Fertility Experiences

The National Sterility Congress is taking place this week, and one of Institut Marquès’ contributions consists of our learnings on the embryos thanks to the Embryoscope.

When our center’s biologists come into the In Vitro Fertilization lab every morning they are fascinated by every embryo’s video.

These images are so shocking that we have been wanting to share them with our patients ever since we first saw them, in order to share our excitement with them… At first, I personally felt sorry as they were missing on such a beautiful process, so we started designing a system to put an end to this situation. After much work, this week the new system is all set to see the green light: all our patients can access their embryos’ images from their homes, see how every one of them is at that same moment, and how it has developed since fertilization. It’s like an “Embryo Big Brother”… watch the video, it’s worth it!

This week we’re presenting a beautiful study in London that shows what happens to embryos when they get to the uterus, both naturally through the fallopian tubes and after an In Vitro Fertilization treatment through the cervix.

The endometrium (the inner membrane of the uterus) has several motion schemes and during the embryo’s arrival phase, its function is to keep it in the uterine cavity, impeding its expulsion and implantation in inadequate areas.

In this video of an embryo transfer, we can see how the microdrop containing the embryos is moved from one place to another following different motion patterns: undulating, vibratory, slow, fast, and with rest phases.

After an embryo transfer, most of our patients feel guilty for not resting enough, especially when the cycle isn’t successful.

We tell them rest isn’t necessary right after embryo transfer or even during the days after, but they’re surprised by this fact and don’t pay much attention to us.

They’re afraid if they get up or make any kind of effort, such as going to the restroom, the embryos “will fall”; they think they must be alert to keep them in the uterus.

This generates an added anxiety to the stress of not being able to rest as much as they’d wish. Additionally, this coincides with the most nerve-generating and emotional lability phase: the two week wait until the pregnancy test.

It’s a waiting period that’s full of desire and hope that the embryos will implant, full of fear of failure and full of emotion.

These findings downplay the importance of rest and support the early mobilization of patients after embryo transfer. I believe it will help to know that implantation doesn’t depend on anything you can do or stop doing, and that once embryos arrive to our uterus, the endometrium is in charge of the rest…

It’s as if it cradled the the embryos for their implantation in a good spot!

Today I’d like to share the results of a survey we’ve carried out on our patients with you.

We’ve asked up to one thousand patients from 31 different countries, all childless and with fertility troubles, if they would prefer to have twins, an only child, or if they didn’t mind either option.

The results show that most patients would rather have twins, up to 70% either want a twin pregnancy or don’t mind, whilst only 30% wish for a single pregnancy.

As sterility specialists, we aren’t surprised by these findings. Every day we go through the conflict between what our patients want and what we, as doctors, recommend, as it’s hard to explain all the risks a twin pregnancy entails to a woman whose biggest fear is never becoming a mother. When speaking of the possibility of giving birth to twins, most imagine they’d be double times happier because their family would already be complete.

It’s hard to decide on the number of embryos we must transfer to achieve success while preventing, at the same time, a twin pregnancy.

For an embryo to implant after In Vitro Fertilization, and for it to lead to an evolutive pregnancy, it’s necessary: that the uterus is ready to take it in, that the embryo has an adequate morphology (number of cells, similar appearance of these, etc.), that it has a normal chromosomal set, a powerful energy (given by mitochondria, less intense as ovaries get older), for the embryo and endometrium to work together to achieve implantation, and for immunological rejection not to happen. For us, who dedicate our lives to this matter, every single baby is a miracle!!!

According to studies carried out in our Center, in the best of cases, when embryos come from egg and sperm donors, 50% show chromosomal abnormalities and that percentage is increased with the woman’s age, reaching 85% altered embryos in 40 year old patients.

Thus, the main strategy to reduce the risk of having a multiple pregnancy without lowering pregnancy rates is to analyze the embryo’s chromosomes to transfer only those that have the potential to evolve.

Nevertheless… whenever we see two little ones in the scan, in most cases we wholeheartedly share our patients’ great joy and pride!

Coks Feenstra, expert in twin studies, after intervewing dozens of adult twins, asserts that “being a twin means having double amount of joys and half the number of sorrows.”

12 years ago we had the opportunity of living an excepcional case. We had not double, but triple amount of joys: the birth of identical triplets.

Embryoscope is a new incubator for our small embryos that includes an incorporated video camera to film their development.

 In the medical field, it offers us two main advantages:

• First, we no longer need to remove the embryos from the incubator to watch them under a microscope. Thus, we can prevent any changes in their temperature, light exposure, etc. In the previous post, I described the importance of maintaining the embryo’s environment constant.
• Second, we’re allowed to watch how the embryo has been fertilized and divided. Thanks to this, we can choose the one we consider has followed all the steps and will have a better implantation. With normal incubators, we can only see them once a day, so we have a lot less information about the embryos.

Additionally, Embryoscope gives us the opportunity to learn and discover a whole lot of new things about embryo development!!!

In our Centre, each embryo is evaluated daily. Just like in school, 10 is the top grade we can give them. We base our criteria on: the embryo’s number of cells and whether it’s adequate to the day of development it’s in; whether the cells are similar between them; if they don’t show many fragments (impurities from previous cell divisions); and whether every cell has an only nucleus.

For example, a four-cell embryo, 40 hours after the In Vitro Fertilization, will be given a top grade in the field of cell division. Imagine, though, that in the Embryoscope video we observe that one of the cells fuses with another one and gets absorbed, thus having only three cells remaining. If we hadn’t seen this, it could happen that by exam time on the following day, that embryo already were in eight cells, were given an A by us again and were chosen for the transfer as it would seem one of the top embryos.

This is only one of the many examples I could give you, but we know that the embryos that don’t follow the adequate behavior have fewer possibilities of developing, since an anomalous behavior is associated to having chromosomal alterations or other negative aspects that we don’t know of yet and are trying to discover.

You must already know the fascinating fact that no two people in the whole world are physically equal, except for identical twins, that is, as they come from a divided embryo.

But… Did you know there aren’t two equal embryos either? Were you aware that from the very moment in which fertilization occurs, we begin to differentiate and adopt the characteristics that will make us unique?

Each embryo, each fetus, each child, each person is an unrepeatable miracle from nature. The number of possible genetic combinations is infinite, and the probability that it will be repeated is virtually impossible. The human genome has 3,200 million nucleotides, or subunits that form DNA, that combine differently in every single person.

In this video of Embryoscope you will observe the development of a human embryo from the very moment in which the egg gets fertilized and up to five days later.
A couple of hours after oocyte retrieval, we carry out an ICSI, or the injection of a sperm into each egg, on them.
Embryoscope starts filming immediately after In Vitro Fertilization is carried out.
In the lower right corner of the images we find the time count for each moment.

In this other video of Embryoscope, the images show a mouse’s embryo, which we bought frozen for our Lab’s quality controls and for investigation.

Today, I want to show you around our IVF Lab, how we have made it into a giant uterus and how one must work in it.

First, I must ask you to imagine the inside of a uterus…

How lit up is it? Well, it isn’t at all, so our lab recreates its darkness.

What’s its fragrance? It doesn’t smell like anything. The environmental control ensures that our biologists don’t use any cosmetics or perfumes. Luckily, they’re allowed to use deodorant, though it can’t contain any alcohol or additional scent.

How warm is it? Exactly 37ºC. It counts with a constant temperature control system that supervises both the incubators’ heat and the surfaces where the cult sheets with the embryos are placed.

What do we find in the uterus? Its inner layer is known as the endometrium. Throughout the menstrual cycle it changes and prepares its surface, producing a fluid that will enable the embryo to nest. We recreate this in a fantastic way: we place these endometrial substances in our cult means.

What don’t we find? Pollution of any kind, of course. You can’t even imagine how hard this is to achieve!

Having a sterile atmosphere implies counting with lots of technology and effort. We must prevent all germ-like pollutants from entering, as well as our “special enemies”: organic volatile compounds. These chemical substances are found in paint, solvents, hairspray, cosmetics, etc, and remain in the atmosphere as vapors. They tend to stick to greasy means. Our cult means contain oils, and these substances are embryotoxic.

To access our lab, you must wear a clean uniform, hat, and shoes, and you must take all accessories off, such as a watch or makeup.

When you open the door, you’re surprised by the positive pressure. You feel a slight breeze on your face that prevents the air outside from entering the lab.

The floor is covered with a material that discharges static electricity, and, at first, your feet get stuck to its particle-absorbing rugs.

The ceiling has absolute carbon active filters that maintain the air in the room pure.

The work cabins have a CO2 and humidity concentration that are much higher than normal, since it’s how embryos like to rest. The tables are hydraulic, so when our biologists lean on them they don’t transfer their vibrations to the embryos.

By the way, cell phones don’t ring in the uterus, so they aren’t allowed our lab either. This way we prevent any damages caused by their radiofrequency.

As you can see, we treat our embryos like marquises.

Today has been very special for me professional-wise!

I carried out a press conference in order to present the results of a study that was published in Revista Internacional de Andrología.

We analyzed and compared the concentration of 38 toxic substances in the maternal milk of both catalan and galician women in order to try to prove that the great difference in sperm quality between both geographical areas is due to their different levels of pollution.

These toxics are known as endocrine disruptors, a long compound listing that act as estrogens in women’s organisms.

These substances pile up in fat, which is why we have studied them in maternal milk as it’s technically easier, since the concentration of these in it equals the amount that get to the embryo through the placenta.

A couple of months ago, we also published a study on the presence of toxics in three different brands of commercial milk and two of cereal.

It has been a really difficult task, not only because of the technical matters, but due to the possible social repercussion our findings could have. I have counted with the absolute colaboration of Damiá Barceló and Marinela Farré, both CSIC researchers, Prof. Juan Alvarez, Dr. Ferrán García, and Dr. Temprano (from la Coruña). I also want to thank Revista Internacional de Andrología.

It has been both tough and surprising to see the number of coward professionals who have rather avoided the possible social alarms or economic repercussions caused by the study than informed about the truth.

Here is the text that corresponds to the press release on “poor sperm quality is related to the transmission of toxic substances during pregnancy and lactation.”(PDF)

For obvious reasons, us women are attracted to sperm. In my case, I am dedicated to the study of sterility, so lets say it’s a healthy attraction. For this reason, I have pushed my sterility team to investigate male infertility for ten years.

Institut Marquès has been studying the quality of Spanish males’ sperm since 2003. First, in Tarragona, in a study presented at the SEF (Spanish Fertility Society) Congress, and then in Barcelona and Corunna in a study published in Reproductive Biomedicine. Finally in the whole country (I national study of youth’s sperm quality published in Andrologia and in collaboration with 62 reproduction centers).

We are proud that we have contributed in refuting previous misconceptions about causes for male infertility; (stress, tight trousers, alcohol, etc) they are all myths. The underlying cause are chemical toxics. Industrial contamination is playing a key role in this game.

These toxics are synthesized chemical products made by men, and regularly used in industry, agriculture and at home. They are called endocrine disruptors, a long list of compounds that in the female organism act as estrogens.

They are very resistant to biodegradation and can be found in our diet as well as in the atmosphere. They pile up in our organism, especially in fats, as we are not designed to eliminate them.

Our first contact with these chemicals takes place during the embryonic stage, as they are passed through the blood and placenta from mother to son. The type and level of toxics transmitted depends on the level of toxics that the mother has accumulated.

Currently there is debate on appropriate diets for pregnant women, yet the real issue is not what she eats but what has she been exposed to ever since her childhood, even since her intra-uterine life.

These toxics are absorbed and act as estrogens, or female hormones. During the fetus’ testicular development, the first 2-3 months are vital for testosterone, the male hormone, to act. The problem is that these false estrogens compete with testosterone and don’t let it function properly, thus producing less productive sperm cells and, in extreme cases, even causing chromosomic (genetic) alterations in them.

This is especially happening in industrialized areas and in rural areas that are in contact with pesticides. According to our data, the amount of ejaculation of a Galician male is double than that of a Catalan.

Also, it’s more apparent in young people than in older, as these toxics weren’t present during their childhood.

Once they become adults, this will be a main cause of subfertility in the general population. It doesn’t mean they will be sterile, but it will take them more time to achieve a pregnancy, depending on the age and fertility of their partner.

Individually, it’s a cause of sterility or repeated miscarriages.

According to official data, the main cause for sterility in Spain is the male factor, despite being the country where people have children at latter ages.

We have achieved many progresses in health yet in reproductive health, the level of sperm quality has halved form one generation to another in industrialized areas.

Currently, more experts are complaining about the effects of toxic chemicals for reproductive health.

Before reading this, please watch the video and try and count how many times the players in white pass the ball. Then, please read the last sentence of this text and then you can start reading.

Our eyes capture images, but what our brain actually sees is conditioned by what we know and what we are expecting; the mind compares what it sees to what it knows. This explains why we only notice driving school students when we are obtaining our own driving licence.

The other day, walking across the waiting room towards the changing room to go home, an image caught my attention: I thought I saw a man without arms or legs, with a pair of little green shoes stuck to his thighs. I thought this couldn’t be, that I had worked far too many hours, that if it was the case someone would have said something to me.

So I went back and checked: it was a foreign couple waiting for an egg donation; the woman was the one that had difficulties conceiving, while he only needed a bit of help in order to get his semen sample to carry out an In Vitro Fertilisation.

Two days before, something similar happened: I thought I saw a guy in pretty bad shape. When I went back, there was a young man whose face was all covered in blood and bruises. He was one of our patients’ boyfriend. She had come to donate eggs, and despite his terrible appearance, he was worried that she would get angry if he was late, so he came anyways.

I couldn’t believe anyone in the clinic had noticed these situations, so I started to do my own tests and investigated into this collective blindness. The first one was: one of our foreign patients was sleeping on a sofa after a long journey. Well, I decided to imitate him and laid down in the same position on the sofa in front of him, my white pyjamas on and all.

For the other experiment, I lied on the floor, right in the middle of the waiting room, and started playing with a girl who had come with her parents… we made huge castles with toys.

In both cases NO ONE saw me. In fact, everyone was looking for me all around the place and I was right in front of them.

This happens to us all: our conscious mind is selective and only sees a part of what there is; that is why we each have our own version of reality.

Now play the video again and pay attention to the monkey in it.

One must admit that in the last decades things have changed for the better and, nowadays, we can discuss a seminogram without any incidents.

Four years ago, the School of Medics in Barcelona found out that a patient tried to assault me; more specifically, he tried to throw me out the window! Since they were worried about medical assaults they encouraged me to bring charges.

At the trial the patient stated: “ Your Honor, this woman tried to perform a testicular biopsy on me.” The judge’s mixed reaction of surprise, fright and astonishment was somewhat… amusing.

When a specialist in Assisted Reproduction suggests a biopsy of the endometrium, it is understood that it’s only a regular test, necessary for the analysis of a patient’s fertility, whereas when we ask for a testicular biopsy, the male usually asks whether it wouldn’t be better “to go directly to the sperm bank”…

The myth that fertility is associated to the male and that sterility is associated to women is slowly vanishing. It’s a myth that’s changing at the same pace as all the daily situations that women are faced with in our society.

I’m referring to comments such as those made by mother-in-laws and their friends: “His clothes are much better matched since he got married”, or “they don’t have children yet because she loves going out, travelling, the gym… she’s a bit selfish”, or even “they haven’t had children because she’s waited way too long and now she’s already got a certain age…”

Both socially and reproductively, women haven’t yet gained the presumption of innocence.

That is still the big issue: We are innocent until proven guilty.

Both gynecologists and pediatricians are constantly surprised that most couples haven’t changed a diaper or don’t even know about the umbilical cord up until the moment of labor.

We ask ourselves: have they never taken care of a baby, even if only for a little while? Haven’t they wondered about their own belly buttons? What were they thinking about during these last nine months?

Additionally, they’re usually couples that have broad awareness on common knowledge; they thoroughly get ready for any task, they read about a movie before they watch it at the movie theaters, they study touristic guides before going on a trip… but, nevertheless, they’re widely unaware of many details about the little one that will soon change their lives… quite a lot more than any book or holiday trip.

This has a logical explanation: historically, women were supposed to know how to take care of a baby. Up until recently, it was always us who were in charge of the younger siblings until they got married and started with their own pregnancy cycle.

Suddenly, with no prior notice, intermediate generations changed. We realize that the natural instinct of nursing a baby hasn’t remained in our specie’s genes, and all those supposedly innate tasks must be taught to us.

In the society of information, masters, and on-line courses we live in, where the younger generation has reached top levels of preparation, where everything is studied, all is examined… it’s reasonable to think that, without any previous training, parents will be childcare experts and will know how to feed their newborn or appease its inconsolable crying.

The intensest moment is the day the couple is discharged from the hospital after their first labor, since it suddenly comes to them that they have no clue about how to take care of their baby and don’t dare to leave. They demand information and tips immediately! Well, well, if we were to film all these situations it would be worth a good comedy movie!