Why not all embryos obtain from a cycle of in vitro fertilization are suitable for freezing?

01 Today, in In Vitro fertilization treatments, it is not extraordinary to find ourselves on the day of embryo transfer with a high number of good quality embryos. For a fresh transfer we shall be electing the embryo or embryos that morphologically and kinetically demonstrate greater development and ‘the other’ good quality ones can be cryopreserved. Continue Reading »

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Criteria for embryo classification

01From fertilization and until the embryo transfer takes place in the womb, embryos follow a development that is valued by embryologists daily. Those embryos that have kept a correct evolution and are in better condition are selected to be transferred. Continue Reading »

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Blocked fallopian tube. The involvement of “tubal factor” in fertility

01The Fallopian tubes are trumpet-shaped structures that begin in the uterine cavity and end up opening by the ovaries. After ovulation, the fallopian tubes collect the released egg that is fertilized on the first portion, which is the closest part to the ovary. For this, the spermatozoa travel through the vagina, the cervix, the uterine cavity, and finally the route to the end of the tube. After fertilization occurs, the embryo (fertilized egg) launches its first divisions and travels through the fallopian tube towards the uterus where implantation occur and thus the establishment of pregnancy. Continue Reading »

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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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First Pregnancy Scan after IVF Treatment

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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More information on our website: For further information, consult our website: www.institutobernabeu.com/en/ or www.ibbiotech.com

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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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Is it beneficial to rest after the embryo transfer?

reposoWithout a doubt, one of the most emotionally stressful stages a patient undergoing IVF has to face is the period between the embryo transfer and the pregnancy test result.

It is a natural instinct for someone in this situation to want to do everything in her power to increase the chances of success, which is why she is extra sensitive to any messages she receives from family members, friends, the internet, etc. This leads to a confusing situation because oftentimes the advice received is contradictory. As if that weren’t enough, the vast majority is unfounded and not validated by any scientific evidence. Their question is often “should I rest or not?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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Unraveling the mysteries of ICSI (Intracytoplasmic sperm injection)

We’re dedicating this Instituto Bernabeu forum topic to a very common technique used in the human reproduction laboratory: ICSI or Intracytoplasmic sperm injection. We have prepared this explicative video on the topic, in which Dr. Jorge Ten simply explains what this technique involves, how it is performed, its indications, history and evolution, as well as our reproductive biology team’s efforts to perfect the results. We hope you like it! Continue Reading »

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