In Vitro Fertilization

Thanks to In Vitro Fertilization, we are able to fertilize the eggs (oocytes) with sperm from your partner or from a donor outside the mother's womb, under laboratory conditions.

WHAT IS IN VITRO Fertilization?

In Vitro Fertilization (IVF) is an assisted reproduction technique that consists of the fertilization of the oocyte (egg) by the sperm under in vitro culture conditions in the laboratory, that is, outside the female reproductive system.

It is an assisted reproduction technique needed in cases of female or male infertility or in assisted reproduction techniques such as the ROPA Method for LGBT couples.

To carry out this treatment, first of all a hormone stimulation treatment will have to be carried out with an ovarian puncture to obtain the oocytes. The same day as the puncture there will have to be a sperm sample.

From here, the oocytes and spermatozoids are put in contact with one another, so that fertilisation occurs naturally (conventional IVF) or by micro-injecting the spermatozoids, and this technique is called ICSI (Intracytoplasmic Sperm Injection). The resulting embryos will be cultivated to be subsequently placed inside the maternal uterus.

The spermatozoids used can be isolated from a semen sample (from the husband/partner or an anonymous donor) or obtained through a testicular biopsy. It is a more invasive technique, but also more effective than artificial insemination. The pregnancy rate varies according to the woman’s age.

When is IVF indicated?

IVF for sterility:

  • Tubal factor: absence, obstruction, or injury of the fallopian tubes.
  • Endometriosis.
  • Male factor (alteration of the concentration, motility, or morphology of sperm).
  • Sterility of an unknown origin.
  • Failure of less intrusive treatments: stimulated ovulation, artificial insemination.
  • Diminished ovarian reserve.
  • Immunological disorders.

IVF in the absence of sterility:

  • Preimplantation genetic diagnosis (PGD), with the objective of identifying and rejecting affected embryos.
  • Preservation of fertility.
  • Serodiscordant couples: couples in which one of the members suffers from a chronic, sexually transmitted disease which impedes natural gestation because of a risk of transmission.

Couple's requirements for IVF

IVF cycles can be carried out in all women
who meet the following requirements:

Uterus

The presence of a uterus capable of gestation.

Menstruation

Menstrual cycles within normal.

Health

The absence of a physical or mental maternal disease that contraindicates hormonal and/or gestational treatment.

In vitro fertilization processes

  1. Although the first pregnancies that resulted from IVF occurred in natural cycles (that is to say, without hormonal treatment), treatments involving stimulating ovulation were rapidly incorporated. This is done by administering gonadotropins with follicle-stimulating effects (FSH, LH, HMG). During this period a down-regulation of the pituitary function is usually provoked with other pharmaceuticals similar to GnRH so as to avoid peaks of LH which would alter the maturing follicles. The majority of these medicines are commercialized in solutions to be applied subcutaneously, which facilitates self-administering. On this point, the function of the nursing staff to teach patients how to administer the doses is fundamental. The guideline for stimulation (the type of hormones and the dose) will be individualized and determined principally by age, ovarian reserve, the index of body mass, and the response to previous stimulations.

    The process of stimulation will be monitored by a series of vaginal ultrasounds that permit us to study the number and size of the follicles, complemented by blood work to determine the hormone levels (basically estradiol).

    The stimulation typically lasts 10 to 14 days depending on the protocol used and the response of each patient to the treatment. Once the optimum development of the follicle is achieved, the human chrionic gonadotropin (hCG) is administered so as to induce maturation of the oocytes, and a follicular puncture is programmed for 34-38 hours later.

  2. Ovarian puncture
    The follicular puncture is a simple surgical procedure carried out on an outpatient basis with local or general anesthesia of short duration (intravenous sedation)after which the patient will remain under observation for a period that varies from 2 to 4 hours. The follicles are located by ultrasound, undergo fine needle aspiration, and are submitted to the laboratory where the embryos are identified and the oocytes classified.

    After this initial evaluation, the oocytes will be distributed in culture plates, duly identified and kept in an incubator for 3-4 hours prior to insemination or ICSI. At the same time, the couple brings in a sample of semen which will be treated and from which the best sperm will be selected by way of a wash and centrifugation to concentrate the most motile.

  3. There are two techniques to place the oocytes into contact with the sperm: conventional insemination (which consists of placing some 100,000 sperm of good motility into contact with an oocyte, producing a natural selection of the sperm), or microinjecting a single sperm of good motility into each mature oocyte (ICSI). The use of one or the other fertilization technique is determined by the quality of the semen.

    Regardless of the method employed, the inseminated oocyte will be kept in an incubator, the environment of which is controlled for temperature, humidity, and conditions of CO2 y O2. The day after insemination, the oocytes will be tested to determine if they have been fertilized. After fertilization, cell division begins, giving rise to embryos, which will be evaluated and cared for in a laboratory so as to subsequently select those with the best potential for implantation.

  4. Finally, we proceed to the transfer of the embryos to the maternal uterus by way of the vagina. The embryo transfer is performed on the 2nd-3rd or 5th-6th day after the follicular puncture, selecting the best embryo(s).

    In young patients and with embryos of good quality, the most recommendable course is to transfer one or two embryos on the first attempts. In this way, the risk of multiple pregnancies is reduced, although the law 14/2006 of May 26 permits the transfer of up to a maximum of 3 embryos. The embryos are deposited in the uterine cavity monitored by ultrasound. It is an out-patient procedure that requires no anesthesia or hospital stay.

    With the aim of fostering the embryo transfer and good endometrial conditions, a hormonal treatment of progesterone is prescribed after the follicular puncture and will be maintained until the result of the cycle is known. Strict bed rest is not necessary after this procedure, though it is recommended that the patient refrain from strenuous physical exercise. 14 days after the embryo transfer a pregnancy test can be performed to determine if gestation has commenced.

    Confirmation of a pregnancy by way of an ultrasound will be carried out 15 days after the pregnancy test.

  5. If once the embryo transfer has been performed, there remain embryos of good quality, these will be frozen in liquid nitrogen, so that the couple can use them in the future. Nevertheless, law 14/2006 of May 26 authorizes other possible uses: donation for reproduction, donation for scientific investigation, or ending their preservation.

IVF Results

Rate of baby at home in IVF cycles with own eggs (IVF / ICSI) performed in Gravida, according to the age of the patient.

64.7%

< 35 years

48.2%

35 - 37 years

36.2%

38 - 40 years

14.6%

> 40 years

67.5%

IVF with donor oocytes