Welcome to Fertility Experiences blog

Hi all,
This is a space I have opened to tell you about all our everyday experiences in a Sterility Clinic and to present several debate topics. We are very interested in your opinion and comments, which is why we encourage you to participate in it.

The First Consultation on Sterility

“I have always wanted to be a mother, I waited until I had all I considered necessary to offer to my child. At the age of 33, with a lot of enthusiasm, a daily pill of folic acid and a calendar, I stopped using contraceptive methods, with the hope of becoming pregnant the same month. I have now been trying for more than one year without any success. How is it possible?”

Dr. López-Teijón

Look, Lourdes, after one year of trying only half of the couples your age will obtain a  pregnancy. After the second year, another 30%, while only a further one out of five will become pregnant after seeking medical help. I don’t know why you did not get pregnant, however we will now begin to investigate your sterility problem.

Lourdes

Sterility? (outraged and surprised)

Dr. López-Teijón

I know it is a shock to learn that trying one year without becoming pregnant is called sterility. It is a horrible word which can cause very negative feelings.

Lourdes

I have never thought this could happen to me, that you are saying that I am sterile… Moreover, in the last months I haven’t been well, every time I have the period I feel it like a failure, my world is sinking down.

Dr. López-Teijón

Lourdes, we will find the cause and its solution but today, besides prescribing some tests, I want to talk about how you feel and how all this can be a positive experience.

Lourdes

The experience hasn’t been good so far. My husband thinks some days I reject him while others I look for him, and never knows how to react. Of course, I am scheduling our sexual intercourse around ovulation. He says I no longer enjoy sex and he is partly right.

Dr. López-Teijón

It is very important not to neglect your relationship, you should continue as you always have. Nowadays it is known that some days of abstinence are not convenient to improve sperm quality; in fact it improves the amount of sperm ejaculated, but negatively affects other parameters, such as DNA fragmentation. The ideal thing would be to keep the same frequency as always, and make sure you have sexual intercourse on the 13th day of your cycle. Also, I would suggest that you spend no more than 15 minutes each day talking about it.

Lourdes

If I follow your recommendations I am sure he will be very happy; moreover you told me the only thing he has to do is a sperm analysis. On the other hand, I have to do hormonal tests, scans, checking my Fallopian tubes, and I don’t know what else.

One month later Lourdes comes back with Andrés, who is very anxious to know the results of his sperm analysis.

Dr. López-Teijón

The sperm test shows all is normal and the same for the fallopian tubes test. What is striking is that your ovarian age is greater than expected, as if you were 40 years old, which means your fertility is reduced.

Andrés

This means I am well and Lourdes can stop telling me not to drink, (not) to smoke, to stress me and all this.

Lourdes

Andrés, you make me feel guilty. It looks like I have only got the problem and you don’t have anything else to do. Congratulations, I am happy for you.

Andrés

Doctor, please tell her something, she keeps blaming me, and acting like she is the victim. It looks like she has become obsessed with pregnancy and that it is the only thing that matters.

Dr. López-Teijón

You should be more united and support each other now more than ever. Everyone will react his or her own way to this situation, depending to his or her own personality, the same as you would deal with every problem in your life. I would suggest you take it as a challenge, as a process that can bring you closer if you approach it with a healthy dose of irony, love and romanticism.

Now I will explain how we will do the In Vitro Fertilization, and how we will find your best oocytes.

Lourdes

We will do it because we don’t have a choice, but it seems all so unnatural. My sister has a 6 months old baby; it took two years for her to get pregnant and she recommends me to wait and see if I get pregnant without undergoing an IVF.

Dr. LT

You are right, but nature also expects us women to have our children before we are 30 years old, and with men who have an excellent semen.

It is very important for you to know that during the time we look for a pregnancy until we actually get there, our relationship with our loved ones can change. Your sister loves you but she doesn’t know how her comments can hurt you.

Lourdes

My mother is constantly telling us “all you think of is traveling and going out with your friends” and it really hurts me. Now I told my parents and my sisters and they give me advice all the time.

Dr. López-Teijón

It is a good thing people around you know it, but the best would be to ask them to be silent. Do not allow them to talk about anything related to fertility treatments or telling you what you should and should not do.

Also you should avoid going out with friends with kids or who are pregnant. It is normal that you felt uncomfortable when your sister was pregnant, surely all she talked about was this, and now she is only talking about her baby.

This will also happen to you, however for the moment it will be better not to spend time with friends with kids, or who are pregnant.

Lourdes

What else can I do to not keep thinking about this day in and day out?

Dr. López-Teijón

I think you should concentrate on keeping busy, with your work, your personal interests, etc, filling up you free time. And then spend five minutes of every day thinking about this, your objective, and on how you will feel when you have your baby in your arms, please, think only of this.

This conversation repeats itself during the consultation. A sterility diagnosis is followed by feelings of suffering, negativity, anger, fear to have high hopes, fear of not achieving what you desire, and anxiety. But, with current scientific advances, 95% of women who undertake fertility treatments get pregnant, and so, it is good to know, accept these emotions and know that they are only temporary, that your most intimate, deep and beautiful wish, is about to be fulfilled.

Fresh or frozen embryos? Which is best?

Today Dr. Esther Velilla, Director of our Laboratory, presented the results from last year and I am really amazed, because the pregnancy rate per transfer were the same regardless whether fresh or frozen (vitrified) embryos were used.

And that is including embryos that have been frozen twice! This occurs when we defreeze more embryos than the actual ones that end up being transferred. In these cases they are left in a culture medium and, if they continue to develop up to a blastocyst stage, they will be frozen again.

Honestly, I never thought I would witness something like this in my professional life. It is a huge a medical breakthrough for the following reasons:

  • Greater possibilities of pregnancy for each cycle. We speak of a cycle whenever there is an oocyte retrieval. This means that in many cases we do not have to repeat egg retrieval when a second pregnancy is sought.
  • Reduced number of multiples pregnancies. It often happens that, although our patients prefer a single pregnancy, they ask us to transfer more embryos to avoid the loss of quality when frozen.
  • If, after the egg retrieval, the patient cannot continue the treatment due to  medical or personal reasons, it no longer matters if we do not perform a fresh embryo transfer.  This is of great importance for women with polycystic ovaries, as those run a risk of hyperstimulation.
  • This year several studies highlight that results with frozen embryos can be even better since the endometrial preparation is more physiological. They suggest to freeze them all and not to do a fresh transfer. I do not expect that much, since that would also delay and make the process more expensive. 

At the moment patients do not believe it at all. Last week a very nice husband of a patient told me: “How can it be the same?  It is like with fresh and frozen fish!”. So, I thought, we have to make it known.

The great challenge of vitrifying blastocysts. 

I have already told you how frozen embryos live. The vitrification of blastocysts has been the greatest challenge for biologists. Blastocysts are embryos which are 5 or 6 days old.  They have a mass of 200 cells which generates all the structures of the embryo called internal cellular mass. The other cells, called trophectoderm, form the placenta. Moreover, they have a very big “lagoon” of water which is called blastocoel and an outer membrane which is at the point of collapse, since the blastocyst is the next stage of the embryo prior to implantation in the uterus.

EN-Leyenda

The difficulty when freezing  blastocysts consists mainly in the quantity of water they have. For example, at home it is easy to freeze a chicken but we cannot freeze an egg.

In order to vitrify blastocysts successfully, biologists previously remove their water through a pinch, or as we do in our laboratory, they can surround them with a chemical solution  which absorbs the liquid without, as you may see, affecting them.

Since there is no video available to describe this process, I have requested our embryologists to record a video when putting the  blastocysts in the Embryoscope.

Firstly, we can observe how it is left without water and then how it is rehydrated to be vitrified.

These are images in fast motion, but this process may take hours.

 

We keep on with your genetics

Also you are carrying genetic mutations that predispose you to have serious diseases. Would you like to know which ones?

Nowadays, you have the possibility to know the degree of genetic predisposition that you have to develop diseases such as Alzheimer’s, cancer, heart attack, multiple sclerosis, etc. They are responsible for most natural deaths in developed countries.

Look at the following chart. It could belong to any of us. Your report would be like this one but varying the specific risk for each disease. It’s highly likely that the cause of your death is written in the first five lines. What a shock, isn’t it? Isn’t it unbelievable? Clearly, we are all going to die. This report tells us the cause of our death.

The risk of contracting almost all the diseases is given by the genetic predisposition as well as by the environment and it is very interesting how this proportion varies according to each disease. For example, it is estimated that Alzheimer’s has a 75% genetic basis and a 25% environment / lifestyle basis. In the coronary artery disease, we speak about a 50% of each.

These analyses are done on a DNA sample. The most common way to obtain it is by rubbing with a cotton swab the inside of the cheek inside the mouth. They are usually carried out in a clinical laboratory but nowadays they can also be done online. From an online lab, they send you home a kit for the sample collection that you need to return to them and, in about 2 weeks, they send you the result by e-mail. The price is about 300 Euros.

There are people who say they would not do it because they would live in great anxiety and apprehension.

Others say that they would do this test if this information would give them the opportunity to undergo preventive medicine programs or early diagnosis tests of diseases presenting a high genetic risk.

Let’s imagine that you have done it. You are going to come across that neither the Public Health System nor a private insurance will cover for most of the tests that you have to perform regularly. Thus, the economic aspect is something you should consider.

Recently, Angelina Jolie’s case has been discussed. Approximately 10% of women who develop breast cancer are carriers of genetic mutations. These genes predisposing to cancer are called BRCA1 and BRCA2, and are inherited from the parents. 50% of the children carry them, which means that there is a family history of breast or ovarian cancer before the age of 50. They usually have a grandmother, a mother, sisters or aunts affected. The man, if he is a carrier, transmits those to 50% of his offspring; that is why they can skip a generation.

If a woman carries the BRCA1 gene, it is considered that the probabilities of developing breast and ovarian cancer are 80% and 60%, respectively.

A woman carrying the BRCA2 gene, has 85% probabilities of developing breast cancer and 23% probabilities of developing ovarian cancer.

Angelina Jolie is a carrier and she decided to have a bilateral mastectomy and have her ovaries removed.

This is a rather special situation because you can make a very effective prevention, but this is not possible in most diseases: you cannot remove the liver, the lung, the bladder…  In most of the cases, the only thing you can do is to have tests done in order to have an earlier diagnosis.

Are you willing to take a “look at your future”?

Would you perform it on your child?

Do you think that, in the future, life insurance companies might ask for it?

Hereditary diseases. Would you like to know which ones you can transmit?

You’re carrying between 5 and 20 severe recessive mutations. Let me tell you about it:

Mutations are changes that occur in the genetic map of every living being, some are transmitted to children and others are not, depending on the affected cells.

In theory, they are necessary for the evolution of the species (we descend from the chimpanzees so imagine how many mutations have occurred up to now!) but too often nature makes a mistake and errors take place that cause or predispose to more or less serious diseases.

Being a carrier means that you have one of the two copies of this gene altered but you are not sick because the healthy copy performs its normal function.

1.8% of the children are born with genetic diseases. They may be inherited or occur spontaneously, we call it de novo. The most common hereditary diseases are cystic fibrosis, fragile X syndrome and spinal muscular atrophy, among others.

Right now, scientists have developed genetic tests allowing us to find out what hereditary diseases we are carriers of. They are useful to provide us with our “gene card” as well as our partner’s before having a child because, should he be a carrier of the same mutation, the children will have a 25% chance of showing that disease.

There are different kits that study a greater or lesser number of diseases, around 1.000 – 2.000 mutations related with the 200-300 most common hereditary diseases. (There are more than 6.000 hereditary diseases, but most of them are very rare).

These tests are done on a blood sample and have an approximate cost of 500 Euros. We can have the result in 2-3 weeks and it should always be explained by an expert.

If it turns out the two partners have the same mutation, we can perform an In Vitro Fertilization with Preimplantation Genetic Diagnosis (PGD) to transfer only the healthy embryos or perform a study about the disease in the embryo during the first months of pregnancy.

The economic implication has different points of views. Some North American insurance companies include it in the coverage of the future parents because it is cheaper for them to pay for this test than to finance the diagnosis and treatment of a child with a serious chronic disease.

The cost of an In Vitro Fertilization with PGD for these kinds of diseases is high. The cost for the diagnosis of the foetus is cheaper but if it is affected, it implies the termination of the pregnancy.

I have asked many people these days and now I ask you if you would like to get to know your gene card.

Bear in mind that these tests allow the birth of children not affected by mutations that you and your partner are carriers of, but do not guarantee the birth of a healthy baby because many of the diseases are caused by de novo spontaneous mutations.

Usually we do not think that it is going to happen to us, but when we see in the media a very sick little boy, him and his family surrounded by suffering, continuous treatments, uncertainty about the future, etc., our hearts get broken.

As for the moral implication, I have heard all kinds of opinions: people who refuse it because they think we are going to make designer babies, eugenics, fear of abuse or genetic manipulation, people who say that it is fine but who would not do it and people who consider it a breakthrough and, if they can, they will perform the genetic analysis to find out whether they are carriers.

According to my experience, patients who have the same mutations end up with recurrent miscarriages, with a history of dead children or with a child with severe disabilities. They do not look for designer babies. They just want to have a healthy baby!

In our team, the gynaecologists who practice obstetrics and gynaecology inform about these tests to women who would like to get pregnant, but that becomes harder to explain for the gynaecologist who does assisted reproduction. Let me explain you why: as a referral centre, most of the patients we look after have a long history of years of infertility or of unsuccessful treatments. I will tell you about a case of a German couple I saw yesterday, a 40 years old couple: she has undergone an endometriosis operation and her ovaries respond poorly and he has a very low sperm concentration. They have already done four IVF cycles in their country. Well… You must imagine that I was not able to tell them: “Have you thought that you might also be carriers of hereditary diseases?” I think they already have enough problems.

We often say that genetics are the future, but now it starts to become the present.

 

IVF to the Beat of the Music. We Have Made our Embryos Dance

I couldn’t imagine the enormous impact of the publication of the results of the In vitro Fertilization with music, both among colleagues from other centers, our patients and the media.

Once the scientific study was presented at the European Society of Human Reproduction’s congress (ESHRE) in July 2013, the doctors were dying of desire to talk about this with the parents of the first-born children. It’s funny because, even though the embryos have no sense of hearing, they all tell us stories that closely relate their children with music: they cease to weep when they hear music, it helps them to sleep… What it really is a striking coincidence is an Italian twin that, ever since he was very small, seems to be singing.

After discovering that musical vibrations improve the fertilization rate, we have implemented them to all of our incubators.

The songs are selected based on the choices of the biologists because they constantly hear them when they open the incubators and they play at a very high volume.

The music style is changed every month although we have seen no differences between them. This month is very lively as we have heavy metal playing.

Patients can see from their computer or mobile phone how their embryos develop in the Embryoscope and also listen to the music playing. It’s exciting!

Now we are continuing with this line of research to find out if music also improves embryo development and its implantation in the uterus. I will keep you updated…

First baby born in UK with musical IVF

The story of an IVF

Almost every day, I receive visits from patients who come to our clinic to introduce me to their children. I am really glad they do so because we all have done our best so that those children can be born.

Today I want to explain what the process of In Vitro Fertilization consists of, making use of the fact that I am also explaining it to Sofia, an Italian girl who has come to meet me today.

In the video that you will find bellow, you will be able to see the whole process, from the moment we receive the first email until the day we receive the results of the pregnancy test, including the laboratory procedures and the doctor’s consultation.

Surrogate Motherhood

Surrogate motherhood or surrogacy has been in the news these days in Spain because of two cases: a couple from Asturias who was not allowed to bring back to Spain their twins born in India via surrogacy and a Balearic gay couple who also used surrogacy in Thailand, and expect quintuplets! (one of the surrogate mothers is expecting twins and the other one, triplets).

I would like to tell you more about this topic and know your opinion about it. I think it’s something very important and controversial that can be seen in many ways.

When there is some news about reproduction, the media usually call me to discuss about them. Today, before speaking to a radio station, I was reading material that I had written ten years ago and I was surprised at how my opinion has changed. I’ve gone from believing that surrogacy was horrible, even a way to use the body of a woman in a situation of need, to help doing it to whom asks me to. This evolution comes after learning about different situations (like the one about a girl whose son died in childbirth and whose uterus had to be removed due to an hemorrhage), and also after seeing the dedication and love attitude of women pregnant thanks to surrogacy.

Where is it allowed?

Legally, in Europe the parenthood of the child is determined by birth; the law forbids to rent a womb.

As an exception, England allows it only if there is a family connection between the two women, if there is no financial arrangement and if both of them are English. Following the same law, in South Africa, a 48 years old woman could give birth to her daughter’s triplets.

It is also allowed in some states of the USA, Canada, Russia, Ukraine, and also in India and Thailand, but the problem in those last two countries is to bring the child back to Europe, as the documentation required is often difficult to obtain.

In the last few years and until January 2013, many surrogacy treatments have been performed in India because of their low cost and easiness during the process, since the fertility clinics themselves are also responsible for the surrogate mothers, from their selection up to the birth. Should the legal requirements change, I guess this will become again the main destination country.

Who may need to rent a womb?

We constantly take care of people who would like to have some information about how and where to do it.

On the one hand, it is requested by couples or single women presenting a medical inability to carry a pregnancy (because their uterus has been removed, because they were born with uterine malformations, because they are taking medications that are incompatible with a pregnancy or because they suffer from conditions where a pregnancy is contraindicated). Some people think that there are also women who would like to use it it in order to avoid risks and damaging their own body. I believe that is the answer to ignorance and a certain frivolity, and the truth is that I’ve never had this request at my clinic.

On the other hand, it is requested by gay men, singles or couples, as well as by heterosexual single males. Increasingly, men claim their rights to single parenthood; you all know celebrity cases which have used it.

Why is a woman willing to be a surrogate mother?

What kind of women are capable to go through a fertility treatment, a pregnancy and a birth and then deliver the newborn to other people?

A study presented in an international congress stated that surrogate mothers have no psychological consequences and that the reasons why they do it are in 91% of the cases to help, although it is actually to help their children. An 8% does it for the pleasure of being pregnant (our experience as gynaecologists says that being pregnant is not a pleasure, indeed, in most cases it’s just the opposite: the pleasure lies in having a child) and only 1% says that they do it exclusively for the money.

From what I’ve seen over the years, most surrogate mothers do it to get resources to support their children. They are proud of it and live it as “I’ll help you raise your child and you help me raise mine.”

A child conceived this way can have three mothers, the biological mother, (who provided the eggs), the gestational mother (who carried the pregnancy), and the legal mother, who will look after the child forever. It may also be that there is a legal father.

The woman who carries the pregnancy is the gestational mother but usually not the biological mother. The oocytes are either from the legal mother or from an egg donor; moreover they always have their own children, among other things to avoid the risk of becoming sterile because of a complication during birth.

What kind of relationship is created between the woman and the child’s parents?

The relationship between the legal parents and the surrogate mother is very different depending on the countries and cultures.

In the USA and Canada, they can meet and have the relationship that they have decided to establish. Online communication is very frequent, even visits and occasional gifts, but they can also remain anonymous. In these countries, the woman who is going to act as the surrogate mother sets the rules. She can even be the one who selects the legal parents.

After the birth, a fast trial is done in which the three parts are present and where the end of the contract they had made as a ‘temporary adoptive mother” is signed, that is, as someone who cares about the child during a period in which the legal parents are unable to do it: pregnancy. I know patients that, after this trial, a week after birth, went all together to a barbecue at the gestational mother’s house.

Emotional support is necessary in these cases and, in these countries, both the surrogacy agencies and the legal parents provide it.

In India and Thailand, the centre itself takes care of everything, they have homes in which they live until after the birth and there is no communication at all with the legal parents. Three possible candidate profiles (containing photos, medical and family history, etc.) are sent to the legal parents from Thailand or India for them to choose one of them. When patients ask me for advice about which candidate to choose, I feel very bad and I tell them that it should be the centre and not them to choose her. After the childbirth, there is paperwork to do in court and with the police. In many cases, they leave the country with the baby appearing as a child of the surrogate mother and the male partner, and then in Europe, the wife adopts him or her.

Economic aspects

A surrogacy process is payable in stages; there are fees for each part of the process to be paid according to the evolution of it, with a price list for extras such as amniocentesis, twin pregnancy, etc.

The amount paid to the surrogate mother is much less than you think. Most of the money goes to lawyers, agencies, medical expenses for the fertility treatment and pregnancy, childbirth and the incubator if needed, insurance and trips. A process of surrogacy, if everything goes well on the first try, can cost around 50,000 Euros in India or Thailand, nearly the double in the USA and intermediate prices in other countries.

Obviously, there are many people who, despite a whole-hearted desire to have a child, can not afford it economically.

What must be taken into account?

It’s necessary to have an attorney specialized in this area in the parents’ country of residence. It’s also very desirable to have a specialist in reproductive medicine who has handled many cases and is up to date with the clinics’ medical aspects. I know of many patients who have privately organized the whole process through the Internet and have suffered a fraud.

I’ve been able to see and share all kind of experiences with the patients that I have accompanied through this adventure: negative experiences because of repeated failures or, for example, after arriving to India to start the process and noticing a rejection’s attitude of the centre’s staff because the husband is in a wheelchair (in their culture, it’s still widespread to conceive illness as a divine punishment), as well as fantastic experiences because of finally having that child in their arms.

Questions for the debate

Without a doubt, the scientific and medical progresses such as surrogacy create a social, cultural and legal debate. It’s quite clear that not everything that is technically possible is morally acceptable.

What do you think, on an ethical level, about surrogacy?

Do you think that the trouble and risks of pregnancy can be paid with money? Or instead, should it be seen as a help exchange?

How would you write the law in your country? Would you allow surrogacy in all cases, in just a few or never? Would you be a surrogate mother for your sister?

Music enhances In Vitro Fertilisation

We’ve conducted a study showing that musical vibrations increase the chances that the sperm fertilises the egg, ie that music improves IVF. We’ll present these findings at the European Congress of Sterility (ESHRE) that will take place from the 7th to the 10th of July in London.

The idea came thanks to you, because we wanted to show you the “embryonic life”.

Since the beginning of assisted reproduction, we have tried that the conditions of the embryos in the laboratory are most similar to the ones in the fallopian tubes and in the uterus, both physically and by the development of culture media that contains the same nutrients.

Remember the video The IVF Lab? I tried to imagine myself as an embryo… At that moment I thought: what would I hear in the womb?

That was how, in collaboration with a sound engineering consultancy, we devised a system to stream music inside incubators up to 80 decibels for 24 hours a day.

What have we done? We’ve analysed 985 in vitro fertilised eggs from 114 patients. These were randomly divided into two groups and were cultured in two different incubators: one provided with a loudspeaker system and the other in a conventional incubator.

The results show that those grown with music had statistically higher fertilisation rate, increased by 4.8%.

We chose three different musical styles -pop, hard rock and classical music- to measure possible variations depending on the frequency of the beat, but we did not detect significant differences between one and the other.

Clearly, embryos have no sense of hearing and they’re not able to hear anything, then why does music improve fertilisation rates?

In natural conditions, oocytes and embryos travel through the fallopian tubes into the uterus due to continuous peristaltic movements that move them, surround them with the nutrients they need, and drive them away from their waste metabolites.

These cell movements facilitate the exchange of substances, but embryos in the laboratory remain static in the culture media, and, as a result, the released toxic products -free radicals or ammonium – are stored in the culture medium in which they lie.

Our hypothesis is that micro vibrations stir the culture media, thus producing a more homogeneous distribution of the nutrients and dispersing toxic products to avoid their accumulation.

The effect of musical vibrations on cell growth in vivo and in vitro has been studied in several fields but this is the first time that the effect of music on the in vitro fertilised oocytes has been investigated.

Since the beginning of IVF, the advances have been continuous and the success has been greatly improved. To you it may seem small, but an increase in fertilisation rate of almost 5% is in fact a great achievement, especially for a referral centre like ours .

This whole experience has made me think that I am part of a big band and our music is life…

Watch this one minute video in which you see the evolution of a newly fertilised oocyte until the 5th day with one of the songs played in the incubators.

Captura de pantalla 2014-03-17 a las 12.51.44

Preimplantation Genetic Diagnosis

Today we shared some sad news during our medical session. One of the cases we commented was Sandra P.’s.

Sandra and Pedro came to our centre after 3 years of sterility due to a blockage in her fallopian tubes. They had undergone two In Vitro Fertilisation cycles at another centre and had had no success.

Before going on with a new treatment, we decided to have some tests done first, including a basal hormone analysis. These are performed on the second or third day of the menstrual cycle and they show the patient’s ovarian age. You must know that, sometimes, our biological age doesn’t correspond with the age of our ovaries, there’s usually a three years different between both approximately.

Well, while Sandra was 38 at the time, her ovaries appeared to be 40 years old. We suggested it would be convenient to analyze the chromosomes in the embryos, and they agreed. During the cycle we obtained 7 oocytes, and IVF was performed on the 5 most mature oocytes, 3 of which fertilised. Three days after fertilisation, two embryos had evolved. We planned to analyse both embryos genetically on that same day, but in the end the couple decided not to. They preferred to have the transfer on that very day as, being only two, they thought it was useless to choose the best, and, additionally, they would save the cost of the analysis.

Sandra became pregnant. That same week, though, we diagnosed her embryos Down Syndrome during the amniocentesis test and her pregnancy was interrupted.

Reaching this circumstance is sad, as we had the opportunity to prevent such an unfortunate situation by means of Preimplantation Genetic Diagnosis.

Let me show you how it’s done…

See… all cells are equal in a 3 day old embryo. We can extract one and analyse it and it will be regenerated in a few hours (like a lizard’s tail)… It seems science fiction but we can actually know an embryo’s karyotype (the map of its chromosomes) in 48 hours.

What is Preimplantation Genetic Diagnosis?

According to studies conducted in our centre, in the best of cases, ie using embryos from donor sperm and oocytes, almost half of them show chromosomal abnormalities. It seems a lot, but truth is human reproduction is quite ineffective: in an egg donation cycle we usually transfer two embryos hoping one will implant.

The percentage of abnormal embryos increases accordingly to the woman’s age, so 78% of the embryos of 40 year old patients are altered.

Percentage of embryos with abnormalities in cycles for patients using normal sperm without previous miscarriages:

Women aged 35-37: 70.6%

Women aged 38-41: 78%

Women aged 42-43: 92%

Preimplantation Genetic Diagnosis allows us to transfer embryos that, besides looking physically good, don’t display abnormalities. The technique isn’t used systematically because it’s still quite expensive and not all centres can perform it, though centres who do not offer it can send the cell to another centre for it to be analysed.

Daily, we study many cells from embryos who lie in incubators in other centres, some of which are very far away. The cell arrives and, before 48 hours go by, the results are sent by mail and the healthy embryos are transferred fresh 2 days later, 5 days after IVF.

It has happened that in some cycles all embryos show abnormalities and cannot be transferred. This has even been the case for patients for whom we’ve analysed up to 10 embryos! If these hadn’t been examined, the patient would have had 2 or 3 fresh embryos transferred, she would have frozen the 7 remaining embryos and would have undergone 2 or 3 more cycles with these… including everything it entails: hope, money, travel, absence at work, etc.

Preimplantation Genetic Diagnosis allows us to select the chromosomally normal embryos. Hence, we increase the chances of pregnancy and decrease the risk of a spontaneous miscarriage or finding a problem we could’ve prevented during an amniocentesis test, like in Sandra P.’s case.

Anecdotes that have happened to us over the years

As you know, I like to tell you about the day by day in our clinic, as we often experience genuinely funny situations. With all due respects towards our patients, I’m gonna tell you about the ones I remember. Some have happened directly to us and some belong to colleagues who work in other centres.

A patient from Kenya who lives in Holland comes for an embryo adoption. She gets all serious and asks Dr. Jordi Suñol whether her child will speak Swahili, Dutch, Spanish or Catalan.

During a first visit a cell phone doesn’t stop ringing. It sounds something like: tweet, tweet, tweet. The patients leave but the tweeting persists and I start looking for the phone. I approach the sound and grab the small plastic bag from where it comes. Imagine what my face looked like when out of it… flew a real bird!

Once I asked Mercè Insa, our secretary, to go pick a sperm sample from a male in his white car in front of the emergencies entrance. Mercè asked the man to please give her his sperm and he answered: “Lady, don’t rush it, don’t you think we should get to know each other better first?” She insisted, while a couple of meters away a disabled adapted white car didn’t stop beeping and calling for her…

A patient comes with a much younger husband. He’s so young that on the day of the embryo transfer he rather stayed in the waiting room because he still hadn’t finished playing with his gameboy.

Working with many different languages sometimes leads to hilarious situations. Betty Guzman works at the reception desk. A couple of days ago, Gwen, one of our Patient Assistants, called her and asked her to call a cab for a British couple. Before hanging up, Gwen exclaimed “wonderful!” A few minutes later, the cab driver came, very fed up, ‘cause he couldn’t find the so-called Mr. and Mrs. Wonderful anywhere around.

Once, my attention was brought to a patient’s file whose occupation appeared to be “autist”. Betty asserted that’s what he answered when she asked. Apparently, in Italian an “autist” is an “auto (car) driver.”

Before an In Vitro Fertilization we always do a catheter test. We introduce the cannula through the cervix to ensure it will enter easily on the day of the transfer. Well, last month Dr. Martí did a catheter test to a patient and, when she was done, the girl, completely euphoric, thanked us: “you’re so straight-forward, my first time at your clinic and half an hour later my embryos are already on board!”

Dr. Carles Catllà saw a couple who couldn’t get pregnant. They owned a chicken farm. All the tests came out normal so they said they’d test an idea they had come up with. Three months later, she came back already pregnant. They explained: hens only lay eggs in the daylight, so to increase their production, farms are continuously lit so they don’t stop ovulating. They placed the same lights on their headbord and never turned them off.

Blood types also give place to amusing situations. I can perfectly remember a patient who had difficulties becoming pregnant due to her husband’s poor sperm quality. When I asked for his blood type, his tone suddenly became ironic: “JB positive.” This also reminds me of another time in which a patient was convinced her blood type was H2O.

Once, the video machine in the sperm sample collection room was damaged and we couldn’t turn the TV off. One of our secretaries took the technician to the room, the door closed all of a sudden and wouldn’t open again. There they sat for a good while, with an erotic movie playing in the background. Awkward much?

I remember a day in which a gay man came asking for an egg donation. Much to my surprise, he thought we would be using my own eggs! I felt absolutely ridiculous, I even explained I no longer have any oocytes left myself!

After a day with lots of surgery, Dr. Manuel Elbaile goes into the room of a patient whose breast he just removed due to cancer. He wanted to tell her family everything had gone allright. He was shocked when he found his patient sitting right there, wearing the same clothes she wore that morning. He almost died at the thought he had removed someone else’s breast! Maybe the patient who had to have her uterus removed? It turned out that the girl had an identical twin who was all dressed in black as well.

Dr. Pere Barri examines a patient who lies in gynaecologic position. The nurse tells her to please place her hands behind the neck (this position is necessary for a palpation of the breast). The patient quickly places her hands behind the neck… of the doctor! Can you imagine?

In Alicante, Dr. Rafa Bernabeu has a first visit with a couple who has troubles conceiving. He realizes there is some information missing in their medical history. “What’s your phone?” he asks. Surprised, the couple answers: “A red, cordless one. Can it have something to do with what’s happening to us?”

A very small Chinese woman goes to the hospital in Badalona to give birth. They give her a black, sack-like bag and tell her to put all her belongings inside. The assistant couldn’t help but laugh when she suddenly went into the room and saw that the patient had placed herself, from top to bottom, inside the plastic bag!

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