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ESHRE
11Ago

Por el Comité Editorial de Reproducción Bilbao

Durante la primera semana de julio tuvo lugar la 37º edición del congreso organizado por la European Society of Human Reproduction and Embryology (ESHRE).  Para los que no la conozcáis, es una de las asociaciones más importante del mundo en materia de Reproducción Asistida y la más grande en Europa, y su congreso anual el que mayor número de especialistas en medicina reproductiva congrega en el mundo.

Para que os hagáis una idea de su importancia, parte de las recomendaciones que hemos seguido todas las clínicas de infertilidad, han sido seguiendo sus directrices junto a las disposiciones del Gobierno.

Este año, por primera vez, y debido a las medidas de seguridad para evitar la propagación del virus, el congreso se ha contado con la peculiaridad de haberse realizado de forma de forma virtual.

Para Reproducción Bilbao, la participación en este congreso ha sido un motivo de éxito. Cada año se presentan multitud de comunicación y posters en el congreso, siendo el porcentaje de admisión muy bajo. En este sentido, nuestra comunicación “COVID-19 among assisted reproduction patients in Spain. What should we do to stop the spread of infection” fue una de las seleccionadas para ser presentadas en el congreso, lo que supone todo un motivo enhorabuena y constatar que los estudios que hemos realizado sobre las medidas que se deben aplicar en las clínicas son las correctas.

Nuestra comunicación ha sido el resumen del estudio que hemos llevado a cabo desde Reproducción Bilbao sobre 194 pacientes de la clínica y 19 miembros de nuestro equipo entre los días 4 y 18 de mayo.  Para realizar el estudio, hemos realizado un doble test a las pacientes que han acudido a la clínica para realizarse bien una punción ovárica o una transferencia, aplicando tanto el test PCR como el test para determinar su serología. Del mismo modo, este doble test se ha aplicado a todas las parejas de nuestras pacientes.

De la muestra que seleccionamos, es interesante destacar que el 30,4% de las mismas permaneció confinada durante el estado de alarma, y que casi otro 30% realizó teletrabajo durante todo este periodo.

Del total de la muestra, 189 pacientes fueron asintomáticas, mostrando dos ellas cierta determinación serológica una vez realizada la prueba en sangre y ninguna dio positivo en el PCR. Además, 8 confirmaron que en su entorno cercano si hubo casos de coronavirus y sólo una tuvo opción de realizarse el test una vez notificado el contagio.

Por lo tanto, la conclusión de nuestro estudio tal y como lo presentamos fue la conveniencia de chequear, con respecto a COVID19, a las pacientes y sus parejas más allá de la evaluación de la sintomatología (teniendo en cuenta el porcentaje de asintomáticos transmisores) para estar totalmente seguros de que no existe el contagio.

 

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
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