PATIENTS.Discover all you need to know on assisted reproduction

PATIENTS.Discover all you need to know on assisted reproduction

Patients: FAQs

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Sterility is the inability to achieve a pregnancy after a year of regular unprotected sexual intercourse.

According to epidemiological studies, infertility affects one in six couples, and is on the increase.

Infertility is the inability to produce pregnancies capable of evolving to foetal viability. It s situations such as repeated miscarriage, intrauterine foetal death, premature birth, etc.
Our recommendation is that you should seek a consultation after one year of sexual relations aiming to achieve a pregnancy. There are special cases, however:

  • Couples affected by known or evident fertility disorders, who should do so as soon as they wish to have a baby.
  • Woman at advanced stages of reproductive age; patients over 35 years old should seek a consultation after 6 months of failed attempts.
  • Infertile couples or those with negative history in terms of reproduction (more than 2 miscarriages, births of premature or extremely premature foetuses, intrauterine foetal deaths for unexplained reasons or which are potentially recurrent, previous children with birth defects, carriers or sufferers of transmittable diseases).
Alterations that can reduce the probability of spontaneous pregnancy can affect the production of male and female gametes, their effective interaction or the capacity of the already fertilised embryo to be implanted and developed:

  • Gamete production alterations:
    • Male:
      • Lack of spermatozoa production.
      • Alterations in the number, mobility and morphology of the spermatozoa.
    • Female:
      • Anovulation (polycystic ovary syndrome, premature ovarian failure, etc.).
  • Alterations preventing or complicating contact between gametes:
    • Erectile and ejaculation alterations.
    • Vaginal alterations complicating or preventing intercourse.
    • Sperm transport alterations in the male or female genital system.
    • Alterations in the capture of the oocyte by the fallopian tube.
    • Fertilisation alterations.
  • Implantation alterations:
    • Alterations in the transport of the embryo to the uterine cavity.
    • Embryo implantation alterations.
  • Alterations of unknown cause:
    • The treatment is based on the application of different therapeutic resources, ing the most ideal form for each patient. Only the doctor responsible for the reproductive assistance can properly assess the circumstances of a specific case.The wishes, expectations and preferences of the patients must also be considered. Making use of their autonomy, they must finally choose between the clinically applicable options.
    • The wishes, expectations and preferences of the patients must also be considered. Making use of their autonomy, they must finally choose between the clinically applicable options.
The diagnosis is the deductive process by means of which the doctor tries to identify the origin of the infertility affecting a couple.
The tests have been being carried out in order to study the causal factors described throughout the years of investigation with maximum precision. There are many diagnostic tests and in many cases several can be applied to the study of a single factor.
The medical history is the basic instrument for any medical action aiming to learn the family, general and reproductive personal background of both partners, the presence of symptoms, hormone systems involved, sexual dyss or existence of general processes potentially affecting fertility.

The woman will undergo general, genital and breast physical examination. If the history or the symptoms of the man make it advisable, they will be referred to an andrologist.

We must only consider three groups of tests with systematic application.

  • Seminal quality analysis (initially by means of a seminogram).
  • Tests of anatomic and al normality of the uterus and fallopian tubes.
  • Tests to establish the ovulation quality.

The structural and al normality of the uterus and tubes is investigated by means of diagnostic imaging tests:

  • Transvaginal ultrasound
  • A hysterosalpingography is an X-ray performed by introducing a radiological contrast agent through the cervix to obtain images of the tubes.

Normal ovulation and the normal hormonal of the ovary can be studied by means of several tests:

  • Menstrual history.
  • Ultrasound. It is possible to detect the existence of follicles in the ovary that can guide us on the status of the ovary reserve.
  • Hormonal determinations: The levels of the follicle-stimulating hormone (FSH) and oestradiol in the initial follicular phase (towards the third day of the cycle).
  • Simultaneously, general blood parameters are usually determined, as well as active infection markers for hepatitis B and C, human immunodeficiency virus (HIV) and syphilis.
In these cases, there are tests that will only be requested in specific cases in view of the existence of medical history or diagnostic findings advising their use. Some of the most important complementary tests:

  • Advanced seminal tests: Sperm ion and survival test. Hormone and metabolic studies: Prolactin, androgens, thyroid hormones, anti-Müllerian hormone.
  • Microbiological studies: Cultivation of genital exudate, infection markers for chlamydia.
  • Immunological studies: antiphospholipid, anti-thyroid antibodies, etc. Along with the following studies, they can be of interest in certain cases of repeated loss of pregnancy. Haematological studies: markers of states of hypercoagulability such as thrombophilias.
  • Genetic studies: Karyotype, study of mutations or polymorphisms associated with monogenic diseases, study in chromosome microdelections associated with deficits in spermatozoa production.
  • Testicle biopsy: for the obtainment of spermatozoa from the testicular tissue. If sperm production is very severely affected, it can be useful for morphological or genetic studies contributing to the clarification of the origin of said alteration.
  • Laparoscopy: to confirm the severity of suspected diagnoses of tubal affectation established by means of ultrasound or hysterosalpingography, or for their treatment. It is an invasive technique consisting of the inspection of the internal genital system of the woman using an endoscope, which is introduced through an incision generally close to the navel. If a pathology susceptible to surgical correction is identified, the laparoscopy makes it possible to perform surgical treatment of certain processes using special instruments and techniques that do not the opening of the abdomen.
  • Hysteroscopy: consists of the examination of the uterine cavity by means of an optical system introduced through the cervix. In a large number of cases, it can be performed without anaesthesia or admission, as it is not usually painful. In other circumstances, it also permits the surgical treatment of other alterations of the cavity.
Wanting to have a child and not being able to fulfil this desire spontaneously is a source of stress, anxiety and, in some cases, depression.

Why is stress common?

Stress is closely related to the experience of infertility, as it is expressed as a result of difficulty conceiving a child, of not knowing the cause, of not knowing if it will happen one day, of the pressure felt from the outside world. Couples with reproductive problems usually refer to infertility as the worst crisis of their lives.


What alteration in emotional states can occur?

  • Anxiety. Product of the uncertainty and inability to foresee whether a pregnancy will eventually be possible. It has very characteristic symptoms: difficulty breathing, dizziness, intense headaches, etc.
  • Depression. In many cases, the concept of infertility is intolerable for those suffering it. The depression rates in patients with reproductive problems are comparable to patients diagnosed with cancer, chronic pain and heart disease.
  • Anger. Why me? This is a very common question. They are angry but they cannot explain with whom, whether it is with themselves, their partner, the doctor who has given them the diagnosis, or with a superior being who is punishing them.
  • Sensation of "nothing in my life makes sense if I do not have a child".
  • Sadness vs Hope. Mood swings are characteristic in patients with reproduction problems. Continuous sensation of living a roller coaster (hope due to the treatment, sadness due to failures).
  • Reduction of the frequency and spontaneity of sexual relations.


Why do the partners have different feelings in view of the same situation?

Gender differences between men and women make each partner respond differently in view of the different situations which they have to face.

When the partner faces a reproductive problem, the woman tends to express sadness by crying and seeking refuge in their loved ones. The man, however, usually adopts behaviours of avoidance, seeking refuge in his work, in going out with friends, etc. This does not mean that one is more affected and committed to the idea than the other, but that each partner expresses their emotion in their own way.

In view of this situation, it is important:

  • To know that, although their reactions are different, both partners are experiencing a difficult time.
  • To have fluid dialogue between the couple with respect to these reactions.
  • To respect each partner's expressions of anxiety.


What things could improve these sensations?

  • Going through this experience together, as a couple, feeling accompanied by your partner. Although they cannot not always come to consultations together, it is essential to feel and know that their partner is present.
  • Asking for help when considered necessary. Psychologists are very useful in these times and will provide tools to help them overcome the most difficult situations.
  • It is essential to have other projects under way, as well as the desire to be parents. Focusing on a single objective that is not totally dependent on us is not beneficial, particularly when we do not know when that objective will be achieved.
  • Not seeing the treatment as the last option to be parents but as a treatment that we all hope will give results, but which at the same time may not be the last resort.


What can be done in view of a negative result?

One of the worst moments in the treatment is receiving negative results from a pregnancy test. Here are some guidelines for dealing with a negative result:

  • Knowing that reproduction treatments do not ensure a pregnancy.
  • It is important to have other projects under way in order not to think that the world is closing in on us because we have not achieved a pregnancy with this attempt. For example, having an outing planned for the weekend, meals with friends, etc.
  • It is not emotionally beneficial to think that this is the last try! Trying to see it as another attempt will help reduce the anxiety caused by thinking that it is the last possibility.
  • If you are not up to it, do not force meetings there are children. That is to say, parties with family or friends everything revolves around children, pregnancy, childbirth stories, etc.
  • Try not to speak about the failed treatment every day. Our recommendation is to find within the couple times to reflect on the negative result of the test and what to do the day after. Talking about it constantly is not beneficial for your state of mind, as it prevents us thinking about something else.
  • Use energy. Play sport, go for a walk, run, help tire the body out to be able to sleep better.


When to say "enough".

Saying "enough" is health and, sometimes, very necessary. Just as it is important to walk the path necessary to achieve the desire to be biological parents, it is also important to know when to stop. It is not beneficial for the couple to continue trying cycles repeatedly at any cost, even when their physical and mental strength and economic resources are scarce. It must be remembered that there are alternatives to "biological" paternity.

How to decide whether to resort to gamete donation.

The donation of gametes in heterosexual couples is usually a difficult decision and one which s time to reflect. Consulting with a specialist psychologist is the most recommendable option in these cases.

Some questions that can help to reflect are:

  • What do I want to have a child?
  • Do I want a child to raise it, give it my love, it the things I have learned, or do I only want to have a child so that it can physically look like me?
  • Do I know the donor ion process? Do I know their motivations?
  • Do I know the importance of environmental factors in the development of the children?


In gamete donation, is it recommended to tell the child about their origin?

Currently, many patients turn to gamete donation to have a child. Some because they do not have a partner or male partner, and other because their gametes do not permit them to achieve a pregnancy.

This means that the child will have no genetic link to one or both of its parents. This lack of genetic link is the basis of the questioning: "should I tell my child about their origin?", "what should I tell them?", "how and when do I say it?"

Some suggestions to bear in mind when taking the decision:

  • Currently, scientific research in this field suggests that adopting a stance of sincerity with the child will favour the parent-child relationship. We must take into ac that love, care, values and customs are not transmitted genetically.
  • Who tells the child? Always their parents. Do not wait for someone else to tell them.
  • When? From 3 years and up to 8 is considered a good time, as the child is starting to build their identity, their image of themselves and others during this period. That is, start to respond when the child starts to ask. Thus, the child sets the rhythm at which they can understand the answers. It is important not to put it off until periods such as adolescence or pre-adolescence typical conflicts of this stage of development always arise.
  • How do I tell them? As a story or with analogies. Small children usually understand what we are explaining better if we use examples that they can understand. There are illustrated stories that allow the child to understand the way they came into the world by gamete donation easily.
  • Why tell them? They are not more yours if you do not tell them and no less yours if you do. The genetic load of human beings does not determine their tastes, their ways of thinking, feeling, acting and loving. These characteristics are only achieved with parent-child interaction with the transmission of values and the education that we give our children.


Women with no male partner and same sex couples.

In these cases, there is not necessarily a reproductive problem. Therefore, the emotional conflict generated in patients with reproductive problems is not always present.

These women usually come to consultations:

  • Very excited and sure of their decision.
  • With the support of social networks, although not always family networks.
  • Doubts on how to integrate their partner.

Current scientific evidence has not discovered significant differences in relations between children of mothers with a female partner, single mothers and heterosexual mothers (with a partner) either on a psychological level or in terms of social development, development and gender behaviours.

To perform any of the assisted reproduction treatments, patients will need the help of a series of professionals in medicine, nursing, embryology, psychology, etc.

Each of them will be present in one or several stages of the process, sometimes directly and sometimes with more or less visibility, but all of them form part of a large team whose only aim is the integral care of patients/couples.

For this reason, in each of the stages and in each of the different levels of care, patients will have nursing professionals who will be their reference from the first visit consultation to the end of the cycle in the pregnancy test consultation.

The educational work for the correct completion of the treatments, the care and accompaniment of the patient/couple in the different processes (insemination/puncture/transfer) will continue to be down to the nursing staff, along with the necessary pre-, intra- and post-procedure information.

Details such as: how to come for a certain test, its duration, recommendations after it, need for rest, feeling pain or discomfort, what changes to introduce in your lifestyle, who to turn to in case of...? When the patient has vast information on what they are going to ener in the different parts of the treatment and the different scenarios thereof, the levels of anxiety and fear of the unknown reduce; it also helps to feel professionally accompanied with personalised care, with sufficient time and, of course, knowing how and who is there at each moment.




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