The first of the doubts or one of the very important and most frequent questions that patients ask us is: If the hormones or supplements that are given for stimulation in a treatment are always needed. Well no, they are not always needed, it really depends a lot on what type of treatment we are going to do. Remember that there are two large groups in assisted reproduction: Low complexity and high complexity. In low complexity there are programmed intercourse, which can only be the monitoring of a natural cycle or a stimulation of that cycle to encourage a little more opportunity and produce more follicles or more eggs and insemination. So, they are not always needed, although the ideal for the vast majority of patients is to accompany it either with oral pills that are not hormones and/or with injections that are hormonal to promote the ovarian response.

The next question, although it may seem a little funny or comical, is: Do you get pimples or pimples? The answer is also dependent on the patient, yes, if they can extract it because remember that what we are generally injecting are two hormones, which is: FSH and LH, that is, follicle stimulating and luteinizing, what these hormones do is at the ovarian level, they favor that there is a greater response in the number of ovules or eggs that the ovary will generate. By stimulating the ovary and producing the follicles, what it will do is that there will be higher levels of estrogen or estradiol and then the estrogen, the estradiol sometimes can remove a little pimple, a pimple or even give us a a little bad mood or a little loud, that is, changes in mood. So, yes hormones can sometimes have some alterations.

Another very important question is: Does the birth control pill make you sterile or infertile? and the answer is no, not at all. When we stop the medications, whether oral pills or transdermal or subdermal implants, the truth is that it may take a cycle or two for the ovarian cycle to regulate, but generally there are no problems with sterility or infertility. This question is very similar to the one that many patients ask me when I have patients with polycystic ovary disease, insulin resistance or a history of diabetes or they are already known diabetics and they tell me: “But metformin is going to make me diabetic” and it is not true, the What metformin does is lower sugar levels, taking advantage of the fact that insulin is transported in a more appropriate way for the process and uptake of glucose and is taken to the liver. So, the contraceptive pill is not going to be sterile for you even if you have been taking it for a year, two, three or five years.

Also, in addition to medication issues, one of the most important questions is whether recanalization is important, can it be done, or cannot be done in patients who have already had their fallopian tubes operated on after childbirth, after a cesarean section. Some patients have told me “I went to another center and it’s been 10 years since I had OTB (Tubal Occlusion) surgery and they told me that it didn’t matter that they could do recanalization.” Be careful! Generally in all the articles and in all the works there are some important topics, the first is the time elapsed of the previous tubal occlusion or salpingo surgery, that is, it is not preferably recommended in women who are more than 5 years after having had the operation. but we do not have to be so blunt or so drastic, that is, if I have a woman who had surgery at 28 years old and is now 32, we can probably try to do recanalization, but if I have a 40-year-old woman who had surgery at 36, because at the age of 40 it makes no sense to do recanalization, first because the possibility of success is around 60-70% for those tubes to remain well and secondly, with age it will be very difficult to spontaneously get a pregnancy. So, the key to this question specifically is the importance of whether or not it can be done based on age or time, preferably in women under 36 years of age and who have not had more than five years since tubal occlusion surgery. .

Another very important question about recanalization, they tell me: “They only tied me up, so is it necessary to have recanalization or not?” Eye! Here it is very difficult to know which recanalization or tubal occlusion technique was performed because only the doctor who performed it will know about it, but the most important thing is that many times they are done in a health system, called IMSS, ISSSTE or Health and Safety. so they don’t tell them what they do. I generally tell my patients: In almost all tubal occlusions, what we do is, if we tie the two ends, both the anterior and the posterior, but then we make a cut to make a separation of about a centimeter from the tube and thus we have less chance of spontaneous pregnancies in women who wanted to do an occlusion, so I don’t think they just tied it and even if it was tied, generally due to the pure process of fibrosis and inflammation, recanalization has to be done in the vast majority of surgeries.

Another very important question that is asked very frequently is: If I had a salpingo or a tubal occlusion, does it generate ectopics after doing a recanalization? And the answer is: Yes, the proportion of ectopic pregnancies in women who have already had tubal surgery and then had recanalization is more or less three times higher than a woman who did not have surgery or who does not have tubal surgery, that is, The general population has an ectopic rate of around 2% to 4%; out of every 100 pregnant women, four may have an ectopic pregnancy due to inflammatory lesions, adhesions or due to some motility factor in the tubal cilia, but when they have already had surgery and the We recanalize, although the tube remains permeable there will be some fibrosis or narrowing and this favors the possibility of ectopic on that side of reconstruction being around 10% or even 12%. So, if it is very important for women who have already had a previous ectopic pregnancy or who underwent recanalization, to be very careful at the time of pregnancy to do a very early follow-up and know that this intrauterine sac is in the uterus and is not tubal. .

Now we are getting into the low-complexity techniques, the best known of which is insemination, scheduled intercourse, because that is also something very important and sometimes patients have doubts. I have had patients who have scheduled intercourse in other centers. in women of 38, 39 or 40 years old because they want to go with very simple methods, that do not involve hormonal and that are as physiological as possible… It is not wrong to do it, it is simply that the probability of success in women over 38 years of age with scheduled intercourse is less than 7% to 8%. What does this mean? That the general population is going to get pregnant for every 100 women who are trying their cycle, 20 patients per cycle, means that a woman who is 38, 39 or 40 years old will not have half the chance that the population in general, then we can lose very important time.

And then other patients tell me: “They told me that with two inseminations I have a 60% chance.” The reality is that no, insemination is a very simple technique, it is also very easy to do but it has its precise indications. First: At least one patent tube. Second: That the spermatic capacity gives us above 5 million sperm per milliliter and that more than 50% of that sample moves and third and the most important is: That the woman preferably be under 36 years of age. It must be remembered that inseminations worldwide are increasingly lower in the number of patients who do so because they come at an average age of 38, 39 or 40 years. It does not mean that it does not work in that type of patient, but that in these patients it is best to move on to more complex techniques, but if you are under 36 years old and have all the characteristics of a tube, at least one patent and semen or REM, it is the best option. proper training if you can try and the probability of success per attempt is 25 to 30%. This means: Of 100 women, 25 or 30 are going to get pregnant in one attempt, the 70 left over in the next attempt will get 21 patients pregnant, the other 50 that remained in the next attempt will get 15 pregnant. If we put together the three… The 100 patients who tried 3 cycles, so yes, more or less 60-65% of the patients who enter an insemination technique are going to get pregnant in those first three attempts.

A very important question from patients is: Hey, I’ve been trying for three or four years, so can insemination be done or do I have to go to in vitro? The reality is if it has been noticed that after six years of frequent relationships where when doing the initial basic studies, such as hysterosalpinography or spermatic training and both are normal, in young couples, the probability of insemination will be lower but that It does not mean that it is not a viable technique. What I recommend, remember, is: First you have to see the age of the woman, you have to see how the tubes are and you have to see how the semen is and obviously go to a specialist.

The other question is, can you have triplets? And the truth is that with insemination techniques it is: Yes. Why? Because in an in vitro we control and we are going to put only one, two or three embryos but in an insemination if I stimulate and we have two, three or even four eggs, then they can fertilize the two, the three or the four and the two, the three or all four can be implanted… It would not be ideal but there is a higher rate of twin and triplet pregnancies with insemination than, for example, in a natural cycle.

Now we are going to get to in vitro fertilization. In vitro fertilization is a technique that began in 1978, but the last 10 years have exacerbated the number of techniques and treatments that can arise from in vitro fertilization and how we can monitor the development of the eggs and also the development of the zygote when it is already fertilized, which is called the embryo. Normally people are very afraid and their main question is: “They told me that babies come out with defects if I do an in vitro technique.” The reality is that no, there are several works called “Cochrane” that It is an accumulation of several centers worldwide where they report all the in vitro cycles they have and see if there are more births with some alteration or congenital defect than the general population and a conclusion has not been reached for more than 20 years . So, don’t have any problems because in vitro techniques, both traditional in vitro and ICSI, which is injecting sperm into the egg, will not cause more congenital defects in the embryo.

The next one is: Do twins or triplets always appear? No, the truth is that many centers worldwide are already opting for single embryo transfer, in some centers in Mexico we are still transferring 2 but very few centers worldwide already transfer three embryos, so triplets are very unlikely to emerge. Although it can cause an embryo inside the uterus to divide into two and implant and become three babies, it can happen but the proportion is very small, but twin pregnancy is very high. The proportion of patients who get pregnant, out of every 100 women, 65 here at Creafam will get pregnant on the first attempt and of those 65 patients who got pregnant, approximately 25 patients will end up with a twin pregnancy and the other 40 with a twin pregnancy. single, that is, the twinning rate is around 30 to 32% depending on the age of the woman.

One of the patients who came to the talk with us told us that in another center they told her that they could choose their sex, eye, hair or skin color. One of the things that we can choose is the sex through a technique called genetic diagnosis but also that technique, in addition to selecting the sex, the main or primary advantage is that we can review 5, 7, 9, 11, or the 23 pairs of chromosomes that we have Including the sexual ones, however, although work is being done at the molecular and nanotechnology level to see if we can select eye color, skin color, it is not yet feasible in any center or with any current technique to determine If they are going to have a child with blue eyes and curly, dark brown hair, then it is not true, the only thing we can know with certainty with this type of genetic diagnosis techniques is: See that that embryo is chromosomally good before transferring it and The other is obviously knowing that what we are going to transfer is a boy or a girl or a boy and a girl as you want.

Well, I hope that it has helped you a little with all the doubts and questions you have, but in any case, we are going to continue doing various topics and in-person or virtual talks, remember every first Thursday of the month we have a live talk on YouTube so that there we can Ask your questions and concerns and also remember that you can make a virtual call and make a zoom consultation for any questions, clarifications or to schedule an appointment.