Difference between identical and fraternal twins

Apr 17 2014

01Before establishing the biological origin differences between identical and fraternal twins, let’s make a quick note on the etymology of both words.

Etymologically both terms have the same origin (Latin gemellicium) and were used interchangeably to refer to children born in the same delivery. The only difference was the use of the term fraternal twin in the popular speech twin and identical twin in the cultivated speech. However, the semantic evolution of both words has been accompanied by the numerous advances in the field of genetics and knowledge of the development of the human embryo. In fact, since they differ in the latest edition of the dictionary of the RAE: Continue Reading »

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How many eggs on average are donated on an Egg Donation treatment at Instituto Bernabeu?

Apr 10 2014

01 In Spain, we performed 40% of all egg donation cycles in Europe. The experience accumulated at Instituto Bernabeu for over 15 years, allows us to offer to our patients a high quality and personalized treatment.

When a patient decides to go for an Egg Donation treatment, a chain work is set in the organization, in which we guarantee a commitment of trust, reliability and professional quality.

Why an “x” number of eggs are donated? Why not only one?

We need to keep in mind that in the developing process of a fertility treatment, there are a number of facts subject to human biology itself.

To begin with, not all the eggs collected will be suitable to be fertilized. Only those ones that have achieved an adequate maturity will have that option. Not all the mature eggs will get fertilize and some others will have an abnormal fertilization so there will be discarded for a possible transfer.

The eggs fertilized with normalcy that is the generated embryos from the fertilization, will have a different pattern. Each embryo has its own destination. Some will get blocked during the observation period before the transfer, some others will survive until the transfer day but with bad or low quality, and only a few will have an adequate morphology and development to be selected for the embryo transfer. This is a completely normal development that happen in all assisted reproduction cycles both with own eggs and donated eggs.

Sometimes, patients understand the “loss” of embryos as a poor outcome. How these can happen if we had so many embryos and we ended up with just a few? The main reason is natural biological selection within the absolute normality.

At Instituto Bernabeu the egg donor is selected individually in each case, ensuring the maximum similarity with the recipient patient, and is treated in a safe and controlled manner to guarantee obtaining an adequate number of eggs, always under close medical supervision.

The average age of an egg donor in our clinic is 25 years old. After the ovarian stimulation we retrieve all the eggs possible. Currently our average number of donated eggs is 12 per cycle. The rate of mature eggs is 90%, this demonstrate the proper selection of egg donors and the correct enforcement of the ovarian stimulation patterns.

The fertilization rate, that is the number of embryos generated by the amount of eggs fertilized, is 75%. From this point onwards and as I explained above, each embryo will have a different development.02But not only is the number of eggs retrieved important, the quality is essential. This is determined primarily by the age of the woman, a comprehensive selection of the egg donor, the quality in the implementation of stimulation protocols and the fact that many egg donors have previous proven fertility. This allows performing the embryo transfer, in a high percentage of cases, the 5th day of embryonic life (for the most advanced embryonic development called blastocyst).

The entire set of facts can offer our patients the possibility of transferring a high number of quality embryos, in fact 60% of cycles quality embryos can be frozen (vitrified) with a cumulative pregnancy rate of 85% per cycle.

This is especially important in the group recipient patients to who, in many cases, by age or medical history or by choice is decided to transfer a single embryo to avoid the risk of twin pregnancy.

The quantity and quality of eggs donated per cycle at our center ensures the highest probability of normal to term pregnancy.

Dr. Lydia Luque, Gynecologist at Instituto Bernabeu.

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What is a Chemical Pregnancy?

Mar 17 2014

01 There are times when we give patients the results of  in vitro fertilization, we tell them that the test is positive but that it is not good news, and that the chances that it evolves into an ongoing pregnancy are slim. It is a very difficult situation, emotionally, since it is very hard for patients to understand what has happened. If it really is positive, then why isn’t that good news? If it’s not good news, then why do I still have to take medication?

Most of these cases will show a negative result some days later, and it is considered a chemical pregnancy. What has happened is that there was implantation of the embryo (if not the  bHCG could not have come back positive) and the embryo stopped developing some days later. This is simply a very early miscarriage, so early that it cannot be confirmed via ultrasound, and is resolved without any medication or D&C.

This situation occurs in around 10% of IVF cycles. This means that around 1 in 10 embryo transfers, the pregnancy test is positive but the pregnancy will never be seen on an ultrasound. This is clearly linked to the  bHCG levels taken 8-10 days after embryo transfer, but must be confirmed a few days later with another test, as we explained previously.

These “chemical pregnancies” are not only in assisted reproduction, but also occur naturally in spontaneous pregnancies. The majority of them are undiagnosed, because women confuse them with delays in their period. However with new pregnancy tests, which are getting more sensitive, women more frequently are seeing unclear or positive results then are then negative a few days later. This should be seen as a natural part of reproduction: just as some embryos are unable to implant, others that do are not able to continue their development, and never seen on an ultrasound.

Patients are obviously full of doubts when this situation arises: what consequences does this have in the future? Is this an obstacle in trying to obtain a pregnancy? Does it lessen the chances in a future attempt?

02The answers we can give based on scientific evidence are quite positive. Couple who have a positive result have a better prognosis in future attempts. This has been proven in a number of publications  and should be explained to patients so that it is taken into account when making a decision.

Even though it does not mean anything negative in the reproductive future of a couple, many chemical pregnancies cause a sense of “loss” that adds to the emotional burden  already present for people with fertility problems. This is why we should always be present for any concerns that these patients may have, and give them all the necessary information that they need to overcome the situation and continue to try and reach their goal.

Dr. Joaquín Llácer, gynecologist for Instituto Bernabeu.

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First Pregnancy Scan after IVF Treatment

Mar 05 2014

01 Confirming pregnancy after IVF and Egg Donation . The first ultrasound in which we can see the pregnancy  is a very emotional time for the parents, especially for patients who have gone through  treatments for assisted reproduction. For these patients, after having a positive pregnancy test , their anxiety does not go away but gets stronger until the pregnancy is seen to develop normally. Therefore it is very important to know what happens during this exploration, and what to expect.

When is it done?

It should be carried out  between week 5 and 7 of pregnancy, therefore between 3 and 5 weeks after  embryo transfer. To calculate the pregnancy after IVF, we always set a theoretical last mentrual period date 14 days before egg retrieval.

Exactly one month after the embryo transfer is a great time to carry out the scan and see clearly if the pregnancy is progressing or not. If this is done sooner, we can create confusion and uncertainty since most of the time it will not be conclusive.

How is it done?02

The ultrasound must be done vaginally. This shows the images more clearly, and it is more precise in showing that everything is evolving correctly. We know that carrying out the ultrasound this way does not negatively affect the pregnancy.

 Why is it important to do an ultrasound in the 6th or 7th week?

  1. We can confirm that the pregnancy is in the uterus, and rule out ectopic pregnancy (found outside the uterus).
  2. We can see if it is a single or a multiple pregnancy.
  3. It allows us to evaluate whether or not the pregnancy evolution is as it should be. If it is not evolving well, it can give us an idea as to why.

What will we see in the scan?

In the first scan after IVF carried out in week 6 or 7 of pregnancy we can see the following structures:

  1. Gestational Sac. This is the earliest structure seen. It is a dark image, surrounded by a halo, found within the uterus (in the endometrium, which we observed growing during the ovarian stimulation). The average size at week 6 is around 14mm, but this varies greatly can sacs that are much smaller and much bigger are not considered abnormal.
  2. Yolk Sac.  This is a vestigial structure that is seen at the start of embryonic development. Its round, white shape, resembling the follicles during stimulation. It measures around 3-4mm, and if it is larger than 6mm it is considered a poor prognosis.
  3. Heart beat. Tends to appear around week 6. The heart rate at this time is between 90 and 110 beats per minute, and will increase in the coming weeks.
  4. Embryo. The cell mass that has all of the embryos organs. It is a structure attached to the yolk sac. In week 6 sometimes it is not seen yet, as its size is between 2-8mm. this varies greatly, and will grow very quickly (around 1mm daily).

In case these structures are not seen, or their sizes are not as expected, does this mean the pregnancy is lost?

We msut be cautious in interpreting the ultrasound findings at this time, since there are a number of factors that can lead to an incorrect diagnosis:

  1. The variations in normal embryo development. Even though it is very early on in the pregnancy, there are many variation in the appearance of ultrasound findings. Therefore any diagnosis must be confirmed a few days later.
  2. Differences in the quality of the image depending on the patient. Every patient is different, and their tissues pass the ultrasounds waves in different ways. Images can be unclear if the transmission is not good.
  3. Placement of uterus and location of gestational sac. Depending on the distance between the ultrasound probe and the gestational sac, the image can be more or less clear. This can mean that the diagnosis is inconclusive.

Dr. Joaquín Llácer, Co-Medical Director of Assisted rReproduction at  Instituto Bernabeu.

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Semen quality parameters according to the World Health Organisation (WHO)

Feb 17 2014

01The spermiogram is a basic tool that provides us with some of the best information to assess male fertility. It is also very useful in order to formulate a personalized treatment plan for the couple.

The World Health Organisation (WHO) has published several editions of the “Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction”, the last one in 2010. Those manuals help and guide andrology laboratories to determine sperm quality. Moreover, in recent years, the European Society for Human Reproduction and Embriology (ESHRE) in collaboration with the WHO have developed a program to improve standardization between laboratories in terms of sperm sample diagnosis and assessment criteria. Continue Reading »

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Endometrial polyps, what are they and how are they formed?

Feb 05 2014

01Endometrial polyps are protrusions or growths in the endometrium, the lining of the uterus. Contain abundant inside your blood vessels and endometrial glands that respond to hormonal stimuli.

Polyps proliferate to form a region of the basal layer of the endometrium, and are less responsiveness to hormonal changes. Taking place repetition of menses, the endometrium functional layer surrounding the polyp breaks off and becomes increasingly individual from a pedicle. Continue Reading »

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What is the endometrium?

Jan 20 2014

01endometriosisThe uterus, the organ where pregnancy takes place, has a cavity inside where implantation occurs.  This cavity is covered by a soft tissue called endometrium, the “nest” that the uterus prepares every month for a possible embryo.

During the menstrual cycle the endometrium goes through 3 main phases:  menstrual phase, when it is shed in order to grow again, follicular phase or preovulatory, when it grows, and luteal phase or postovulatory when it reaches the proper state in which to produce implantation.  These phases of the cycle are easily seen in an ultrasound. Continue Reading »

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Genetic approach to embryo implantation failure and repeated miscarriage

Dec 16 2013

Couples that don’t achieve pregnancy after in vitro fertilization treatments and those who lose their pregnancy in early stages require a multidisciplinary approach in order to diagnose and treat their reproductive problem.

 01.3-1-20_2

From a genetic point of view, these patients are more likely to produce embryos with chromosomal abnormalities. To improve these couples’ pregnancy rates, the preimplantational genetic diagnosis (PGD) can be applied. In these cases, the goal is to select the embryos with the highest capacity of resulting in an ongoing pregnancy thanks to the fact that the PGD allows us to identify the number of chromosomes in the embryo. Only embryos with the correct number of chromosomes can lead to a healthy child, others will arrest in their development or will lead to a miscarriage. Continue Reading »

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Embryonic arrest, why don’t all of my embryos develop equally?

Dec 02 2013

01.Embrion-Humano-10-celulas_-Dia-3When one starts an in vitro fertilisation (IVF) treatment, one of the most frequent concerns is the number of high quality embryos that can be obtained.

This number is variable and depends on several factors such as the ovarian reserve and gamete quality (egg and sperm). Once the eggs are fertilised, they are considered embryos, which begins after their early division. The embryo division is observed in the IVF laboratory on a daily basis and is key information to determine the embryo quality. The Spanish Association of Reproductive Biology (ASEBIR) establishes a classification according to various observed morphological parameters, which indicate the embryo quality according to their capacity to implant in the womb. Continue Reading »

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Legality of egg donation in Spain: Anonymity and confidentiality

Nov 19 2013

Ovocito-e1322819738144Reproduction treatments with donated eggs have gained significant importance in recent years.

It is worth noting the main characteristics that the Law 14/2006 on assisted human reproduction techniques states on egg donation, which are explained below: Continue Reading »

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