Instituto Bernabeu stands out with 16 scientific investigations at the ESHRE 2021 International Congress


Instituto Bernabeu stands out with 16 scientific investigations at the ESHRE 2021 International Congress

Instituto Bernabeu breaks a record in 2021 with a total of 16 scientific works that will be exhibited at the XXXVII edition of the ESHRE Congress. The international meeting of the European Society for Human Reproduction and Embryology collects scientific works from the clinical research groups which address from the application of artificial intelligence in assisted reproduction treatments, to genetic research and the impact of new strategies to achieve the miracle of pregnancy. The pandemic continues to require the greatest caution and therefore this new edition will be held virtually.

These 16 works are the symbol of the importance of research in all areas of reproductive medicine for the IB Clinic Group. With a clear objective, to contribute to knowledge and science advancement.

The studies presented show the breadth of fields Instituto Bernabeu investigates to address the causes and find new strategies for human infertility. Three of these investigations have a special mention and will be presented orally by their main authors who stand out for their special scientific value.

Artificial Intelligence

Always linked to the latest news, Instituto Bernabeu presents in the ESHRE Congress an oral communication based on the application of Artificial Intelligence (AI). The clinic has developed a machine learning algorithm to predict the probability an in vitro fertilization (IVF) the embryo is aneuploid, which is the presence of an abnormal number of chromosomes; and / or mosaic, in this case the embryo has a mixture of chromosomally normal and abnormal cells (for one or more chromosomes). During the study, 22 variables (maternal, paternal, embryonic and of the IVF cycle) of 6,989 embryos obtained in 2,476 cycles were recorded. And two predictive machine learning models were established, one for aneuploidies and the other for mosaicism.

1 . Application of machine learning to predict aneuploidy and mosaicism in embryos from in vitro fertilization (IVF) cycles

J.A. Ortiz, R. Morales, B. Lledó, E. García-Hernández, A. Cascales, J.A. Vicente, J. González, J. Ten, A. Bernabeu, J. Ll. Aparicio, R. Bernabeu

Vaginal y endometrial microbiome

This research has focused in the studies of the vaginal microbiome, where Instituto Bernabeu remains at the forefront of research. In it, the Institute researchers have verified that there is a characteristic pattern in the vaginal and endometrial microbiota on patients with chronic endometritis to become a diagnostic method.

2. Characterization of vaginal and endometrial microbiome in patients with chronic endometritis (CE)

F. M. Lozano, A. Bernabeu, B. Lledó, R Morales, F.I. Aranda, J. Ll. Aparicio,R. Bernabeu

Chromosomal variants

This research has focused on investigating the impact polymorphic chromosomal variants have on reproductive problems. The study reveals that women carrying polymorphisms have a lower average level of anti-Müllerian hormone and a lower embryonic survival rate after thawing of previously cryopreserved eggs. This study offers valuable information to advise patients before starting assisted reproductive treatment. And it means enhancing the personalized treatment and approach given to patients.

3. Impact of female chromosomal polymorphic variants on ovarian reserve markers and fertility treatments prognosis

L. Luque, N. Ruiz, Á. Linares, J. Bartolomé, J.A. Ortiz, A. Fabregat, E. García-Hernández, J. Ten, R. Bernabeu

Researchers at Instituto Bernabeu present in Poster format another 13 investigations of high content and scientific value.

Fresh vs Frozen PGT-A

Fresh vs frozen PGT-A cycles in donor oocyte recipients has analyzed the results of more than 300 in vitro fertilization (IVF) cycles of women who used a donor eggs in whom the preimplantation genetic test to detect aneuploidies (PGT-A) in the embryo has been performed. The results of the transfers made fresh versus frozen were compared. The study indicates that when PGT-A testing is deemed necessary in oocyte recipients, cryopreservation may have an adverse impact on IVF results.

4. Fresh vs frozen PGT-A cycles in donor oocyte recipients

J.C. Castillo, J Guerrero, J Ten, M Martínez, J Ll. Aparicio, A. Bernabeu, R. Bernabeu

How a previous c-section affects

Another of investigations presented by Instituto Bernabeu at the ESHRE has studied patients with a previous c-section who undergo in vitro fertilization (IVF). And he has analyzed whether this may have a correlation with a possible deterioration in the implantation of the embryo after fertility treatments. The study has evaluated the parameters of uterine contractility and vascularization in 3D ultrasound in women who underwent an embryo transfer. And the result is that 3D vascularization rates are lower and there are fewer uterine contractions in patients with a previous cesarean section.

5. Uterine vascularity in women with previous caesarean section and its potential role in implantation failure: a retrospective cohort study

B. Moliner, J. Ll. Aparicio, J.C. Castillo, P. Cirillo, A. Fuentes, A. Bernabeu, R. Bernabeu

Exome sequencig

This research aimed to show how exome sequencing in patients who recurrently and inexplicably develop fetal malformations, in combination with the preimplantation genetic test for monosomal diseases (PGT-M), could lead to a healthy newborn.

6. Exome sequencing and preimplantation genetic testing for unexplained recurrent foetal malformations

E García-Hernández, R Morales, B Lledó, JA Ortiz, A Turienzo, F. Lozano, A Fuentes, J. Ll. Aparicio, A Bernabeu, R Bernabeu

Maternal age and mosaicism

Genetic studies are very present in Instituto Bernabeu researches. The objective, in this case, has been to evaluate whether maternal age has an impact on the clinical outcome of mosaic blastocysts, those that have two or more chromosomally different cell lines. The research details that, in the absence of euploid or chromosomally normal embryos, mosaic embryos could be considered for transfer, with similar results regardless of maternal age.

7. Clinical outcomes of mosaic embryos are similar between young and older women

A. Cascales, R. Morales, B. Lledó, J.A. Ortiz, J. Guerrero, J. Ll. Aparicio, R. Bernabeu

Impact of “rescue” strategies

Progesterone administered vaginally doesn’t achieve optimal serum levels in up to 30% of patients who receive frozen embryos. An alternative strategy is to administer additional progesterone subcutaneously. This work reveals that after receiving additional subcutaneous progesterone supplements, women with low serum progesterone levels on the day of cryotransfer have similar pregnancy rates to women with normal levels.

8. Low serum progesterone on the day of frozen embryo transfer after artificial endometrial preparation: exploring the clinical impact of “rescue” strategies

A. Herencia, J. Ll. Aparicio, J.A. Ortiz, J.C. Castillo, C. Gavilán, B. Moliner, A. Bernabeu y R. Bernabeu

Premature Ovarian Failure of unknown cause

In the study of Premature Ovarian Insufficiency (POF), a frequent cause of female infertility, the Bernabeu Institute research has carried out the sequencing of the complete exome in women from families affected by Premature Ovarian Insufficiency of unknown cause with the aim of identifying mutations in genes. This problem is suffered by women under 40 years of age who prematurely lose the function of the ovary. 43 genetic variants were identified in 39 genes expressed in the ovary and related to POF or linked to ovarian physiology. The work has described genes that have never been associated with the POF pathology, which may be involved in key biological processes for ovarian function.

9. Identification of novel variants and candidate genes in women with familial idiopathic premature ovarian failure using whole-exome sequencing

R. Morales, B. Lledó, J.A. Ortiz, F. Lozano, A. Bernabeu, A. Fuentes, J. Ll. Aparicio, R. Bernabeu

Low ovarian response

Instituto Bernabeu maintains a constant line of research on low ovarian response. Although there’s some evidence for the possible effect of the immune system on ovarian function and implantation, the role it plays in assisted reproductive treatment is unknown. The objective of this work has been to investigate the association between serum cytokine levels and ovarian reserve and response. The research suggests that the IL-6 / il-10 ratio can be used as a biomarker to predict ovarian response and offer real expectations regarding the success of IVF.

10. The IL-6/IL-10 ratio is higher in patients with low ovarian response

A. Fabregat, M. Hortal, B. Lledó, J.A. Ortiz, B. Moliner, A. Bernabeu, J. Ll. Aparicio, R. Bernabeu

Re-expansion after blastocysts thawing

Re-expansion of the thawed blastocyst at the time of transfer has been considered a good prognostic factor, but thawed embryos do not always re-expand. This research has evaluated the relevance of this situation and for this the clinical results of the re-expanded embryos have been compared with those that collapsed after their thawing and transfer. The study concludes that re-expanding blastocyst transfer after thawing could be a positive indicator of clinical outcomes. And in case of embryos that don’t re-expand, research indicates the possibility of transferring two embryos.

11. Clinical relevance of re-expansion after blastocyst thawing (POSTER)

M. Aparicio, L. Herrero, L. Cascales, J. Ll. Aparicio, J. Ten, R. Bernabeu

Laser-assisted artificial collapse effect before vitrification

This work developed by the Instituto Bernabeu Embryology Unit has evaluated the effect of laser-assisted artificial collapse before vitrification on pregnancy and implantation rates after the transfer of heated vitrified blastocysts. 394 women were included in the study. The results indicated that artificial contraction by laser-induced collapse before vitrification significantly increased implantation and clinical pregnancy rates after transfer of a single thawed embryo.

12. Laser-assisted collapse of blastocysts prior to vitrification improves clinical outcomes.

J.Ten, J. Guerrero, A. Rodríguez-Arnedo, L. Martí, M. Herreros, N. Díaz, R. Sellers, M. C. Tió, A. Bernabeu, J. Ll. Aparicio, R. Bernabeu

Progesterone studies

Assisted reproduction treatments with vitrified embryos are the most common, given the increasing effectiveness of this technique in the Instituto Bernabeu laboratories. To optimize results, preparation of the uterus is essential. And progesterone is possibly the most important medication. Research has compared two ways of administering it vaginally, on the one hand the classic one, using micronized tablets, and the other recent one with the use of vaginal ovules. And the results obtained in this research presented at ESHRE 2021 are very positive. With the new preparation there is a significant decrease in patients who arrive at the transfer with inadequate progesterone levels. This strategy allows optimizing the chances of success and improving the quality of life of patients, reducing the risk of additional injections after the transfer and during the pregnancy first trimester.

13. Progesterone levels and clinical outcomes using a single pessary of 400 mg of vaginal progesterone in artificial cycles for embryo transfer 

J. Ll. Aparicio, A. Pitas, J.A. Ortiz, C. Gavilán, A. Herencia, S. Albero, J.C. Castillo, A. Bernabeu, R. Bernabeu

PGT use for cryptic translocation

Chromosomal translocations are frequently associated with birth defects, early and spontaneous pregnancy loss, and infertility. However, submicroscopic translocations (so-called cryptic translocations) are too small to be detected by a conventional karyotype, so discovering them is challenging. The objective of this study is to investigate the feasibility of using the PGT preimplantation genetic test as an indicator of cryptic translocations balanced by parents. It shows the value of the PGT in cases of unexplained recurrent miscarriage, followed by a father’s FISH to better describe variations in chromosome copy number and identify pairs in which one of the members carries a cryptic translocation. Research cautions that accurate diagnosis of parental chromosome translocation can only be achieved with FISH, but FISH would not be performed unless PGT showed variations in chromosome copy number.

14. A feasible diagnostic approach for the cryptic subtelomeric traslocations in early recurrent miscarriage patients by preimplantation genetic testing (PGT)

B. Lledó, R. Morales, J.A. Ortiz, A. Cascales, A. Fabregat, J. Ten, B. Moliner, A. Fuentes, A. Bernabeu, J. Ll. Aparicio, R. Bernabeu

Double stimulation and FSH

This study in which 134 patients have participated, determines that the performance of a second ovarian stimulation in the luteal phase is superior to that achieved in the follicular phase, both in the group of participating patients and in all genotypes separately. Furthermore, the results are better when the patients are stimulated with the type of follicle-stimulating hormone (FSH) that already had the highest performance in follicular phase for their genotype. It has also been observed that stimulation in the luteal phase is longer and more gonadotropins are consumed than in the follicular phase, especially in patients with the SS or heterozygous genotype, when two different forms of a particular gene are inherited, one from each parent.

15. Follicle-stimulating hormone receptor genotype and its influence on the results of double ovarian stimulation in IVF cycles

M. Hortal, B. Lledó, J.A. Ortiz, A. Fuentes, A. Cascales, F.M. Lozano, A. Bernabeu, J. Ll. Aparicio, R. Bernabeu 

Cryopreservation and birthweight

Currently, frozen embryo transfers exceed those of fresh embryos in in vitro fertilization (IVF) treatments. This study has evaluated 670 oocyte recipient patients who underwent fresh or frozen embryo transfers at Instituto Bernabeu. Research results have shown no difference in birth weight, large-for-gestational age, or premature birth between fresh and frozen embryo transfers. The study concludes that embryo freeze / thaw procedures have no impact on birth weight.

16. Birthweight is not affected by freezing process. Results from a quasi-experimental study using the Oocyte Donation Model

N. Díaz, J. Ll. Aparicio, E. Álvarez, E. Serrano, J. A. Ortiz, A. Bernabeu, J. Ten, R. Bernabeu

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