IF YOU DO NOT ACHIEVE A PREGNANCY
YOU WILL GET A FULL REFUND OF YOUR MONEY!
ARTIFICIAL INSEMINATION
What is artificial insemination?
Artificial insemination is a fertility treatment in which a sperm sample is placed inside the uterine cavity of the women while she ovulating.
To be able to carry out an artificial insemination with good prospects of success, two factors need to be considered:
-
The woman’s age shouldn’t be over 35 years
-
Short time duration of sterility
How is the artificial insemination done?
For an artificial insemination the ovaries need to be stimulated with hormones through daily subcutaneous injections beginning on the first days of the cycle. During the stimulation the ovarian reaction needs to be monitored through a series of ultrasounds. The objective of the stimulation is to achieve the development of one or two follicles in order to minimize the risk of a multiple pregnancy. Once the ovulation has started the artificial insemination will be carried out after 25-40 hours.
If the sperm sample of the partner shall be used, he will have to come to the clinic previously to deliver the sample and have it prepared in the laboratory.
The insemination will be done ambulatory by passing a catheter into the cervix through which the sperm sample will be introduced into the uterus.
Once this is done, after some minutes of rest, the woman can go home.
How long does the process take?
The duration of the artificial insemination treatment depends mainly on the ovarian stimulation phase. If the response is adequately, we achieve a proper follicle development after eight to ten days of stimulation. Sometimes it is necessary to prolong the stimulation in order to accomplish the desired follicle development.
In the majority of cases, the insemination will be finalized within a period of 15 days.
Is it obligatory to stimulate the ovaries?
The ovarian stimulation is not obligatory for artificial insemination in women ovulating regularly. Nevertheless, it is recommended to do so since it improves remarkably the chances of success.
How often do I have to attend the clinic?
During the treatment, it will be necessary to attend the clinic several times for the follicle development control. Usually it won’t be necessary to attend for more than three ultrasound controls before programming the insemination.
Which tests are necessary for the artificial insemination?
The recommended tests for the artificial insemination are:
Type of sperm
The sperm used for the artificial insemination can be from the partner or a donor.
In case using donor sperm, it will be chosen according to the established law, preserving maximum phenotypical similarity with the patients.
How is the sperm prepared?
On the day of the insemination, the sperm sample will be prepared in the laboratory through a sperm capitation process, which consists of selecting the progressively mobile spermatozoa apt for the fertilisation of the eggs.
What shall be done after the insemination?
After the insemination, it is suggested to apply progesterone supplements for some days in order to support the embryo implantation.
Can I live a normal life?
After the insemination cycle, the woman will not notice much difference to her natural cycle. It is recommended to lead a normal life as much as possible.
When shall the pregnancy test be done?
It is recommended to make a pregnancy test in urine two weeks after the insemination.
How often can an insemination be done?
Like in a natural cycle, the inseminations can be repeated in each cycle. It is not necessary to sit one cycle out in order to increase success rates.
Is there a limit to the amount of inseminations?
The success rates for inseminations maintain stable during the three first attempts. If no pregnancy is achieved after three inseminations, it is recommended to pass on to a different, more effective treatment.
Success rate
The success rates of artificial insemination depend on the patient’s age, reaching 27% using the partner’s sperm and 33% with donor sperm. These rates are similar to the ones a non-sterile couple would have during a natural cycle.
Risks of artificial insemination
The principal risk of artificial insemination is a multiple pregnancy depending on the number of follicles developing during the stimulation. This risk is controllable by monitoring the treatment via ultrasound.
IN VITRO FERTILISATION (IVF)
Which tests are necessary for an In Vitro Fertilisation (IVF)?
To carry out an In Vitro Fertilization (IVF) a previous study with the following diagnostic tests is necess
-
Hormonal analysis to analyse the ovarian reserve. The Anti-Müllerian-Hormone (AMH) can be determined at any time of the cycle or the FSH and Estradiol on day three of the cycle
-
Spermiogram to evaluate the quality of the sample. If the sperm quality is very low it will be necessary to amplify the andrological studies by additional tests
-
Gynecological ultrasound to exclude a pathology in the uterus or ovaries.
-
Karyotypes to exclude genetic abnormalities which might affect the embryo
-
Serologies to exclude the presence of transmittable infectious diseases.
What is In Vitro Fertilisation?
In Vitro Fertilisation (IVF) is an assisted reproduction treatment where the eggs are fertilized with sperm in the laboratory.
The In Vitro Fertilisation (IVF) consists of three main phases:
-
Ovarian stimulation
-
Retrieval of the eggs for fertilisation and embryo culture
-
Embryo transfer into the uterus
How are the ovaries stimulated?
To carry out an In Vitro Fertilisation (IVF) with good success rates a sufficient number of eggs need to be retrieved. This will be achieved through a controlled stimulation of the woman’s ovaries by administering subcutaneously hormone injections.
The stimulation protocol will be individually adjusted according to the ovarian reserve of the woman. During the stimulation, the response of the ovaries needs to be monitored through a series of ultrasounds until a correct number of follicles with an adequate size are grown. In this moment, the ovulation will be triggered and 36 hours later the eggs are harvested.
How are the eggs obtained?
The eggs will be retrieved through ovarian puncture guided via ultrasound. It is a simple intervention of only ten minutes and will be carried out under sedation. It is not painful because the woman will be sleeping during the entire procedure. Since it is an ambulatory process, the patient will be able to go home shortly after the egg retrieval.
How often do I have to come to the clinic during the ovarian stimulation?
Usually not more than three ultrasound controls are necessary before programming the egg retrieval.
Type of sperm
For the In Vitro Fertilisation (IVF) a sperm sample from the partner can be used as well as a sperm donor.
In case using donor sperm, it will be chosen according to the established law, preserving maximum phenotypical similarity with the patients.
How is the sperm obtained?
Usually the sperm is obtained through masturbation on the day of egg retrieval. If necessary a frozen sperm sample can be used.
Another way of obtaining sperm is the testicular aspiration (TESA) and the testicular biopsy (TESE). Both techniques shall be used in case no spermatozoon is found in the ejaculate.
In case donor sperm is used the sample will always be a frozen sample.
How does the egg fertilisation take place?
The fertilisation happens in the laboratory after the egg retrieval. The laboratory techniques for egg fertilisation are either a conventional IVF or a microinjection of the sperm (ICSI).
Currently ICSI is the most common technique to fertilise the eggs, especially if there is a history of previous fertilisation failures or bad sperm quality. For the rest of the cases counts, if a solid number of mature quality eggs is available, it is possible to use the conventional IVF technique.
What happens in the laboratory between egg fertilisation and embryo transfer?
Once the eggs are fertilised we have to wait and observe their evolution in the laboratory. After 18-21 hours their correct fertilisation will be controlled and the embryos stay inside an incubator, which provides ideal conditions for their development.
Every day the evolution of each embryo will be analysed until day five when the transfer inside the uterus will occur. This long culture until day five allows us to select those embryos (blastocysts) with the best implantation capacity increasing thereby chances for a pregnancy.
How are the embryos transferred?
The embryo transfer is a simple procedure which neither requires a hospital stay nor anesthesia. The catheter is introduced into the uterine cavity via the cervix in order to place the embryos right inside the uterus. Usually one to two embryos are transferred but currently the trend goes towards transferring only a single embryo to reduce risks of a multiple pregnancy.
What happens to the unused embryos?
If after the embryo transfer more embryos of good quality are left over, they will be frozen.
How long takes the entire process?
The duration of the In Vitro Fertilization (IVF) depends on the elected type of stimulation protocol. For a short stimulation protocol, the duration should be of 15-17 days approx. If a long protocol is to be used we have to consider 10-15 days of previous preparation additionally.
What should be done after the embryo transfer?
After the transfer, the progesterone treatment started after the egg retrieval needs to be continued. If all goes well, the embryo will have implanted a few of hours after the transfer even though we won’t know for sure until the day of the pregnancy test.
Can I do something to improve my chances after the embryo transfer?
It is very common to ask oneself what to do after the transfer to increase chances for a pregnancy. There is nothing additional one can do to increase the probabilities for a pregnancy apart from waiting for the embryos to implant correctly and pursue a normal and relaxed lifestyle.
Can I live a normal life during the In Vitro fertilization?
During the treatment it is recommended to lead a calm life, avoiding bigger efforts and sports. On the day of egg retrieval, bed rest at home will be necessary. Furthermore, sexual intercourse should be avoided during the entire process.
When can I restart another IVF attempt?
Ideally, the woman waits for her ovaries to return to their normal state before restarting another round of stimulation for In Vitro Fertilisation. It is recommended to wait a couple of cycles before commencing a new treatment.
Is it possible to do IVF without stimulation?
An In Vitro Fertilisation within a natural cycle is done in women with previous treatments and a low response to stimulation where the retrieval of only one naturally selected egg is pursued. This option has low success rates and is reserved for couples who do not accept egg donation treatment.
Is there a limit to IVF treatment attempts?
There is no limit to the number of In Vitro Fertilisations (IVF) cycles but usually it is not more than three. It is convenient to re-evaluate the case after each cycle, which did not lead to pregnancy in order to determine if more tests are necessary.
What shall I do to receive transfer of my frozen embryos?
The transfer of frozen embryos only requires a well-developed endometrium. Therefore an oral or transdermal hormone treatment is applied which starts on the first day of the cycle. Some days after, the correct development of the endometrium is confirmed and the transfer organized.
The embryos will be thawed the day of their transfer. If the frozen embryos are of good quality and even more if they are blastocysts, their survival rate is higher than 90%.
Even though good pregnancy rates are achieved with frozen embryos, they still do not accomplish the same numbers as fresh embryos, which are 40% higher.
Risks of IVF
The most important risk of In Vitro Fertilisation (IVF) originates from the ovarian stimulation and the egg retrieval.
Because of the ovarian stimulation, a hyper stimulation syndrome can occur due to an excessive response of the ovaries to the medication. Currently this risk is minimum since individualized protocols are used.
The egg retrieval can lead to small bleedings, which generally disappear on their own. In exceptional cases, an intervention might be necessary.
A multiple pregnancy is another consequence of In Vitro Fertilisation (IVF). The single embryo transfer policy is helping a lot to reduce considerably the number of multiple pregnancy.
Success rates
In Vitro Fertilisation (IVF) is one of the best available fertility treatments. The success rates depend mainly on the woman’s age, being high until the age of 39 and decreasing gradually from this age on.
How long can the embryos stay frozen?
The embryos can stay frozen until their final destination, established by law, is decided. The freezing duration does not affect the results.
DONATION
In some sterility cases the indication is to change the gametes of the couple. This could imply the eggs, the sperm or both. The recommended treatment, if the patient’s own eggs or sperm cannot be used is donation. The gametes used for treatments derive from donors who meet all legal necessities established by law in order to be able to donater.
Egg donation
What is egg donation?
Egg donation is an assisted reproduction treatment in which eggs from a donor are fertilised in the laboratory, with the sperm from the partner or a donor.
The egg donation consists of three phases:
-
Synchronization with the donor
-
Preparation of the endometrium
-
In Vitro Fertilisation of the donor eggs and embryo transfer afterwards
When is egg donation recommended?
Egg donation is indicated if the woman cannot achieve pregnancy with her own eggs.
Frequent causes are:
-
Advanced age
-
Low egg quality
-
Low ovarian reserve after repeatedly failing IVFs
-
Genetic diseases
Which tests are necessary for egg donation?
To carry out egg donation the following tests are necessary:
-
Gynecological ultrasound to exclude a pathology in the uterus or ovaries
-
Spermiogram to evaluate the quality of the sample. If the sperm quality is very low it will be necessary to amplify the andrological studies with additional tests
-
Karyotype to exclude genetic abnormalities which might affect the embryo
-
Serologies to exclude the presence of transmittable infectious disease.
How long takes an egg donation treatment?
Within one month the treatment can be finalized.
How often do I have to come to the clinic during the egg donation?
For egg donation, it is necessary to attend the clinic twice. The first time for organizing the cycle and to freeze a sperm sample if necessary. The second time for the embryo transfer.
During the treatment, an ultrasound control for the endometrium will be made at your own doctor’s practice.
Who are the egg donors?
Egg donors are young women between 18 and 35 years in excellent physical and mental health. To become a donor they will have to pass through a series of tests, which include studies of their personal and family record, psychological evaluation, general and gynecological exploration and blood tests to exclude possible infectious diseases and to carry out the necessary genetic testing.
How can we improve the selection of the donor?
With the aim of offering the highest quality treatments, our clinic applies to its donors a genetic test to rule out serious hereditary diseases.
Everyone is at risk for a genetic disease even without a family history. Diseases like Cystic Fibrosis, Muscular Dystrophy and Fragile X Syndrome appear in about 1-2 cases per 8000 born children so we must take them into account when making a reproductive approach. Less common diseases such as Thalassemia, Gaucher's Disease, Spinal Muscular Atrophy and many others, also merit consideration by the severity of its prognosis.
Applying the genetic test to the donor and the father, we can detect genetic alterations that can develop up to a total of 250 diseases, so that we almost entirely eliminate the risk of having a child with one of these diseases.
How is my egg donor chosen?
The assignation of a donor is made by a specialized medical team and according to the physical characteristics of the patients and their blood groups. This task is of tremendous responsibility and therefore every process of assignation considers the singularity of each case.
Which information do I get about the egg donor?
In Moldova, egg donation is anonymous which protects both, the identity of the donor as well as the patients’ and their offspring. Nevertheless, it is possible to receive general information about the donor, such as her physical aspects, blood group and age. At Barcelona IVF we also share characteristics of the donor with you, which are related to her hobbies, personality and the reason why she donated.
Why is the synchronization with the donor necessary?
For egg donation treatment it is important that donor and patient initiate their cycle at the same time to ensure that the patient’s uterus is prepared when the embryos are ready for transfer. This period takes approx. two to three weeks.
How do I prepare my endometrium?
To have the endometrium prepared for embryo transfer a hormonal replacement treatment is necessary. The treatment starts with estrogens and the correct development of the endometrium needs to be monitored via vaginal ultrasound. Once the eggs are retrieved from the donor, progesterone will be added to ensure the endometrium is receptive on the day of embryo transfer.
How are the embryos obtained?
The embryos are obtained through In Vitro Fertilisation of the donated eggs with the partner’s sperm or donated sperm. These embryos are kept in culture in the laboratory for five days until their transfer.
How are the embryos transferred?
The embryo transfer is a simple procedure which neither requires a hospital stay nor anaesthesia. The catheter is introduced into the uterine cavity via the cervix to place the embryos right inside the uterus. Usually one to two embryos are transferred but currently, the trend goes towards transferring only a single embryo in order to reduce the risk of multiple pregnancies.
What happens to the unused embryos?
If after the embryo transfer more embryos of good quality are left over, they will be frozen.
Can I live a normal life during the egg donation?
Yes, until the day of transfer. On this particular day it is recommended to rest and from then on you should lead a calm life avoiding bigger efforts. There is no inconvenience regarding travelling after the embryo transfer.
Can I do something to improve my chances after the embryo transfer?
It is very common to ask oneself what to do after the transfer to increase chances for a pregnancy. There is nothing additional one can do to increase the probabilities for a pregnancy apart from waiting for the embryos to implant correctly and pursue a normal and relaxed lifestyle.
Is there a limit to egg donation attempts?
There is no limit to the number of egg donation treatments but usually, 90% of the patients become pregnant within the first three attempts of egg donation cycles.
Success rates with egg donation
The egg donation is the sterility treatment with the highest success rates due to using donor eggs from young women without any sterility problems. Thanks to the good pregnancy rates it can be considered to perform a single embryo transfer which avoids the risk of multiple pregnancies.
Risks of egg donation
The main risk of egg donation is multiple pregnancies if more than one embryo is transferred. Currently and due to the very good results from long culture and blastocyst embryos, many couples decide to transfer only one embryo to avoid a twin pregnancy.
Sperm Donation
What is sperm donation?
Sperm donation consists of using sperm originally from a donor in any of the assisted reproduction treatments: artificial insemination, IVF or egg donation.
When is it recommended?
Sperm donation is indicated in the following cases:
-
Sperm quality not sufficient for use
-
Genetic diseases
-
No male partner
Who are the sperm donors?
Sperm donors are young men in excellent physical and mental health. To become a sperm donor you will have to pass a series of tests, which include studies of their personal and family record, psychological evaluation, andrological exploration and blood tests to exclude possible infectious diseases and to carry out the necessary genetic testing. To become a sperm donor it is not sufficient to have a normal spermiogram but the sample needs to have a very good recuperation capacity and good survival rates after thawing.
How is my sperm donor chosen?
The assignation of a sperm donor is made by a specialized medical team and according to the physical characteristics of the patients and their blood groups. This task is of tremendous responsibility and therefore every process of assignation considers the singularity of each case.
Which information do I get about the sperm donor?
In Moldova sperm donation is anonymous which protects the identity of the donor as well as of the patients’ and their offspring. Nevertheless, it is possible to receive general information about the donor, such as his physical aspects, blood group and age.
Embryo donation
What is embryo donation?
Embryo donation is a treatment in which the woman receives legally donated embryos from couples not desiring more children.
When is embryo donation recommended?
Embryo donation is recommended for those who need to use gamete donation and for ethical reasons prefer using donated embryos.
Which tests are necessary for embryo donation?
To carry out embryo donation the following tests are necessary:
-
Gynecological ultrasound to exclude a pathology in the uterus or ovaries
-
Serologies to exclude the presence of transmittable infectious disease.
Who are the donors?
In order to donate an embryo for reproductive destination it must come from a couple in which both parties meet all legal necessities to be considered as donors.
How is the embryo donation done?
The transfer of donated embryos only requires a good development of the woman’s endometrium. Therefore an oral or transdermal hormone treatment is applied which starts at the beginning of her cycle. Some days later the correct preparation of the endometrium is confirmed and the embryo transfer organized. The embryos are thawed on the day of their transfer.
Success rates for embryo transfer
The success rates for embryo donation are equivalent to those of frozen embryo transfers, which are above 40%.
EGG VITRIFICATION
FERTILITY PRESERVATION
What is fertility preservation?
The preservation of the woman’s fertility consists of freezing her eggs at an age where they still have good pregnancy potential.
When is it recommended?
Fertility preservation is recommended in the following cases:
-
When a woman wishes to postpone her procreation
-
When a woman will receive treatment which might affect her reproductive capacity
Can all women preserve their fertility?
No, for preserving a woman’s fertility with good success rates, her age, as well as her ovarian reserve, needs to be considered.
How is fertility preservation done?
To preserve fertility it is necessary to obtain her eggs through stimulation treatment and egg retrieval, similar to In Vitro Fertilisation (IVF). The obtained eggs will be frozen via vitrification.
How long can the eggs stay frozen?
The eggs stay frozen as long as necessary without any effect on their quality.
What do I have to do if I want to use my frozen eggs?
In order to use these eggs, they need to be thawed in the laboratory and fertilised with sperm from the partner or donor. The obtained embryos stay in culture until their transfer on day five. Embryos, which have not been transferred, will be frozen.
The woman will have to prepare her endometrium through hormonal replacement treatment with estrogens and progesterone in order to be able to receive the embryos.
WOMEN WITHOUT MALE PARTNER
Women without male partner can get pregnant through assisted reproduction treatment using donor sperm.
Which treatment can be done?
The recommendation which treatment to choose depends on the evaluation of the clinical history of each case.
The most common treatment if the fallopian tubes are permeable and the ovary function is correct is artificial insemination with donor sperm (IAD). If no pregnancy is achieved after several insemination attempts or if there is a problem with the fallopian tubes, In Vitro Fertilisation (IVF) with donor sperm will be recommended. Occasionally, especially if there is a low ovarian reserve, a double donation might be indicated: egg donation with donor sperm.
In case of homosexual couples in which both would like to participate in the process, the ROPA method would be an option.
RECIPROCAL IVF (ROPA)
RECIPROCAL IVF (ROPA)
What is Reciprocal IVF?
Through this technique, it is possible that both women participate in the pregnancy process. One will be the genetic mother, the other the gestational one. One woman contributes with her eggs, functioning as a donor, the other woman will receive the embryo transfer and be the recipient.
What treatment receives the donating woman?
The donating woman will have to undergo ovarian stimulation in order to obtain the eggs and later on carry out In Vitro Fertilisation (IVF). The retrieval of the eggs will be done under sedation and takes approx. ten minutes. Once the eggs are harvested, they will be fertilised with donor sperm and from there on the evolution of the embryos will be monitored in the laboratory until their transfer on day five.
How does the woman receiving the embryos prepare herself?
The embryo-receiving woman will have to prepare her endometrium with estrogens. This endometrial preparation will be done simultaneously with the ovarian stimulation of her partner. Once the endometrium of the receiving woman is prepared and the embryos are in the laboratory, their transfer into the uterus of the receiving woman will be carried out.
Which tests are necessary?
To carry out the Reciprocal IVF the donating woman needs to do the following tests:
-
Hormone analysis to check the ovarian reserve
-
Gynecological ultrasound to exclude a pathology in the uterus or ovaries
-
Karyotype to exclude genetic abnormalities which might affect the embryo
-
Serologies to exclude the presence of transmittable infectious diseases.
The embryo-receiving woman needs to have the following tests:
-
Gynecological ultrasound to exclude a pathology in the uterus or ovaries
-
Serologies to exclude the presence of transmittable infectious diseases.
Success rates
The success rates for the Reciprocal IVF are the same as for In Vitro Fertilisation (IVF) and depend mainly on the age of the egg donating woman, with more than 50% until 39 years and progressively diminishing after that age.
