ESPAÑOL


FREQUENTLY ASKED QUESTIONS

In-vitro fertilization


  • What are the success rates in in-vitro fertilization (IVF) with non-donor oocytes?
  • What are the basic tests we should have done for a correct diagnosis before undergoing IVF?
  • What are the medications I should use if I undergo an IVF cycle?
  • Is miscarriage more frequent in older women?
  • How long should a patient who undergoes IVF stay in Argentina before coming back home?
  • Should women over 35 years of age consult a reproductive endocrinologist before 12 months of unprotected sex?
  • Is it possible to diagnose genetic diseases in an embryo?
What are the success rates in in-vitro fertilization (IVF) with non-donor oocytes?

Clinical pregnancy rate depends on the female’s age. It is about 45% in women below 38 years old, around 35% in women between 38 and 40 years old, and 20% in women over 40 years old.
See success rates

What are the basic tests we should have done for a correct diagnosis before undergoing IVF?

Patient:

  • Hormonal profile (FSH, LH, E2, PRL, TSH) between day 2 and day 4
    of menstrual cycle.
  • Hysterosalpingography.
  • Transvaginal ultrasound (between day 2 and day 4 of menstrual cycle)
  • Cervical culture (Chlamydia and Mycoplasm)
  • Pap smear
  • Bloodwork:
  • HIV (AIDS), hepatitis B and C, RPR (syphilis)
  • Blood type and Rh factor
  • Rubella serology (IgG)
  • Hemogram, hepatogram, lipidogram, glycemia, EKG (electrocardiogram)

Partner:

  • Semen analysis
  • Bloodwork:
  • HIV (AIDS), hepatitis B and C, RPR (syphilis)
  • Blood type and Rh factor
What are the medications I should use if I undergo an IVF cycle?
Is miscarriage more frequent in older women?

Miscarriage and chromosomal anomalies increases when female age increases. This is only true for non-donor eggs. In the case of oocyte donation, miscarriage and chromosomal anomalies are not affected by the recipient’s age.

How long should a patient who undergoes IVF stay in Argentina before coming back home?

We try to reduce the number of days in Argentina. Usually, 10-12 days is enough.

Should women over 35 years of age consult a reproductive endocrinologist before 12 months of unprotected sex?

Yes, it is advisable to consult a reproductive endrocrinologist after only 6 months of unprotected intercourse without conception.

Is it possible to diagnose genetic diseases in an embryo?

Yes, preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) is used to find out chromosomal anomalies or genetic mutations. Main indications are familial history of a specific disease, multiple failures during prior attempts to conceive via assisted reproductive technologies and recurrent miscarriage.

Egg Donation


  • What are the main indications for receiving donated oocytes?
  • What are the requirements to be a recipient?
  • What are the success rates in egg donation?
  • What are the medications I should use if I am a donor egg recipient?
  • In egg donation, does the pregnancy rate decrease in women over the age of 40?
  • What is the top age to be a recipient in CEGyR?
  • What happens if the donor cycle is cancelled or if no oocytes are retrieved?
  • Is it an anonymous program?
  • What is the age of donors?
  • Why is it a more affordable program than most in the USA and Europe with equally high success rates?
  • How long should a recipient stay in Argentina before coming back home?
  • How many embryos are to be transferred to the recipient?
  • What are the obstetric risks in egg donation?
  • How long will I wait until the transfer is done? How long is the waiting list?
  • Is it usual to have foreign recipients in your egg donor program?
  • Can we use donated sperm to fertilize donated eggs?
  • Do you transfer on blastocyst stage?
What are the main indications for receiving donated oocytes?

Most women receive donated eggs because their ovaries do not produce good quality and/or quantity of oocytes. The main reasons are advanced female age, diminished ovarian reserve, women who are known to be affected by or known to be the carrier of a significant genetic defect or who have a family history of a condition for which carrier status cannot be determined, and women with poor oocyte and/or embryo quality or multiple failures during prior attempts to conceive via assisted reproductive technologies.

What are the requirements to be a recipient?
  • Required age: up to 50 years inclusive.
  • An up-to-date clinical, gynecological and infectious evaluation:
  • An up-to-date gynecological evaluation that should include: Pap smear, breast examination, transvaginal ultrasonography and a hysterosalpingography.
  • HIV (AIDS), hepatitis B and C, RPR (syphilis) (both the recipient woman and her spouse/partner)
  • Blood type and Rh factor (both the recipient woman and her spouse/partner)
  • Rubella serology (IgG)
  • Cervical culture (Chlamydia and Mycoplasm)
  • If the patient is more than 40 years old: hemogram, hepatogram, lipidogram, glycemia, EKG (electrocardiogram) and surgical risk, and mammography.
  • Psychological evaluation by CEGyR professionals both individually and together with the patient’s spouse/partner.
  • The male factor is tested with a complete semen analysis.

See Screening Checklist

What are the success rates in egg donation?

The clinical pregnancy rate is about 60-65%. Twenty five percent are twins and less than 1% are triplets.

What are the medications I should use if I am a donor egg recipient?
In egg donation, does the pregnancy rate decrease in women over the age of 40?

No it does not. Success rate depends on the age of the eggs and not on the age of the uterus. Several studies have showed that rates are stable in recipients between 25 and 50 years old.

What is the top age to be a recipient in CEGyR?

Recipients should not be over 50 years old.

What happens if the donor cycle is cancelled or if no oocytes are retrieved?

At least 6 (six) mature oocytes are guaranteed to each recipient. If donor cycle is cancelled or less than six oocytes are retrieved, the recipient will be matched with another donor. No extras will be charged in these cases.

Is it an anonymous program?

Yes, it is. No identifying information about the donor will be given to the recipient and vice versa.

What is the age of donors?

In our program, they are between 21 and 32 years old. This policy reduces chances of bad quality oocytes and aneuploidies (less chances of miscarriage and chromosomal abnormalities like Down Syndrome).

Why is it a more affordable program than most in the USA and Europe with equally high success rates?

We do split cycles. Sharing the donor oocytes among several recipients reduces costs and shortens the waiting time. As young women donate eggs, most times they are good quality, so that with only 6 (six) mature oocytes the pregnancy rate is good. Besides this, Argentine currency is devalued. This is a high price in terms of local costs but is a low price in comparison to those from the USA and Europe.

How long should a recipient stay in Argentina before coming back home?

We recommend staying for 7 (seven) days. During the staying, the recipient couple will have an appointment with the psychologist, they will have a semen sample frozen and used for fertilization, and they will undergo the embryo transfer.

How many embryos are to be transferred to the recipient?

One or two blastocysts will be transferred to the recipient uterus. The aim is to sustain a good pregnancy rate, reducing the twins rate and avoiding having triplets.

What are the obstetric risks in egg donation?

Some papers showed that risks in egg donation are related to the fact that average maternal age is higher than average age in women who get pregnant with their own eggs. This means that risks are not related to the fact that eggs are donated but to the age of recipients. Obstetrics risks in women over 40 years old are hypertension, diabetes, preterm delivery, low-birth weight and second half hemorrhage. These complications are usually well managed in expert prenatal care.

How long will I wait until the transfer is done? How long is the waiting list?

Average time from the day you decide to receive donated eggs to the day the embryos are transferred to your uterus is about 2-3 months.

Is it usual to have foreign recipients in your egg donor program?

More than 20% of all recipients are from abroad. Most of them come from USA, Canada, Australia and New Zealand. They also come from the rest of Latin America (mostly from Uruguay, Paraguay, Chile, Bolivia and Peru) and some countries of Europe.

Can we use donated sperm to fertilize donated eggs?

Yes, you can. In Buenos Aires, there are sperm banks were patients can get donated sperm.

Do you transfer on blastocyst stage?

We always transfer on blastocyst stage. We usually transfer one or two blastocysts. Transferring on blastocyst stage increase the pregnancy rate a lot. In case that we don’t have any blastocyst to transfer (which is very unusual), we allocate new eggs to the recipient with no extra cost. We guarantee that all the recipients will have at least one blastocyst to transfer.


Male factor


  • What are the most frequent causes of male infertility?
  • What are the main procedures used in the case of male infertility?
  • What are the main points to look at in a semen analysis?
  • What is the meaning of teratozoospermia?
  • Are there any other studies that can be done if I have severe teratozoopermia?
  • What is MSOME?
  • What is IMSI?
  • What do embryologists see when they do IMSI?
  • Who may obtain benefit from using IMSI?
  • What are the risks when using IMSI?
  • What should I do if I have severe teratozoospermia (a strict Kruger morphology index below 6%)?
  • Can I use my own sperm if I have azoospermia?
What are the most frequent causes of male infertility?

Sometimes there is no evident cause. However, factors such as varicocele, testicular infections, genetic diseases, and the use of drugs, alcohol and smoking impact on the quantity, motility and/or morphology of spermatozoids.

What are the main procedures used in the case of male infertility?

In mild and moderate cases, intrauterine inseminations can be used. In cases of severe male infertility, in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) has to be used.

What are the main points to look at in a semen analysis?

The main points are sperm concentration, motility and morphology

What is the meaning of teratozoospermia?

Teratozoospermia is the term used for referring to an alteration in the morphology of the sperm. It is mild when morphology is less than 14% normal (using strict criteria or Kruger criteria). It is severe when it is less than 4% normal.

Are there any other studies that can be done if I have severe teratozoopermia?

Patients with teratozoospermia should be studied in depth. Several studies, including electronic microscopy, can help in understanding what the pathology present in the semen is, what the prognosis is, and can help the biologists who do the ICSI to choose a healthy sperm to be injected into the oocyte.

What is MSOME?

MSOME is a real-time, high magnification motile sperm organellar morphology examination. It is a diagnosis tool that allows embryologists to magnify sperm up to 6,000 times and let us decide if conventional ICSI is good enough or if IMSI may offer a benefit. This is the same technology that is used in IMSI.

What is IMSI?

Intracytoplasmic morphologically selected sperm injection (IMSI) is a technology that allows embryologists to magnify sperm up to 6,000 times compared to the standard 200 to 400 times magnification associated with traditional fertilization approaches. This is the same technology that is used in MSOME but this is a therapeutic tool.

What do embryologists see when they do IMSI?

IMSI makes it possible to discard sperm whose nuclei have an abnormal shape or contents. The optimum nucleus is smooth and symmetric, with an oval configuration. Using IMSI, the embryology team can identify any malformation or vacuole in the nuclear mass and they can choose the spermatozoa with optimal length and width.

Who may obtain benefit from using IMSI?

Men whose semen sample shows less or equal to 4-6% of normal spermatozoa (by the strict Kruger morphology criteria) may benefit from IMSI.

What are the risks when using IMSI?

IMSI is still an investigational technology that is supposed to be at least as good as conventional ICSI, but has the potential of having better results in those cases that may benefit from it. Some papers have already published increased pregnancy rates. Nowadays, all over the world, hundreds of children have already born after doing IMSI with no increased abnormalities. There are no theoretical risks in using IMSI.

What should I do if I have severe teratozoospermia (a strict Kruger morphology index below 6%)?

A patient with a severe alteration in the sperm morphology should retrieve a semen sample for MSOME. Depending on morphologic alterations found, IMSI may be suggested. If morphologic alterations are not too important, conventional ICSI will be suggested.

Can I use my own sperm if I have azoospermia?

If you have azoospermia, you should undergo a testicle biopsy. Sometimes sperm is present in testicle but not in semen. If it is not present, donor semen should be used. There are some other tests like karyotype and chromosome Y microdeletions in the blood which can help in understanding the prognosis and the possible inheritance pattern of this pathology.



Egg freezing


  • What is the top age to freeze eggs?
  • What is the ideal number of eggs to freeze?
  • Who could need to freeze eggs?
  • What is eggs vitrification?
  • What will I do with the frozen eggs? How can I use them after thawing?
What is the top age to freeze eggs?

Although there is no consensus about a top age to freeze eggs, we should know that in older women the success rate decreases. Ideal, it is suggested to freeze eggs in women below 35 years old. However, if you are between 35 and 40 and you are wondering if it is worthy or not,  you should know that it could be worthy in case you are not planning to have a pregnancy in the next couple of years. The earliest is usually the best. In women over 40 years old, egg freezing is controversial due to the low success rates.

What is the ideal number of eggs to freeze?

Although there is no ideal number of eggs to freeze, some published studies have shown that probabilities of getting a pregnancy increase when you have more frozen eggs. Even more, the number of children that you could finally have is also related with the number of eggs that were frozen. This is the reason why many women choose to freeze eggs in more than one cycle, in order to have more frozen eggs available for the future.

Who could need to freeze eggs?

Most women freeze eggs because they have the desire  to postpone the moment to get pregnant and they would like to preserve the best oocyte quality. Although the eggs quality is lower in women of advanced age, when you freeze eggs, you maintain the egg quality some better. The most common reasons to freeze eggs are social and medical. Among the social, there are women who seek job stability, professional or academic growth, or a better economic situation before taking the decision of getting a pregnancy. Among the medical reasons, both in some cancer treatments and in the case of ovarian surgeries (endometriosis, cysts or others), when it is suspected that the ovarian reserve may become impaired after the intervention to be performed, oocyte cryopreservation is a good alternative.

What is eggs vitrification?

Vitrification is the term used for the technique with which currently the eggs (and also the embryos) are frozen. More than a decade ago, slow freezing was used. Both are cryopreservation techniques, except that vitrification is a more effective technique as it causes less damages to cell structures. The most important feature is that, by freezing the eggs so quickly, ice formation inside the egg is prevented, which could injure internal cellular structures. Vitrification began as an experimental technique but, by 2012, the American Society for Reproductive Medicine (ASRM) considered it a technique that could be routinely used.

What will I do with the frozen eggs? How can I use them after thawing?

The frozen eggs remain in this state until you decide to use them. At that moment, they will be thawed. Those who survive (currently the survival rate of cryopreserved oocytes exceeds 90%), are used for an in vitro fertilization (IVF) or ICSI with the sperm of your partner or with donor sperm, according to your needs, as if it were a regular IVF. And some few days, when the embryos got to blastocyst stage (day 5), the transfer will be done to the uterus (those that are not left over and not transferred, will be cryopreserved, usually in the blastocyst stage).



Preimplantation genetic screening (PGS)


  • ¿What is the preimplantacional genetic screening (PGS)?
  • ¿Hay resultados falsos positivos y falsos negativos en el PGS?
  • What do mosaicisms mean?
  • ¿Can we know the gender of the embryo?
  • What are the advantages of PGS?
¿What is the preimplantacional genetic screening (PGS)?

Using PGS, we can assess the number of chromosomes that some cells of the analyzed embryos have. We do a biopsy of the embryo in blastocyst stage and then we freeze the embryo until we get the result (some days later). Once we have the result, we thaw and transfer the normal blastocysts one by one. Implantation rate increases a lot as we are going to transfer just embryos with normal karyotype.

¿Hay resultados falsos positivos y falsos negativos en el PGS?

As in any diagnosis test, we have false positives (we report abnormal embryo when it is a normal embryo) and false negatives (we report a normal embryo when it is abnormal). However, wrong results as these are not frequent, and depends on the technology that the program uses for PGS.

What do mosaicisms mean?

When one embryos has both normal and abnormal cells, that is called mosaicism. The most important problem is that it is difficult to know what the real impact on the newborn health is.  Although there are some reports of newborns coming from mosaic embryos, there is no consensus if it is safe or not to transfer them. Next-Generation DNA Sequence (NGS) is one of the most modern techniques for PGS; using NGS, more mosaic embryos than in the past are diagnosed. It could be an advantage, in case that transferring mosaic embryos would increase the risk of having a baby with abnormalities. But, it could also be a disadvantage, in case that we are not transferring an embryo that could have been a healthy baby.

¿Can we know the gender of the embryo?

As we can see how many chromosomes each embryos has, and some of those chromosomes are the sexual ones, when doing PGS we could know if the embryo is male (46,XY) or female (46,XX).

What are the advantages of PGS?

When using PGS, time-to-pregnancy is decreased, and the implantation rate is increased. These high implantation rates has stimulated the policy of elective single-embryo transfer (e-SET). There are some other potential advantages for women with recurrent miscarriage, recurrent implantation failure and advanced reproductive age. However, there are no good-quality evidence supporting the use of PGS in these mentioned cases.


Contact Us

Dr. Demián Glujovsky in CEGYR Buenos Aires
Viamonte 1432 - Buenos Aires Argentina
info@fertilityargentina.com
Phones:
Argentina:+54 (11) 5031-2060
USA:+1 (718) 475-9269
Australia:+61 (7) 3 106-8961

Newsletter



Fertility Argentina

ESPAÑOL