Alicante excels at the world’s most important international congress on reproductive medicine.

Instituto Bernabeu presents 12 studies based on Artificial Intelligence, ovarian stimulation and pharmacogenetics at the European Society of Human Reproduction and Embryology scientific meeting.

Spain is a world scientific leader in the field of Reproductive Medicine. In times when it is necessary to vindicate the contribution of our researchers to society and to highlight their work, special mention should be made of the team of scientists from Instituto Bernabeu Group, whose work has been recognised by the scientific committee of the ESHRE, the European Society of Human Reproduction and Embryology prestigious congress. Recently, the results of the papers selected for the congress 39th edition, which will be held in Copenhagen (Denmark) between June 25 and 28, have been announced.

The professionals’ scientific value is also shown by their selection as speakers at different meetings parallel to the congress. The prestigious American journal Fertility and Sterility of the American Society for Reproductive Medicine (ASRM) will be holding an interview with Dr Ruth Morales, Director of Instituto Bernabeu’s Genetic and Reproductive Counselling Unit to discuss her work on embryonic mosaicism. The interview will be included in a podcast available to 50,000 reproductive medicine professionals who subscribe to it.

In turn, IB’s medical co-director, Dr Andrea Bernabeu, has been invited to participate in the pre-congress course to address the importance of ovarian stimulation in assisted reproduction and the role of the microbiome study in infertile women. And the director of the Embryology Unit, Dr Jorge Ten, a member of the new Artificial Intelligence International Unit applied to Reproductive Medicine at IB, is one of the 5 scientists who will evaluate the most outstanding works and its medical contributions after the ESHRE congress.

Among the selected research, it is worth highlighting the 6 that have been chosen as papers to be presented by their main authors, due to the quality of these works and the relevance of the conclusions drawn.

1 Mosaic embryos and its impact in the child’s future health.

Knowing the impact on the baby’s future health and development in those cases of embryos classified as mosaic is the aim of one of the research projects highlighted as paper. These embryos are classified as such after in vitro fertilisation (IVF) in which the pre-implantation genetic test for aneuploidy (PGT-A) has been performed and the embryo has normal and abnormal cells.

In their research, Instituto Bernabeu scientists have found no significant difference between children conceived after low-moderate grade mosaic embryo transfer versus chromosomally normal or euploid embryos in terms of outcomes before and after the baby’s birth and its physical health.

With this study, Instituto Bernabeu increases the safety of giving adequate genetic counselling regarding mosaic embryo transfer.

2 Artificial Intelligence to increase pregnancy rates.

Since the emerge of Artificial Intelligence, Instituto Bernabeu has been attentive to its evolution as a useful tool to improve treatments. At the ESHRE, two of the papers highlighted by the Scientific Committee as presentations, are studies developed in the clinic about AI.

One of them is the first study in the world in which an AI-based embryo selection algorithm has been integrated and validated in the IVF laboratory. Scientists at Instituto Bernabeu have concluded that it is able to predict which embryo will have the best ability to implant in the mother’s uterus and which will give rise to a healthy baby. Main benefit for patients is the increased pregnancy rate.

3 AI and Pharmacogenetics: treatment personalisation.

Another research carried out at Instituto Bernabeu’s Department of Molecular Biology and Genetics suggests that the combination of AI and pharmacogenetics has made it possible to identify genetic variants that could predispose some women to a suboptimal ovarian response. That is, in those patients from whom very few oocytes are recovered after undergoing ovarian stimulation. Thanks to this study, it is possible to individualise the treatment of those women who carry genetic variants, personalising their treatment with higher doses of gonadotrophins or with longer stimulations.

4 Ovarian reactivations with PRP

Low ovarian response is a real challenge that researchers at Instituto Bernabeu have addressed through various studies. This time, they have analysed the effect of Platelet Rich Plasma (PRP) administration in the ovary has on the ovarian response of patients suffering from low response. Conclusions point to promising results as it has been observed that more oocytes are obtained, especially in women under 40 years of age.

This study represents a breakthrough in strategies to improve the number of oocytes obtained in patients with low ovarian reserve who are to undergo repeated cycles of oocyte storage.

5 The vaginal microbiome influence in the embryo’s implantation failure.

Another of Instituto Bernabeu’s lines of investigation is the female genital tract microbiome. In this case, the study has investigated the relationship between the abnormal vaginal microbiome (dysbiosis of the vaginal microbiome) and proinflammatory cytokines in patients who suffer recurrent embryo implantation failure. The study reveals that microbiome alteration produces an imbalance and inflammation that may be behind these failures, so to improve treatment in these patients, the administration of antibiotics or probiotics may be the strategy to improve and solve this alteration.

6 Does sperm DNA fragmentation affect pregnancy?

Sperm quality and its effect on pregnancy is another of the studies presented by Instituto Bernabeu experts at the ESHRE. This time, the research studied whether sperm DNA fragmentation influences pregnancy and live birth rate. Sperm DNA integrity is important for optimal fertilisation, implantation and pregnancy. The study was conducted in patients who received donated oocytes and were inseminated with the partner’s sperm. Researchers at Instituto Bernabeu have determined that sperm DNA damage can affect assisted reproduction treatment and therefore live birth rate.

Featured poster: Why do young women have abnormally high aneuploidy rates?

The Scientific Committee has chosen an Instituto Bernabeu study as the featured poster, which will be exhibited and will also open a debate, due to the interest it arouses and the conclusions it draws. The research has been based on identifying genetic variants that can explain why there are certain young patients who, due to their age, are not expected to have high aneuploidy rates, chromosomal alterations in the embryo. This research has made it possible to describe for the first time genes associated with these alterations in the embryo, involved in important biological processes. Researchers at Instituto Bernabeu point that an exome will make it possible to determine the cause and offer a prognosis as well as appropriate genetic counselling.

The legal vacuum of supernumerary embryos in Italy.

As well as delving into medical research, Instituto Bernabeu also carries out studies in the Law filed. The institution will be present with a legal study analysing the legal loopholes currently existing in Italy with embryos left over from fertility treatments.

In Spain there is a regulation, uncertain in Italy, which implies problems for the clinics, among others, regarding the cost of keeping frozen embryos and possible bad clinical practices.

Double stimulation in case of poor prognosis

Another poster evaluates whether there is variation in conventional double treatment results to accumulate oocytes, involving vitrification in the first stimulation, compared to another double stimulation strategy in which no freezing is performed. The researchers are based on studies indicating that oocytes vitrification in older patients can affect their quality and thus that of the embryo. After analysing parameters such as the number of obtained oocytes, their maturity and fertilisation rate, the embryo biopsy rate and the genetic results obtained and comparing both treatments, the researchers conclude that vitrification does not seem to affect the parameters analysed for clinical results, and indicate it is a strategy that reduces the IVF laboratory work and, in turn, reduces costs to patients.

Effects of maternal age on the embryo

Motivated by the patients undergoing IVF cycles increasing age, one of the presented papers focused on whether the presence of polymorphic variants, or DNA changes, in female chromosomes negatively affects the embryos chromosomal status. The study has shown that polymorphic variants in the genetic test examining the size, shape and number of chromosomes in a sample of female cells (karyotyping) can have a direct effect on embryonic ploidy and mosaicism status. This means that, if transferred, the embryo may have chromosomal abnormalities leading to implantation failure and even miscarriage. The findings of this work help to optimise and personalise treatment. It allows researchers to recommend karyotyping to patients undergoing IVF cycles and, with the results in hand, to offer genetic counselling on the presence of polymorphic variants implications.

Oocytes quality

In the same direction, another research project aims to investigate the possible influence of the presence of maternal polymorphic variants on the oocytes quality and the embryo development. Researchers have begun to attach importance to these variations occurring in a specific place in the DNA. It has been found that it can have a negative effect on certain parameters, which is why they are increasing their efforts to advise patients about IVF treatment.

Understanding the causes of male infertility

Finally, Instituto Bernabeu presented another study in poster format highlighting the discovery of a clinical designed genetic variants that may be behind altered sperm samples.

The satisfaction of the professional and human team that make up Instituto Bernabeu Group for their participation in this edition of the ESHRE congress is very high. The 12 papers that will be presented in Copenhagen are an endorsement of the clinic’s research work, which aims to improve, optimise and personalised each patient’s treatment.