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A serodiscordant couple is defined as a couple where one partner has a communicable infectious disease such as HIV and the other does not. It can also apply to other diseases such as hepatitis C and hepatitis B.
In cases where the male partner has the disease, the main way to eliminate the risk of infection is to perform a seminal lavage. The semen is processed in the laboratory, the semen is washed and a fraction is sent to confirm by molecular biology techniques that there are no traces of infection in the sample. If this is the case, the sample, which will remain frozen, can be used safely for subsequent treatment.
If the woman is the carrier of the infection, it is important that she has an undetectable or low viral load before starting treatment. In cases with a high viral load, it is recommended that the relevant treatment be carried out before the assisted reproduction treatment, in order to reduce the presence of the virus as much as possible and thus the risk of transmission to the child. Likewise, if treatment is required during pregnancy, it must be appropriately adjusted and approved for pregnancy by the specialist who is following the patient. In this situation of adequate treatment and undetectable viral load, the risk of transmitting the infection to the foetus is very low.
In order to be able to complete any assisted reproduction treatment, it is very important to have all the necessary facilities, as well as the required team of professionals. The laboratory is essential for diagnostic tests such as semen analysis in the case of males, as well as for the development of the treatment.
All semen preparation prior to insemination also requires the sample to be processed in the laboratory. In addition, for IVF treatments, it is essential to have the facilities, equipment and, of course, professionals who can carry out gamete retrieval, in vitro fertilisation and embryo development.
The operating theatre will be essential for IVF treatment, as it requires a small intervention called "puncture" to extract the eggs and start the process in the laboratory. In addition, having an operating theatre also allows us to carry out other types of interventions necessary for some patients, such as hysteroscopies, curettage, laparoscopies, etc.
Another advantage of having an operating theatre is that it allows us to carry out embryo transfers in sterile conditions to avoid any type of environmental contamination from the moment the embryo leaves the incubator until it is deposited in the uterine cavity.
Oligozoospermia is the presence of an abnormally low number of spermatozoa in the ejaculate.
Patients with oligozoospermia, especially in cases of severe oligozoospermia, may progress to a diagnosis of cryptozoospermia and subsequently to azoospermia, i.e., absence of sperm in the ejaculate.
The diagnosis of oligozoospermia must be associated with tests to evaluate the origin of this oligozoospermia and to be able to anticipate its evolution. In this way, an early diagnosis makes it possible to establish an adequate treatment (hormonal, antioxidants, etc.). Likewise, patients with moderate or severe oligozoospermia are usually recommended to cryopreserve a semen sample in order to foresee a possible absence or decrease in sperm quality.
With Artificial Insemination, success rates of up to 30% (depending on the age of the patient) can be achieved after 3-4 attempts. If pregnancy is not achieved after these attempts, we usually propose a more complex treatment such as in vitro fertilization (IVF).
The fact of having carried out an ovarian stimulation treatment prior to artificial insemination allows us to see how the ovary responds to the medication, even if it is at much lower doses. It also allows us to know how the endometrium is developing and if there are any problems at that level.
We definitely start the cycle with more information than if we had not performed any previous stimulation, although the techniques are usually very different in terms of doses of hormonal medication, the objective with IVF being to recruit a large number of follicles, while with artificial insemination, the maximum is 2.
The ovarian reserve physiologically decreases with age, this is the first cause to take into account and, unfortunately, it cannot be avoided.
There are other less proven factors, which are toxic substances. Toxins can condition fertility, although it is not known whether they directly affect the ovarian reserve or whether they act more on the quality. Smoking, for example, is one of these factors that can increase oxidative stress at the ovarian level.
Patients who undergo ovarian stimulation usually retain more fluid, as well as increase the volume of their ovaries.
In artificial insemination treatments there is usually no weight gain.
However, in vitro fertilization there is. Although the response is variable, given that the medications and doses can be different, in ovarian stimulation for in vitro fertilization there is usually an average weight increase of 1 kilo. This increase is transitory and usually decreases at the end of the cycle (as soon as menstruation stops if the treatment has not worked).
Before an ovodonation, the male partner is usually asked to undergo a karyotype blood test. The karyotype test examines the size, shape and number of chromosomes. Chromosomes are the parts of cells that contain genes.
At the seminal level, the sperm DNA fragmentation test can be ordered. Thanks to the analysis performed by this test, either of the two types of fragmentation (single or double stranded) can be revealed. If sperm fragmentation is altered in the ejaculate, depending on the predominant type, the proposed treatment will be different.
Those women who are going to undergo IVF treatment with oocyte donation should undergo several tests, regardless of age. Each of them is listed below:
- CBC with blood count, biochemistry and coagulation.
- blood group + Rh and indirect coombs.
- Thyroid study with TSH, T4L and if possible anti-TPO and anti-TG antibodies.
- Vitamin D.
- Serology for Syphilis, Hepatitis B and C, HIV, Rubella, Toxoplasma and Cytomegalovirus.
- Cytology of the last year if possible (at least negative of the last 3 years if same sexual partner).
In addition to these tests, depending on the patient's age, other complementary studies may be requested.
The male factor as a possible cause of sterility will be studied mainly by performing a semen analysis. This test consists of analyzing a semen sample to evaluate different parameters and thus find out if there is any alteration that may explain or be the cause of sterility. Basically, the pH, volume, concentration and total number of spermatozoa in the sample are evaluated, as well as their motility and morphology. For assisted reproductive techniques, ideally we will also request an EMR (motile sperm count) to know how many motile sperm are actually recovered after processing the sample.
If the semen analysis is altered, it is recommended to repeat it after at least one month to verify that the alterations are still present and have not appeared only occasionally. There are cases in which, if the alterations are important, it will be necessary to complement the study with more tests such as a semen and urine culture to rule out infection; a sperm fragmentation; a genetic study in case this could be the cause of the male factor, etc.
Egg cryopreservation consists of three phases. First, stimulation of the ovaries is carried out to develop multiple oocytes. Here, an increase in the size of the ovaries occurs, which could lead to ovarian torsion. In addition, this phase also has the potential risk of causing ovarian hyperstimulation in the woman.
Secondly, the ovaries would be punctured in order to retrieve the oocytes. This is a simple surgical procedure that is performed under anesthesia, so complications may arise from the anesthesia itself. Bleeding may also occur.
Finally, vitrification of the eggs takes place. When these eggs are to be used, they will have to be thawed, which may pose a danger to their survival.
In artificial insemination (AI) it is important to know the ideal moment to perform the insemination, that is, to place the semen in the uterus.
For this it is essential to do ultrasound controls to control the size of the follicle. In the case of elongated follicles, two diameter measurements are always taken to see the real size of the follicle in order to know at what moment to induce the ovulation externally, with the administration of ovitrelle.
The moment when the dominant follicle reaches about 17 mm is usually on day 9 of the stimulation cycle, but there are women who reach the size of 17 before or after. That is why it is so important to do ultrasound controls every 48 hours.
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 plays 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.
Inflammation of the ovaries may be related to pelvic infections or endometriosis.
Pelvic infection is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes or ovaries.
Endometriosis is a benign condition that occurs when the endometrium (the mucous layer that lines the uterus) grows in other parts of the body such as the ovaries, tubes, pelvic area or intestines, among others.
Transtubal transfer is no longer used, since the highest pregnancy rate is achieved with intrauterine embryo transfer.
In the past, ZIFT was a technique that was performed, but its results are not as good as in utero transfer. Likewise, it is a more invasive technique, since it requires sedation of the patient and is performed laparoscopically.
Currently, embryos can be transferred at day 5 (blastocyst), the maximum that technology allows today.
In most pregnancies it is possible to lead a normal life and even do moderate physical activity, but on some occasions it is necessary to recommend that the pregnant woman rest.
Among the reasons for which rest may be recommended during pregnancy are vaginal bleeding, the threat of premature delivery, intrauterine growth retardation, medical procedures, loss of amniotic fluid, preeclampsia and maternal illnesses.
The IAD only requires the medical participation of one of the women of the couple, so the other is not involved in the treatment itself. However, for legal purposes, if both want to be the future parents of the baby, both must always sign the informed consent.
Of course, if that is not their wish, only the signature of the woman performing the treatment will be required.
Embryonic blockage is the term used to refer to the fact that the embryos have not been able to form a blastocyst. They are normally embryos that usually stop developing on day +3/4 at the cell/morula stage.
Approximately between 50-60% of the embryos have the capacity to reach the blastocyst, the embryos that do not achieve this suffer the so-called embryonic arrest. Poor oocyte and seminal quality can be a reason for blocking the embryos. For example, it has been seen that sperm DNA fragmentation has a negative effect on embryonic development, producing a slower evolution of the embryos and being negatively related to embryonic arrest.
Another factor to take into account is the age of the oocyte. We know that the presence of chromosomal abnormalities in the oocyte increases with the age of the woman, influencing the embryonic genetic load and therefore its development. In addition, there are studies that show that one of the main causes of embryonic arrest is the presence of chromosomal abnormalities in the cells of the embryo. Specifically, it has been seen that almost 70% of the embryos that do not form the blastocyst have chromosomal abnormalities.
Advances and new technologies have allowed embryos to be cultured up to day +6 of embryonic development. The long culture allows us to select the embryos that have the capacity to form the blastocyst on day +5/+6 and, therefore, allows us a better embryonic selection. It will not be until day +3 of the culture when the embryo activates the embryonic genome, this activation is essential for the embryos to reach the blastocyst stage.
In artificial insemination cycles it is not usually necessary to prepare the endometrium separately since, thanks to the secretion of estrogens by the ovaries, they will act on the endometrium causing its gradual growth.
In a small group of patients, it may happen that this synchronous endometrial development does not occur and that, when performing routine ultrasound controls during the cycle, we find that the endometrium is not growing as it should. These patients may benefit from low doses of estrogens during the end of ovarian stimulation to externally support endometrial growth.
In most instances 2 to 4 mg of oral or vaginal estrogens are sufficient to achieve adequate thickness. Also, all patients will use progesterone after insemination to promote implantation.
Sperm morphology is one of the most important determinations and one of the critical parameters in determining a man's ability to fertilize. Sperm morphology evaluates the morphometric characteristics of the sperm head, midpiece and tail.
Normal spermatozoa have an oval head and a long tail. In contrast, abnormal sperm have defects in the head or tail, such as a large or misshapen head or a double or crooked tail.
There are not many known factors that can improve sperm morphology and thus increase the percentage of normal forms.
It has been seen that the time sperm spend stored in the epididymis can be a determining factor in seminal quality; low ejaculatory frequency has been related to increased exposure to the effects of oxidative stress.
The time of sexual abstinence is one of the clinical criteria taken into account during seminal analysis; the interval recommended by the WHO is 2 to 7 days. Some studies have shown that increased ejaculatory frequency has positive effects on different conventional semen parameters, including sperm morphology.
In Assisted Reproduction, when performing IVF, we can improve fertilization results in cases of alterations in sperm morphology with intracytoplasmic sperm injection (ICSI). This technique makes it possible to select the spermatozoa at the time of fertilization also based on morphological criteria.
Yes, it is possible to have a missed abortion in an IVF treatment with donor eggs.
We define miscarriage as uninduced embryonic or fetal loss before the 20th week of gestation. A missed or delayed abortion is characterized by the arrest of gestation without spontaneous expulsion of the embryo or fetus and usually occurs between the second and third trimester of pregnancy.
As with other types of miscarriages, one of the main causes is a genetic or chromosomal alteration in the development of the fetus. Likewise, infections, endocrine or hormonal disorders or problems in the uterus or cervix can also cause a miscarriage in the first weeks of gestation.
The risk of miscarriage is around 25% after the age of 35, while it increases to 50% in women over the age of 40. If we apply these percentages to egg donation, we know that the risk of miscarriage in egg donation is around 25% because the oocytes come from women under 35 years of age. So it may be normal in an oocyte donation treatment to have a missed abortion.
Sperm vitality is the test that indicates the number of live sperm present in an ejaculate sample.
Mainly, the analysis of sperm vitality is carried out through two methodologies:
- Eosin staining
- the most widespread analysis among most assisted reproduction units. It consists of, through a series of fixation and coloration processes, distinguishing live sperm from those that are not through the color they present. The rationale is based on the absorption of different dyes, eosin in this case, by dead cells, so that when counting we will observe non-stained (live) sperm and stained (dead) sperm, expressing said result as a percentage after having counted at least 200 cells.
- Hypo-osmotic test
- based on the semi-permeability characteristic of the membranes and its variations in media of different osmolarity.
When one technique or another has been performed and the number of live or dead spermatozoa is obtained, the result can be established. If the percentage of live sperm is equal to or greater than 58%, sperm vitality is considered to be correct.
The time in which the results of the PGD are provided is usually between 2 and 4 weeks, although these may vary depending on the technique, the genetic laboratory, etc. Also, some laboratories offer the possibility of making a diagnosis in 24 hours, although these cases are usually studied, both because of the costs and the associated risks.
An important aspect is the case in which a previous genetic study is required to analyze hereditary diseases. These cases involve a variable prior study depending on the pathology and knowledge of the disease that can take up to 2 months. After this period of time, the assisted reproduction treatment must be carried out, which will conclude with the genetic diagnosis. In other words, this process can take up to 4 months.
Vitamin D supplementation before pregnancy is not a routine practice in the field of assisted reproduction. However, such supplementation would be indicated in those women who are seeking pregnancy and who are known to be vitamin D deficient, since vitamin D deficiency during pregnancy has been associated with an increased risk of miscarriage and complications during pregnancy.
Women at higher risk of vitamin D deficiency are those with dark skin, vegan diet, little exposure to sunlight, or a history of a baby with rickets or a body mass index (BMI) > 30.
No, ovarian stimulation causes follicles to grow that would not naturally grow, but it does not accelerate the rate of follicle or egg loss.
In a woman's normal cycle, a follicle is selected to be the one chosen for ovulation. Along with that selected follicle, a cohort of follicles that are not chosen will be lost after ovulation.
In ovarian stimulation, this cohort of pre-selected follicles is used so that they grow and more eggs can be obtained than are produced naturally and thus have a greater yield of the assisted reproduction technique.
In general, during an assisted reproduction treatment, you can lead a normal life unless otherwise indicated by the gynecologist. Weight training is usually discouraged during the final phase of ovarian stimulation and after an embryo transfer.
In the case of ovarian stimulation, when the ovaries begin to increase in size the patient usually feels more swollen and may have abdominal discomfort or pain. If she has this discomfort, it is better not to do intense physical exercise. In any case, regardless of the clinical manifestations that you may notice, if the ovaries have increased in size, it is advisable to avoid physical exercise (such as weight lifting) because of the risk of ovarian torsion (the ovary can rotate on its own axis and the blood supply is blocked). This is a serious complication that has to be treated in the operating room to recover the ovarian vascularization.
After an embryo transfer, it is also recommended to avoid exertion, especially during the following 3 days, to avoid any type of uterine contraction that could decrease the chances of the embryo implanting.
Infertility is usually diagnosed if a woman has not become pregnant after having unprotected sex (i.e., without using contraception) for one year. However, in the single woman, the outcome of assisted reproductive treatments must be considered in order to evaluate whether or not she has a fertility problem.
In single women, it is usually recommended to start assisted reproductive treatments when they have the desire to become pregnant. Treatment options vary depending on the age and ovarian reserve of the woman.
If there is no previous pathology, it is usually started with DAI and it is recommended to perform 3-4 cycles before moving on to IVF with donor sperm. If the woman does not achieve pregnancy after the IVF cycles deemed necessary, a sterility problem can be diagnosed, for which sometimes, unfortunately, the main cause cannot be identified.
In most sperm banks it is possible to reserve doses of donor sperm for successive pregnancies in order to have biological siblings. The number of doses to reserve will depend on the type of treatment.
This reservation can be made as long as the availability of donor sperm doses is verified and the donor has not reached the number of newborns allowed by the Spanish assisted reproduction law (a maximum of 6 children).
These types of lesions in themselves do not prevent pregnancy, but if the alteration detected is of high grade (H-SIL), it is recommended that the lesion be removed (usually with a simple surgery called conization) before the woman becomes pregnant.
In other cases, with controlled low-grade lesions (L-SIL), pregnancy will not be contraindicated. Dysplasia has not been shown to have a negative effect on fetal development.
What is important to keep in mind is that women who have previously undergone conization will have an increased risk of cervical incompetence, which can lead to premature delivery. As a preventive measure, serial cervical length measurements should be taken during gestation.
In cases where the length is very short or becomes shorter during pregnancy, preventive treatments such as cervical cerclage or pessaries are indicated to try to avoid preterm labor as much as possible.
In vitro fertilization (IVF) is a treatment in which embryos are generated in the laboratory from the gametes of the future parents or from anonymous donors. These embryos are then placed in the woman's uterus by embryo transfer.
In order for these embryos to implant in the endometrium, the endometrium must have the same characteristics as it would have had if fertilization had taken place in the uterus and not in the laboratory.
This implies that the endometrium must be exposed to the same hormonal variations as in a natural cycle. For this purpose, progesterone administered exogenously by means of vaginal or oral ovules is used.
In a normal cycle, after ovulation, progesterone begins to rise so that the endometrial tissue can be modified to allow implantation and the development of the eventual embryo. When we perform an embryo transfer, what we need is to reproduce this situation so that the embryo can implant.
Normally, the progesterone treatment starts a few days before the embryo transfer. In case of transfer in the same cycle as the follicular puncture, it starts the same day of the puncture, otherwise, it varies according to the stage of embryo development.
In case of transfer in a natural cycle (when no hormonal treatment is given to prepare the endometrium), progesterone is started on the same day of the transfer, but it is very unlikely that progesterone does not have to be taken after the embryo transfer because it is always preferred to support the luteal phase with exogenous progesterone.
There are birth control methods that are based on the observation of cervical mucus precisely because it varies greatly in each phase of the cycle.
At the end of the menstrual period, the cervical mucus is thin and clear (or whitish). Normally in the ovulatory phase (in the days immediately before ovulation and one day after ovulation) its characteristics change to facilitate the entry of sperm into the uterus and fertilization of the egg.
On those days it is usually whiter and above all it changes consistency, it is less dense and more filamentous. This can help to identify the most fertile days (which are those preceding ovulation up to 24 hours after it has taken place).
Gonadotropins are hormones that are used primarily to stimulate the ovaries, and eventually to stimulate sperm production in males.
In women who need to undergo assisted reproduction treatment to become pregnant, either artificial insemination or in vitro fertilization, gonadotropins are needed to stimulate the growth of eggs.
Gonadotropins are hormones that are administered by subcutaneous injections and are administered by the patient herself with the help of very easy-to-use devices. Depending on the treatment and the particular case, the physician will choose the appropriate doses of gonadotropins.
The side effects of these hormones are usually emotional lability and mood swings, headache and in the last days of the treatments abdominal distension and menstrual-like sensations.
It is very important to use gonadotropins only under medical prescription, with ultrasound controls to evaluate the response of follicles in the ovaries and to indicate the days to be administered and the dose.
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.
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.
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 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).
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.
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.
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.
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.