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
12Jul

María De Las Heras from Reproducción Bilbao performed a [wp_colorbox_media url=»https://reproduccionbilbao.es/wp-content/uploads/2016/06/ESHRE2016.-POSTER-Reproduccion-Bilbao.jpg» type=»image» hyperlink=»poster presentation«] at 32 nd ESHRE Meeting at Helsinki. The validation of the Eeva testTM algorithm in an Embryoscore incubator was assessed.

The published data confirmed a positive and significant association between the high scored embryo transfers and a higher ongoing pregnancy rates.

The advantages of undisturbed embryo culture in a stable device such as the EmbryoScope time-lapse incubator in association with the use of the model of Eeva Test TM do represent an important improvement in IVF, reducing early pregnancy loss and increasing ongoing pregnancy and implantation rates.

Moreover, although the evaluation of morphokinetics of embryos does not replace the genetic embryo selection, it is hard to understand how standard incubators without any kind of video-time- lapse system are still in use in some assisted reproduction centers. In this setting, the ability to choose the most suitable embryo to be transferred allows to perform a single embryo transfer in most of the cycles at Reproducción Bilbao, thus avoiding multiple pregnancies.

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)

cultivo-embriones
20Jun

Por María De Las Heras

¿Qué significa cultivar embriones? Muchas pacientes se lo preguntarán cuando reciben la llamada del embriólogo para informarle de que sus embriones “en cultivo” están evolucionando correctamente, o que vamos a realizar un cultivo hasta blastocisto… y se preguntarán ¿dónde cultivan mis embriones? Con este post queremos intentar explicar en qué consiste cultivar los embriones y la importancia de que este cultivo se lleve a cabo utilizando los “medios de cultivo” adecuados.

La finalidad de la fecundación in Vitro (FIV) y el cultivo embrionario es conseguir embriones de buena calidad capaces de desarrollarse e implantar, dando lugar a nacimientos viables. El éxito de la FIV está sensiblemente comprometido si las condiciones del cultivo no son las óptimas, ya que, de esta forma, se puede afectar al desarrollo embrionario normal y disminuir la viabilidad del mismo.

Para obtener un correcto desarrollo embrionario es necesario no sólo disponer de condiciones óptimas en el ambiente del laboratorio e incubadores sino también de unos medios de cultivo adecuados que soporten el desarrollo desde la obtención del ovocito hasta la transferencia del embrión al útero.

Cuando la fecundación se produce de forma natural tiene lugar en las Trompas de Falopio y desde allí el embrión avanza hasta alcanzar el útero, donde podrá implantarse, sobre el día 5 o 6 de su desarrollo, en el estadio de blastocisto. El embrión humano a medida que avanza por las trompas hasta alcanzar el útero e implantarse va cambiando sus necesidades energéticas para su correcto desarrollo. Por ello, durante el tiempo que avanza por las Trompas, el líquido que le rodea y le facilita los nutrientes va cambiando de composición .

Este cambio en las necesidades del embrión tiene que verse reflejado en los medios de cultivo que utilizamos en el laboratorio permitiendo simular al máximo el ambiente uterino. Para ello utilizamos placas de cultivo embriotestadas en las que depositamos microgotas de estos medios de cultivo donde colocamos los embriones. A medida que estos se desarrollan, como hemos dicho, sus necesidades energéticas cambian y para satisfacer esas necesidades es necesario que el embriólogo en el laboratorio vaya cambiando a los embriones de medio. Esto es, a medida que se desarrolla el embrión en el laboratorio se han de modificar las condiciones del medio en el que vive, de la misma forma que ocurre en la fecundación in vivo (en las trompas de Falopio de la mujer).

Al inicio de las técnicas de fecundación in vitro, los embriones se transferían al útero “cuanto antes”, ya que no existían medios que pudieran soportar un correcto desarrollo hasta blastocisto y se transfería más de uno ya que la congelación de embriones tampoco estaba muy desarrollada. Actualmente, los medios que se usan en los laboratorios, junto con la aparición de incubadores como el Embryoscope TM o el Geri TM que mantienen más estables las condiciones de cultivo permiten a los embriólogos cultivar los embriones hasta estadios más avanzados de su desarrollo. De esta forma, la capacidad de seleccionar el mejor embrión (aquel con mayor probabilidad de implantación) mejora. Además, al seleccionar mejor y disponer de un programa de vitrificación muy desarrollado, podemos transferir un solo embrión. Todo ello nos lleva a tener más embarazos en general y menos gestaciones múltiples en particular, en definitiva a tener los mejores resultados.