PGD reduces the number of transfers needed to achieve a pregnancy

This method for embryo selection reduces the number of transfers needed to have a healthy baby, and it also significantly decreases the likelihood of miscarrying.

DGPIt is a well-known fact that maternal age plays a role in reproduction. We are all aware that between the ages of 25 and 35 female reproductive capacity declines by up to 50%.  After this age, a female may have difficulty conceiving or may be more likely to spontaneously miscarry. The good news is that science is progressing in terms of prevention: reproductive medicine offers us a solution thanks to the information we obtain from the DNA of our embryos through Pre-Implantation Genetic Diagnosis (PGD).

When this type of technique is used in assisted reproduction, it is possible to genetically analyse embryos to determine which ones are carriers of chromosome abnormalities or monogenic disorders. In a Pre‑Implantation Genetic Diagnosis (PGD), the embryos are studied in order to transfer those which are unaffected and to ensure that the baby will be free of the condition being studied.

In this regard, we study the DNA of the embryos and select those which are free of chromosome abnormalities. This allows us to increase the likelihood of pregnancy and, at the same time, decrease the likelihood of implantation failure, spontaneous miscarriage and/or therapeutic abortion. Read more ›

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The importance of Vitamin D in Reproduction Treatment

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

Vitamina DOptimal 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 ›

Posted in Assisted Reproduction, Fertility

6 FAQs while waiting for your Beta-hCG result

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

Test embarazoWaiting 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.

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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 ›

Posted in Assisted Reproduction, Fertility

Melatonin and Sperm Quality

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.

Melatonina_nuecesAerobic 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 ›

Posted in Assisted Reproduction, Fertility

What tests are ordered in a Basic Fertility Study?

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).

ICSI GINEMEDPatients 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 ›

Posted in Assisted Reproduction, Fertility

What causes poor ovarian response and how is it treated?

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).

ovulosIn 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 ›

Posted in Assisted Reproduction, Fertility

New research on male infertility: Fertile Chip – What does it really entail?

Male factor infertility is -increasingly- being addressed in important studies and scientific publications. And although the most basic test in the study of infertility is the semen analysis, when additional information is needed we can turn to more specific tests such as the sperm DNA Fragmentation analysis, sperm FISH analysis, karyotyping and cystic fibrosis studies.

As regards sperm DNA Fragmentation, up until now this analysis examined the fragmentation of single-stranded DNA in spermatozoids.

GinemedFertileChip

What does this mean?

DNA is located in the nucleus of the sperm cell and contains the chromosomes and all genetic information which the male will pass on to his offspring. This genetic information is stored in a compact form in the nucleus, but if it were ‘decompacted’ it would consist of two parallel strands that can connect together. These strands are the instructions for the identity of offspring.

As we mentioned before, up until now single-stranded fragmentation studies were performed and techniques were used to process the samples and eliminate this fragmentation. At present, however, studies are being carried out not only on single-stranded fragmentation, but also on double-stranded fragmentation. It appears as though repairing this fragmentation is not so simple when both strands of DNA are damaged, thus affecting the rate of development of both the embryo and the pregnancy.

Therefore, advances are being made in techniques for the elimination of sperm with double-stranded fragmentation in samples to be used for ICSI. Read more ›

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How to overcome anxiety during fertility treatment

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 ›

Posted in Assisted Reproduction, Fertility

When and why to undergo an endometrial biopsy

As specialists in assisted reproduction we are continuously researching new techniques to improve treatment success rates. Today we are going to talk about the benefits of an endometrial biopsy.

What is the endometrium?

Simply speaking, the endometrium is the active layer which lines the inner walls of the uterus. When stimulated by hormones (either from the ovary or external hormones from medication), the endometrium grows and prepares to receive the embryo which will develop there throughout pregnancy.

What is an endometrial biopsy?

It is a procedure which is performed in the doctor’s consultation room without sedation or anaesthesia. After placing the speculum, the cervix is visualised and a thin tube is inserted to collect some endometrial tissue. The procedure allows us to obtain a sample to send off to the laboratory for different types of analyses. Read more ›

Posted in Assisted Reproduction, Fertility, Gynaecology

Increasing pregnancy rates per transfer: the Time Lapse technique

This new visualisation system is key to the monitoring of embryo development.

Timelapse

As biologists we are faced with a dilemma when it comes to evaluating the development of embryos obtained through assisted reproduction treatment. Viewing them through a microscope – to see the number of cells, fragmentation and other morphological indicators – allows us to classify qualitative data with the purpose of selecting the embryos with the greatest chances of implantation for the transfer.

However, this way of viewing the embryos means that we have to remove them from their controlled culture conditions: a change in temperature and humidity and exposure to concentrated atmospheric oxygen and light radiation; these are all factors which can have a negative impact on embryo development.

This is the reason why embryos are observed and evaluated only when strictly necessary. In turn, however, this means that the information we have on embryo development –information which is necessary for selection of the best embryo to transfer- is very limited.

The development of image-capturing systems integrated in incubators, known as Time Lapse monitoring systems, has changed the way we see embryos. These systems take a series of photographs at specific time intervals, usually every 5 to 15 minutes. The images are viewed like a video which allows us to observe embryo development in real time and, essentially, analyse certain morphological events that are key to embryo development. Determining how and when these key elements in embryo development occur is called morphokinetic analysis, and it allows us to develop new algorithms for embryo classification. Read more ›

Posted in Assisted Reproduction, Fertility