IVF Add-ons

What additional tests/techniques can be used in an IVF cycle?

Many patients who come to Clínica Tambre to undergo in vitro fertilization treatment after having had several failed cycles agree on one of the following things:

Either they have not received sufficiently comprehensive diagnostics from the beginning, or personalized techniques have not been implemented for each cycle. In this article, we explain as a list the most relevant techniques and advances to be able to complement IVF treatment.

What tests/techniques are recommended for IVF treatment?

The male factor:

Comet Fertility ®

It allows evaluation of the percentage of DNA fragmentation in an ejaculate. Fragmentation is defined as the presence of breaks in DNA. The DNA molecule consists of two strands that form a double helix. These breaks can occur in one of the chains, which is called single-strand fragmentation, or in both, which would be double-strand fragmentation. While increased single-strand breaks are associated with male infertility, increased double-strand breaks are associated with increased risk of miscarriage and poorer embryo quality due to sperm.

FERTILE Chip®/ ZyMōtTM

If there is increased DNA fragmentation, this device will select the sperm with less DNA fragmentation for ICSI.

There are other alternative sperm selection techniques. For example, MACS is another technique that can be used to select sperm with lower DNA fragmentation. MACS is used to filter out apoptotic sperm. Apoptosis is called programmed cell death. High DNA fragmentation eventually leads to apoptosis, but it is not entirely clear whether all fragmented sperm express markers of apoptosis and whether this is true for both single strands and double strands. Instead, the Fertile Chip was specifically designed to filter fragmented sperm, both single-stranded and double-stranded.

Therefore, we can say that Chip Fertile is more suitable from selection procedures for men with sperm DNA fragmentation, especially double-stranded. It should be noted that the use of this filter requires a certain semen quality, so Chip Fertile cannot be used in certain cases. In this case, MACS or other types of filters can be used alternatively, which help us, even if only partially, to reduce the number of fragmented sperm.

Chromosperm and FISH:

This allows the chromosome content of a semen sample to be determined. If a high percentage of sperm in the ejaculate have more or fewer chromosomes than they should, this could lead to altered results of in vitro fertilization treatment. Here, Chromosperm evaluates a general chromosomal profile, while FISH analyzes five specific pairs of chromosomes (those most commonly affected in fertility problems). An ejaculate with a high percentage of chromosomally altered sperm may result in a higher number of embryos that have chromosomal abnormalities.

What tests/techniques are recommended for IVF treatment?

The female factor:

ES (Endometrial Solution)

ES TIME
Test that determines the implantation window based on an endometrial biopsy.

ES META

A test that examines the microbiome and endometrium for infections using a biopsy.

These tests are performed in women with suspected implantation failure. Both tests can be performed together using a single endometrial biopsy. Approximately 5 days after ovulation or 5 days after egg retrieval, the uterus is ready to receive an embryo, this period is called the implantation window. In some women, this implantation window may be shifted, so that an embryo transfer must be performed in due time to achieve implantation. The implantation window is determined by gene expression testing. An altered microbiome or infection of the endometrium may also prevent embryo implantation. An appropriate therapy recommendation follows with the evaluation of the test.

3D ultrasound or hysteroscopy

Uterine abnormalities can be detected thanks to a 3D ultrasound of the uterus. These can be, for example, a septum, deformations of the uterus, polyps or fibroids. Such abnormalities can prevent implantation of the embryo or lead to miscarriage. Many of these abnormalities can be operated on and removed or corrected by hysteroscopy (uterine endoscopy).

Thrombophilia diagnostics and antiphospholipid syndrome.

Congenital thrombophilia risk factors associated with an increased risk of thrombosis. Diagnosis is made by blood analysis. Women in whom positive thrombophilia markers are detected have a higher risk of embryo implantation failure and miscarriage, in addition to an increased risk of thrombosis. Anticoagulants can be used to minimize these risks.

What techniques are recommended in an IVF cycle?

GERI – Time Lapse

For the optimal development of the embryo, it is important to create conditions as similar as possible to those in the uterus. Therefore, it is necessary to adapt the environmental conditions of the laboratory and equip it with carbon filters, positive pressures, etc. Above all, the quality of the embryo incubator is crucial.

In the past, embryologists observed the embryos only once a day. To achieve this, they had to take them out of the incubator and place them under the microscope. Embryo quality was assessed because of this single moment. However, recently, incubators have been developed that require virtually no interruption of the microenvironment in which the embryo is developing. This is the case with Time Lapse GERI, a state-of-the-art embryo incubator.

Intracytoplasmic sperm injection (ICSI)

IVF with ICSI is a reproductive technique that fertilizes an egg by inserting a single sperm through microinjection. After fertilization, the egg turns into a pre-embryo, which is then placed in the uterus for its further development.

By injecting a single sperm directly into an egg, ICSI helps sperm overcome many of the natural barriers they would encounter in fertilizing an egg. For example, if a man has poor sperm motility, which means his sperm do not swim well, ICSI helps to bypass this problem during fertilization. If a man suffers from a low sperm count where the likelihood of fertilization is low, an embryologist can perform ICSI to fertilize an egg.

Spermslow

SpermSlow™ is a semi-viscous medium containing hyaluronic acid to slow movement and select an individual sperm with improved genetic and developmental integrity

Embryo selection and transfer of a single embryo

The selection of embryos for transfer is based on a number of morphological parameters statistically related to the possibilities of implantation and pregnancy. Thus, embryos are classified into grades according to the appearance they have under the microscope, with numerous embryonic classifications depending on the center. The embryo with the best assessment is transferred first, and the remaining embryos, also assessed as good, are cryopreserved to be transferred in subsequent cycles in case the transfer of the selected embryo has failed.

In Clínica Tambre we are committed to the transfer of single embryos at the blastocyst stage. In this stage, which is reached on the 5th day, and thanks to the confidence we have in our technologies and techniques, we can see the viability and development of the embryos, to later decide on the embryo with the greatest implantation capacity. In this way, the chances of pregnancy increase.

Transferring multiple embryos increases the possibility of multiple pregnancies, which can lead to risks and complications such as preterm birth, hypertension, preeclampsia, and other risks to both mother and child, especially at the woman’s advanced age.

EmbryoGlue / culture medium

Some people may have heard of a special culture medium to transfer embryos into the uterus (called: EmbryoGlue). We do not use it in Clínica Tambre because numerous studies have indicated that it does not significantly improve pregnancy or implantation rates. Therefore, we rely on our proven culture medium, with which we have good experience.