Motherhood is a desired and long-awaited moment for hundreds of women. But the reality is that for some it is a rocky road with obstacles along the way. Assisted reproduction is one of the most avant-garde fields of medicine, in which research and technology are at the service of our patients’ dreams. For this reason, at IVI we are specialists in high complexity assisted reproduction. So we can treat even the most difficult cases and help them achieve what they long for.

Implantation failure or repeat miscarriages

Implantation failure is when the patient is not able to become pregnant after the transfer of 2 euploid embryos. This type of embryos are chromosomally normal embryos –containing 46 chromosomes. Implantation failure can also occur in cases where pregnancy is also not achieved when 4 blastocysts have been transferred. Unfortunately, 5% of IVI patients have experienced this at some time.

On the other hand, repeat miscarriage is diagnosed when a woman has had two gestational losses before the 24th week. In this case, 6% of our patients have experienced two or more previous miscarriages.

If you are in either of these two situations, at IVI we are specialists in High Complexity Assisted Reproduction and we can help you. We have a study that approaches the issue from two angles: the diagnostic study –analysing personal and family history– and the therapeutic study –through a series of tests.

Diagnostic study for implantation failures or repeated miscarriages

• Imaging tests –3D ultrasound, hysteroscopy or laparoscopy– to detect possible genital organic pathologies.
• Blood tests to determine causes associated with maternal thrombophilias.
• Endometrial receptivity analysis
• Preimplantation Genetic Testing (PGT-A) for the detection of chromosomal abnormalities

In the event that this series of tests does not enable our specialists to determine the cause of either of these two problems, a reproductive immunology study will be considered in our Immunology Unit. There are occasions in which these infertility problems, which seem to have no apparent reason, are due to immunological alterations.

Therapeutic study for implantation failures or repeated miscarriages

• Imaging tests –3D ultrasound, hysteroscopy or laparoscopy– for the treatment of possible genital organic pathologies detected.
• Treatment, guided by haematologists specialising in reproductive pathology, against congenital or acquired thrombophilias.
• Preimplantation Genetic Testing (PGT-A + PGT-SR) or gamete donation, to prevent the transmission of parental chromosomal anomalies or embryonic anomalies, in coordination with specialists from IVI’s Reproductive Genetics Unit.

Becoming a mother after 40

Many women decide to postpone motherhood –for whatever reason– and when they decide it is the right time, they encounter many difficulties. Age is one of the main obstacles when a woman undergoes assisted reproduction treatment. From the age of 35 onwards, there is a decrease in the quality of the oocytes. This increases the chances of generating embryos with aneuploidies. Age also affects the number of oocytes, which can lead to a low ovarian reserve. If this happens, after ovarian stimulation for an IVF cycle, the patient does not generate enough oocytes.

In cases where a woman wants to become a mother after the age of 40, the first thing to do is to carry out a fertility study. For this purpose we have different diagnostic tests, such as 3D ultrasound and anti-Müllerian hormone (AMH) testing. The second step will be for the specialist and the patient to make a joint decision. Finally, based on the most suitable treatment chosen, we offer patients different options adapted to their case.

Preimplantation Genetic Testing (PGT-A) to select the best embryos, with the aim of achieving a healthy baby in the shortest possible time.

• Oocyte accumulation, for those cases in which there is a low ovarian reserve and PGT-A has been previously recommended. It may also be advisable for these patients to opt for DuoStim.
• Egg donation, to rule out the negative impact of age on oocyte quality.

Patients with low ovarian reserve

A woman is considered to be a low responder when optimal ovarian stimulation is not achieved. The main characteristic of these cases is the low number of oocytes. Therefore, the lower the number of oocytes, the fewer embryos to select and transfer. As a result, the chances of achieving pregnancy in this type of patient are lower. As we mentioned above, childbearing age is getting later and later, so in the future there will be more women with a low response. This may be a new challenge for IVI in High Complexity Assisted Reproduction. Fortunately, however, there are several options available to us:

• Accumulation of oocytes from different cycles. This way we manage to combine the possible transfers into a single transfer. This technique achieves lower cancellation rates, higher cumulative newborn rate and cycles with a higher number of frozen embryos.
• Genetic PLUS IVF, as the main factor in low response rates is the decrease in ovarian reserve due to age. Although there may also be other causes, which lead to low response and a higher probability of generating aneuploid oocytes. In cases of low responders with advanced maternal age, oocyte accumulation is the best option. This, together with PGT-A helps to rule out chromosomally abnormal embryos.

IVI Regenerate Ovary

In addition, at IVI we are working to offer you the IVI Regenerate Ovary technique in the near future. This involves the application of plasma rich in growth factors (PRGF). It is a promising alternative for patients diagnosed with low ovarian reserve, among other issues. This is another example of IVI’s expertise in high complexity assisted reproduction

One of the maxims of IVI and its professionals, throughout its 30 years of history, is constant research and innovation. The fact is that many of the patients who come to our clinics have a difficult history, for different reasons. For them, we are specialists in high complexity assisted reproduction. In order to provide them with solutions.