Patient Case Study | Barcelona IVF

What is a fertility patient case study? A fertility patient case study is a report where assisted reproduction specialists from the top IVF clinics in the world share their patient cases that are unusual, challenging, yet successful. In this post, we are presenting a patient case study from Barcelona IVF, a fertility clinic based in Spain. The case is presented by dr. Raul Olivares, the Medical Director of the clinic. Dr. Raul Olivares began working in assisted reproduction in 1996. Since that time and during the last 10 years, he has become one of the pioneers in using IMSI and Embryoscope. Dr Olivares and his experienced team are proud to have not only good results but also very positive feedback from the patients.

The couple that visited Barcelona IVF to realize their dream of a healthy baby had a history of recurrent miscarriages. They had two previous natural pregnancies in 2020 and 2021 that ended in miscarriages at 6 and 8 weeks. The couple turned to dr. Olivares for help and were looking for IVF with PGS (Preimplantation Genetic Screening).

Initial Diagnostic at Barcelona IVF

The woman was 42 years old and had a BMI of 20.3. Her last AMH level was 4.22 ngr/ml (tested in April 2021). The patient has not had any previous successful pregnancies that resulted in a live birth.

Her partner was 50 years old and is a father of a 16-year-old boy. His last spermiogram showed normozoospermia (1.5 ml, 80 mill/ml, 42% a +b, 5% normal forms) with a normal DNA fragmentation rate (12%, TUNEL).

What IVF protocol and procedures were used?

The couple had a previous round of IVF at another clinic which produced 9 oocytes and 3 blastocysts that, after PGS testing, turned out to be all genetically abnormal. The protocol used was urinary HMG 300 IU/day plus GnRH antagonist. ON the basis of the above data, dr. Olivares decided to change the approach and implement a new protocol using corifollitropin alfa (Elonva 150 IU) in order to try to achieve a bigger number of eggs to perform PGS.

The stimulation took place using the following protocol:

• Day 1 – First day of full period
• Day 3 – Elonva 150 s.c.
• Day 7, 8 and 9 – Orgalutran 0.25 mgr s.c.
• Day 10 – The first scan. Added Meriofert 150 IU s.c. to the Orgalutran.
• Day 11 – Meriofert 150 IU and Orgalutran 0.25 mgr both s.c.
• Day 12 – Second scan. One more day of Meriofert 150 IU plus Orgalutran 0,25 mgr, both s.c. (bloodwork: estradiol 3,185 pgr/ml, progesterone 0.3 ngr/ml)
• Day 13 – Ovulation triggered with Triptoreline acetate (Decapetpyl) 0.3 mgr s.c. There were 12 follicles of at least 17 mm.

What was the result before the embryo transfer?

On day 15 of the cycle, the egg collection was performed where 22 eggs were retrieved, being 19 metaphase II. ICSI was carried out and 17 eggs got fertilized. All embryos were placed under the Time-Lapse incubator (Embryoscope) and on day 5  a biopsy was performed on 9 blastocysts that developed. They all had good morphology (they were embryos 4AA, 4AA, 4BA, 3AB, 3BB, 2AA, 2AA, 1BA, 1BB) but PGS revealed that all 9 embryos were genetically abnormal so, unfortunately, no embryo transfer took place.

What was done differently? Egg Donation.

On the basis of not-so-optimistic results, Dr. Olivares’ recommendation was to consider egg donation. After thoughtful consideration, the patients accepted the advice and started a cycle using fresh donor oocytes. The recommendation was to use fresh donor eggs as fresh oocytes offer a bigger number of blastocysts and of better quality.

A previous synchronization was therefore carried out by putting the patient and the donor on a contraceptive pill. When the patient had her period started hormone replacement therapy was introduced to build her endometrium prior to embryo transfer. On day 8 of the cycle, the thickness of the patient’s endometrium was 8.9 mm and showed a triple line pattern.

What was the new result before the embryo transfer?

On day 15 of the recipient’s cycle, the eggs were retrieved from the donor. 11 oocytes were collected and 9 of them were mature. ICSI was carried out on all of them and 7 turned out to be fertilized.

The Embryo Transfer

The embryos were left in culture in time-lapse incubators until day 5. As a results, 5 top quality blastocysts developed (4AA, 4AA, 4BA, 3AA and 2AA). One of them was transferred and the remaining 4 were frozen.

The Pregnancy

Twelve days after the embryo transfer the couple reported a positive pregnancy test. The ongoing pregnancy was confirmed with two ultrasound scans carried out at 6 and 8 weeks. The pregnancy went smoothly and the patient delivered a healthy boy at 37 weeks. A happy ending at Barcelona IVF.