Reproductive medicine and ginecologic endocrinologie
Societies of reproductive medicine all around the world agree that a couple should attend a specialized consultation on reproductive medicine when they have had over 1 year of unprotected sexual intercourse without achieving pregnancy, with the exception of women over 35 years old, they should not wait more than 6 months.
In the first fertility consultation we conduct a complete clinical evaluation where we gather the antecedents of both partners, perform a physical examination of the woman, pelvic ultrasound to study the uterus and ovaries and review all the tests in any previous treatments performed. This way we have a broad enough vision which allows us to establish a work plan in terms of studies and treatments.
The study of the couple with reproductive difficulties does not have to be a long and complex process and in fact in the vast majority of cases we can start with the corresponding treatment in a very short time. Many couples have slight alterations in their reproductive system or are diagnosed as infertility without apparent cause, their problem can bo solved with low complexity treatments such as Intrauterine Insemination. In this type of treatment a mild ovarian stimulation is performed in order to achieve the production of 2 or 3 ovules and induce ovulation, then a sample of capacitated semen is placed inside the woman’s uterus, hence improving the natural conditions for the fallopian tubes to capture the ovule and generate an embryo.
In Creafam Puebla the average age of the patients who undergo Intrauterine Insemination is 32 years and the probability of generating pregnancy is 30% per cycle performed. When there are other factors such as advanced age or more important alterations of the uterine tubes or low seminal quality, In vitro fertilization should be performed to create the conditions to generate pregnancy; in these cases, with an average age of 38 years and transferring 2 blastocysts the pregnancy rate is 65%. There are many clinical factors that can influence to vary more or less these possibilities, but the most important are the age of the woman and the time that they have without conceiving. In view of this and in the eagerness to offer better expectations to our patients, in Creafam Puebla we incubate the zygotes for 5 or 6 days in our laboratory, which has allowed us to reduce the number of embryos to transfer and thus reduce the risks of multiple pregnancy without deteriorating in pregnancy rates. We recently presented our experience in the congress of the Mexican Association of Reproductive Medicine where in transfers on day 6 of development, with a fashion of 1.6 embryos transferred, the pregnancy rate was 66%. We also presented a comparison of transfer in day 3 vs day 5 of development, observing that it allowed us to decrease the mod a of embryos transferred from 2.4 to 1.6 respectively, improving the pregnancy rate from 48.42% to 64.53%. Even with this high rates, we wished to improve our services and for this reason we implemented the use of the Primo Vision System, through which we can perform a more continuous monitoring of embryos that has allowed us to make better decisions regarding the embryos to be transferred to the uterus and, therefore, increase the expectations of generating pregnancies, up to 96% success rates. With adequate facilities, state-of-the-art technology and a clear and well structured clinical advice we can offer a real alternative to solve the different situations that generate reproductive difficulty in couples who come to our practice with a high expectation of success.