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Bronet F.,IVI Madrid
Current Opinion in Obstetrics and Gynecology | Year: 2017

PURPOSE OF REVIEW: To find the way of having more and better blastocyst is essential. How to culture embryos up to blastocyst stage remains critical. RECENT FINDINGS: Several studies show how a blastocyst score can predict the implantation potential. If that score is enough to choose the best blastocyst, as culture conditions would not be affected in these days, we would not need to check early cleavage embryos, even it could be better for the embryo development. SUMMARY: The item that should be discussed is if it is better to evaluate or not embryos at early cleavage stages. If we do not check embryos on days 2 and 3, we should change our way to work and how to culture those embryos. First step would be to perform all embryo transfers on day 5 or 6. If we let embryos grow to blastocyst without any morphology evaluation, we should adapt several steps in our laboratory, for example we should move to a single-step culture medium or we should not do assisted hatching on day 3 embryos. Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.


Garcia-Velasco J.A.,IVI Madrid | Fatemi H.M.,Nova IVI Fertility Abu Dhabi
Reproductive BioMedicine Online | Year: 2015

Worldwide, gonadotrophin-releasing hormone (GnRH) antagonists are gaining ground, and the number of patients being treated for IVF with a GnRH antagonist is increasing. Cycle planning in GnRH antagonist IVF cycles has been a challenge. During the past 2 years, debate has been ongoing about the possible disadvantages of oral contraceptive pill (OCP) pre-treatment in GnRH antagonist IVF cycles. A recent meta-analysis clearly showed a significant decrease in ongoing pregnancy rates between patients who received OCP pre-treatment and those who did not. In this review, the published meta-analysis are is evaluated. It is argued that caution must be exercised in drawing conclusions too quckly on whether or not OCP pre-treatment might have a negative effect on outcome in GnRH antagonist IVF cycles. © 2014 Reproductive Healthcare Ltd. Published by Elsevier Inc. All rights reserved.


Meseguer M.,University of Valencia | Rubio I.,University of Valencia | Cruz M.,University of Alicante | Basile N.,IVI Madrid | And 2 more authors.
Fertility and Sterility | Year: 2012

Objective: To quantify the effect on reproductive outcome of culturing and selecting embryos using a novel time-lapse monitoring system (TMS). Design: Retrospective observational cohort study. Setting: University-affiliated private center. Patient(s): Donation and autologous intracytoplasmic sperm injection (ICSI) cycles from ten IVF clinics using similar procedures, cultured in TMS (n = 1,390) or in a standard incubator (SI; n = 5,915). Intervention(s): None. Main Outcome Measure(s): Clinical pregnancy rate confirmed by ultrasound in week 7. Result(s): A logistic regression analysis, which included all significant confounding factors, was used to evaluate the effect of culturing and selecting embryos with the use of TMS. Comparing clinical pregnancy rates per oocyte retrieval with TMS and SI treatments gave a crude effect of odds ratio [OR] 1.190 (95% confidence interval [CI] 1.058-1.337). Oocyte source, maternal age, day of transfer, and number of retrieved oocytes were identified as significant confounding factors. After accounting for confounding factors, the effect of TMS culture was OR 1.201 (95% CI 1.059-1.363). Limiting analysis to treatments with embryo transfer and including number of transferred embryos as a confounding factor likewise gave a significant effect of TMS with OR 1.157 (95% CI 1.018-1.315). Conclusion(s): Analysis of retrospective data indicated that culturing and selecting embryos by TMS significantly improved the relative probability of clinical pregnancy (+20.1% per oocyte retrieval, +15.7% per embryo transfer). The elevated clinical pregnancy rate was attributed to a combination of stable culture conditions and the use of morphokinetic parameters for embryo selection. © 2012 by American Society for Reproductive Medicine.


Basile N.,IVI Madrid | Meseguer M.,University of Valencia
Expert Review of Obstetrics and Gynecology | Year: 2012

Current methods of embryo evaluation rely mainly on static observations of the embryo's morphology. These observations are inevitably restricted to specific times and, considering that the development of the embryo is a dynamic process, several critical stages in between observations may go unnoticed. These methods are also very subjective, and variations between embryologists may affect critical decisions that will, in turn, affect the overall success of the IVF clinics. On the other hand, an increased number of multiple pregnancies calls for a reduction in the number of embryos transferred, making the selection procedure even more challenging for the embryologist. Therefore, new markers that may aid the selection of embryos with higher implantation probabilities are needed. This review details what is known about time-lapse imaging, its application in embryology and the possible use of this technology as a novel selection tool. © 2012 Expert Reviews Ltd.


Fatemi H.M.,IVI | Garcia-Velasco J.,IVI Madrid
Fertility and Sterility | Year: 2015

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious, and potentially lethal, complications of controlled ovarian stimulation (COS). Induction of final oocyte maturation with a bolus of gonadotropin-releasing hormone (GnRH) agonist (GnRHa), instead of the criterion standard hCG, in patients undergoing ovarian stimulation significantly reduces the risk of OHSS and could be considered to be more physiologic. A bolus of GnRHa used in this context also acts as a luteolytic agent. From a clinical point of view, the most significant benefit of GnRHa trigger is its ability to induce quick and reversible luteolysis and thus reducing the risk of OHSS development. This paper describes the pathophysiology of OHSS, focusing specifically on the luteolytic benefits of using GnRHa to decrease OHSS and the possible corpus luteum rescue modalities available.


Basile N.,IVI Madrid | Caiazzo M.,IVI Madrid | Meseguer M.,IVI Valencia
Current Opinion in Obstetrics and Gynecology | Year: 2015

Purpose of review Time lapse technology represents a new tool in the in-vitro fertilization (IVF) laboratory. It can aid the embryologist in the detection of objective and quantifiable markers associated with embryo viability and implantation. The purpose of this review is to explain how embryo morphokinetics can be used as an adjunct to standard morphological assessment and to evaluate its potential value to improve IVF outcomes. Recent findings Several algorithms have been developed. Some utilize early kinetic markers, whereas others rely more on later stages of embryo development. Even though over a handful of randomized control trials are in progress, at this point, only one has been published demonstrating a significant increase in implantation rates and ongoing pregnancy rates when selecting embryos on the basis of a combination of morphological assessment and morphokinetics. Summary We believe that standard morphological assessment should remain the gold standard to initiate embryo evaluation; however, if possible, it can be complemented with the use of morphokinetics. This new approach will allow the embryologist to perform a more accurate and objective embryo selection and therefore reduce the number of embryos transferred while maintaining or even improving clinical results. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Cobo A.,IVI Valencia | Garcia-Velasco J.A.,IVI Madrid | Domingo J.,University of Las Palmas de Gran Canaria | Remohi J.,IVI Valencia | Pellicer A.,IVI Valencia
Fertility and Sterility | Year: 2013

The aim of this review is to provide current knowledge on oocyte cryopreservation, with special emphasis on vitrification as a means to preserve fertility in different indications. Major advancements achieved in the past few years in the cryolaboratory have facilitated major changes in our practice. Areas such as fertility preservation for social or oncologic reasons, the possibility to create oocyte banks for egg donation programs, the opportunity to avoid ovarian hyperstimulation syndrome, or to accumulate oocytes in low-yield patients, or even to offer treatment segmentation by stimulating the ovaries, vitrifying, and then transferring in a natural cycle are some of the options that are now available with the development of cryopreservation. We present general experience from our group and others on fertility preservation for age-related fertility decline as well as in oncologic patients, confirming that oocyte vitrification is a standardized, simple, reproducible, and efficient option. © 2013 American Society for Reproductive Medicine.


Ruiz-Flores F.J.,IVI Madrid | Garcia-Velasco J.A.,IVI Madrid | Garcia-Velasco J.A.,Rey Juan Carlos University
Current Opinion in Obstetrics and Gynecology | Year: 2012

Purpose of review: To summarize the literature related to the value of surgery in endometrioma-associated infertility and present the most recent evidence in support or against the surgical removal of endometriomas with special attention before commencing in-vitro fertilization (IVF) treatment. Recent findings: Many studies support the evidence that surgical removal of endometriomas is deleterious to ovarian reserve and function. There is now convincing evidence that surgery for removal of endometriomas does not offer any additional benefits in terms of fertility outcomes. Other concerns after surgery are a higher risk of premature ovarian failure, earlier age at menopause, and higher cancellation rates in IVF cycles as well as the inherent risks of an invasive procedure. Summary: Laparoscopic surgery for the removal of endometriomas is still a very common practice in the field of reproductive medicine. Although endometriomas per se may be detrimental to the ovarian reserve, the current evidence points toward an even lower ovarian reserve after surgery. Additionally, a reduced response of the ovaries to gonadotrophins has been described in different studies after surgical removal of endometriomas. The quality of the oocytes retrieved in IVF cycles is not improved after surgery. Patients going through an operative procedure might extend the time to pregnancy. Surgery should be envisaged only in specific circumstances such as pelvic pain or difficult access to growing follicles but not offered to every single patient with endometrioma-associated infertility. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Castillo J.C.,FIV Valencia | Juan G.-V.,IVI Madrid | Humaidan P.,University of Southern Denmark
Journal of Assisted Reproduction and Genetics | Year: 2012

Purpose This study aimed to explore the incidence of empty follicle syndrome (EFS) in oocyte donors who had final oocyte maturation triggered with GnRHa and to compare the incidence of EFS in this group of patients with IVF patients who had final oocyte maturation with hCG. Methods Data including 2034 oocyte donation cycles and 1433 IVF cycles performed between years 2009 and 2010 was retrospectively analyzed to identify cases of EFS in each group. Results The incidence of EFS in the two groups did not differ significantly, 3.5% versus 3.1%, (n.s.). Conclusions This large retrospective analysis indicates that the incidence of EFS is not increased after GnRHa triggering as compared to hCG triggering. © 2012 Springer Science+Business Media, LLC.


Ortega I.,IVI Madrid | Duleba A.J.,University of California at San Diego
Annals of the New York Academy of Sciences | Year: 2015

Resveratrol, a natural polyphenol found in grapes, berries, and medicinal plants, exhibits antioxidant and anti-inflammatory activities and has been proposed to be a longevity-prolonging agent. There is also growing evidence that resveratrol has cardioprotective properties and beneficial effects on both glucose and lipid metabolism. Recently, several studies have examined the use of resveratrol as a therapeutic agent to treat numerous pathological and metabolic disorders. Herein, we present insights into the mechanisms of action, biological effects, and current evidence of actions of resveratrol on the ovary. In vitro, resveratrol inhibits proliferation and androgen production by theca-interstitial cells. Resveratrol also exerts a cytostatic, but not cytotoxic, effect on granulosa cells, while decreasing aromatization and vascular endothelial growth factor expression. In vivo, resveratrol treatment reduced the size of adipocytes and improved estrus cyclicity in the previously acyclic rat model of polycystic ovary syndrome (PCOS). In addition, resveratrol increased the ovarian follicular reserve and prolonged the ovarian life span in rats. Taken together, resveratrol emerges as a potential therapeutic agent to treat conditions associated with androgen excess, such as PCOS. The efficacy of resveratrol in the treatment of gynecological conditions requires further investigation. © 2015 New York Academy of Sciences.

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