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Over nearly four decades, The age of first pregnancy among Spanish women has increased by seven points, Or the same, in 1985 she decided to become a mother at the age of 25 (on average). Today, This decision has been postponed till 32(on average 2023). There is not just one, but many and all kinds of reasons for this, social and economic. The decision to become a mother is in many cases determined by women’s professional development and the difficulties that prevent young people from achieving a state of emancipation and stability.
But biology cannot stand still and wait for changes in the real estate market or better employment conditions. As he comments on this medium Elena Carrillo de AlbornozWhen it came to getting pregnant, said the medical director of the fertility unit of the Ruber International Hospital in Madrid, “Oocyte age determining factor. By age 30, a woman’s eggs are of the highest quality and are found in greater abundance in the ovarian reserve; By the age of 30 to 35, this quantity and quality decreases, although not by a significant percentage, but by the age of 35, both ovarian reserve and the quality of eggs decrease and with it the chances of pregnancy also decrease. It happens. ,
This is where fertility therapy comes into play. Which is allowing more and more women and couples to launch their life project. Gynecologist Elena Carrillo de Albornoz is part of the scientific committee I Seminar on Assisted Reproduction, composed of experts in reproductive medicine from Ruber International Hospital; At the meeting, national and international experts shared the main advances in this field over two days in Madrid: non-invasive analysis of embryos that will soon reach the clinic; Improve knowledge of causes preventing embryo implantation; Optimization of assisted reproductive technologies, and new ovarian rejuvenation strategies, etc.
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All the keys to infertility, a growing problem that “doesn’t discriminate”
All the keys to infertility, a growing problem that “doesn’t discriminate”
“Today we transfer one embryo in each treatment implementation rateWith euploid biopsied embryos (chromosomally altered since they have been observed for the first time), from all sides 65% and 48% healthy child. When we transfer an embryo without a biopsy, we do not know its chromosomal status, the implantation rate is slightly lower and depends significantly on the patient’s age: in young women or in patients with embryos transferred from egg donation, The implantation rate per embryo is 55%, while the implantation rate of a healthy baby is about 40%.” explains Elena Carrillo de Albornoz, for whom the improvement in these data comes hand in hand with the development of new techniques and studies carried out before the transfer of both embryos and uterus.
In relation to the embryo, the primary reason for non-completion of implantation is found to be chromosomal abnormalities: “To the extent that it is believed that once three euploid embryos have been transferred, 95% of patients have become pregnant,” recalls the expert.
Embryonic reasons preventing pregnancy are: aneuploidies, or what is the same, a change in the number of chromosomes in some cells or in all, that is, they have more chromosomes or they have chromosomes missing. Additionally, there are other, lesser known problems that prevent implantation that relate to “embryonic morphology, metabolism, and cellular connections”.
When can we choose without aggression?
Today, identification of euploid embryos requires a biopsy, in which cells are removed from the trophectoderm, the outer layer of the blastocyst. Although Non-invasive techniques to perform preimplantation genetic diagnosisDue to which the related risks are reduced.
At one of the symposium tables, several experts debated three strategies, of which they summarized Yosso FrancoDirector of the Auxiliary Fertility Laboratory of Ruber International Hospital. Uses one of these techniques Artificial Intelligence (AI) To evaluate potential morphological and morphokinetic differences between aneuploid and euploid embryos; second analysis cell-free DNA (cfDNA) which releases the blastocyst into the culture medium, and studies the third Fetal metabolism, through a tool that combines hyperspectral analysis and AI and thus measures the potential of the fetus for development; The latter determines cytoplasmic metabolism by excitation using fluorescent light.
According to embryologists, non-invasive genetic study of cfDNA could replace current preimplantation genetic diagnosis, just as it has replaced amniocentesis. At the moment, this non-invasive study can be applied mainly in “young patients who have no indications for invasive diagnosis; in general, in women under 38 years of age.”
Yosso Franco believes that non-invasive and objective techniques, “Where is embryology going”Will contribute to correct embryo selection, avoid miscarriage and increase the rate of healthy babies at home.
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Other important aspects affecting pregnancy rates are uterine factors -The health of the endometrium, without further ado, as well as immunohaematological issues, which are also addressed at the conference.
in the words of vega cabezuelo“The uterus is very important in this,” says Ruber International, an expert in infertility and assisted reproduction and one of the moderators of the symposium, Beyond Embryo Quality. Communication between embryo and endometriumSo that it can implant and have an evolutionary pregnancy.
At the meeting, some factors in utero were reviewed that can influence implantation “and should not be ignored”, as is the case adenomyosis (occurs when the tissue that normally lines the uterus, endometrial tissue, develops into the muscular wall of the uterus), isthmocele (scar from a previous cesarean section) or refractory endometria (“Where everything is perfect, but the embryo never implants”). It is also explained how improve implementation “With antibiotics, if there is inflammation; with probiotics, to improve the endometrial microbiota; with immunomodulators, if a protein of the immune system can block implantation,” the gynecologist summarized.
With regard to immune factors, or how the body reacts to this process, Sylvia Sanchez RamonHead of the Ruber Clinical Immunology Unit presented the data Work published in February scientific report, The study represents a new contribution of this team in the so-called Immunological code of pregnancy. It refers to the immunological recognition of the infant’s in utero natural killer (NK) cells, i.e. a type of lymphocyte that acts as an anti-infection agent, which They are associated with recurrent miscarriage, implantation failures, and preeclampsia. In particular alterations or abnormal combinations between NK cell receptors and the child’s histocompatibility molecules (the child’s HLA-C).
Research on nearly 400 couples shows that these combinations are associated with frequent infertility due to autoimmune causes. “We have currently made improvements to identify patients Classification with the other that we propose a little More accurate and saves 14% patients Which could not be diagnosed properly earlier. It is important to know which group should be treated,” says the immunologist.
Faced with the aging of the ovary, what techniques allow its regeneration?
The meeting concluded by focusing on one of the most innovative advances in the field, something that “years ago seemed more science fiction than science,” he says. santiago bauCo-Director of Fertilization Unit in vitro And geneticists from Ruber International Hospital, who conducted this table.
“It is a scientifically proven fact that age is one of the parameters that has the greatest impact on fertility. There are also other activities, such as cardiovascular or neurological activities, which deteriorate much more slowly, while women’s fertility The potential is very narrow; we know that the rates of miscarriage and chromosomal changes increase from the age of 38-39. Therefore, CTechnologies that attempt to reverse as much as possible the natural aging of the ovaries are increasingly in demand.“, the gynecologist tells DM.
To achieve this, as Santiago Bau briefly explains, you can resort to ovarian rejuvenation techniques, which essentially include activation in vitro of ovarian tissue refurbishing it with follicles and transplanting it; Other techniques include Add substances to the ovary that will allow its rejuvenationSuch as platelet concentrates or infusion of stem cells with regenerative purposes.
New strategies that explore repair damaged eggs, either due to age, due to oxidative stress itself, or due to exogenous agents, and which are based on action at the telomeric level; In meiosis transfer; in mitochondrial transplantation, and in drugs that manage to repair oocytes, among other advances that will ultimately improve pregnancy outcomes.
