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Alcobendas SANITAS ASSISTED REPRODUCTION CENTRE

We have the most advanced techniques to help you get pregnant.

We have the most advanced techniques to help you get pregnant.

Assisted Reproduction Techniques

The Alcobendas Assisted Reproduction Centre offers all the solutions to help to make the dream of many couples to be parents a reality when they have problems achieving a spontaneous pregnancy. Thus, we have all the assisted reproduction techniques currently available.

Artificial insemination with donor sperm (AID)

It is an assisted reproduction technique that is mainly used in infertility cases the woman has at least one ing fallopian tube and the man has severe sperm problems, necessitating the use of semen from a sperm bank.

It can also be used by women who do not have a male partner but would like to have a baby.


When is AID used?

It is mainly used in the following cases:

  • Azoospermia (complete absence of sperm in the semen) and inability to obtain viable sperm from the testicle or the sperm duct that connects it to the body's exterior.
  • When men have severe fertility problems that cannot be resolved by IVF/ICSI.
  • When men have genetic conditions that are likely to be passed on to their children and that cannot be bypassed by embryo ion processes.
  • When women are severely sensitive to the Rh factor, have had previous miscarriages as a result, and cannot be treated by other means.
  • When women do not have a male partner, whether they are homosexual or would like to raise a child alone.

 

What are the possibilities of success offered by AID?

In absence of female pathology, the pregnancy rate after an adequate number of cycles of treatment (around 6) can reach 80%.

 

What are the relevant legal aspects related to AID?

Here are some aspects that can be of interest for users of AID:

  • The donation of gametes is anonymous, and so the recipient is not permitted to provide or their donor. The AID user and the children born from the application of this technique have the right to obtain general information on the donor which does not their identity.
  • Sperm donors are of legal age, have not received any compensation and have been accepted after the legally established studies have not revealed evidence of diseases that can be transmitted to offspring or the recipient of the gametes, or of seminal alterations.
  • The donation must have been made at an officially accredited Sperm Bank.
  • The responsibility of donor ion corresponds to the medical team of the Sperm Bank, which must guarantee the fulfilment of the conditions of suitability d by the law. The ion of said donor is made seeking the maximum phenotypic compatibility possible, although it is not possible to guarantee that these characteristics will be present in the newborn.
  • The maximum number of pregnancies from a single donor is 6, including their children born by non-assisted reproduction.
  • To undergo the treatment, the written consent of the woman and her spouse, if she has one, is d. This consent establishes the legal filiation of the child born, which may not be challenged by any of the signatories after the completion of the technique.

Artificial insemination with the partner´s sperm (AIH)

Artificial insemination is the simplest assisted reproduction technique and basically consists of ing the sperm into the woman using a special instrument.

 

When is AIH used?

  • When there are low to moderate defects in semen quality due to a moderately low sperm , reduced mobility, or slightly abnormal sperm morphology.
  • When there is poor quality cervical mucus, which can act as a barrier to sperm as it makes its way up towards the uterus and fallopian tubes.
  • In cases of infertility with unknown or unapparent cause, which is the case for patients whose conventional diagnostic tests have shown normal results.
  • Other situations AIH can improve the chances of conception are: mild endometriosis, fallopian tube abnormalities that do not result in complete obstruction, certain ovulation disorders, etc.

 

What is the general procedure for AIH?

AIH is generally performed after ovary stimulation: the patient receives a treatment aiming to ensure ovulation by treating possible defects in the spontaneous cycle in some cases and increasing the number of ovules that can become fertilised (controlled by regular ultrasounds) in others. In the following days, the insemination itself is performed, for which the man must obtain a seminal sample which is processed in the laboratory in order to the most useful spermatozoa it contains and eliminate the rest of the semen.

The insemination is performed in the consultation room and the gynaecologist introduces a fine, soft plastic tube through the cervix to deposit the small volume of liquid containing the ed spermatozoa in the uterus.


What are the possibilities of success offered by AIH?

The probability for each cycle is 10-15%. The majority of pregnancies are obtained in the first three cycles of treatment.

In vitro fertillisation (IVF) and sperm microinjection (ICSI)

In vitro fertilisation involves putting the male gametes (sperm) and female gametes (eggs) into contact so that fertilisation and initial embryo development can take place outside the mother's body.

There are two methods to produce the fertilisation:

  • In vitro fertilisation (IVF): the spermatozoa collide with the oocytes in ideal conditions to make the fertilisation occur spontaneously.
  • Sperm microinjection (ICSI): consists of intervening more actively in the fertilisation process, introducing a sperm cell inside each oocyte.

When fertilisation and development in vitro of the embryos obtained is achieved, the adequate number thereof is ed to be transferred to the uterus, in order to achieve an evolutionary pregnancy.


What is the general process of IVF/ICSI?

An ovary hormone stimulation treatment is d. This process has three objectives:

  1. To block the physiological mechanisms controlling the ovarian cycle, in order to modify it according to the treatment needs.
  2. To stimulate the development of several ovarian follicles.
  3. To generate the final maturity of the oocytes with another hormone preparation.

When the desired follicle growth is obtained, the drug triggering the final maturity changes is administered and the follicle puncture is scheduled around 36 hours after. The oocytes are ed by puncturing the ovary through the vagina with ultrasound control and under anaesthesia.

The spermatozoa are generally obtained from a sperm sample. All the samples are subject to in-lab preparation, in order to the spermatozoa which will be used in the fertilisation techniques. If the fertilisation is obtained, the resulting embryos are classified according to their quality after several days of in-lab cultivation, in order to those with the greatest implantation probabilities to be transferred to the maternal uterus.

The embryo transfer is completely painless, does not anaesthesia and makes it necessary slightly to modify the subsequent life regime.

The evolutionary embryos not transferred to the uterus are cryopreserved and, if pregnancy is not achieved, they will be transferred to the patient before starting a new ovary stimulation.


What are the possibilities of success offered by IVF/ICSI?

It predominantly depends on the age of the patient and the number and quality of the embryos transferred. In general, the average pregnancy per cycle started is between 29-35%, although this percentage can vary between 10-40% according to the specific circumstances of the patients.


When are IVF and ICSI used?

They can be useful in the treatment of different fertility disorders:

  • When the fallopian tubes are non-existent or severely injured.
  • When semen quality is severely affected by a low sperm , poor mobility, or an abnormal incidence of morphological abnormalities.
  • In cases of moderate or severe endometriosis, consisting in significant endometrial patches outside of the uterine cavity.
  • In cases of abnormal ovulation that cannot be resolved by other treatments.
  • In cases of immunological disorders with implications for reproduction.
  • In cases of previous failure of fertility procedures.
  • When the cause of infertility or sterility is unknown.
  • In cases requiring Pre-implantation Genetic Diagnosis.
  • Other situations.

Choosing the specific kind of in vitro fertilisation (conventional IVF or ICSI) in each case is a matter of considering the patient's history and the characteristics of their gametes, once these have been assessed in the laboratory. The final decision, therefore, is made just before the technique is carried out.


What are the relevant risks of IVF/ICSI?

The chances of multiple pregnancy (more than one foetus) and high-degree multiple pregnancy (more than two foetuses) increase as a result of the transfer of more than one embryo to the uterus.

Furthermore, there is a risk of ovarian hyperstimulation syndrome, which is an abnormal response to ovary stimulation treatment.

Pre-implantation genetic diagnosis (PGD)

This is a series of procedures aiming to learn the genetic characteristics of the embryos obtained by means of in vitro fertilisation, in order to those which are suitable for their transfer to the uterus.

 

When is pre-implantation genetic diagnosis (PGD) used?

This technique can be useful in different situations:

  • Patients infected with or carrying genetically transmittable diseases due to the alteration of a gene, known as monogenic diseases.
  • Patients who are carriers of transmittable chromosome alterations.
  • Patients with greater risk of genetic alterations in their gametes (oocytes and spermatozoa), which could determine the formation of genetically abnormal embryos.

Sperm extraction

This is the procedure aiming to obtain spermatozoa from the testicular tissue, the epididymis or another segment of the seminal channel (series of ducts communicating the testicle and the outside of the body), in order to use them for the completion of assisted reproduction techniques.


When is sperm ion used?

Testicular or seminal channel spermatozoa ion techniques can be useful when there is not a sufficient quantity or adequate quality of spermatozoa in the ejaculate to be used in assisted reproduction techniques.

The most series for of this type of disorder is the absence of spermatozoa in the sperm, known as azoospermia. This serious seminal quality condition can be the result of two types of disorders:

  • Alteration of the testicular capacity to produce spermatozoa.
  • Alteration of the transport of the spermatozoa from the testicle to the outside.

Oocyte donation

Oocyte donation can be used in cases in which they do not offer sufficient quality to achieve a pregnancy, they have been used up or when the woman carries a genetic or chromosome alteration.


Who can donate eggs?

Any woman aged between 18 and 35 years with a good state of physical and psychological health.

Access our Donors section to learn for about it.


Can the identity of the donor be known or can the donor know the identity of the woman to whom she has donated?

No, the donation of oocytes is anonymous as well as altruistic.


What treatment must the woman who is going to receive donor eggs undergo?

According to whether she has menstruations or not, the treatment can change but, in general, the endometrium is first prepared with estradiol tablets and then also with progesterone; both are the hormones which act naturally in the formation of an endometrium suitable for the implantation of an embryo.


Does this technique offer good pregnancy options?

Yes, it is the technique that generates the best results given that the oocytes come from healthy, young women.


What are the relevant legal aspects related to oocyte donation?

The legal regulation of the use of donor oocytes for reproductive purposes is found in the Assisted Reproduction Law (Ley de Reproducción Asistida) and its complementary regulations. Some relevant aspects of these regulations are the following:

  • The donation of oocytes is altruistic, voluntary and anonymous, and so the recipient is not permitted to provide or their donor.
  • The user of the technique and the children born from its application have the right to obtain general information on the donor which does not their identity.
  • Oocyte donors are of legal age and under 35, are accepted after the legally established studies have not revealed evidence of diseases that can be transmitted to offspring or the recipient of the oocytes.
  • The maximum number of pregnancies that can be obtained from the gametes of a single donor is six, including their children born by non-assisted reproduction.

Our donors not only comply with all the ments with respect to genetic studies as established in the law but also with the classic criteria established for the donor-recipient assignment (phenotypic characteristics), which is performed through genetic matching which minimises the probability of recessive genetic diseases in the future baby.

Fetillity preservation

Fertility preservation treatments are those in which the purpose, as in the other reproductive therapies, is to achieve a pregnancy, but in the long term rather than immediately. This decision can be taken due to several circumstances, for example, in the diagnosis of cancer. Chemotherapy or radiotherapy treatment can cause the loss of oocytes and ovarian atrophy, which, in most cases, will be irreversible given that the ovaries have a set number of germinal cells which will not regenerate.

There are also non-malignant diseases which will treatments such as some types of autoimmune diseases, for example, and the woman may simply decide for various reasons, such as not wishing to get pregnant at that comment, to use these techniques.


What types of fertility preservation treatment are there?

  • Oocyte freezing: consists of the completion of an ovary stimulation cycle to recover oocytes which will later be frozen by a specific process called vitrification.
  • Embryo freezing. The oocytes are fertilised in vitro and the resulting embryos are frozen.
  • Freezing of ovarian tissue (in girls or adult women). Although it is not a consolidated therapeutic option and must still be considered an experimental technique.
  • Sperm freezing in men, prior to cancer treatment.

Vitrification is the technique for freezing the eggs that have shown the best results. Unlike classic freezing, with this method, we avoid the formation of harmful crystals at cellular level.


Why should you preserve your fertility?

The ovary s as a storage facility for eggs; it contains its greatest number (6-7 million) is during foetal life (within the uterus of the mother). From that time, the number reduces: when you are born, it reduces to 1-2 million oocytes and at around 50 years the ovary reserve runs out and the menopause s.

 

5 stages can be distinguished in the ovary reserve:

  1. Start of ovulation: Around 13 years.
    At the start of puberty, there are 300,000 to 500,000 eggs left.
  2. Fertility peak: Around 20 years.
    The ovary is at full ; these are the best quality eggs and it would be to optimum time to get pregnant, vitrify the eggs or donate them.
  3. The decline commences: Around 35 years. From 26-30 years, the decline commences and at 35 years we speak of the point of the maximum turning point. At this age, if, after 6 months of actively trying to get pregnant you do not achieve it, we recommend that you see a specialist.
  4. Difficulty achieving an evolutionary pregnancy: Around 42 years. As you get older, the eggs' number of chromosomes changes such that, upon fertilising these "older eggs", the embryo may have a higher or smaller number of chromosomes (out of these possible chromosome alterations, the best known is Down syndrome). From 40 years, the possibility of achieving a natural pregnancy is 5% per cycle. At 40-42 years, the possibility of having a live newborn after in vitro fertilisation with your own eggs is 13% and 9% at 43-44 years. At 45 years, most women are incapable of getting pregnant; this is the case for both natural conception and in vitro fertilisation, with the use of donated eggs being the reasonable alternative.
  5. Menopause: cessation of menstruation from approximately 51 years. This is the average age of menopause, the moment when the ovary no longer has eggs and the woman stops having periods.

 

Is there a study to assess the ovary reserve status?

To determine the ovary reserve of a woman, both hormonal analysis and transvaginal ultrasound are used to the antral follicles. The anti-Müllerian hormone is a substance produced in the ovary and is one of the markers best reflecting not only the ovary reserve but also the response to ovary stimulation treatments and the probability of pregnancy.

It can be measured at any point of the cycle: levels between 2-7 ng/ml indicate a very good reserve, between 1-2 ng/ml is a normal reserve and levels below 0.6 ng/ml are considered low reserves.


What is the best age to vitrify eggs?

The optimum time to vitrify eggs in order to delay the age at which to have a baby would be between 30 and 37 years. Above that age, the quality of the conserved eggs reduces and the possibilities to achieve an evolutionary pregnancy are less favourable than with younger eggs.


Does the egg vitrification technique have risks?

The risks are minimal and it is a treatment which is very well tolerated by most women.
The main ones are the risks derived from the ovary stimulation treatment, generally minor abdominal discomfort; risks derived from the anaesthesia or the follicle puncture such as pain and bleeding, although they are usually minor.


Does it affect subsequent fertility?

It does not affect subsequent fertility.


How long is needed to vitrify eggs?

Approximately 15 days are needed to mature the eggs and to make them optimal to be vitrified; controls are performed every 3-4 days with the gynaecologist during this period.

The medication is administered daily at home and, in each control, the gynaecologist will indicate the necessary dosage.

The eggs are ed in the operating theatre under sedation and the period will occur some days later as normal.


Is the process painful?

The medication is administered subcutaneously; it is injected but it is designed so that the woman can do it herself at home easily and comfortably.

To make the egg ion process painless, sedation is used; it is performed in the morning and in the afternoon you can continue with your normal life.

Embryoscope technology

Our laboratory has an embryoscope: the embryo cultivation system allows us to maintain the most adequate conditions we currently know of, those closest to those of the body of the woman. On top of this, the system captures images, as a general sweep of each of the embryos every 10 minutes. Thus, the embryos found in this system are observed 24 hours a day (time-lapse cultivation) unlike a conventional incubator each embryo is usually observed on a single occasion every 24 hours. This methodology allows us to obtain a large amount of information on the development of the embryos and increase the probability of pregnancy.

In vitro fertilisation with pre-implantation genetic screening

The in vitro technique (the union of the spermatozoa and the oocyte to achieve fertilisation and the initial embryonic development outside of the woman's body) is combined with the genetic study of the embryos or pre-implantation genetic screening, to offer a unified treatment which gives greater possibilities of success in pregnancy and greater peace of mind, with no risks for the mother.

One of the areas of knowledge that has most evolved and which we apply in reproductive medicine is genetics. We have diagnostic techniques that enable us to study the chromosomes of each of the embryos generated in the laboratory and to select those with no anomalies to be transferred to the uterus of the woman, increasing the probability of success, the safety, and reducing the risk of miscarriage.

The medical treatments must be personalised and there will always be a specialist recommendation that will indicate the treatment that will provide the best results. However, this technique is recommended in case of failed implantation, repeated miscarriage and according to the age of the mother, among other factors.

What does IVF with pre-implantation genetic screening consist of, step by step?

1. The process begins with the controlled medical stimulation of the ovaries of the woman.

2. A sufficient number of eggs which can be fertilised to generate embryos is obtained.

3. These will be developed in the laboratory in a completely controlled environment.

4. Between the third and fifth day of life of the embryos, the obtainment of the embryonic material necessary for the genetic study (a small sample is extracted) will be performed.

5. The embryos will be cryopreserved until the genetic analysis indicates which of them are free of chromosome alterations.

6. In a subsequent cycle, the endometrium of the woman is prepared so that it is receptive and the embryo/s is/are devitrified for their transfer.

The other frozen embryos with no anomalies are kept in this state.

In vitro fertilisation with egg donor and pre-implantation genetic screening

This in vitro fertilisation treatment with egg donor also includes the genetic study of the embryos, that is, the pre-implantation genetic screening technique, to offer a unified, more comfortable and easier treatment with greater chances of success and peace of mind, always without risks for the mother.

In the case of the egg, the age of the woman is a determining factor of the quality thereof but since they are donor eggs, they are better quality and have fewer alterations in their chromosomes.

This technique would be used when it is suspected that the cause of the failed implantation or the miscarriage lies in the sperm cell. We could, therefore, detect genetic (chromosome) alterations in the embryos and transfer to the uterus the free embryos thereof, improving the results and reducing the risk of miscarriage.

What does IVF with donor eggs and pre-implantation genetic screening consist of, step by step?

1. The process begins with the donor-recipient selection and assignment.

2. The donated eggs will be fertilised to produce embryos.

3. These will be developed in the laboratory in a completely controlled environment.

4. Between the third and fifth day of life of the embryos, the obtainment of the embryonic material necessary for the genetic study (a small sample is extracted) will be performed.

5. The embryos will be cryopreserved until the genetic analysis indicates which of them are free of chromosome alterations.

6. In a subsequent cycle, the endometrium of the woman is prepared so that it is receptive and the embryo/s is/are devitrified for their transfer.

The other frozen embryos with no anomalies are kept in this state.

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