During the follicular phase of a woman's reproductive cycle a follicle stimulating hormone (FSH) may be prescribed. FSH stimulates the development of follicles in the ovary and helps produce eggs. Around the 11th day of the cycle, a single injection of a medication such as choriogonadotropin (hCG), may be given to facilitate the maturation of the developing eggs and trigger ovulation. At this point, fertilization is attempted either through sexual intercourse or artificial insemination (AI).
Artificial Intrauterine Insemination (IUI)
Places sperm directly into uterine cavity. In order to prepare for AI, a woman usually takes Fertility drugs in advance. The man must produce sperm at the time the woman is ovulating. The sperm are then "washed", using high-tech laboratory procedures and are then inserted into the uterine cavity through a long, thin catheter. To reduce the risk of multiple births, the amount of the drug and the response to it is carefully monitored with several ultrasounds and blood tests for estrogens levels. Artificial insemination is also performed through donor insemination, which involves the same process as described for IUI, except that the semen sample comes from a donor.
Artificial Insemination is useful for women who have structural problems, when the cervical mucus is unreceptive, when donor sperm are required, when the male partner's semen contains low numbers of sperm, or when unexplained Infertility exists in both partners.
In Vitro Fertilization (IVF)
In IVF eggs are gathered from the woman’s ovaries and mixed with the man’s sperm outside the body, usually in a glass dish in a laboratory. The fertilized eggs are then cultivated for two or three days to embryo stage and transferred to the woman’s uterus.
The first stage involves stimulating the woman’s ovaries so that several eggs mature. Normally, a woman produces one egg in each menstrual cycle, but with IVF, many ovarian follicles are produced by hormone stimulation and several eggs are obtained (usually 7-15) and a number of embryos are produced after oocyte fertilization.
Two or three embryos are replaced into the woman’s uterus to increase the chance of getting pregnant the first time (by Spanish law we can’t replaced more then three embryos).
Once the woman’s own hormones have been suppressed, she can begin taking the medication that will stimulate the ovaries and egg production. She may need to have injections daily for 12 - 18 days. The response of the ovaries will be carefully monitored using ultrasound scanning and a blood test. The next stage of the procedure is egg collection. This takes place when the ultrasound scan shows a sufficient number of large follicles. The woman is given an injection late at night to give the ovaries containing the eggs their last ‘push’ towards maturity. Ovulation normally occurs 36 hours after this injection, so egg collection is scheduled to take place just before ovulation occurs (at about 34-35 hours).The eggs are usually collected using a fine, hollow needle guided by ultrasound. While the patient is sedated for 15-20 minutes, under ultrasound control, a needle is inserted into the ovaries and eggs are aspirated.
Multiple eggs are removed from the woman and placed in a special medium for two to three hours. The male semen is processed, using different techniques to obtain a vigorous motile sperm. The prepared sperm is then introduced into the medium containing the egg(s) and then placed in an incubator overnight.
The next day, the eggs are observed through a microscope to see if fertilization has occurred. The second day cell division will have started and the embryo might now have two or four cells.
The embryos will be checked by our embryologist to ensure that they are developing normally and, if all is well, embryo transfer can take place. By transferring one or two embryos we reduce the risk of a multiple pregnancy. Occasionally in older patients we transfer three embryos. The embryos, together with a tiny amount of nutrient fluid, are put into a catheter and placed into the woman’s uterus through her cervix with special ultrasound guidance. The procedure is short, painless and generally no requires anaesthesia.
If there are ‘spare’ embryos of good quality these can be frozen and stored for use in a future treatment cycle if needed.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is a highly sophisticated technique for injecting one single sperm into an egg using microscopic and micromanipulation instruments. In men with low sperm count, low motility or a high number of abnormal sperm, this technique has proven to be a highly successful remedy.
The procedure of ICSI is able to achieve a high rate of fertilization and normal embryo development. ICSI has even been successful in cases where sperm must be taken directly from the testes (testicular biopsy) due to the absence of sperm in the ejaculate or a previous vasectomy.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation genetic diagnosis (PGD) is a technique used to detect whether an embryo created in vitro is carrying a specific inherited genetic defect that will give rise to a serious disorder.
Most couples who request PGD are likely to be at high risk of transmitting a serious genetic condition to their children. Parents may have these conditions themselves or be carriers of the conditions.
PGD involves the removal of one or two cells from an embryo created by IVF, usually three days after fertilisation when the embryo has about eight cells.
This is a procedure of making a tiny hole in the membrane surrounding the embryo before implanting to assist it in attaching to the uterus. This thinning the membrane of the fertilized egg may increase implantation rates in eggs from certain women, such as those over age 40.
Sometimes, a woman who is older or has “premature aging” of her ovaries might not have a successful IVF cycle. In these cases, which are not that uncommon, patients are offered the opportunity to use eggs from a donor. These donor egg cycles allow the woman who otherwise would have no chance for pregnancy carry and deliver her own baby using the sperm from the husband.
During a medication-prepared embryo transfer cycle as a patient, the woman will follow a treatment schedule first using estrogens (pills or patch) and progesterone (suppository) in order to achieve appropriate endometrium (uterine wall lining) for embryo transfer.
In cases where more eggs develop into embryos than are going to be transferred to the patient, the couple will have the option of cryopreservation, or freezing, of the embryos for transfer into the woman's uterus at a later date. During a medication-prepared frozen/thawed embryo transfer cycle as a patient, you will follow a treatment schedule first using one injection to suppressed your own hormones, then estrogens (pills or patch) and progesterone ( suppository) in order to achieve appropriate endometrium (uterine wall lining) for embryo transfer.
A testicular biopsy involves a small surgical procedure that takes place while a patient is under local anesthesia. This involves the insertion of a needle into the testis in order to obtain a small sample of tissue. The procedure can take between fifteen minutes to a half an hour to take place. The tissue that is extracted is then prepared for laboratory analysis to determine the presence of sperm. This provides insight into any abnormalities regarding sperm production.
In cases where sperm production problems severely affect male fertility, a testicular biopsy can sometimes assist as part of an infertility treatment for couples trying to get pregnant. In some cases, the presence of sperm in small areas of the testis can be retrieved via testicular biopsy. This sperm can then be used in infertility treatments using assisted reproductive techniques (ART).
Donor insemination is where semen from a donor is artificially inseminated into a woman who wishes to have a baby but does not have a mail partner or a mail partner has fertility problems (the absence of sperm).
Couples who wish to use a semen sample can take many of the man’s and the donor’s physical characteristics into account when making their selection, including race, weight, height, hair and eye colours. They can also request that the donor’s blood type be compatible with their own. How are donors selecting?
1. Donors are chosen from among 18- to 35-year-old men. The donor must give his informed written consent and agree to provide information on his family and personal medical history.
2. He must also undergo a physical exploration and provide a semen sample for analysis.
3. His genetic analyse, blood group, Rh factor will be determined and he must have blood tests to check for the presence of hepatitis B and C, syphilis, chlamidia, citomegalovirus and HIV.
Under Spanish law, a donor’s semen must be frozen and donation is anonymous. AID is indicated in the following cases: for men with secretory azoospermia, i.e., no sperm in their testicles, for people with serious hereditary diseases that can often be passed on to children but cannot be diagnosed in the embryo, for single women who want to be mothers. AID is legal in Spain in all the above-mentioned cases.
Freezing semen samples can be useful in these cases:
- Donor's semen
- For men who need to undergo medical treatments that may make them sterile, like vasectomies, prostrate surgery, testicular cancer, radiotherapy and chemotherapy;
- When semen is poor quality before to do ART (ICSI), semen after testicular biopsy,
- Semen after washing in a case of sexual transmissible disease, semen for absent husbands undergoing infertility treatment.
Andrology laboratory
Our andrology laboratory is a fertility lab whish is providing specialized fertility services like semen and testicular tissue analysis, sperm processing for IUI, IVF and ICSI, sperm washing in a case of sexual transmissible disease, sperm cryopreservation.
In Embriology laboratory we perform all the Human reproduction techniques such are IVF, Intracytoplasmic sperm injection (ICSI), biopsy of the embryos for Preimplantation genetic diagnosis (PGD), Assisted Hatching, culture of embryos, cryopreservation of sperm and embryos. In our laboratory we assure the control of temperature, humidity, number of volatile particles, we guarantee an environment of work, optimal for manipulation of the gametes and embryos.
All works are implemented within a horizontal flow laminar bell in order to ensure more safety and sterility; we have various incubators for gametes and embryos, steromicroscopes to observe and examine the gametes and embryos, inverted microscope with integrated heater plate to put into practice the gametes and embryos micromanipulation and the biopsy of the blastomeres for the PGD, assisting hatching and ICSI.
It’s a new technique developed for the freezing of oocytes, which allows women to delay motherhood with guarantees.
Vitrification of oocytes offers also great benefits:
- Preserve fertility by freezing eggs in their most fertile women so may delay the arrival of a child for personal reasons or work.
- Being mother after cancer treatment. Chemotherapy and radiation often cause irreversible damage to the eggs. Patients suffering from cancer can vitrify their oocytes before undergoing cancer therapy, and be able to have a child once the disease has been overcome. Ovarian stimulation needed to obtain the oocytes may vary depending on the type of cancer, and should always be done with the consent of the oncologist.
- To be an alternative, in those cases in which ethical or moral convictions, for the couple who does not want to freeze embryos in an IVF cycle.
- To collect oocytes after ovarian stimulation cycles in order to obtain an adequate number of embryos and can choose those that are more likely to implant in the uterus. This is indicated in case of patients with low ovarian reserve, and those that are going to perform Preimplantation Genetic Diagnosis (PGD).
- Be an alternative in case of ovarian hyperstimulation syndrome (OHSS), reducing the severity.
