There are many causes of infertility. To achieve a successful pregnancy, it is necessary for a healthy ovum to be found with healthy sperm and fertilize the ovule, thus creating an embryo. This embryo must find a suitable place to grow, that is, a healthy uterus. If there is a problem in any of these stages, there may be difficulties in achieving pregnancy.
Some of the conditions that we find that hinder pregnancy are frequently:
- In some women the ovaries do not release an egg every month due to hormonal imbalances
- In men, it may happen that they are not producing enough sperm, or that they are not healthy.
- Another possibility is that the fallopian tubes are blocked or nonfunctional which prevents the union of the ovum and sperm
Finally the problem may also be in some condition of the uterus such as fibroids, polyps or infections
It is extremely important to emphasize that not all cases of infertility are due to female factors, in fact in 30 to 40% of couples with fertility problems the cause is the male factor.
In a “normal” ejaculation there are more than 15 million mobile sperm per cubic millimeter, however some men produce a smaller amount or do not produce sperm; On the other hand in some cases enough sperm are produced but there are obstructions in the ducts that prevent them from being released.
Just because the semen seems normal, does not mean that there are sperm or if there are, that these are normal. To know these details, it is important a sample of sperm be analyzed in a laboratory dedicated to infertility.
In Vitro Fertilization must not necessarily be performed in all cases. In fact, in Panama Fertility there is no “most people,” each patient and his partner are treated individually according to their condition. We work with standards and proven protocols of high quality, however, the treatment plan is personalized to the patient. In order to know which is the best protocol for each patient, we carried out the Integral Evaluation Program, which is specifically designed to be able to give a satisfactory solution in 95% of the cases and a response the same day of your consultation.
PGD allows the highest pregnancy rates for each embryo that is transferred. Regardless of age, in case of having a chromosomally normal embryo, embryo transfer can reach success rates of up to 70% in a single cycle; this allows us to have greater confidence in the embryo to transfer so that we can transfer only one embryo at a time. This translates to a higher implantation rate, decreases pregnancy loss rates, allows you to achieve pregnancy in the shortest time possible, which means you can have your baby at home more quickly.
Finally, it is important to understand that with PGD, normal embryos may not be identified for transfer. Although this is a disappointing experience, the most important thing to understand is that it also means that a possible failed transfer or a loss of pregnancy has been avoided, with all the pain and time this entails.
We are very proud to have the highest success rates in the region. The rates of pregnancy and baby at home after an IVF cycle are closely linked to the age of the patient and training and experience of the doctor. This is due to the fact that as the age increases, the number of available ovules decreases while the chances of losing the pregnancy increase, all as a result of ovarian aging.
Some women will need several IVF attempts before achieving pregnancy, which is why we have created Comprehensive Programs such as Baby at Home, where at a much lower cost you have several opportunities to have your Baby Contigo ™. This plan includes everything necessary to achieve this goal.
The woman’s ovarian reserve is directly related to her age and has direct direction with the number of ovules that she can produce during an ovarian stimulation.
The ovarian reserve gradually decreases after 30 years, which means that the potential to achieve a pregnancy decreases with age. In order to determine the ovarian reserve of each woman several studies are carried out among which are: measurement of Anti-Mullerian Hormone (AMH) and Follicle Stimulating Hormone (FSH) levels as well as the antral follicle count using ultrasound (AFC).
To achieve ovulation every month it is necessary that several hormonal events involving the brain, the pituitary gland (pituitary gland) and the ovaries occur in a synchronized manner.
Some medical conditions, stress and other situations can negatively influence the timing of this sequence of events; that is why if a woman does not ovulate every month should be ruled out conditions such as polycystic ovarian syndrome (PCOS), thyroid disorders and elevation of the hormone prolactin, to mention only the most common situations.
There are several ways to evaluate uterine conditions. Mainly looking for structural problems that may prevent the development of the embryo such as polyps or uterine fibroids. The best way to evaluate the uterine cavity is by means of a hysterosonogram (also known as sonogram with saline infusion) or by hysteroscopy. These tests allow to see in detail the structure of the endometrium. Sometimes it will be necessary to perform an endometrial biopsy to rule out chronic inflammation and it may even be necessary to carry out molecular studies.
For men, the evaluation is less complex. A sperm analysis, known as a spermiogram, is performed to visualize the amount of sperm present in the ejaculate and determine if the amount and movement of these is adequate to reach and fertilize an egg. A low amount of sperm can be secondary to problems in the production or blockages in the male ducts, which prevents enough sperm from being released. It is very important to understand that even if an ejaculate seems normal, it may be abnormal when examined.
Our Comprehensive Evaluation Program was developed to be able to respond to 95% of women the same day of their first visit.
Traditionally couples have to wait months for the results, but aware that their time is valuable we have developed this program to help reduce the stress associated with infertility.
IVF involves a series of steps that typically include:
- 8-12 days of ovarian stimulation to reach oocyte extraction
- On the day of oocyte extraction, the ovule will be fertilized with sperm
- Then depending on each particular case we will decide together with the couple which route to take for the following steps:
- Fertilization / Fertilization: conventional IVF or ICSI?
- When to perform the embryo transfer: Transfer on day 3 or day 5?
- Embryo Transfer: Fresh or Frozen?
- If frozen, will the transfer be made in the future using a natural or artificial cycle?
- Genetic tests: Do we perform Preimplantation Genetic Diagnosis before the transfer?
Depending on your individual case, our team of doctors will help you make these decisions.
A pregnancy needs a healthy embryo to be transferred in a delicate way to a receptive uterus, at the right time. A healthy embryo (euploid) has 46 chromosomes. Too many or too few chromosomes make the embryo probably not implant or end in pregnancy loss.
On the other hand, an euploid embryo has approximately 70% chance of being implanted successfully, this means that on average between one and two euploid embryos per cycle are needed to achieve a pregnancy.
It is not necessary to transfer all the embryos. We rely on the American Society for Reproductive Medicine guidelines to determine the ideal number of embryos to transfer in each case; the surplus can be cryopreserved for use in a subsequent cycle in case the first one does not work or when the couple decides to have another baby in the future.
Embryo cryopreservation began decades ago and currently around 98% of embryos preserved with this technique survive. Studies show that the results after a transfer of cryopreserved embryos are similar or even better than those of a fresh transfer.
There are different reasons why we can recommend the cryopreservation of embryos in order to transfer them in another cycle.
- Preterm Progesterone Elevation: If progesterone rises earlier than normal it can cause alterations in the window of endometrial implantation that usually lasts 24 hours. This implies a reduction in the chances of achieving pregnancy in that transfer.
- Problems in the endometrium: Sometimes a polyp or fluid can be detected in the endometrial cavity, both situations can negatively affect the chances of success of that specific transfer.
- Risk of ovarian hyperstimulation: In patients who produce many ovules, the ovaries can be hyperstimulated and require time for hormones to be regulated. In these cases it can be dangerous to transfer the embryo and the patient becomes pregnant.
Embryo cryopreservation began in the 80s, since then there have been pregnancies and newborns of embryos frozen for more than 20 years without having detected any problem.
Unfortunately, around 20 to 25% of all pregnancies end in losses. The possibilities increase according to the age of the patient.
At 20 years between 10 and 15% of pregnancies end in losses while at 45 years that percentage reaches 75%.
In Vitro Fertilization (IVF) alone can not prevent a pregnancy loss but it allows to perform the Preimplantation Genetic Diagnosis (PGD) of the embryos, ensuring that the embryo to be transferred is chromosomally normal, which helps to reduce the chances of loss of pregnancy so that the chances of a Baby at Home are increased after an embryo transfer.
Consultorios Médicos Punta Pacífica,
6º Piso Local 617,
Hospital Punta Pacífica Panamá,
Consultorios Médicos Punta Pacífica,
6º Piso Local 617,
Hospital Punta Pacífica Panamá,