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 ›
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.
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 ›
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 ›
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 ›
This new visualisation system is key to the monitoring of embryo development.
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 ›
“Fruit and vegetables with high levels of pesticide residues are associated with a lower total sperm count, a lower percentage of morphologically normal sperm and a decreased volume of ejaculate among men presenting to a fertility clinic.”
These are the conclusions drawn from a study carried out by Chiu et al., and published in Human Reproduction in 2015. It is the first study to deal with the relationship between the presence of pesticides in food and sperm quality, others only having evaluated the presence of environmental or work related pesticides (occupational contamination). Read more ›
Acquired immunodeficiency syndrome (AIDS) is considered one of the most serious and tragic epidemics of the twentieth century. It is caused by the HIV virus and affects both men and women. It possible to contract it through sexual relations, blood, and, on occasions, a mother can pass this on to her child during birth.
Thanks to research and improvements in treatment, which are becoming more and more personalised, HIV has become a chronic and controllable disease. This has led to an improvement in the patients’ quality of life and life expectancy. Quality of life meaning, the ability to follow life’s normal path without their daily lives being constantly restricted by the illness. This, in turn, leads to the desire to think about the future and have children. Read more ›
The hysteroscopy is a useful tool both for the diagnosis and the treatment of many gynaecological diseases and conditions. This is the traditional standpoint, yet for some time now it has been considered that it is the field of infertility which can benefit most from this type of technique.
It is widely known that submucosal fibroids affect implantation; however, other pathologies such as polyps, adhesions (Asherman syndrome) and a uterine septum can also make conceiving a pregnancy difficult. Read more ›
Despite the fact that treatments have improved, both in terms of efficiency and safety, the hormone medication required by treatments is still a source of concern and fear for many patients. Ginemed’s research into assisted reproduction has meant that, in certain cases, we have been able to carry out in vitro fertilisation treatment without hormones. As this respects the natural ovulatory cycle of the woman, it is also known as a pure natural cycle.
What is a natural cycle?
Naturally, women produce one egg in every ovarian cycle; as the development of this egg has not been forced or altered (the egg’s natural selection has been respected) it benefits from having reached optimum maturity. While there is one downside, that we only obtain one egg per cycle, the excellent quality of this egg balances out this disadvantage. Read more ›
The endometrium: the tissue that lines the inside of the uterus, acts as a “bed” or “cradle” for the embryos during the implantation process.
Apposition: the first moment when the embryo finds “its spot” in the endometrial cavity, is the first step in the implantation process. After this follows adhesion, the moment when the embryo makes contact with the endometrium, and finally, the trophoblasts invasion.
We all know, that in order to conceive a pregnancy, it is essential for this “bed” to be well-made and that this is why the sex hormones (estradiol and progesterone) act to prepare the endometrium, making it its most receptive during this period.
It is hardly surprising therefore, that assisted reproduction treatments have placed such importance on the appearance of the endometrium and why we aim to ensure that it is adequately prepared; either using exogenous hormones (oestrogens and progesterone); or using the woman´s own ovulatory cycle, to achieve the optimum endometrium for the embryo transfer. Read more ›