Archive for the 'Reproductive biology' category

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

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?

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

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

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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Contamination, environmental toxins and fertility

Instituto BernabeuScientific evidence from the last 15 years shows that without a doubt, environmental toxins before conception and during pregnancy cause long-lasting effects on reproductive health. An example of this is the exposure to mercury, which causes cognitive impairment in children. Another example is the exposure to agricultural pesticides, which is associated with sperm quality alterations and higher incidence of testicular and prostate cancer for men, and in women it interferes with the development of puberty, ovulation, fertility and menopause. Continue Reading »

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Using Magnetic Fields to Select Healthy Sperm: MACS (Magnetic Activated Cell Sorting)

MACS Instituto BernabeuIt is well known that having the best possible sperm quality is important to the success of assisted reproduction techniques. To achieve this, the lab has to improve sperm quality based on its motility and morphology, selecting the sperm that is considered to be the best.

However in every ejaculate sperm with abnormal membranes are found, which are programmed to “die”. This process is called apoptosis, or programmed cell death.   Approximately 20% of sperm in subfertile patients are  thought to be in the process of “celular death”. Continue Reading »

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Avoiding multiple pregnancy: Why is it important to avoid pregnancy of twins or triplets?

trillizosMultiple pregnancy is, along with ovarian hyperstimulation, the most significant complication in fertility treatments.

Most couples that go through assisted reproduction techniques consider multiple pregnancies to be desirable or the lesser evil. However, pregnancies of twins and even more so triplets are associated with a series of complications that challenge the pregnancy ending in the birth of a healthy baby. Let us not forget that the birth of a healthy baby is the only objective of assisted reproductive techniques. Continue Reading »

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Towards a Positive Embryo Transfer

sala-transfer-lowAt first glance, the embryo transfer seems to be the quickest and simplest step in the In Vitro Fertilisation (IVF) process. However, it is actually the most critical step in the entire treatment. Successfully overcoming previous hurdles means nothing if the embryo transfer is not done well. This happens if too much time lapses between when the embryo is taken out of the incubator and when it is placed back in the uterus. Continue Reading »

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Instituto Bernabeu Shared Risk Program: serious commitment to the result

“WE’RE NOT TALKING ABOUT STATISTICS, WE ENSURE YOUR PREGNANCY.”

IFRAME Embed for Youtube

Instituto Bernabeu has always been loyal to its patient care philosophy, and is even more so now in these current hard times, by planning and implementing new projects and services aimed at helping couples achieve their dream of parenthood.

We want to share your efforts and risk by promising to back up every activity with the latest equipment, innovative techniques and cutting-edge technology alongside our entire team’s professionalism, experience, warmth and dedication. Continue Reading »

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Why is fresh egg donation better than frozen?

ovulo congeladoOne of the most controversial questions for patients looking for egg donation is whether or not the eggs are fresh, and if this makes a difference.

With the use of cell vitrification during recent years, survival after thawing has improved greatly for sperm and embryos. However, the size of an egg (the largest cell in the human body) makes it more susceptible to thermal stress. Therefore the rate of survival is not as high, and it is possible that certain cellular structures suffer in the freeze-thaw process. Continue Reading »

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