How has assisted reproduction progressed in recent years?

35 years ago the first girl in Spain was born in Barcelona by in vitro fertilization (IVF). Today, more than three decades later, we can say that assisted reproduction techniques have evolved remarkably and, in fact, according to data from the Spanish Fertility Society (SEF), 8% of all children who are currently born do so with the help of these techniques. But, In what and how has it evolved?

Ernesto Bosch, medical director of IVI Valencia, points to the DNA sequencing techniques that "allows to identify healthy carriers of diseases". This technique is very useful, especially, indicates the expert, in the case of treatments with egg or sperm donation. "We can ensure that if a patient is a carrier of a chromosomal disease, the donor or donor does not have it ". In this way, Bosch continues, "we can prevent two people with the same mutation from getting together because, doing so, the child would have a much greater chance of developing this disease".

To this is added, in the case of embryos already formed, the so-called PGS diagnosis, a technique that allows the selection of non-chromosomally altered embryos. As a consequence, explains Elena Santiago, gynecologist specialized in fertility treatments at the Tambre Clinic in Madrid, "we increase the possibility of having a healthy baby, we reduce the chances of abortion and increase the possibility of pregnancy by transfer ". With this technique, points out Santiago, "on day 5 of the embryo culture a biopsy of the highest quality embryos is performed, obtaining cells from their outer layers ". These cells contain chromosomes that represent the genetic state of the embryo; This is how they are analyzed in a genetic laboratory and after 10 days it is possible to know if the embryo contains aneuploids or if they do not have any chromosomal alteration.

When it comes to implanting the embryo there are also new techniques that translate into more successful pregnancy. In the case of patients who have suffered recurrent pregnancy losses or failed implantations, they can undergo the ERA test. "With this endometrial receptivity test we can study the genes that are relevant in the implantation process ”, Assures Santiago.  To perform this test, the patient undergoes the preparation of the endometrium in the same way that she would do for an embryo transfer. However, instead of transferring, an endometrial biopsy is performed. The result, says Santiago, "will tell us if the endometrium is receptive or not at that specific moment, in such a way that it will help us to identify the ideal moment for the transfer ".

Progesterone levels also play a fundamental role, as pointed out by the medical director of IVI Valencia. "We published a study in IVI a year ago in which we demonstrated how the levels of progesterone in the blood on the day of the transfer were closely linked to the success of the transfer ". This, the expert points out, has led to changes in clinical practice in this regard.

There has also been clear progress in treatment guidelines, as assured by Bosch. The medical director of IVI Valencia assures that the arrival of "more and more precise medicines has allowed to establish new more successful guidelines". For example "at IVI, thanks to the extensive database we have, we have been able to establish specific guidelines according to the patient's profile and their particularities ". This, he points out, "will intensify with the application of artificial intelligence ".

Support: More Success, Fewer Multiple Pregnancies

Another of the great advances in the field of assisted reproduction is the reduction of multiple pregnancies. As explained by the gynecologist specialized in fertility treatments at the Tambre Clinic in Madrid, "the improvement of laboratory techniques, which allow a better selection of embryos, has made it easier for us to reduce the multiple pregnancy rate ". And it is that, as Santiago points out, having better embryos means that only one embryo is transferred per treatment, "In such a way that we reduce the risk, because multiple pregnancies are associated with more risks. In our clinic we are very strict with this matter ".

In the case of artificial insemination, the reduction of this risk derives from a greater control in ovulation. "Today, with a more precise measurement of ovarian reserve we can better predict how the patient will respond to treatment, in such a way that we can control obtaining one, two or at most three eggs ", explains Dr. Bosch.

Article prepared by Marta Riesgo

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