Clinica EUGIN

Barcelona, Spain

Clinica EUGIN

Barcelona, Spain
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Vassena R.,Clinica EUGIN | Eguizabal C.,Basque Center for Transfusion and Human Tissues | Heindryckx B.,Ghent University | Sermon K.,Free University of Brussels | And 7 more authors.
Human Reproduction | Year: 2015

STUDY QUESTION Are there effective and clinically validated stem cell-based therapies for reproductive diseases? SUMMARY ANSWER At the moment, clinically validated stem cell treatments for reproductive diseases and alterations are not available. WHAT IS KNOWN ALREADY Research in stem cells and regenerative medicine is growing in scope, and its translation to the clinic is heralded by the recent initiation of controlled clinical trials with pluripotent derived cells. Unfortunately, stem cell 'treatments' are currently offered to patients outside of the controlled framework of scientifically sound research and regulated clinical trials. Both physicians and patients in reproductive medicine are often unsure about stem cells therapeutic options. STUDY DESIGN, SIZE, DURATION An international working group was assembled to review critically the available scientific literature in both the human species and animal models. PARTICIPANTS/MATERIALS, SETTING, METHODS This review includes work published in English until December 2014, and available through Pubmed. MAIN RESULTS AND THE ROLE OF CHANCE A few areas of research in stem cell and reproductive medicine were identified: in vitro gamete production, endometrial regeneration, erectile dysfunction amelioration, vaginal reconstruction. The stem cells studied range from pluripotent (embryonic stem cells and induced pluripotent stem cells) to monopotent stem cells, such as spermatogonial stem cells or mesenchymal stem cells. The vast majority of studies have been carried out in animal models, with data that are preliminary at best. LIMITATIONS, REASONS FOR CAUTION This review was not conducted in a systematic fashion, and reports in publications not indexed in Pubmed were not analyzed. WIDER IMPLICATIONS OF THE FINDINGS A much broader clinical knowledge will have to be acquired before translation to the clinic of stem cell therapies in reproductive medicine; patients and physicians should be wary of unfounded claims of improvement of existing medical conditions; at the moment, effective stem cell treatment for reproductive diseases and alterations is not available. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Kawachiya S.,Kato Ladies Clinic | Bodri D.,Clinica Eugin | Shimada N.,YuMe | Kato K.,Kato Ladies Clinic | And 2 more authors.
Fertility and Sterility | Year: 2011

In a 7-year (2002-2008) retrospective study of a large IVF program based on minimal ovarian stimulation and single ET (47,841 single ETs), monozygotic twinning occurred in 1.01% of 14,956 clinical pregnancies. Blastocyst culture was associated with a significantly increased monozygotic twinning risk (adjusted odds ratio, 2.04; 95% confidence interval, 1.29-4.48), whereas embryo freezing, type of stimulation protocol used, intracytoplasmic sperm injection fertilization, or zona removal did not influence its incidence. © 2011 by American Society for Reproductive Medicine.

Garcia D.,Fundacio EUGIN | Bautista O.,Clinica EUGIN | Venereo L.,Clinica EUGIN | Coll O.,Clinica EUGIN | And 2 more authors.
Fertility and Sterility | Year: 2013

Objective: To evaluate the effect of physician training in empathic skills on patients' satisfaction just after their first consultation in a private fertility clinic setting. Design: Prospective study. Setting: Private fertility clinic. Patient(s): Thirteen physicians were evaluated by 2,146 patients. Intervention(s): The empathic training of physicians was centered on emotional intelligence, communication elements, social styles and empathy, and practical workshops. After their first consultation with the physician, patients answered a self-rating questionnaire comprising five scales: information provided, dynamic of the visit, time dedicated, patient-physician interaction, and expertise. Main Outcome Measure(s): Patients' satisfaction scores after the empathic training of physicians. Result(s): For all five scales, the empathic training resulted in a significant change of the global scoring distribution with a shift toward higher scores. The intervention also resulted in a lower likelihood of low scoring (in the lower quartile) for all the items. Conclusion(s): Training in empathic skills of physicians resulted in higher patient satisfaction levels on the perceived information quality, communication skills, and time dedicated at first consultation for fertility treatment.

Bodri D.,Clinica EUGIN | Colodron M.,Clinica EUGIN | Garcia D.,Fundacio Privada Eugin | Obradors A.,Clinica EUGIN | And 2 more authors.
Fertility and Sterility | Year: 2011

Objective: To compare pregnancy and implantation rates with transvaginal (TV) versus transabdominal (TA) ultrasound-guided embryo transfer (ET). Design: Randomized, clinical trial registered at (NCT 01137461). Setting: Private, infertility clinic. Patient(s): Three-hundred thirty randomized recipients of donor oocytes. Intervention(s): Embryo transfer using TV (with empty bladder, using the Kitazato ET Long catheter) versus TA ultrasound guidance (with full bladder, using the echogenic Sure View Wallace catheter). Main Outcome Measure(s): Overall pregnancy, clinical pregnancy, implantation, and ongoing pregnancy rates. Duration and difficulty of ET. Patient-reported uterine cramping and discomfort, as evaluated by questionnaire. Result(s): No statistically significant differences were observed in clinical pregnancy 50.9% versus 49.4% (95% confidence interval of the difference: -9.2 to +12.2%), implantation 34.5% versus 31.4% (95% CI of the difference: -4 to +10.3%) between the TV and TA ultrasound-guided groups. Transfer difficulty (6% versus 4.2%) and uterine cramping (27.2% versus 18.3%) were not statistically significantly different between treatment groups. Total duration (154 ± 119 versus 85 ± 76 seconds) was statistically significantly higher in the TV ultrasound group. Light to moderate-severe discomfort related to bladder distension was reported by 63% of the patients in the TA ultrasound group. Conclusion(s): Transvaginal ultrasound-guided ET yielded similar success rates compared with the TA ultrasound-guided procedure without requiring the assistance of a sonographer. It was associated with increased patient comfort due to the absence of bladder distension. © 2011 by American Society for Reproductive Medicine.

Garcia D.,Fundacio Privada EUGIN | Vassena R.,Clinica EUGIN | Trullenque M.,Clinica EUGIN | Rodriguez A.,Clinica EUGIN | Vernaeve V.,Fundacio Privada EUGIN
Patient Education and Counseling | Year: 2015

Objective: To evaluate motherhood intentions and awareness of the limits of fertility as related to menstrual cycle, female age, and assisted reproductive technologies (ART) in oocyte-donation candidates in Spain. Methods: Cross-sectional study with 229 women seeking information about oocyte donation in March-October 2013. Women were interviewed by healthcare professionals. Results: The majority of participants (95.6%) wanted to be mothers in future and 36.7% already had children. Even so, knowledge about female reproduction was low: 48.3% failed to identify the ovulation time, 48.5% missed women's fertility peak before 25, and 27.9% overestimated the age limits for ART. University education does not improve global fertility knowledge and is associated with a later intended age for childbearing (p (0.001), which results in a twofold risk of childlessness at age of 30 (RR. (1.95, 95% CI 1.11-3.43). Conclusion: We conclude that fertility knowledge is insufficient but, encouragingly, nearly 30% of interviewees were proactive in seeking information from the healthcare professionals. Practice implications: The future fertility of young people should be protected through educational interventions emphasizing the increasing phenomenon of age-related infertility at every point of contact with a women's health professional, for instance, when oocyte-donation candidates attend a fertility center for an information visit. © 2014 Elsevier Ireland Ltd.

Bodri D.,Clinica Eugin | Bodri D.,University of Barcelona | Sunkara S.K.,Guys And St Thomas Hospitals National Health Service Foundation Trust | Coomarasamy A.,Birmingham Womens Hospital
Fertility and Sterility | Year: 2011

Objective: To compare GnRH agonists and antagonists in oocyte-donation IVF treatment cycles by a systematic review and meta-analysis of trials. Design: Systematic review and meta-analysis of randomized clinical trials (RCT). Systematic literature searches were conducted, and all randomized trials that compared GnRH agonists with antagonists in oocyte-donation IVF treatment cycles were included. Study selection, quality appraisal, and data extractions were performed independently and in duplicate. Setting: Tertiary fertility center. Patient(s): A total of 1,024 oocyte donors treated in eight RCTs. Intervention(s): Comparison of GnRH agonists versus antagonists in oocyte-donation IVF treatment. Main Outcome Measure(s): Ongoing pregnancy, oocytes retrieved, duration of stimulation, gonadotropin consumption, and ovarian hyperstimulation syndrome incidence (OHSS) per randomized oocyte donor. Result(s): Meta-analysis of these studies showed no significant difference in ongoing pregnancy rate between the GnRH agonists and antagonists (risk ratio [RR] 1.15, 95% confidence interval [CI] 0.97 to 1.36). The duration of stimulation was significantly lower with the GnRH antagonist protocol (weighed mean difference [WMD] -0.90 days, 95% CI -1.61 to -0.20). No significant differences were observed in the number of oocytes retrieved (WMD -0.60, 95% CI -2.26 to +1.07), gonadotropin consumption (WMD -264 IU, 95% CI -682 to +154), or OHSS incidence (RR 0.62, 95% CI 0.18 to 2.15). Conclusion(s): No significant differences were observed in ongoing pregnancy rate or the number of retrieved oocytes after donor stimulation with GnRH agonist or antagonist protocols. © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc.

Begueria R.,Clinica EUGIN | Garcia D.,Fundacio Privada EUGIN | Obradors A.,Clinica EUGIN | Poisot F.,Clinica EUGIN | And 2 more authors.
Human reproduction (Oxford, England) | Year: 2014

STUDY QUESTION: Does paternal age affect semen quality and reproductive outcomes in oocyte donor cycles with ICSI?SUMMARY ANSWER: Paternal age is associated with a decrease in sperm quality, however it does not affect either pregnancy or live birth rates in reproductive treatments when the oocytes come from donors <36 years old and ICSI is used.WHAT IS KNOWN ALREADY: The weight of evidence suggest that paternal age is associated with decreasing sperm quality, but uncertainty remains as to whether reproductive outcomes are affected. Although developed to treat severe sperm factor infertility, ICSI is gaining popularity and is often used even in the presence of mild male factor infertility.STUDY DESIGN, SIZE, DURATION: A retrospective cohort study spanning the period between February 2007 and June 2010. A total of 4887 oocyte donation cycles were included.PARTICIPANTS/MATERIALS, SETTING, METHODS: Fertilization was carried out by ICSI in all cycles included, and the semen sample used was from the male partner in all cases. The association of male age with semen parameters (volume, concentration, percentage of motile spermatozoa) was analyzed by multiple analysis of covariance. The association of male age with reproductive outcomes (biochemical pregnancy, miscarriage, ongoing pregnancy and live birth rate) was modeled by logistic regression, where the following covariates were introduced: donor age, recipient age, semen state (fresh versus frozen) and number of transferred embryos (3 and 2 versus 1).MAIN RESULTS AND THE ROLE OF CHANCE: We identified a significant relationship between paternal age and all sperm parameters analyzed: for every 5 years of age, sperm volume decreases by 0.22 ml (P < 0.001), concentration increases by 3.1 million sperm/ml (P = 0.003) and percentage motile spermatozoa decreases by 1.2% (P < 0.001). No differences were found in reproductive outcomes (biochemical pregnancy, miscarriage, clinical pregnancy, ongoing pregnancy and live birth) among different male age groups.LIMITATIONS, REASONS FOR CAUTION: The use of donor oocytes, while extremely useful in highlighting the role of male age in reproductive outcomes, limits the generalization of our results to a population of young women with older male partners. No data were available on perinatal and obstetrical outcomes of these pregnancies. Most (75%) cycles used frozen/thawed sperm samples which might have introduced a bias owing to loss of viability after thawing. ICSI was performed in all cycles to control for fertilization method; this technique could mask the natural fertilization rate of poorer sperm samples. Furthermore, we did not use stringent ICSI indications; and our data are therefore not generalizable to cases where only severe male factor is considered. However, male patients were of different racial background, thus allowing generalizing our results to a wider patient base.WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that paternal age does not affect reproductive outcomes when the oocyte donor is <36 years of age, indicating that ICSI and oocyte quality can jointly overcome the lower reproductive potential of older semen.STUDY FUNDING/COMPETING INTERESTS: This study was supported in part by Fundació Privada EUGIN. The authors have no conflicts of interest to declare. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Vassena R.,Clinica EUGIN | Vidal R.,Clinica EUGIN | Coll O.,Clinica EUGIN | Vernaeve V.,Clinica EUGIN
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2014

Objective The menstrual cycle is a finely tuned biological process comprising a precisely orchestrated sequence of events: follicular growth, selection and ovulation, extensive endometrial changes, corpus luteum (CL) growth and maturation, and luteolysis. Differences in the length of the menstrual cycle (MCL) have been associated with variable female fecundity. However, the reason for these differences is so far unknown. The donor-recipient model, separating uterine from ovarian factors, allows clarifying the origin of MCL-associated fecundity variations. Study design We analyzed retrospectively 2015 oocyte donation cycles, resulting in 3427 embryo transfers (ET) and pregnancy follow-up. Results Surprisingly, we found that oocyte donors MCL of 34-35 days were strongly associated with significantly higher biochemical, clinical and ongoing pregnancy rates in woman who received the embryos, compared to the reference group of MCL of 27-29 days. Moreover, donors with longer MCL presented higher ovarian response to stimulation and lower amount of hormonal stimulation needed to achieve multifollicular growth. Conversely, MCL of <25 days were associated with a poorer ovarian response to stimulation, less cumulus oocyte complexes (COCs) and less mature oocytes (MII) retrieved; however, the quality of oocytes in these women is not associated to their ovarian response, as evidenced by the pregnancy rates obtained when transferred into an adequately prepared endometrium. Conclusions We conclude that oocyte quality, rather than natural endometrial preparation, is the main reason for the reported higher fecundity of women with longer MCL. This result is further confirmed by our data on bleeding length in the donor pool. Response to ovarian stimulation is the definitive test of ovarian reserve; moreover, since different MCLs result from varying length of the follicular phase, longer MCL should be associated with a higher number of follicular recruitment events. We hypothesize that MCL is associated with - and a marker of - ovarian reserve in healthy reproductive age women. © 2014 Elsevier Ireland Ltd.

Bodri D.,Clinica EUGIN | Bodri D.,University of Barcelona | Guillen J.J.,Clinica EUGIN | Lopez M.,Clinica EUGIN | And 2 more authors.
Human Reproduction | Year: 2010

Background: Race and ethnicity are one of the newly investigated patient-related prognostic factors that might affect the outcome of assisted reproduction techniques. To our knowledge no data currently are available on the effect of race on oocyte donation outcome.MATERIALSA retrospective, matched cohort study was performed in a private infertility centre evaluating 1012 Black, South-East Asian and Caucasian recipients undergoing their first oocyte donation cycles. Results: A significantly lower ongoing pregnancy rate (24.6 versus 36.8, OR: 0.56 95 CI: 0.40-0.77, P = 0.01) was observed among Black recipients compared with their matched Caucasian counterparts. The prevalence of uterine fibroids (49.6 versus 17.1, P < 0.0001) and previous history of tubal infertility (53.2 versus 16.5, P < 0.0001) was significantly higher among Black women. Multiple logistic regression analysis showed that, after adjusting for confounding variables, Black race was an independent risk factor for not achieving an ongoing pregnancy (for ongoing pregnancy, adjusted OR: 0.62 95 CI: 0.43-0.89, P = 0.009). Ongoing pregnancy rate (37.2 versus 37.2, OR: 1.0 95 CI: 0.49-2.04, P = 1.0) was not significantly different between South-East Asian and matched Caucasian patients. Conclusions: Black race was an independent risk factor for not achieving an ongoing pregnancy after oocyte donation. Although yellow race does not seem to adversely affect oocyte donation, larger studies are still warranted to draw more solid Conclusions: Race should be considered as an independent prognostic factor in oocyte donation.

Madero S.,Clinica EUGIN | Rodriguez A.,Clinica EUGIN | Vassena R.,Clinica EUGIN | Vernaeve V.,Clinica EUGIN
Human Reproduction | Year: 2016

Study Question Is there a difference in live birth rates following endometrial preparation with either a constant or increasing estrogen dose in fresh embryo transfer from oocyte donation cycles? Summary Answer There is no difference in live birth rates between a constant dose versus an increasing dose of estrogen after fresh embryo transfer in oocyte donation cycles with oral or transdermal supplementation. What is Known Already Endometrial preparation (EP) with estrogen and progesterone, and embryo-endometrial synchronicity are determinant for adequate embryo implantation. Estrogen is crucial and different exogenous administration patterns could imply variations on EP. Moreover, estrogen undergoes metabolization by the intestines and liver when administered orally, an effect that is bypassed by transdermal administration. Information on the effect of replacement patterns and route of administration of E on reproductive outcomes of women undergoing fresh embryo transfer from oocyte donation cycles is scarce. Study Design, Size, Duration Retrospective cohort study including 8362 embryo transfers following ICSI, corresponding to 8254 patients, between October 2010 and March 2015. A total of 5593 (66.9%) patients received an increasing E dose (ID) (oral: 2 mg/day day(d)1-7, 4 mg days d8-12, 6 mg d13-embryo transfer; transdermal: 75 μg/3 days on d1-6, 150 μg/3 days d7-embryo transfer) while 2769 (33.1%) received a constant dose (CD) of estrogen (oral: 6 mg/day 1-embryo transfer; transdermal: 150 μg/3 days d1-embryo transfer). Embryos were generated by ICSI with fresh or vitrified donor oocytes fertilized with either fresh or frozen sperm from either the couple partner or donor. Participants/Materials, Setting, Methods Cohort allocation was not related to patient characteristics; instead it reflected an internal policy change in E administration. Effect of estrogen dose (ID versus CD) on biochemical, clinical, ongoing and live birth rates, stratified by administration route, was analyzed by univariate and multivariate analysis adjusted by donor and recipient demographic and cycle characteristics. Main Results and the Role of Chance No difference in live birth rate was found between CD and ID for oral (33.0 versus 32.5%, P = 0.81) and transdermal (35.3 versus 33.5%, P = 0.33) supplementation. Biochemical pregnancy rate was higher in CD than ID (53.7 versus 47.5%, P < 0.001) when patients received oral supplementation. Adjusted analysis confirmed that oral administration had a greater impact on biochemical pregnancy rates than transdermal (odds ratio (OR) 1.28; 95% confidence interval (CI) 1.11-1.48, P = 0.001 versus OR 1.13; 95% CI 1.00-1.30, P = 0.055). Sub-analysis of transfers between day 12 and 15 of estrogen supplementation showed no difference between CD and ID in pregnancy outcomes. Demographic variables and cycle characteristics were comparable between both groups. Moreover, the use of the oocyte donation model reduces confounding factors related to oocyte age, embryo aneuploidy, and embryo quality. LIMITATIONS, REASONS FOR CAUTION The greatest limitation of this study is its retrospective nature. On the other hand, this study was performed using donated oocytes; although this is unlikely to affect the results, we cannot exclude the possibility that a high quality female gamete responds differently to endometrial state in comparison to a patient's own oocytes. Wider Implications of the Findings In fresh embryo transfer from oocyte donation cycles, changes in the protocol of E replacement do not seem to have an impact on clinical outcomes and performance; for this reason estrogen replacement protocols can be adjusted to the patient's characteristics and preferences as well as to the most cost effective strategy. © 2016 The Author.

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