How to prepare for IVF?

Juan Manuel Moreno García, MBMS
Embryologist , UR Vistahermosa

Donor Eggs, Embryo Transfer, Failed IVF Cycles, IVF Abroad, Success Rates

How to prepare for IVF?
From this video you will find out:
  • How should patients prepare for IVF treatment?
  • What diagnostic tests are essential before starting an IVF cycle?
  • Why is it important to assess both partners’ fertility before IVF?

Preparing for IVF – diagnostics, the procedure, and important tests

Watch the video recording of our webinar titled “Preparing for IVF – diagnostics, the procedure, and important tests to make the best from an IVF cycle”. The webinar topic was presented by Dr. Juan Manuel Moreno, Director of the Embryology Laboratory at the Reproduction Unit of Clínica Vistahermosa in Alicante.

Before an IVF cycle

Being told that IVF is needed to have a family is a daunting prospect. Patients are often left wondering what exactly the procedure entails alongside what they can do to aid a successful outcome. Whilst the internet can be an incredibly useful tool, it also has the capacity to leave individuals feeling overwhelmed with an overload of information, fertility myths and, at times, conflicting advice.

In this webinar, Dr Juan Manuel Moreno, embryologist and director of the laboratory at UR Visterhermosa in Alicante, Spain, outlines the in vitro fertilisation treatment process and describes the diagnostics tests he believes are crucial for helping medical teams advise patients how make the most out of an IVF cycle.

Regular advances in reproductive methods and technology are constantly improving pregnancy rates, offering increased hope to many who are desperate to become parents. As innovative as this is, technology doesn’t hold all the answers. It’s therefore imperative that patients are correctly diagnosed with any underlining medical conditions, and that they are properly prepared in advance of their treatment.

All patients undergo basic fertility testing before embarking upon any cycle of IVF, however, Dr Moreno believes additional testing also needs to take place, arguing that it’s only when medical teams have a complete understanding, about a person’s fertility, that they can begin to decide on the best route forward. Having full information of the whole reproductive situation is essential for assessing what fertility treatment options are best advised to give patients that greater chance at pregnancy.

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.


- Questions and Answers

What do you think about using embryo glue in case of implantation failure? Is it effective?

Embryo glue doesn’t help implantation. It’s something that we use in our clinics as a standard in every treatment as it helps. It’s like a viscous liquid that we use in the place for the deposition of the embryo but it has nothing to do with implantation. It has to do with a better use and an improvement in the process of the culture.

I’ve had a failed IVF with ICSI with fresh eggs. My doctor recommended endometrium scratch with the 2nd cycle. Not sure if I should go ahead with it as it costs extra. What’s your opinion?

Nowadays there is no scientific or medical evidence that endometrium scratch improves implantation. Anyway, most clinics—and we can include ourselves—do it because our aim is to do all we can to help the implantation. So, should you have it? We think that, yes, you should.

I’m a healthy 32-year-old woman. However, after 2 years of trying we ended up in two IVF cycles with 14 and 10 eggs. Unfortunately, they could not be fertilized. The embryologist explained the next day that they had abnormal morphology—cytoplasmic halo like cytoplasm which could be seen after denudation and could not be fertilized with ICSI or IVF. What could be wrong with our eggs?

According to the doctor’s experience, the most important thing that you need to know when you want to fertilize the eggs is if they are mature or not—especially if you are going to do an ICSI because the IVF can be done with any egg but ICSI can be done only with mature eggs. Only 20% of eggs, once they have been retrieved and we know if they are mature or not, are considered perfect but this is not what we need to take as a starting point. What we do need to take a starting point is to check if the eggs are mature and if so, you need to fertilize all of them. Then if the fertilisation rate it not good then you can think about not doing another technique or improving the matureness of the eggs in another cycle but if you have 14 or 10 eggs you need to check which ones are mature and these ones should be fertilized. No other factors should be taken into account.

Does your clinic offer donor egg or embryo guarantees?

We don’t believe in guaranteeing pregnancies because that’s not possible but our guarantees involve donor egg, embryo or IVF programs. If you are not pregnant after 3 cycles, we refund 100% of the money, so it’s a guarantee. A refunding guarantee—that’s what we offer. That’s how we commit to our patients.

Is it recommended to do PGS in the case of egg donation?

In the first instance, unless there is some kind of pathology or problem, it is not necessary because the donors have stayed in Vistahermosa clinic and screened genetically and we do a parallel of lots of genes so it makes no sense. Or maybe the sperm is altered or the FSH is altered but not because of the donor.

I’m planning a second IVF with my own eggs. What if it fails? Should I keep trying with my own eggs? I’m 32. Is the egg quality the most important?

Being 32, you should try at least until you have had 3 cycles as you are very young so you have the eggs but you also you have the age, which is an important factor. What we recommended is to use time lapse in every case so that we can check that the development of those embryos is improving and always do the transfer around day 5 because we have a more advanced embryo. So, the implantation rate could be better and we could control the quality of the transfer. Most centres do the transfer around day 3. We highly recommend doing it on day 5 because from day 3 to day 5 we get much more information so if we transfer two days before, we miss that information if we don’t have so many details about what we are transferring.

What documents does the patient need to provide for the first exam/meeting with the doctor?

It depends, but normally it’s your medical history, an ultrasound scan and a transfer test to avoid any problems during the embryo transfer and, if you have a partner, ask him for an analysis if possible—DNA fragmentation and FISH (semen analysis)—and for both of you etiology, which are your viral tests, and the karyotype also to check if you are chromosomally normal. We could send you this in an email if you want to have it.

Is it normal to prescribe Levothyroxine if you don’t have an underactive thyroid?

Not necessarily. But this is something personal for each clinic or doctor but normally it’s not very common.

Do you still accept patients in December? Do you close for the Christmas break?

We are a hospital. We never close. We are always open, Christmas, summer, so patients are welcome when they need it. We are open 365 days, 24/7.

I have been told that as I am over 50 I have a much higher chance of miscarriage. What is your opinion?

Here there are several factors. For someone over 50, the technique could be egg donation for sure. If you have a partner, we should also check how old he is and the sperm quality, and evaluate all the issues. We should also look at how you feel, your body mass index, your health and some other things before going ahead. (Elaboration on the question): the patient would use donor eggs and donor sperm. We should check your body mass index, your physical condition because you are at the age limit for treatment. If we could do it, we need to be sure that we can help you and we could transfer one good blastocyst but only one. This is mainly to protect you because a pregnancy at fifty years of age can be quite dangerous.

How do you determine when I’m ready for the embryo transfer (with an egg donor)?

When you have a triple line in the endometrium. When you have a trilaminar in the endometrium and the thickness is over 7 millimetres.

Do you do Skype consultations?

Yes, we do Skype consultations every day except Sundays, so that could be possible. We are quite flexible about the working hours, too.

If so, how much does it cost?

Normally it costs 50 euros but for the webinar attendees, it’s free.
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How will this affect my future child? 40+ intended parents’ concerns (age, donor conception, single motherhood)
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Juan Manuel Moreno García, MBMS

Juan Manuel Moreno García, MBMS

Juan Manuel Moreno García has a degree in biology from the University of Alicante, a Master’s degree in Human Reproduction and Human Reproductive Biology, has completed postgraduate courses in Obstetrics and Gynecology at the University of Valencia. He is also Semen Analysis Specialist and has been awarded numerous diplomas by ESHRE and the Association for the Study of Reproduction Biology (ASEBIR). Dr. Juan Manuel Moreno García is a Director of the Embryology Laboratory at the Reproduction Unit of Clínica Vistahermosa in Alicante. Dr. Moreno is a Member of Scientific Associations: Spanish Association of Biologists (COB), Association for the Study of Reproduction Biology (ASEBIR), Spanish Fertility Society (SEF), Spanish Society of Andrology (ASESA), European Society of Human Reproduction and Embryology (ESHRE).