tratamientos
tratamientos de fertilidad humana / fertility patagonia

It's based on the artificial introduction of semen inside the woman's uterus. It consists of three phases:

1. Ovarian stimulation with ovulation-inducing substances is highly convenient to achieve the expected results. Entails the development of multiple eggs, which involves taking the risk of 15-20% of twin pregnancies, an issue that is important to know and discuss among patients and medical equipment.

2. Preparation of the semen consists of selecting and concentrating the mobile sperm, as the low mobility of these is one of the factors that may adversely difficult the achievement of pregnancy .

3. The insemination is carried out in the consultation. It is not necessary to apply any type of anesthesia and it doesn't affect the patient at all. Insemination is usually done over two consecutive days after induced ovulation. For each of them it will be needed to provide the lab with a semen sample. After the deposit of the semen was properly treated in the womb, the woman should rest for a few minutes. As for the results obtained in the artificial insemination at the IVI, we note that for every 100 insemination cycles, 13 result in pregnancy, and out of 100 couples who completed4 cycles, 60 get pregnant. Of all pregnancies achieved, 15-20% are twins and another 15% will miscarry.

Although currently most cases of male infertility can be solved, there are some occasions on which is necessary to use sperm donation. In addition, the Law contemplates in our country insemination to single women, and on the other hand, some men are carriers of congenital diseases that may transmit to his descendants; hence the IVI has a semen bank for these cases.

Sperm donors are routinely studied to rule out any communicable disease and particularly control the existence of HIV antibodies. A particular sample of semen is frozen for 6 months before use. Only if the donor shows negative for antibodies of the HIV after those 6 months of quarantine, the sample is used. We also monitor very strictly hereditary diseases that may carry the donors or their close relatives. Keep in mind that some hereditary diseases are manifested at different stages in life, so that its existence may be not detected at the time of donation.

As a result, insemination with donor semen provides pregnancy rates per cycle of 25% and 80% per patient with a maximum of 6 cycles.

Nowadays it has become the converging point of all those reproductive failures that initially had not been resolved in a simpler way with the other treatments. In addition to IVF, specifically intracytoplasmic sperm injection (ICSI), is the solution to male infertility, so that today we can say that male infertility has become a problem of the past in the vast majority of cases.

IVF consists of six phases: ovarian stimulation with hormones, removal of the ovocytes, insemination of these, in vitro cultivation to various stages of the embryo development, embryo transfer, and freezing and defrosting of the embryo.

1. Ovarian stimulationallows us to obtain several eggs in one cycle and is necessary because the chances of pregnancy increase proportionally to the number of embryos transferred, since not all ovocytes obtained become embryos suitable for transfer. The stimulation requires intramuscular injections and / or subcutaneous injections and several (3 or 4) office visits to the IVI Centres to monitor the outcome of the application.The probability of an exaggerated reaction (hyperstimulation) with risk for a patient is less than 1%.

2. Extraction of ovocytes. The extraction is performed by transvaginal puncture under ultrasound guidance. The average duration of this intervention is about 15 minutes, is performed under sedation and the patient is ready to leave to his home after 20 or 30 minutes. The risk of any complications during the extraction of the ovocytes is 1 in 2,500 cases, so it can be considered nonexistent.

3. Insemination. Once collected the ovocytes, it is required a semen sample. To perform the insemination, there are two alternatives: the traditional insemination, putting together ovocytes with sperm previously treated and selected, and intracytoplasmic sperm injection (ICSI) as detailed in the proper section.

4. Embryo in vitro cultivation. The fertilized ovocytes are detected the next day. From this point the embryos are kept at the proper type of cultivation suitable for its growing. Usually the embryos grow for a total of three days. Sometimes it is appropriate to extend the cultivation of the embryos in the laboratory to the stage called blastocyst. We use the technique of co-culturing embryonic cells of the endometrium, which was originally developed in the IVI , being its effectiveness recognized internationally. Not for nothing it has been awarded with the annual prize of the American Fertility Society for Reproductive Medicine on three occasions (1995, 1997 and 1999), for work that led us to develop the Co-embryo culture. In short, it comes to cultivating the embryos with human endometrial epithelial cells, which is their natural environment. In this cultivation the embryos develop for 6 days to reach, most of them, the optimal stage for implantation.

5. Embryo transfer: The moment of transfer of embryos to the uterus is decided based in each particular case. Depending on the characteristics of the embryos, embryologists recommend the most appropriate time between the second and sixth day after collection and fertilization of ovocytes. Likewise, the transfer can be either in the uterus or fallopian tubes. Uterine transfer takes place via transcervical, requires no anesthesia and is most common in IVF. Usually 2 or 3 embryos transferred, because the present high rate of embryo implantation advised to limit their number to reduce the incidence of multifetal pregnancies (our statistics show that this is the number that gives higher rates of pregnancy without increased risk of multiple pregnancy) . The results for IVF practised in the IVI are the highest in the world, we find this true year after year in different international forums where we contrast the experiences of other specialists dedicated to human reproduction. Within our policy of providing accurate information to our patients about the success rates obtained, we have established in our website (www.ivi.es) a section where they can find annual reports on the results of the Group in the previous year as well as other interesting news. We consider this essential for couples who are having trouble on deciding for a center to begin treatment. As a guideline, we can say that since late 1999 and on an ongoing basis over recent years, pregnancy rates with IVF and ICSI have not dropped 50%, still above 60% for egg donation. In addition, success rates with frozen embryo transfer are now comparable to other treatments, and are above 40%.

6. Freezing and thawing of embryos, after transfer of embryos appropriate for each case, the remaining viable embryos are subject to a freezing process to preserve them for a while. This procedure enables the availability of these embryos when they are needed by the couple. If no pregnancy, or after its conclusion, we proceed to the thawing and transfer of embryos that survived freezing. Although historically, the results with frozen embryos have been lower than with other treatments, in the IVI, and for almost two years now, we have been able to raise them to virtually the same as with IVF. There is no greater risk of abortion or embryonic malformations by transferring previously cryopreserved embryos. According to the Assisted Reproduction Law, the maximum time that some embryos can be stored in these conditions is five years.

Microinjection of a single sperm into the ovocyte is the same treatment to IVF with a difference on how to inseminate the ovocytes. You only need a live sperm for each ovocyte which, unlike IVF, can be performed with semen samples of extremely low quality; even in cases of total absence of sperm in the ejaculation, since in these cases we obtain sperm directly from the epididymis or the testicle through a small intervention performed to men, called testicular biopsy and which can be done once we have obtained the ovocytes.

However, we have developed for the first time in the world, freezing techniques for testicular biopsy which can allow to use for ICSI, sperm from any source (ejaculate, epididymis or testicles) after thawing. Moreover, in most cases it is not necessary to defrost the whole sample, which is why a single biopsy usually allows for the completion of several ICSI attempts.

The chances of success with ICSI are the same as with conventional IVF. However, it is important to know that couples subject to ICSI have a primary problem far more serious: the difficulty of fertilization with sperm of the male. Therefore it is important to note that with this technique, even with the lowest quality sperm samples, only 2% of the cases present a failure of fertilization of all ovocytes injected, but tend to be those with less than three mature available ovocytes.

When semen samples are pathological, we always do additional tests to find whether there are chromosomal defects and / or genetic diseases that may justify or even recommend that this sample should not used carelessly. In these cases, it is also more likely to find lower quality embryos.

The possibilities of pregnancy with ICSI are basically the same as with IVF, taking into account what was mentioned above on sperm quality.

Sperm retrieval

In patients with azoospermia (no sperm in the ejaculation), it is possible to retrievesperm from the testicle or the spermatic way. We now know that in the case ofazoospermia, and sperm tract obstruction (obstructive azoospermia), sperm can berecovered almost 100% of cases, whereas in non-obstructive azoospermia (theproduction deficit) this value decreases to 50%. In obstructive cases, recovery can usually be performed by a simple puncture of the epididymis or directly from the testicle, while in patients with non-obstructive azoospermia, it is usually necessary to make asmall intervention similar to a biopsy. When assisted reproduction is carried out, associated with sperm retrieval, the steps are similar to those of IVF (in vitro fertilization), except that the sperm should beretrieved beforehand. In general, recovery of sperm, takes place the same day that theextraction of the eggs. Since these sperm have very low mobility it should be used forICSI (injecting a sperm into an egg), which can achieve similar rates of fertilization than with ejaculated spermatozoa. In some cases, it is often possible to cryopreserve(freeze) recovered material so that if it was necessary to repeat the procedure, those sperm can be used.

Embryo cryopreservation

Criopreservación embrionaria

Cryopreservation offers the possibility of preserving embryos using this technique to improve the treatment outcomes, avoid multiple pregnancies and also allows a new attempt in those cases where pregnancy had not been initially achieved . In addition, sperm and testicular or ovaric tissue can be frozen in order to preserve the future fertility on patients with certain pathologies, that could affect it.

Pre-implantation genetic diagnosis

It is a procedure which examines the genetic constitution of the embryo before transfer. One or two cells are extracted from the embryo to be analyzed with special diagnostic techniques. Embryos that present any genetic anomaly, are never transferred. It is indicated especially in sex-linked genetic diseases such as hemophilia, or in cases of repeated abortions.

Ovocyte donation

When patients have reached menopause prematurely or have been removed both ovaries, when chromosomal abnormalities are consistently transmitted to descendants, or do not respond well to the ovary-stimulating drugs or repeatedly fails to IVF; or even in other circumstances, there is a real possibility of becoming pregnant through egg donation. Women recipients must take a medication that provides their uterus the ability of transferred embryos implanted, and whilst a donation is waited for, must remain in contact with IVI Center to be located at the moment is done.

Ovocyte donors are monitored and controlled exactly with the same tests as sperm donors in order to rule out any congenital (as long as they have already shown in the donor), birth and sexually transmitted diseases. This one is the most efficient method for assisted reproduction.

Insemination using the Semen Bank

It is used when the male has inherited diseases or inability to produce sperm. The first rule governing this technique is the anonymity of both donor of the semen and of the patients who use it. The donor candidates undergo a series of tests before being accepted: general examination, blood, semen, study of sexually transmitted diseases, genetic evaluation. The choice of the donor is determined by the characteristics of the male: is chosen as a donor of blood group and similar physical characteristics. The technique used is the same as in the case of conjugal insemination, but using the sample from sperm bank.

The fertilized eggs can be seen by the next day. From this time the embryos are kept in the type of crop suitable for development in each case. Usually the embryos remain in culture for a total of three days. Sometimes it is appropriate to extend the cultivation of the embryos in the laboratory until it reaches the blastocyst stage . We use the technique of Co-culturing embryonic cells of the endometrium, which was originally developed at IVI ,which its usefulness has been recognized internationally. Not for nothing has been awarded the annual prize of the American Fertility Society for Reproductive Medicine on three occasions (1995, 1997 and 1999), for the work that led us to develop the Co-culture of embryos. Ultimately, it comes to cultivating the embryos with human endometrial epithelial cells, which is its natural environment. In these cultures the embryos develop for 6 days to reach ,in the majority of cases, the optimal stage for implementation.

Assisted Hatching

Embryos are surrounded by a layer called the zona pellucida, which has to fall off to be implanted. This happens once the embryo is in the uterine cavity, thinning its zona pellucida, which can do so gradually, aided by substances produced by himself. There is evidence that some embryos may lack the ability to thin and shed the zona pellucida.For this reason, it was designed a procedure called assisted hatching, by which the embryo is performed a small opening in the zona pellucida, a few minutes before transferring, in order to facilitate the release and subsequent implantation. This technique, usually carried out in embryos of women over 37, in embryos with thickened zona pellucida, and in patients with previous failures of IVF in which embryos were transferred in apparent good quality and not implanted.



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