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Mes: junio 2019

ESHRE - Viena
28Jun

The difference between quantity and quality

By Gorka Barrenetxea

The contribution of our team to the last ESHRE meeting held in Vienna has included a poster with oral defense entitled “Lack of predictive value of ovarian reserve tests for pregnancy likelihood. The huge difference between quantity and quality”.

Ovarian stimulation is a crucial part of an IVF procedure. The aim of this step of the cycle is to obtain an adequate number of oocytes to have the highest chance to achieve a pregnancy. In cases of low ovarian reserve “adequate” means as many as possible since the possibility of developing an euploid embryos increases. Among normoresponder patients, adequate means also as many as possible (once we are able to avoid ovarian hyperstimulation syndrome thanks to the implementation of agonist trigger).

A lot of different markers have been proposed to predict the number of eggs we can obtain after a given stimulation. Among them, the antral follicle count has been shown (by far) to be the most efficient according to the results of our study.

However, quantity does not mean quality. Thus, the factors capable to predict number of oocytes are not the best ones to predict the likelihood of an ongoing pregnancy. According to our data, age is the factor related to success in terms of pregnancy.

So, predictors of ovarian quantitative response to stimulation (the so called ovarian reserve tests) should not be offered as “fertility tests” since they are not independently related to pregnancy chance, neither after sexual intercourse nor after IVF treatments.

ESHRE - Viena
27Jun

Preservation of oocytes. The beginning of a new era.

By Gorka Barrenetxea

 

Once vitrification of oocytes became technically possible offering good results, the fate of many women changed. First, those women diagnosed of cancer, for example, and waiting a treatment that could make them infertile, had the chance of preserving their fertility by freezing their oocytes. But in the end, fortunately, the percentage of such patients is low

 

So things go further. Many women who decide, either by themselves or by “social” reasons (let`s say absence of a partner, work issues and so on), to postpone a pregnancy may, nowadays, preserve their own oocytes. Probably, once they decide to achieve a gestation in the future, they will be able to become pregnant by natural means. Actually, 80% of population does not have fertility problems.

 

But, if such problems occur, i.e. to find it difficult to achieve a pregnancy, they may use their own younger oocytes. In Spain, almost one third of assisted reproduction treatments are fulfilled by using donor (young) oocytes. It is clear than most of those women would have desired to be their own egg donors.

ESHRE - Viena
27Jun

What to do with mosaic embryos

By Gorka Barrenetxea

Thanks to PGT-A (testing of embryos for aneuploidies) the chance of achieving an ongoing pregnancy per transfer has increased enormously. But, this is only true regarding the transfer of euploid embryos. Unfortunately, the selection of embryos means that in some cases no euploid embryos will be available for transfer. Furthermore, in other cases, a possible mosaicism will be the final genetic diagnosis. And the question is: what should we do with these embryos. Should they be considered abnormal (since they are not euploid) o could be regarded as “almost normal” embryos?

Actually, PGT-A assesses trophoectoderm (and no embryo cells) and sometimes there is no a correlation between a mosaicism in the external layer and the genetic burden of the embryo. Furthermore, in no few cases, the so called “possible mosaicism” reflects technical problems with the NGS (the usual procedure employed for the genetic analysis).

The available data in the literature allows the transfer of mosaic embryos once some conditions are fulfilled. Low level mosaic embryos (with a single aneuploidy) may be transferred. However, an invasive prenatal diagnostic procedure (amniocentesis) should be offered to the patient. Anyway, the possibility of having final reports different from euploid or aneuploid embryos, i.e. mosaicisms and/or non informative results must be known by patients before PGT-A is offered.

ESHRE - Viena
27Jun

Progesterone: is it only an endometrial receptivity issue?

By Gorka Barrenetxea

The role of Progesterone administration during the frozen-thawed embryo transfers has been deeply debated during the last ESHRE meeting held in Vienna this month. On one hand, Elena Labarta from IVIRMA-Valencia has shown the results of studies demonstrating that low levels of serum progesterone in the day of embryo transfer are associated with low ongoing pregnancy rates. At the same time, the author has revealed that it is possible to “rescue” a bad cycle (in term of insufficient progesterone levels) by adding the hormone subcutaneously the day of embryo transfer and onwards.

Georg Griesinger has underlined the fact that the role of progesterone does not limit to endometrial receptivity. Indeed, immunomodulation and myometrial quiescence are also affected by progesterone levels.

Definitely, once ovarian stimulation has been thoroughly assessed and euploid embryo (the seed) transfer has become the gold standard in assisted reproduction, endometrial preparation (the ground) and adequate progesterone administration (both, in term of doses and via of administration) play the starring role in assisted reproduction.

ESHRE - Viena
26Jun
BARRENETXEA.ESHRE.2019
vii reunión nacional grupos de interés sef
10Jun

Córdoba, 7-8 de Junio de 2019.

Los grupos de interés (GI) constituyen los motores de la Sociedad Española de Fertilidad (SEF). La puesta en común del estado de la ciencia en diferentes campos de la medicina reproductiva, la participación activa de socios de la SEF en el trabajo que redunda en beneficio de todos los especialistas en el campo no son sino unos ejemplos de su muy importante labor.

Y cada dos años, los grupos nos muestran su trabajo. Su arduo trabajo. Ha correspondido a Córdoba albergar la última reunión, la de mayor asistencia de los grupos de interés hasta la fecha y coordinada por la Dra. Marta Devesa (Dexeus, Barcelona).

La reunión ha permitido, por ejemplo, presentar la guía para el Manejo de la paciente con endometriosis durante la edad fértil. Se trata de una guía basada en la evidencia elaborada por el Grupo de Trabajo de Endometriosis, siguiendo una muy rigurosa metodología (GRADE) propuesta y desarrollada por la iniciativa Cochrane y reconocida por Guía Salud de elaboración de guías de práctica clínica).

Por su parte, el Grupo de Trabajo de Fracaso Reproductivo, ha presentado las “Recomendaciones para el Manejo del aborto recurrente”, un documento que sin duda ayudará a los profesionales en la toma de decisiones en este difícil campo.

El GI de Endocrinología ha revisado diferentes aspectos de la estimulación, inducción ovulatoria y manejo de la fase lútea en los ciclos de reproducción asistida, mientras que el GI de Presevación de la Fertilidad ha realizado una reflexión sobre el hecho de que la preservación de corteza ovárica deje de ser una técnica experimental y pase a ser asistencial.

Se han organizado dos mesas de discusión conjuntas (con participación de todos los grupos. La primera ha versado sobre la Genética en Reproducción y la segunda sobre la utilización de Tratamientos Adyuvantes en Reproducción Asistida, para intentar obtener mejores resultados.

Nuestro director, Gorka Barrenetxea, ha tomado una parte activa en la reunión. Además de presentar una ponencia sobre los resultados del estudio BIRTH (estudio sobre la utilización de una nueva FSH recombinante en estimulación ovárica llevado a cabo en 26 centros de reproducción asistida en España) , ha moderado junto con Irene Cuevas la reunión conjunta sobre tratamientos adyuvantes en reproducción asistida en la que han participado como ponentes los doctores Joaquín Llácer (Instituto Bernabeú, Alicante), Miguel Ruiz (CREA, Valencia), Yolanda Cabello (Hospital Ruber, Madrid) y Luis Alfonso de La Fuente (Instituto Europeo de Fertilidad, Madrid).

En definitiva, la medicina reproductiva avanza gracias a la SEF y a sus miembros, alma máter de la sociedad en palabras del presidente el Dr. Luis Martínez Navarro.

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