Egg quality is one of the most important and probably least known aspects of assisted reproduction. Finding a morphologically normal egg does not guarantee the subsequent achievement of pregnancy, but it does allow the prediction of a high percentage of the embryonic evolution, always taking into account other aspects such as age or ovarian reserve. Thus, we can distinguish three types of indicators, gynecological, morphological, and embryonic.
The male factor has become one of the most relevant aspects of assisted reproduction recently. Different genetic diagnostic techniques have been used to analyze the role that the male is playing in achieving a pregnancy.
The period of abstinence is an aspect that has varied over the years, thinking at first that the greater the abstinence, the better the result of both the seminal diagnosis and the embryonic evolution and term pregnancy. Some studies show that a period of frequent ejaculations after a period of abstinence can improve sperm quality.
The period of abstinence differs according to the assisted reproduction unit attended and the standardization of the processes. The recommendations of the World Health Organization is to have sexual abstinence of between 2-7 days. If the abstinence is less than two days, we will find spermatozoa that possibly have less DNA fragmentation, but the count of the number of spermatozoa is lower than in normal conditions. If we have a high abstinence period, it is likely that we will find reduced sperm motility.
In conclusion, it is important to have an optimal period of abstinence according to the recommendations of the assisted reproduction center in order to maximize the chances of success in each case.
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.
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.
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.
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.
Women who have hypothyroidism suffer from a slowdown in the production of hormones by the thyroid gland.
In these women, it is necessary, regardless of the technique used (fertilization in vitro, ovodonation), to correct with thyroid hormone (oral tablets) until a good TSH is obtained, below 2.5 (thyroid hormone) to guarantee that the implantation can be produced without problems.
This treatment will continue until pregnancy and it is important to make periodic controls with the endocrinologist to evaluate if it is necessary to increase or decrease the doses of the treatment.
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.
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.
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.
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.
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).
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.
The number of embryos to be transferred to a patient does not depend on the technique that has been practiced on the embryo, but on the day it is found, its quality and the intrinsic characteristics of each patient. The performance of a Preimplantation Genetic Diagnosis is associated in most cases with advanced maternal age (screening of aneuploidies) or the presence of serious genetic pathologies (in many cases present in the woman). In both cases, multiple pregnancy is contraindicated.
For all these circumstances, the medical advice is usually the transfer of a single embryo.