Being sexually active while undergoing ART decreases sperm DNA fragmentation and improves Mother-to-Embryo immune tolerance.

Generally speaking, specialists in reproductive medicine have customarily recommended that patients beginning a cycle of assisted human reproduction refrain from sexual activity while in treatment; this is the same as the guideline for men undergoing a sperm analysis – a test for which the male should have an abstinence of 2-5 days, as this allows us to ensure that the parameters obtained are comparable in different situations.

However, scientific evidence has shed light on this area of expertise, bringing about substantial change with the help of current data that has disproved this preconceived idea.

In this regard, recent scientific publications have demonstrated the benefits of ejaculating several times during the days prior to leaving the sperm sample for the laboratory. This is due to the fact that these ejaculations decrease the fragmentation of sperm DNA, thus guaranteeing that the spermatozoids obtained will have higher quality. Additionally, it is best for the male to have the final ejaculation as close as possible to the time of providing the sample for oocyte fertilisation in the laboratory.

Nevertheless, we must keep in mind that having several ejaculations means that we will obtain a lower volume of ejaculate and fewer spermatozoids. Therefore, for patients with severe oligospermia (less than 2 millon/ml) or hypospermia (less than 1.5 ml), the recommendation is to leave a sperm sample to be frozen, in advance, which could then be used in the event that there are no spermatozoids in the fresh sample provided on fertilisation day. Read more ›

Recent studies indicate that women with high levels of Vitamin D will have greater chances of having children.

Optimal nutritional status in women during the preconception phase and adequate intake of all essential nutrients are both very important when it comes to boosting fertility as well as in the evolution of a pregnancy.

Among these nutrients, we would particularly like to mention the role played by Vitamin D for two reasons:  there is growing evidence concerning its implication in male and female fertility, and there is also a high prevalence of low Vitamin D levels in women trying to get pregnant or women undergoing assisted reproduction treatment.

We can obtain Vitamin D by consuming foods that are a source of this vitamin: dairy products, oily fish, egg yolks, etc.; or by synthesising it in our skin after exposure to sunlight (UVB). It is estimated that 50% of the general population is at-risk for low levels of Vitamin D, especially in cases of inadequate Vitamin D intake, poor intestinal absorption, medication intake or insufficient exposure to sunlight.

Vitamin D is essential to bone metabolism and to the absorption of Calcium and Phosphorus in the intestines, but this vitamin also affects different organs, including anti-inflammatory and immunomodulatory effects on the pancreas, the brain, the cardiovascular system and the reproductive system.

There are studies that indicate a link between Vitamin D and the quality of eggs and embryos. However, the explanation that is most strongly supported by science is the one that associates this micronutrient with the immune processes in embryo implantation. Read more ›

Although we can’t speed up the clock, it is in our power to resolve any doubts you have during this period of time.

Waiting for your Beta-hCG result is the last step in Assisted Reproduction Treatment. It is a period of 12-15 days during which the patient can experience anxiety, doubts and uncertainties while waiting for her beta-hCG test results.

Implantation is a delicate process that is out of our control. For this reason, and because we cannot reduce the wait time, we can offer you quality medical information to resolve all your doubts and uncertainties and reduce your levels of stress and anxiety. That way, you will feel more calm and relaxed while you wait for your results and will understand what is occurring at each moment.

Here we have compiled a list of the 6 most frequently asked questions that our patients have while waiting for their Beta-hCG results:

When I use the vaginal pessaries I don’t think the medication is being properly absorbed.

As long as the pessary remains in the vagina for about 20 minutes it will dissolve and properly absorb. If the remainder of the pessary comes out, it is usually the capsule that contains the medication or oil that is used as a medium for dissolving certain medications that cannot be dissolved in water. We recommend inserting the pessary at night right before bed or, if it’s during the day, we suggest using panty liners or sanitary napkins to prevent unwanted stains.

How should I administer the progesterone pessaries?  Oral or vaginal administration?

Both administration routes are valid. We normally recommend using the pessaries vaginally so as to avoid the effects of the first step (passing through the liver). When it is used vaginally, the pessary is more effective as it is better absorbed. Furthermore, oral administration tends to result in symptoms such as nausea, dizziness and drowsiness. Read more ›

Recent studies have demonstrated the benefits of melatonin on the reproductive organs when assisted reproduction techniques are used.

Melatonin is a natural compound produced by a small structure in the brain – the pineal gland, also known as the epiphysis cerebri- found in the centre of the brain. This endocrine gland serves a unique and interesting purpose: it naturally converts the information we receive about environmental light and is the main control centre of our biological rhythms.

From the time we are three months old melatonin is circulating in our bodies. Melatonin circulation increases as daylight starts to disappear, making it the true “hormone of darkness”. Its rise each night “opens the doors to falling asleep” and, throughout life, levels decrease. This fall in melatonin levels is associated with insomnia and a higher prevalence of cancer.

Thus, melatonin is capable of coordinating and regulating the body’s biological rhythms; it is also a powerful antioxidant and an excellent natural protector of cells.

Aerobic organisms, those which utilise oxygen in their metabolism, are constantly exposed to oxidative stress (OS). OS occurs when the generation of free radicals exceeds the capacity of natural antioxidants to eliminate them, thus affecting the integrity of DNA. Free radicals are produced during normal cellular metabolism and in some situations such as exposure to ionising radiation, ultraviolet rays, environmental contamination, tobacco consumption, etc.

Semen contains antioxidants which protect germ cells from environmental oxidative danger.  However, antioxidants are eliminated with the use of assisted reproduction techniques (ART), thus leaving the spermatozoids vulnerable to oxidative damage. Read more ›

The purpose of these tests is to diagnose the most common fertility problems.

In a Basic Fertility Study we need to know if ovulation is occurring, if the fallopian tubes are permeable and if there are an acceptable number of motile spermatozoids. Additionally, we must evaluate ovarian reserve if the female is over the age of 35, or in women under the age of 35 if we suspect poor ovarian response. For women who have irregular cycles we will also need to evaluate their basal gonadotropin levels (FSH and LH), as well as prolactin and progesterone during the second phase of their menstrual cycle (days 20-22).

Patients with infertility do not present a greater number of thyroid conditions than the general population, meaning a thyroid function study will only be performed if a thyroid disorder or abnormal menstrual cycles are suspected, or in women who do not ovulate.

To evaluate ovulation we must test the female’s level of progesterone between days 20-22 of her cycle, or a few days later in women who have longer cycles. Read more ›

Poor response to ovarian stimulation is one of the major challenges assisted reproduction specialists must deal with.

There are no established criteria for defining a poor response. In fact, it was not until 2010 that the European Society of Human Reproduction and Embryology reached a consensus on its definition. It was determined that in order to confirm a poor response, at least 2 of the following criteria must be met:

• Age ≥ 40 years or any other risk factor for poor response (presence of endometriosis, absence of one ovary, etc.).
• A previous cycle with ≤ 3 oocytes retrieved using a standard stimulation protocol.
• Abnormal ovarian reserve test results (antral follicle count less than 5-7, Anti-Müllerian Hormone less than 0.5 – 1.1 ng/ml).

Normally, poor response to stimulation is the result of diminished ovarian reserve, which is in turn due to a lower number of follicles able to be stimulated using ovarian stimulation medication.

Recently, other factors which may be involved in poor response have been studied, such as a hypoandrogenic state (low levels of androgens) or a decrease/malfunction of follicle-stimulating hormone receptors (the hormone which stimulates follicle growth).

In regards to treatment for poor ovarian response, there are no widely accepted recommendations. Increasing the dose of gonadotropins (medication used for ovarian stimulation) has not shown, above certain levels, to improve the number of oocytes obtained.

One way of increasing ovarian androgens is to administer a medication we call aromatase inhibitors; these inhibitors prevent androgens from converting into oestrogens, in turn increasing the level of androgens. Nonetheless, recent studies have not proven this inhibitor to be effective in terms of live birth rates.

The other way to boost androgen levels in the ovaries is to use medications with LH activity during ovarian stimulation.  This LH activity may improve a poor response, though there is currently not enough evidence to show that the use of this type of medication improves pregnancy rates in patients with poor ovarian response in cycles of IVF (In Vitro Fertilisation). Read more ›

The day arrived when you felt fully prepared, or as prepared as one can be, to have children. But then the months, even the years, started to go by, with doctor’s consultations, disappointments, and now you are on this roller coaster of emotions called fertility treatment.

Everyone going through this process is most likely dealing with a large amount of emotional baggage, uncertainty and failed attempts, matters which have surely caused anxiety to appear in their lives. There is no miracle solution for this emotional state and we cannot simply snap our fingers and send it back to where it came from. However, we can understand what it is, where it comes from and what the guidelines are to reducing it to a reasonable level.

Where anxiety comes from

Although the reason we are here today is to learn how to overcome anxiety, we must understand that it is a very useful survival system that human beings have had since our origins: a time when humans lived among nature and had to fight to hunt for food, and to not be hunted by the rest of the animals. This is a system which triggers three possible responses in the face of danger: fight, flight or freeze.

What is anxiety?

Thousands of years have gone by and physical dangers have been replaced by other more psychological ones. Anxiety is the result of prolonged stress in which this mechanism, which is meant to provide us with energy in specific situations, establishes itself as the normal system of functioning. Read more ›