Juan Manuel Moreno García, MBMS
Embryologist at UR Vistahermosa , UR Vistahermosa
Donor Eggs, Embryo Transfer, Failed IVF Cycles, IVF Abroad, Success Rates
Consultants must always start by taking a detailed account of their patients’ clinical history even before running any tests. It’s also critical that testing is carried out on both the male and female in each couple. A woman’s ovarian function needs to be checked, and uterine screening is a necessity to ensure that, when the embryo is transferred, the endometrium is adequate to receive it.Sperm analysis should not only be checked for its count and morphology but also for signs of DNA fragmentation, which can have a negative impact on fertilisation. Dr Moreno would also recommend male patients undergo a FISH (Fluorescence in situ Hybridization) test. This procedure studies the genetic material in the sperm cells to determine whether there are any chromosomal anomalies which could hinder the IVF process. By using these two techniques, in addition to regular semen analysis, medical teams are enabled a greater insight into the genetic condition of the sperm which is going to be used in fertilisation. If any issues are discovered, following these tests, then embryologists can use this knowledge to help them select the individual spermatozoa to use and, through medication, are sometimes able to improve the overall quality of the sperm.
IVF is a thoroughly personalised treatment which needs to be adapted for every patient. Prescribed doses and length of the ovarian stimulation processes must be adjusted to suit each individual woman, in order to maximise IVF potential and also avoid any adverse health complications during the process. Dr Moreno cautions against clinics using a fixed treatment protocol.With IVF it is necessary to surgically retrieve the eggs. This is usually done under sedation and, once collected, the eggs are sent to the clinic’s laboratory where any mature eggs are used for fertilisation. For couples where the male has low sperm quality then ICSI is usually performed. ICSI is the process of injecting a single, handpicked morphologically normal sperm into a single healthy oocyte (egg). After fertilisation the cells are then placed into an incubator, where they hopefully continue to grow and develop for between three to six days. After this time, embryos are then transferred into the uterine cavity with the aim of achieving a pregnancy which results in a live birth. When researching which medical centre to use, Dr Moreno stresses the importance of choosing a clinic which uses time lapse incubators. Time lapse technology improves the embryo culture experience by ensuring the embryos are in a constant, unchanging, environment. As this type of incubator is continuously recording the embryonic development, embryologists do not need to physically remove them from the incubator in order to observe. Time lapse technology creates the optimal conditions required for cultivation. The around the clock imaging also helps embryology teams to be more selective when choosing embryos for the transfer, whilst providing patients with increased information. UR Visterhermosa have noticed improved pregnancy rates when using this type of technology at their clinic. Genetic compatibility testing of embryos can now be carried out too in the form of PGS (pre-implantation genetic screening). PGS is mainly offered when IVF has resulted in a low number of embryos or following implantation failure, or miscarriage, after a healthy embryo has been transferred. For PGS to be carried out a trophectoderm biopsy must take place in order to collect the trophoblast cells, for testing. For this procedure, a small hole is made in the outermost layers of the embryo and a needle is introduced to remove a sample, which is then analysed to give each embryo a genetic diagnosis. Screening helps to detect embryos that might carry any genetic anomalies, enabling the transfer, or freezing, of only healthy, euploid (chromosomally equal) embryos; the ones which are more viable and have a higher reproductive potential.
Dr Moreno would also advise serology testing, especially in women who have suffered from repeated implantation failure or recurrent miscarriage.Serology is the diagnostic examination of blood serum, especially with regard to the response of the immune system. Whilst it is currently a rather controversial topic, research is being conducted into this area as immunology is thought to affect the outcome of an IVF cycle. If testing highlights any immune system conditions, then medication can be administered before, during and after the transfer. Finally, before transferring an embryo, a woman’s uterine cavity should be regularly monitored. A healthy endometrium is known to aid implantation and properly support an embryo in early pregnancy. If required, hormones can be prescribed, by consultants, to improve endometrial thickness and quality. Dr Moreno explains that the only goal any one wants, following a cycle of IVF, is pregnancy and live birth. He advises it’s of utmost importance that medical teams work with their patients, understanding that everyone and every infertility case is different and unique. Treatment protocols and regimens need to reflect this and must be tailormade for each individual. Dr Moreno firmly believes that it’s only by personalising treatment and ensuring a correct fertility diagnosis, that clinics will be able to achieve better results and IVF pregnancy success rates, offering additional hope to couples who are undergoing IVF to try and have a much longed for child.