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Home Reproduccion Bilbao (Page 37)

Autor: Reproduccion Bilbao

ESHRE-2015 - Reproduccion Bilbao
29Jul

Which is the best embryo to transfer? To improve the efficiency of IVF treatments it is essential to identify the right embryo, the one that will lead to a healthy child at home.

Unfortunately, even the transfer of a morphologically “perfect” and chromosomally assessed embryo, does not guarantee a pregnancy.

New methods for the identification of viable embryos are urgently required. It is clear that many other elements play a key role in embryo viability. One of this elements seems to be mitochondrial DNA, which has been one of the main issues in past ESHRE 2016.

Mitochondria are intracellular structures that can be seen as “source” or “processors” of energy. Although DNA is mostly packaged in chromosomes within the nucleus of the cells, mitochondria also have a small amount of their own DNA (“extranuclear” DNA).

Scientists are not sure why some embryos experience a sudden rise in mitochondrial DNA but according to many studies presented at last ESHRE congress, those morphologically and chromosomally “perfect” embryos with unusually high levels of mitochondrial DNA have no ability to produce a baby. One possibility is that defective embryos make more mitochondria to give them enough energy to survive, but ultimately fail to develop and stop growing.

Taking this into account, mitochondrial quantification seems to be a “new” good candidate to be used as a marker of embryo viability in those chromosomally normal embryos.

ESHRE-2015 - Reproduccion Bilbao
13Jul

We do know that thanks to assisted reproduction a pregnancy will be achieved in most cases. However, many times, the road is long and tortuous. And, as a consequence, many patients cannot withstand such a long way and decide to discontinue treatments before conceiving. The question we should be able to answer is why some couples discontinue their treatments.

Research focusing on treatment’s dropouts has been performed. Both physical and psychological burden are the most mentioned causes of treatment discontinuation. Reduction the time to birth (i.e. the period of time from the initial visit to an assisted reproduction center and the achievement of a pregnancy) implies many issues. First, the diagnostic work-up should be simplified avoiding useless diagnostic tests. Second, nowadays, we may propose more comfortable and safer ovarian stimulation strategies (using GnRH antagonists instead agonists or by administering single doses products) thus shortening the treatment, reducing injections and avoiding ovarian hyperstimulation syndromes. Third, laboratory procedures allow us to select the embryo with the highest chance of implantation (incubating embryos into video-time- lapse systems, selecting genetically the embryo, transferring on day 5, avoiding multiple pregnancies).

But even with these advances, many cycles result in failed attempts. In such cases, treatment burden should be reduced by better care organization and support for patients. At this point patients should be well informed, have the opportunity to discuss values and worries about treatment and receive advice to decide whether to continue or not treatment.

This support (information of previous failed attempts, proposal of new treatments and discussion worries) is of utmost importance for patients.

ESHRE-2015 - Reproduccion Bilbao
11Jul

Joaquin Llacer from Instituto Bernabeu (Alicante) offered one of the most brilliant and awesome presentations at ESHRE Meeting held at Helsinki this month. It is admitted that embryo aneuploidy frequency increases with women’s age. According to data from Instituto Bernabeu as much as 40,6% of analyzed embryos showed some type of aneuploidy. Overall, this means that the fate of 4 out of 10 embryos will be either no implantation or a miscarriage. As expected, the aneuploidy rate increased with age. The rate was higher than 80% among women aged 42 and older. No news, here.

But the relevance of Joaquin Llacer`s presentation was the high and in someway surprising high rate of aneuploidies observed among women younger than 22. More than 40% of embryos from women included in this young range were faulty from a chromosomal point of view. This means that even in an egg donation program it is worthwhile to analyze the embryos to be transferred.

In summary, two lessons may be learned from this outstanding presentation. First, the transfer of embryos without a chromosomal analysis (i.e. without performing a genetic screening) will (should) be reduced in the future taking into account that as much as 4 out of 10 embryos may be defective (so, 6 out of 10 useless embryo transfers could be avoided). Second, and more surprisingly, even in the context of an egg donation program genetic screening may be suitable. Anyway, if an egg donation treatment is proposed, it is advisable to choose donors older than 21.

ESHRE-2015 - Reproduccion Bilbao
29Jun

The 32nd Annual Meeting of European Society of Human Reproduction and Embryology (ESHRE) will be held in Helsinki, Finland, from 3 to 6 July 2016, and Reproduccion Bilbao (RB) will take part in it. The aim of the ESHRE is to provide a forum for the exchange and discussion of new clinical and scientific ideas. Annually a meeting is hold in a different European city where clinicians and embryologist bring their latest studies, share there ideas and learn about the latest advances in assisted reproductive area. Reproduccion Bilbao (RB) will contribute to the meeting with a [wp_colorbox_media url=»https://reproduccionbilbao.es/wp-content/uploads/2016/06/ESHRE2016.-POSTER-Reproduccion-Bilbao.jpg» type=»image» hyperlink=»poster presentation«] about Embryoscope and Eeva, the two main time-lapse systems.

Reproduccion Bilbao (RB) IVF laboratory is the only one in the Basque Country equipped with the two main time-lapse systems that are currently in the market, the Embrysocope and the Eeva System. The time lapse technology applied in assisted reproductive area has led to a better culture of embryos and a better knowledge of their morphokinetics allowing the embryologist to select the best embryo for transfer.

In Embryoscope the image acquisition unit is an integral part of the culture chamber, allowing the monitoring of embryos while they remain inside a controlled, stable culture environment. The Eeva System categorizes embryos on day 3 into “High” or “Low” likelihood of usable blastocyst formation groups but fitting into a standard incubator where the conditions are not so stable as in a benchtop incubator as Embryoscope. Taking this into account we decided to check how the Eeva´s prediction would work when embryos were cultured in a benchtop incubator, such EmbryScopeTM, instead of a standard incubator.

Our data ([wp_colorbox_media url=»https://reproduccionbilbao.es/wp-content/uploads/2016/06/ESHRE2016.-POSTER-Reproduccion-Bilbao.jpg» type=»image» hyperlink=»see poster«]) confirm that the Eeva prediction is very useful when embryos are cultured in Embrysocope, due to the association between the high scored embryo transfers and the higher ongoing pregnancy rate. Our results suggest that the perfect incubator would be the one that provides undisturbed embryo culture in a stable device such as Embryoscope does but also permits to implement a cell-tracking software algorithm such as Eeva Test´s model to predict embryo viability.

22Jun

Entrevista el correo - Reproduccion Bilbao 23-04-2016 (Copiar)

QUE HACER CON EL DOLOR DE REGLA
17Jun

Recientemente he leído un artículo en que se habla del tratamiento del dolor de la regla mediante la utilización de un pequeño dispositivo equipado con unos electrodos que deben colocarse en la zona del vientre, este emite pequeñas descargas que ayudan a calmar el dolor. Este dispositivo no es nuevo: es lo que se conoce en medicina con el nombre de TENS ( Estimulación Nerviosa Eléctrica Transcutánea) y es un método de control del dolor conocido desde 1965. Esta basado en la "teoría de la puerta de control espinal". Esta, muy resumidamente, se basa en la diferente velocidad a la que viajan los estímulos a través de las fibras nerviosas según sus características de grosor y estructura y su modulación en el centro cerebral llamado tálamo, a su vez este modulará la respuesta en función de la producción y consumo de endorfinas.

Aunque se ha mostrado eficaz en algunos dolores crónicos con afectación de nervios periféricos es escasamente eficaz en dolores agudos parenquimatosos (viscerales) como la regla, por lo que puede dudarse de su recomendación en este tipo de dolores. En todo caso si puede producir un efecto placebo y por tanto ser utilizado junto con otras terapias.

Respecto a la dismenorrea (dolor de regla), conviene tener en cuenta de forma genérica que se trata de un síndrome en el que pueden concurrir multitud de síntomas: dolor, cefaleas, nauseas, mareos, ansiedad, depresión, irritabilidad, calambres en miembros inferiores… Abarcando tanto el ámbito físico así como emocional e incluso social. Esta variación da lugar a una graduación del padecimiento y por ello al abordaje terapéutico personalizado. Es importante resaltar la importancia de ser valorado por un médico especialista que pueda descartar otras posibles patologías enmascaradas subyacentes que puedan ser graves, tanto ginecológicas (miomas, endometriosis, pólipos, embarazos anormales…) como no ginecológicas (gastrointestinales, urológicas, músculo esqueléticas ) ….

Por todo ello el tratamiento debe ser dirigido y personalizado por un médico especialista. Entre los remedios más comunes se encuentra la administración de analgésicos como dexketoprofeno, ibuprofeno, naproxeno … así como paracetamol. Estos pueden aplicarse junto con otras medidas medidas físicas como la aplicación de calor local, ejercicios físicos (paseos), el aumento ingesta de líquidos, masajes ….. En los casos en los que sea necesario también puede combinarse con antihemeticos, que ayuden a eliminar las náuseas o ganas de vomitar.

Dr. Juan Angel Martínez
Anestesia y Reanimación
Hospital Marqués de Valdecilla

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