1 - INDUCTION OF OVULATION

Approximately 15% of infertility is due to a lack of ovulation. Sometimes, anovulation becomes apparent through alterations in the menstrual period or due to an increase in vellus hair, etc. The majority of anovulatory patients tend to have polycystic ovaries.

Ovulation can reoccur with the use of drugs (clomifene citrate, metformin, femara), which serve to readjust hormonal imbalances. 50% of anovulant patients are able to normalise their menstrual cycles with the use of these therapies. Once the follicle reaches maturity (more than 18mm in diameter), the patient is made to ovulate with hCG and the couple can perform timed sexual intercourse. If the patient is a single woman, an intrauterine insemination with donor semen (IUID) is performed.

 

2 - INTRAUTERINE INSEMINATION (IUI)

This involves the introduction of an improved sample of semen into the patient?s uterine cavity. This could be either a homologous insemination if it is performed with the partner?s semen (IUIP, or heterologous (IUID) if a donor?s semen is used. Current Spanish law (27/05/2006) guarantees that sperm donation is anonymous and confidential. Only in exceptional life or death circumstances for the child can the identity of the donor be revealed.

In general, at FivMadrid, we carry out a single insemination per cycle. Moreover, we advise our patients not to carry out more than 3-4 IUIPs nor more than 6 IUIDs, given that the possibilities of achieving a pregnancy do not rise significantly by increasing the number of inseminations.

The pregnancy rate per cycle (results) stands at about 15% with an IUIP and at about 35% with an IUID. Cumulatively, out of 100 women, 60 will achieve a gestation (in 3-4 attempts) with IUIP and 80 (in 6 attempts) with IUID.

 

3 - IVF and IVF-ICSI

In Vitro Fertilisation (IVF) involves the extracorporeal creation of an embryo. For this to occur, eggs (feminine cell) are collected via a transvaginal ovarian puncture, performed under sedation. The eggs are placed into a dish in an appropriate culture, to which a specified number of sperm (male cell) are added. In 60 ?70% of cases, the sperm will fertilise the eggs and embryos will be produced in vitro.

Intracytoplasmic Sperm Injection (ICSI) is performed when the sperm count is very low. It is also applied in certain cases of infertility of a female origin, (e.g. due to age, endometriosis or idiopathic factors, etc.). This involves microinjecting a single sperm directly inside the egg. This technique also enables cases to be resolved where there is a complete absence of sperm in the ejaculate (azoospermia), whereby the sperm can be retrieved directly from the testis, either by aspiration from the epididymis (Percutaneous Epididymal Sperm Aspiration, PESA) or via a testicular biopsy (Testicular Sperm Aspiration, TESA). In addition to being able to solve the aforementioned problems of male origin, ICSI has also enabled us to give vasectomised men hope again of becoming fathers too.

Embryos which are produced via IVF or ICSI are transferred into the uterus two or three days post-puncture. In order to reduce the number of multiple pregnancies, at FivMadrid we recommend women who are younger than 35 years of age to transfer two embryos (in certain very specific cases, a single embryo) and three embryos in the case of women who are older than 38 years of age.

The pregnancy rate (results) in women younger than 35 years old is higher than 50% and, in general, out of 100 couples, 70 achieve a gestation within four cycles.

 

4- PROLONGED EMBRYO CULTURE (BLASTOCYSTS)

This procedure is normally indicated in patients with repeated failure to implant, in those who are at risk of hyperstimulation, in embryos which are subject to pre-implantation genetic diagnosis (PGD), etc. This involves cultivating the embryo in vitro until it reaches the blastocyst phase.

The pregnancy rate (results) is very similar to that obtained via IVF-ICSI.

 

5 - CRYOPRESERVATION OF EMBRYOS

Embryonic freezing involves storing those embryos, which have not been transferred to the womb during an IVF cycle, in liquid nitrogen. At FivMadrid, however, we only freeze embryos which meet strict quality criteria.

The availability of good frozen embryos offers couples the following advantages: not having to repeat ovulation induction, an increase in the chances of pregnancy and lower economic cost given that the thawing cycle is much cheaper.

• Rate of embryonic survival post-thawing: 60%
• Pregnancy rate per cycle: 40% (transference of three embryos)

 

6 - EGG AND EMBRYO DONATION

The donation of eggs and/or of embryos is recommended when a woman is unable to achieve pregnancy due to early menopause, poor egg quality, repeated failure of IVF, if she is a carrier of genetic illnesses, etc. This involves fertilising the donor?s egg in vitro with the husband?s sperm.

Our egg donation programme is one of the most active in Spain, thanks to the excellent response of Spanish university students to the needs of other women. Current Spanish law (27/05/2006) guarantees that egg donation is anonymous and confidential. Only in exceptional life or death circumstances for the child can the identity of the donor be revealed.

The pregnancy rate (results) per cycle is close to 60% and, in three to four attempts, close to 95%.

With regard to the donation of cryopreserved embryos, at FivMadrid we believe that the donation of those embryos, which have surpassed the legal freezing time limit, to couples who need them would be a good solution, both from an ethical and a practical point of view.

 

7 - PRE-IMPLANTATION GENETIC DIAGNOSIS (PGD)

This procedure is used when there is a high probability that the embryos will inherit genetic abnormalities from parents who are carriers of some hereditary disease. All the embryos undergo a biopsy, with the aim of retrieving a cell in which the integrity of the chromosomes can be determined via colormetric probes. Those embryos which are carriers of the chromosomal alteration are discarded and only those which are free of this alteration are transferred to the uterus.

PGD can also be applied to the embryos of women with a diagnosis of repeated miscarriage, of repeated implantation failure or where there is an age factor, etc. Some couples request this technique in order to select the sex of the embryos and, in this way, be able to have a descendent of a predetermined sex. However, we are unable to help them in this respect, as this is prohibited by law in Spain.

Pregnancy rate per cycle: 25%

 

8 - INFORMATION FOR EGG DONORS

More information: www.haztedonante.es (become a donor)

The request for egg donations is aimed at young women who wish to donate their eggs as an act of solidarity to other women who suffer from different problems of infertility and who would otherwise not be able to have children.

Egg donation is an anonymous, voluntary and altruistic process like any other human donation. The law governing assisted reproduction in Spain allows centres which are specialised in reproduction to give donors economic compensation solely for the inconvenience which the treatment may cause in terms of injections, medical consultations, analyses and the travelling involved, etc.

To be an egg donor, according to the law as it currently stands, you must meet the following requirements:

• Be between 18 and 35 years old
• Be in good physical and mental health
• Sign an consent form
• Be prepared to undergo the following tests:
  • Blood analysis
  • Urine analysis
• Undergo a chromosome study (Karyotype)
• Undergo a study of infectious diseases (Hepatitis B and C, HIV, Syphilis, etc)
• Undergo a gynaecological study (smear test, vaginal cultures)

If you are suitable to be a donor, you would begin a relatively short treatment of ovarian stimulation, after which, between 8 to 12 days later, an ovarian puncture is performed with the aim of extracting the eggs. This aspiration of the eggs is carried out under sedation, on an out-patient basis and takes about 10 minutes. The donors recover from the effects of the sedation in about 30 to 60 minutes, after which time they can go back to their normal daily lives.

The treatment involves virtually no risk for the donor as it is adapted to the characteristics of each person and is carried out under strict medical supervision. Likewise, the chances of the donors themselves achieving pregnancy in the future remain intact, as the ovarian reserve in a woman is around 400-500,000 eggs, of which she will only use about 1% during her lifetime. For this reason, even if all the donations permitted under law were carried out and each one of these resulted in the collection of a high number of eggs, the ovarian reserve would still remain practically unaltered. We are the only centre whose rate of ovarian hyperstimulation stands at virtually zero.

Thank you very much for having taken the time to read this and we hope that we have informed you of the importance of your generous contribution. If you wish to receive more information, please do not hesitate to contact us on (+34) 900101313 or to send us an e-mail to consuta@fivmadrid.es

If you are unable to donate or you do not wish to do so, your role in spreading information is still important, so please do not hesitate to convey this information to other women who might be interested.

On behalf of those women who depend on people like you to have a child, we would like to convey to you their deepest gratitude.