Should I tell my child about his origins? Are there any psychological repercussions?
Although there are several contrasting studies on the psychological effects that receiving donated oocytes (eggs) and/or semen may produce, every family is free to choose their own position on the subject and tell the child from an early age, wait until he or she is older, or never tell them.
This is a personal decision and there is no right or wrong answer; it all depends on the family context, on the social and cultural environment and on the acceptance of the patients themselves, who are considering using an assisted reproduction technique to enable them to have a child.
The psychological effect is believed to be less than in the case of adoption as there is no rejection by or loss of the biological parents, but rather an act of generosity on the part of a donor in order to help the parents conceive a child. This child has never had any other parents or a prior history and therefore there are fewer doubts about his or her origin.
It is true that, genetically, there is a difference, an unknown factor, a mystery, as the law protects both the parents and donors. Even if this law were to change in the future, it could never be backdated. Therefore, even if the child wanted to find out more information in the future, he would only be able to find out what you already know; the blood group and age of the donor at the time of the donation.
There are some very good children’s books on this subject which try to explain, from a very young age, the donation of eggs or sperm so that the child is able to understand why their parents needed help to conceive. Also, nowadays, the media and information available to explain In Vitro Fertilization or Oocyte Donation has progressed a lot.
With the passing of time, the taboos and prejudices on this subject are disappearing, and this has helped communication between children and their parents. In fact, the assisted reproduction techniques available nowadays enable many families to happily embrace this concept.
What do I need to know about pregnancies obtained using assisted reproduction techniques?
- What differences are there compared to a natural pregnancy?
- Is there a higher risk of miscarriage or deformities than in a natural pregnancy?
- Do I have to have an amniocentesis test?
There are no differences in the process of development of the embryo once the transfer has been carried out, nor later in the development of the baby. The pregnancy develops in the same way as a natural pregnancy.
The start date of the pregnancy is calculated by subtracting 14 days from the date of insemination, follicular punction or the date of the punction of the donor in the case of oocyte (egg) recipients.
The weeks of development of the embryo correspond to those of a natural pregnancy. There is no delay or acceleration of the growth of the baby related to assisted reproduction techniques.
When you are pregnant, you often have symptoms which are new or uncomfortable, like, for example feeling sick or experiencing indigestion. In general, these are passing discomforts and there’s no cause for alarm.
However, some symptoms can indicate a more important problem and, in this case it is best to go to your doctor or hospital immediately. For example: severe pain at the beginning of a pregnancy.
The risk of miscarriage is the same (15-20%) as with a natural pregnancy and increases according to the age of the patients undergoing IVF or insemination. For patients receiving an oocyte donation, the risks do not increase as the donation comes from a donor aged between 18 and 35.
Over 40, a pregnant woman, either by natural means or by Assisted Reproduction Techniques, has a higher risk of developing pregnancy hypertension, gestational diabetes… Therefore, these pregnancies must be carefully monitored.
It has been scientifically demonstrated that children born from Assisted Reproduction Techniques do not have a higher risk of genetic alterations or deformities than those children born from a natural pregnancy.
A pregnancy resulting from Assisted Reproduction Techniques does not exclude the need for all the usual tests for diagnosing anomalies in the foetus. Initially, amniocentesis will only be carried out when the result of the triple test (triple screening) produces altered values. The triple-test consists of a blood test (biochemical screening) and an ultrasound which includes measuring the nuchal translucency of the foetus.
Care must be taken with women pregnant with twins because the blood analysis is not reliable and, in this case, only the ultrasound will help the gynaecologist to establish the risk.
In the case of recipients, the triple test should be carried out using the age of the donor (and not that of the recipient) and therefore, the need for an amniocentesis test will be low.
You must always follow your Gynaecologist’s advice of and refer to the law in your country. The triple test and the amniocentesis test are not usually compulsory.
What to do after finishing the treatment
- Can I travel after the IVF or insemination?
- What should you avoid after IVF or insemination?
- What should I do if I have mild bleeding and / or pain before the pregnancy test?
- What happens if I don’t feel anything during these 2 weeks?
- Can I do a pregnancy test before the date specified by the Doctor?
We recommend that after your treatment you spend the night in Barcelona because it is an emotionally charged day for patients. However, many patients cannot stay, and return home by plane, train or car. There is no problem with transportation (vibration, altitude …). You can travel without having to worry and without having to stay lying down.
A naturally pregnant woman is unaware of her pregnancy until the following month, and when she does the pregnancy test she will find out that the embryo has developed independently of her lifestyle. Once the embryos have been transferred, an assisted pregnancy is a pregnancy like any other and there is no need to be too cautious. The only thing that we do recommend in the first two weeks is that you avoid intense exercise and heavy lifting.
During the rest of the pregnancy the advice is the same for natural and assisted pregnancies: Avoid stress, eat healthily and avoid foods and beverages such as alcohol, coffee, raw fish, soft cheese, etc.
Sexual relations are not contraindicated, several scientific studies show no difference in pregnancy rates with or without sexual abstinence after the transfer.
The psychological factor then comes into play and it is advisable to keep your mind occupied until your pregnancy test.
You should not worry it has been known to happen. The treatment together with early pregnancy symptoms can cause headaches, fatigue, swollen breasts, fluid retention and mild bleeding. Please be assured that this is neither a good nor a bad sign; it is very common.
Minor bleeding is usually not serious and it is not necessarily a sign of miscarriage. The transfer took place a few days before these symptoms appeared and although the embryos have not yet implanted, it is not something that you are aware of since it does not necessarily cause bleeding. Repeatedly taking vaginal progesterone can irritate and cause some minor bleeding. The pain and fatigue may be a consequence of hormone treatment.
Many pregnant women, either naturally or with fertility treatments, demonstrate these symptoms during the first 3 months of pregnancy. We advise you to rest and relax.
You can consult your gynecologist to see where the slight bleeding has come from. If the bleeding persists and is accompanied by pain, we advise you to do a scan to eliminate rare complications such as ectopic pregnancies.
Each woman reacts differently to pregnancy. Not all symptoms are a good or a bad sign. You will not necessarily feel something other than what you felt during the hormone treatment. As two weeks is a very short time to experience a strong physical reaction from the body to pregnancy, it is best to wait for the pregnancy test.
We recommend testing for pregnancy on the date indicated by the Doctor. If you do it too early, you may receive a false negative which would have been positive at 2 weeks. Additionally, you should continue the hormonal treatment until the specified date. You may interrupt the treatment, but only after speaking with the medical staff at Eugin.
It is vitally important that you follow the prescribed treatment during the first weeks of pregnancy to avoid the risk of miscarriage. During Assisted Reproduction the treatment involves taking hormones in quantities greater than normal, this in turn reproduces the pattern of hormone levels early in pregnancy.
The hours after receiving the treatment are very intense emotionally for the patient. Some people decide to go home because there is no inconvenience in travelling. Although we recommend that you spend the first night in Barcelona, this is entirely up to you.
Other recommendations we make to patients who have undergone fertility treatment are: no smoking, avoiding stress, no intense exercise or heavy lifting. With regard to food, we recommend that you eat healthy and avoid foods and beverages such as alcohol, coffee, soft cheese, or raw fish. Apart from these things, you can lead a normal life.
We are aware that emotions are intense during this time we, therefore, recommend that you keep your mind occupied with other matters prior to the pregnancy test.
Can I be a father after a vasectomy?
Infertility in men who have had family planning surgery (vasectomy) is a fairly frequent problem as everyone’s circumstances can change, leading to a reconsideration of situations previously thought irreversible. Human Reproduction is a specialised area of medicine which shares the knowledge of reproductive Gynaecology and Biology. It has developed techniques to identify and treat sometimes complex sterility cases, and has enough resources to help patients who want to have a child after having undergone a vasectomy. The current therapeutic procedures are:
- In Vitro Fertilisation (IVF) with intracytoplasmic sperm injection (ICSI); sperm is retrieved from a testicle, epididymis or deferent duct
- Microsurgical repair of the seminal duct (vasovasostomy)
The factors that determine the choice of the therapeutic procedure are first of all the woman’s age (older or younger than 35), and the likelihood of more than one pregnancy in the future.
In the case where the woman is older than 35, and/or the couple do not want to have another child once they have had the first one, the recommended treatment is surgical sperm retrieval in conjunction with IVF-ICSI.
With this alternative the time between carrying out the treatment and the possible resulting pregnancy is quite short and, when no other pregnancy is desired, it is not necessary for the couple to take contraceptive precautions.
If repermeability of the sperm ducts is required in order to bring about a spontaneous pregnancy, then the appropriate treatment is a microsurgical repair of the deferent ducts. When the outcome of the operation is satisfactory and there are spermatozoa when ejaculation occurs and a spontaneous gestation occurs, the couple must take contraceptive precautions if they do not wish have more children.
Moreover, with this technique the time needed to see the results is longer and, therefore, it is not advised for women older than 35.
In the case when after a vasovasostomy a pregnancy does not occur due to the absence, or insufficient quantity of spermatozoa or a lack of them, Assisted Reproduction Techniques (FIV-ICSI) can be considered.
This is made up of a series of tests and analyses which are carried out in order to investigate the theoretical fertility of the couple before considering an IVF-ICSI cycle:
- A blood test is carried out to check that there are no hormonal alterations (FSH, LH and Estradiol)
- A hysteroscopy may be done if there is a chance of an existing pathology. This is a cervix exploration which is carried out without the need of anaesthesia. It allows us to diagnose certain problems and suggest treatments to help solve them. For example, if a myoma or a polyp is identified, the course of treatment would be their removal. This can be carried out during the actual procedure, or could be scheduled for the future.
For men, a testicular biopsy is carried out under local anaesthetic to obtain the spermatozoids (a sample of the testicular tissue is removed). This proceedure can be carried out on the same day as the IVF-ICSI treatment or at the start of the IVF-ICSI cycle. If it were to be the latter, the sample would be frozen and then thawed on the day of the IVF-ICSI.
In general, when the woman does not have a sterility problem, a semen sample of sufficient quality (to retrieve enough spermatozoa) has to be obtained to fertilise the eggs.
Assisted Reproduction Treatments are a series of delicate techniques carried out jointly by Gynaecologists, Andrologists and Biologists in specialised centres.
- Testicular biopsy
- Reconstructive microsurgery of the seminal duct (vasovasostomy)
1.- Testicular biopsy:
It is carried out under local anaesthetic and consists of removing a sample of the testicular tissue. This sample is studied under a microscope, and the spermatozoids are identified and saved. These will be used to fertilise the woman’s eggs, or frozen and kept for the same purpose. Unless the Intracytoplasmic sperm injection (ICSI) is carried out, the quantity of spermatozoids obtained from the testicular biopsy are insufficient to go ahead with an In Vitro procedure.
A vasovasostomy is a precise surgical procedure which aims to rejoin the deferent duct incised during the vasectomy. The vasovasostomy is carried out under local anaesthetic. The surgical magnifying glass is used as the spermiduct has to be restored joining both ends. First new tissue is created by removing the scarred proximal and distal ends (the ends where the deferent was cut) and then they are brought together and stitched with a very fine thread.
Once the vasovasostomy has been performed, several months have to pass for the results to be seen (for enough spermatozoa to be present when ejaculation occurs). Although a vasovasostomy appears to be a simple solution for a vasectomy, in reality this technique is somewhat complex.
Though not usual, sometimes it is impossible to carry out the vasovasostomy correctly as the ends of the deferent duct can break away or fail to join.
Even when the surgery is successful, the result is not always guaranteed as it is not enough to just join both ends of the deferent duct together. Its ability to transport the seminal liquid has to be recovered but the outcome of the procedure is not known at the moment of the surgery. Spermatozoa may not be present.
Although the two previous difficulties may be successfully overcome, the amount of sperm might not be sufficient to carry out Artificial Insemination. Therefore, IVF-ICSI treatment has to be considered as in the above case.
Nowadays it is more advisable to proceed with IVF-ICSI when a couple wants a child after having a vasectomy. On the other hand, when a couple wants to start a new family and have several children a vasovasostomy can be a practical alternative, especially when the woman is young enough to remain fertile for some years.
Can an HIV positive couple have children?
- Can an HIV positive couple have children?
- If a woman is HIV seropositive can she have children?
- Advice for couples who want to have children
- Artificial Insemination with prepared sperm
Thanks to scientific advances and the medicine available for HIV (Human Immunodeficiency Virus), seropositive people these days have a better quality of life, and that is why it is common for many couples in this situation to consider the possibility of starting a family.
A couple where the man has HIV antibodies is able to carry out artificial insemination if he wishes to have a child. This decreases the woman’s chances of contracting the infection.
This technique consists of separating the motile spermatozoa from the rest as the possible HIV virus is contained in the seminal liquid.
Over the last few years this technique has been carried out successfully by using washed sperm for HIV cases. Although there is a theoretical risk of infection, so far there has been no case of seroconversion in women or foetuses.
In order to maximize the efficiency of the procedure and minimize the number of insemination attempts, the woman’s cycle is controlled pharmacologically.
The chances of a resulting pregnancy after two or three attempts range between 50% and 60%.
It is important to bear in mind that when a pregnant woman is a HIV carrier and does not receive the appropriate treatment, the risk of the infection being transmitted to the child ranges between 15% and 20%.
Over the last few years this risk has been reduced to less than 1% as a result of the introduction of new effective medicine for AIDS and later on the use of combined antiretroviral pharmaceuticals as well as strict pregnancy and birth protocols. However, these drugs are potential teratogens (they can cause malformations in the newborn) and have to be administered under specialized control.
In order to reduce the risk during the pregnancy, the woman has to be in a stable condition in order to minimise the need for changes in medication (which are not advised) as well as to avoid any developing infections.
If there is no other infertility factor Artificial Insemination is recommended either with fresh or washed sperm, in cases where the male partner is also a HIV carrier.
Requirements for a minimal risk pregnancy
The infection of the male partner has to be stable with no other illnesses having been recently diagnosed in other words he has to be in good health. Both partners have to undergo a series of additional checks before the insemination to determine their general wellbeing and identify any possible unknown infertility problems.
In this case it may be necessary to apply another Assisted Reproduction Technique, such as In Vitro Fertilisation.
- The woman should be in the best possible physical condition before deciding to become pregnant.
- To know the associated risks of the medication and, if possible, to avoid those parts of the treatment which represent the most risk for the foetus.
- Both partners have to be in good physical condition thus confirming the absence of any recent illness.
- When the man is not infected with HIV, using Assisted Reproduction Techniques such as Artificial Insemination is recommended in order to avoid the transmission of the disease.
When in a couple one or both partners are infected with HIV, they should be aware that if they want to have a child they need specialised help and attention in order not to risk their health and that of the newborn. This help involves four aspects:
- Base illness stability and control by a specialist
- Reproductive advice in order to programme the pregnancy under the best possible conditions or to rule it out in some cases
- Artificial Insemination with washed sperm for HIV cases
- Assisted Reproduction Techniques in cases where a sterility problem may exist
There are very few centres offering experience and standard procedures to help HIV infected patients who want to have children. Barcelona and Milan are two pioneering cities in the development of this technique which essentially consists of using the previously prepared sperm for Artificial Insemination.
Although the Artificial Insemination procedure with previously prepared sperm has to be carried out in Barcelona, in some cases most of the fertility study and the hormone preparation of the woman can be effectively carried out in the couple’s hometown or area.
The whole process is coordinated by post or via the internet. Therefore, many couples who do not reside in Barcelona can take advantage of Assisted Reproduction Techniques in a convenient way. This allows them to reduce the cost of treatment as they do not have to travel to the Clinic more often than is absolutely necessary.
Additional checks for men
Before starting, a series of analytical results and additional tests are necessary for both partners. These can be done in the couple’s hometown in collaboration with the infectious disease specialist who normally attends to the case.
The following tests are required for men:
Spermogram: This spermogram focuses on the fertilisation potential of the male partner’s sperm after having undergone sperm washing, furthermore, this part of the sample should be studied through the PCR technique, to make sure that the washing procedure has been effective. This would mean that the sample would be apt to use without risk of infection. For this reason it has to be performed in Barcelona following the same procedure that will be carried out on the day of Artificial Insemination. Some years ago, we were able to obtain results just a few hours after egg retrieval through the PCR laboratory KITS, which meant we could use a fresh sperm sample on the day of insemination. It is currently not possible to use this system, so results can take 2 to 3 weeks to arrive after retrieval. This technical detail means we can no longer use a fresh sample to inseminate, and must use a frozen one.
The long washing procedure to separate the virus from the sperm sample, together with having to use a frozen sample, may cause the final sample to be NON APT to use. So an IVF-ICSI cycle will be recommended.
Blood tests: These are required in order to be able to control the infection as well as a possible associated pathology. A complete hemogram, hepatic and renal biochemical tests, serologies (HBsAg, anti-HC, lues) and HIV study (viral load levels and CD4 values) can be carried out in the couple’s hometown.
Urethral smear: Sometimes this is required in order to rule out STD’s (sexually transmitted diseases) such as Gonococcus and Chlamydia. These tests can either be carried out in the patient’s home town or in Barcelona.
The report from the specialist in infectious diseases has to be done by the specialist who attends to the male partner’s case and controls his base pathology. This report evaluates the current condition of the illness and specifies the treatment that the patient is undergoing. The specialist fills in a standard form to simplify the information provided.
Psychiatrist report: this report is necessary only if the male partner is undergoing a substitutive treatment with opiates or psychiatric drugs.
Extra checks for women
Gynaecological check-up: This consists of an updated cytology. It can be brought with you or carried out in Barcelona on your first visit.
Blood tests: These consist of a complete hemogram, hepatic and renal biochemical tests, serologies (HBsAg, anti-HBs, anti-HC, rubella, lues, HIV), blood group and Rh. These tests intend to obtain correct preconception evaluation which will be necessary if the outcome of the procedure is successful and the pregnancy does occur. These results can be brought to the clinic from the patient’s hometown given that they are recent.
Hormone analysis: This is done on the third day of the menstrual cycle and is made up of FSH, LH and 17 β-Estradiol. If the third day is a holiday, the test can be done between the second and fifth day of the cycle. The woman can bring the results from her hometown.
Smear test: This is necessary in order to rule out STD’s (Gonococcus and Chlamydia). The results can be brought to the clinic.
Hysterosalpingography: The permeability of the uterus and the Fallopian tubes is checked by means of a contrast x-ray technique. It should be carried out between the eighth and twelfth day of the cycle and can be done in the patient’s hometown. This test is not always necessary.
Viral load determination via PC: this has to be done before insemination takes place. If the pregnancy does occur, the HIV antibody determination has to be performed every three months until birth in order to control seronegativity.
Artificial Insemination requirements
The infection of the male partner has to be stable, in such a way that no other illness has been diagnosed recently and he is otherwise in good health. Moreover, an updated report from the patient’s specialist has to be provided in order to have a professional opinion about his state of health at the given time.
Regarding the woman, the basic requirement is a negative HIV result. If the woman is a HIV carrier too she has to meet the same requirements as the man, and consider other Assisted Reproduction Techniques such as In Vitro Fertilisation.
In order to maximize the efficiency of the techniques and minimize the number of insemination attempts, the cycle of the woman is induced pharmacologically. The couple is also required to sign a consent form.
Can I have a child after a tubal ligation?
It is not unusual for a woman who has undergone tubal ligation to want to become pregnant again some years later. There are many reasons (personal, family, relationship…) to want to have another child as the circumstances vary with time, and a decision which before seemed definitive now has to be reconsidered.
The tubal ligation technique involves surgically blocking the sperm from reaching the ampulla of the Fallopian tube and with it the fertilisation of the egg which naturally takes place in this area. Normally a segment of the tube is tied with an absorbable ligature and removed. As a result of this procedure the cut ends of the tube separate, thereby increasing the contraception effectiveness of the technique. The drawback of the treatment arises when the original function of the tubes has to be restored.
Even if attaining repermeability is technically possible, the procedure involves several disadvantages: the distance between the cut out segments and adhesion among others. Even a perfect surgical technique cannot guarantee the effectiveness of the repair as it depends on many factors (both the permeability and the motility of the tube have to be restored). However, in some cases this technique is especially recommended; for example, when very young women consider more than one pregnancy in the future.
Nowadays women who have undergone tubal ligation often choose IVF as it allows the patient to become pregnant sooner, without having to wait for the results of a surgical procedure. However, the woman’s age is a decisive factor for the successful outcome of this treatment because the chances of a pregnancy decrease with age. Therefore, once the decision has been taken it is not wise to delay it.
Tubal ligation is a definitive contraception method, which explains why women who have undertaken the operation have normally had children before (and were therefore initially fertile) which simplifies the necessary study.
- It is important to have a blood test to see if there are any hormonal alterations. The hormone basal test (FSH, LH and Estradiol) verifies the ability of the ovaries to produce eggs.
- The male partner needs a spermogram. This is a simple analysis which checks the fertilising capacity of the sperm.
- When the results of the tests are ready, the diagnosis is made and the most suitable treatment is recommended.
When the ability of the ovaries to produce eggs is confirmed and there is neither male nor endometrium pathology, in vitro fertilisation (IVF) will be recommended (Artificial Insemination cannot be undertaken when there is a dysfunction of the Fallopian tubes). IVF can be carried out in conjunction with intracytoplasmic sperm injection (ICSI) or without it.
If an endometrial polyp or myoma has been diagnosed, a hysteroscopy can be performed to confirm it. Hysteroscopy is an exploration of the interior of the uterine cavity which is normally carried out without the need of an anaesthetic. Sometimes certain pathologies can be diagnosed and even treated (for example, polyps and myomas can be removed). In this case the recommended technique is also IVF.
How does embryo freezing (cryopreservation) work?
- Why can we not always freeze the embryos left over from a fresh cycle?
- Is there any connection between the cryopreservation of embryos and pregnancies occurring from the fresh embryos transferred from the same cycle?
- How long can my embryos remain frozen for?
During in vitro procedures, there are sometimes extra embryos which should be frozen for future attempts. There is a strict criterion followed for freezing embryos since the freezing and thawing procedures of embryos can be too aggressive.
This process does not modify or alter the quality of cryopreserved embryos. The Vitrification technique has increased exponentially the number of good quality embryos with respect to the transferred “fresh” embryos, as this freezing technique is lighter on the embryos (compared to the slow freezing procedures), hence obtaining a higher rate of survival and pregnancy.
Those patients that have vitrified embryos are contacted every 2 years to confirm that they still wish to keep their frozen embryos for future attempts. The embryos belong to the patient and it is the Clinic’s mission is to ensure safekeeping.
We can freeze embryos in the majority of fresh cycles carried out. We place the leftover embryos in a culture medium to monitor their evolution and Biologists will determine whether they can be frozen or not. The freezing criteria are different to the criteria to evaluate the transfer of fresh embryos: they must meet much more specific requirements as the freezing and thawing can potentially be an aggressive process for embryos.
If we were to freeze all of the leftover embryos, the cancellation rates of a transfer after thawing would be very high. Therefore we do not freeze all the embryos that are left in the laboratory after a fresh transfer. In spite of these requirements, there is around an 8% cancellation rate for cryotransfer after the thawing and re-adaptation in a culture medium of the embryos.
Is there any connection between the cryopreservation of embryos and pregnancies occurring from the fresh embryos transferred from the same cycle?
It is more difficult for the embryos to develop in the laboratory than in the mother’s uterus. According to studies carried out, there is no connection between freezing embryos and the pregnancy rate from fresh embryos. Therefore, if we cannot freeze part of the leftover embryos, this does not mean you are any less likely to become pregnant or vice versa.
50 years old has been confirmed as the limit for a woman to carry out an Assisted Reproduction Technique. We will regularly ask you (every 2 years) if you still wish to keep your frozen embryos in order to try again in the future. The length of time that embryos are frozen for does not affect their quality.
How can I prepare for my treatment?
- What do I need to do before giving a semen sample?
- How can I prepare for my insemination?
- How can I prepare for my follicular punction?
- How can I prepare for my embryo transfer?
We advise that a semen sample be given on the first visit for the sterility study. Sometimes a second sample will be needed on the day of the oocyte punction (IVF/ recipients) or on the day of the insemination (IAC), according to the recommendations of the biologists.
For optimum results, it is better to give the sample after a period of sexual abstinence ranging between 3-5 days. The semen is obtained from masturbation in a room adapted for this purpose and is immediately sent to our laboratory at the clinic where it is analysed. The results will be available after a few days.
It is not recommended to carry out the seminogram after a long period of abstinence as this could give rise to a large number of immotile or dead sperm which may not be realistic.
On the day of the insemination, you must arrive at the clinic, without the need to be on an empty stomach, 30 minutes before the scheduled time when using a frozen semen sample (either from your partner or from a donor). If you have been asked to provide a fresh semen sample you will have to arrive, with your partner, 2 hours before the time scheduled for the insemination.
The doctor will go over the results that have been obtained during the stimulation cycle, answer any questions you may have and explain how the process works. This is usually a swift and painless technique. Following insemination you will rest for approximately 10 minutes in the doctor’s office and then can travel home that same day by whatever means of transport suits you (car, train, plane, etc.).
The day before the follicular punction you must take an antibiotic to avoid the risk of an infection during the procedure.
On the day of the follicular punction, you must not eat or drink anything for at least six hours prior to the procedure. You must arrive at the clinic 45 minutes before the time of the appointment without wearing make-up, perfume, jewellery… You will meet with the anaesthetist and the doctor before the procedure commences.
The doctor will carry out the follicular punction under an anaesthetic sedation to ensure that it is completely painless. Deep sedation is a procedure where the anaesthetist administers a drug via intravenous injection which will send you to sleep for a short period of time (about 10-20 minutes). Once the follicular punction is completed, you will be informed of the results and of the number of oocytes obtained. We will then proceed with the insemination of the mature oocytes with the semen sample.
After the punction you will remain at Eugin Clinic for approximately 2-3 hours. Once discharged, you must go straight home, or to your hotel, and rest for the remainder of the day. You can eat and drink normally in a progressive fashion.
We advise you to stay for 3 to 4 days in Barcelona between the punction (D+0) and the transfer (D+2-3), to avoid the stress and fatigue of travelling.
On the day of your transfer you must arrive at the Clinic 30 minutes before the scheduled time.
The transfer is painless and does not require any anaesthesia or sedation.
In the case of a history of difficult intrauterine inseminations or embryo transfers, or if you feel particularly stressed, we will give you a gentle, relaxing massage before the transfer.
The transfer is done using ultrasound control: it is very important that you have your bladder full at the time of the transfer (drink 3-4 glasses of water and do not urinate for 2 or 3 hours before the transfer). This procedure facilitates the transfer and allows better ultrasound visualisation of the technique.
Upon arrival at the clinic, a translator from the coordination team will stay with you in your individual resting room and will help you, in your own language (if necessary), during your stay at the clinic. An embryologist will give you a brief summary of your cycle indicating the number of available embryos and which we propose to transfer. Only the best embryos are selected for transfer. The transfer will take place with a minimum of 1 good quality embryo and, according to current Spanish legislation, a maximum of 3.
We recommend that you stay in Barcelona for 1 to 2 days. Ideally, you should stay the night before and the night after the transfer to avoid the stress and tiredness of travelling.
What recommendations about the treatment could be useful?
- Are there any side effects during stimulation for insemination or IVF?
- Can I do sports during the stimulation?
- Does the treatment need to be taken at a specific time of day?
- What is the difference between oestrogen patches and pills for the reception of the oocytes?
- How should oestrogen patches be applied?
- Why is the dose of progesterone (vaginal ovules) higher than that recommended on the prospectus in the box?
- What vitamins can I take?
- I am suffering from stress with the hormone treatment, what can I take?
- Is it necessary to have an endometrial ultrasound before my embryo transfer?
Stimulation causes side effects due to the use of hormones. Some patients do not experience any discomfort and others suffer from symptoms such as a bloating, sensitive breasts, water retention, light headaches… If this occurs, inform the medical team and they will tell you what to do.
At the beginning of a stimulation cycle you carry on doing sports withοut any problems.
After the first follicular control, we do not recommend that you continue to do intense physical activity as the ovaries are growing due to the stimulation and this increase in size can cause discomfort. For this reason it is best to temporarily reduce or stop any exercise in order to avoid discomfort or intense pain. By following this advice you will feel better because stimulation will be tiring for you. We want you to be in the best possible state both mentally and physically for your procedure and stay in the clinic.
Depending on the treatment, we will tell you how to administer the medication and if there are preferred times of day for it to be taken.
For example, in the case of insemination or IVF, the doctor will give you a time period for certain medicines to be taken, according to your follicular development.
For the reception of fresh or cryopreserved oocytes, you can choose the timetable that best fits your lifestyle but you must keep to these times. For example, every 12 hours does not mean in the morning with breakfast and at night with dinner, but must be exactly 12 hours (e.g. 8:00 and 20:00). In the case of every 8 hours, this is not morning, midday and night, but 8:00, 16:00 and 00:00, for example.
It is important to take your medication precisely on time because we need the body to have a constant and regular dose of hormones present. Respecting these times also helps you to remember to take the medicine.
The patches have the same effect as the pills as they both contain the same dose of oestrogen.
While taking the pills orally may cause side effects for certain patients with gastric problems or other pathologies, the patches provide a slow release and transdermal diffusion of oestrogen. This is a less aggressive treatment.
According to your age and medical history, your doctor will decide which type of treatment is more appropriate.
The patches can be applied to parts of the body where there is fat tissue: buttocks, outside of the thighs or arms, together or in different places. We recommend that you change the place each time to avoid irritation and saturation of the skin.
The patches should never be applied:
- To the breasts
- To damp or oily skin due to the prior application of creams or oils,
- To broken skin: wounds, moles,…
- To an area subject to friction from clothes: waistband or bra straps,
- In the same place as the previous patch: alternate between 2 or 3 different places.
If the patch accidently falls off, try to re-stick it on to another area or use a new patch which should be removed at the same time as the previous patch would have if it had not fallen off in order to comply with the schedule. You should always wash your hands before handling the patch.
Do not worry it is normal to take a higher dose than that recommended by the manufacturer because this medicine is usually used in hormone substitution treatment for women during menopause. In the field of assisted reproduction we use a higher dose because the requirements of a pregnancy are higher. Progesterone offers support at the beginning of a pregnancy.
The dose we prescribe is 200-800mg per day, depending on the protocol. If you lose a whole capsule, apply a new one. There are applicators available in the chemist to help you insert them. Remember to wash your hands before and after each application to avoid germs and possible vaginal infections.
For women, we recommend folic acid or vitamin B9. This helps minimise the risk of neural tube defects, such as spina bifida in the foetus. The recommended dose is 0.4mg per day. In patients with diabetes, with a family background of spina bifida or any other specific deficiency or in any other case, we recommend 5mg per day. This vitamin is water soluble and there is no risk of an overdose as any excess is eliminated in the urine.
For men, there are also vitamin complexes available that improve the quality of the semen and which are based on L-carnitine, zinc, folic acid and vitamins C, B12, E. There is no scientific evidence that these complexes increase male fertility.
We understand that the hormone treatment may upset you emotionally and cause a certain amount of stress while you are waiting to come to the clinic for your procedure to be carried out. We recommend you maintain a healthy lifestyle and exercise gently to channel your energy: yoga, walking, cycling, swimming… If you are very emotional, we advise you to consult your GP so that he/she can prescribe a non-aggressive natural treatment such as valerian or Bach flowers (active ingredient: populous tremula). There are many natural alternative treatments available that offer good results. We would like to remind you that once the procedure has been performed (transfer or insemination) not all plants and natural remedies are compatible with a pregnancy, therefore it is important to consult your doctor or chemist for advice.
There is no need to have an endometrial ultrasound if your doctor has not recommended that you do so. Most women have a totally normal endometrial development even when they have had assisted reproduction treatment.
The doctor will only recommend it if there has been an insufficient endometrial response in previous treatments, after repeated uterine surgery, pelvic radiotherapy, or when there is a history of a thin endometrium.
Some patients, through their own choice, have an ultrasound for their own assurance. If you wish to do this, we recommend having it after 12 to 14 days of oestrogen treatment.
Why is there so much talk about fertility and how it’s linked to age?
- What is the difference between sterility and infertility?
- Does age influence the possibility of becoming pregnant?
A woman is fertile from the time she begins to have her period, but her fertility diminishes with age. For men there is also a gradual decrease, but later and less pronounced.
For a number of different reasons women decide to have children later and later in life. So with each passing day women find it more and more difficult to become pregnant. A few years ago, Assisted Reproductive Technologies were relatively rare nowadays they are becoming standard practice due to women delaying having children.
Sterility is defined as the inability to conceive. This may be of female or male origin. The couple is considered to be sterile when pregnancy is not achieved after one year of unprotected sexual relations. The concept of sterility must be distinguished from that of infertility. We refer to primary sterility when there has never been a pregnancy and secondary sterility when there have been previous pregnancies but it later it becomes impossible to conceive again.
In the case of infertility, the woman becomes pregnant but suffers miscarriages.
In short, sterility is when pregnancy is not achieved and infertility when, in spite of becoming pregnant, the pregnancy is not carried to term. It is worth noting that in Anglo-Saxon countries, the term “infertility” is often used to refer to both concepts which may lead to confusion when reading texts translated from Spanish.
Between 10% and 15% of the population in the western world is sterile or infertile.
According to the SEF (Spanish Fertility Society) 25% of couples achieve pregnancy within the first month of having regular, unprotected sexual relations; 85% after a year and 90% after 2 years.
This is why, a basic sterility study is recommended after one year of trying to get pregnant without any success and after six months if the woman is over 35.
In our society women enter into stable relationships much later in life and this has had an effect on fertility. The average age of women giving birth for the first time in Spain is 31 years old. Sterility at 30 is 6 times higher than at 20, and doubles again at 40.
Men’s fertility decreases progressively once they reach 50 years old, although alterations in the spermogram’s parameters can be observed from as early as the age of 25, the transcendence is much lower than in women.
Why do sterility problems exist?
- What are the causes of female sterility?
- What are the causes of male sterility?
- What is combined sterility?
- Does sterility of unknown origin exist?
There are various factors which cause infertility or sterility in women. Most are irreversible, but those involving anatomical alterations can be solved with surgical intervention. It is becoming more and more accepted that the quality of the egg is of critical importance and this is closely linked to the age of the woman. Women of advanced age have eggs with a reduced capacity for fertilisation:
Ovarian factors: This includes all those cases where ovulation does not occur. This is usually due to hormonal problems, either the lack of hormones or the excess of some of the regulators of endocrine function: ovarian polycystic syndrome (OPS), anovulation, ovarian failure or premature menopause.
Uterine factors: In this case, infertility and not sterility is much more frequent. Fundamentally, it involves alterations to the internal anatomy of the uterus which may be congenital or acquired and can lead to repeated miscarriages. Congenital uterine deformities include partial or total duplication of the uterus and septums. Causes include polyps, myomas, synechia, and endometritis.
Tubal factors: This includes all those anomalies of the Fallopian tubes which prevent the sperm from meeting with the egg: absence, impermeability or obstruction of the tubes, and salpingitis.
Cervical factors: In this case, the cause is anatomical and/or functional alterations of the neck of the uterus which interfere with the correct migration of the sperm towards the uterus and the Fallopian tubes in their attempt to reach the eggs. This can be due to impermeability of the neck of the uterus (polyps, cysts) or past surgery (conisation).
Genetic factors: Chromosome anomalies which cause miscarriages.
Some of the factors affecting male sterility are:
Genetic factors: Most of these are associated with sperm anomalies, either directly or indirectly: cystic fibrosis, karyotype anomalies like Klinefelter’s syndrome, translocations,…
In most cases of male infertility and low quality sperm, there are no clear causes that can be identified using the diagnostic methods currently available. There is some speculation that perhaps mutations of the Y chromosome could play an important part.
Anatomical factors: Ejaculatory duct obstruction can cause sterility since it blocks the exit of the seminal fluid. Some of these anomalies can be of congenital origin (present at birth) or acquired (infections, scars from surgery on the urogenital tract).
Environmental factors: Lifestyle can reduce the quantity and quality of the sperm (tobacco, alcohol, and other drugs).
Other types of illnesses: There are illnesses that can appear after birth and that can influence male sterility; infection with the parotiditis virus (mumps), hormonal dysfunction…
In some cases, both men and women can be sterile and the couple’s difficulty in conceiving is a result of a combination of these conditions. In other cases, in which the cause could be immunological or genetic, it is possible that both people can be independently fertile but the couple together cannot conceive without assistance.
In around 10% of cases, the basic sterility study does not show any anomalies. In these cases, the abnormalities are probably present but cannot be detected using the methods currently available.
What type of examinations are carried out in a sterility study?
- What are the basic, common examinations?
- What are the examinations for the woman?
- What are the examinations for the man?
Remember that at the EUGIN Clinic you can have all the tests needed for your treatment during your first appointment, on the same day and at a much lower price. This means you don’t have to wait before starting your treatment, you face less disruption and you save time and money.
The diagnosis consists of looking for the causes of the sterility in both members of the couple, as the analysis of only one of its components may be insufficient to issue a diagnostic orientation. These tests form part of a protocol that, once concluded, allows the specialist to orient the diagnosis and the possibilities of pregnancy with respect to the proposed treatment.
The first step in the first visit is to draw up a detailed clinical history, taking into account personal and family background, as well as those environmental or work factors and toxic habits that can influence fertility.
We will also carry out a basic blood analysis on both members (group and Rh factor, biochemical and coagulation, serology to rule out infectious diseases…)
Basal hormonal study: a blood analysis for ovarian and hypophysary function is carried out. It should be done at the start of the cycle, ideally on day 3 of the menstrual cycle.
FSH, Estradiol: LH: Progesterone:
These hormones are produced by the hypophysis or pituitary gland (FSH, LH) or by the ovaries (estradiol, progesterone). They offer different information depending on the day when they are studied, but for the basic study it is necessary to look at FSH, LH and estradiol between days 3 and 5 of the cycle.
Transvaginal ultrasound: An ultrasound examination providing vital information on the morphology of the uterus and the ovaries that allows us to see the changes to the ovaries and the endometrium during the ovarian cycle.
Hysterosalpingography: This is a radiological test involving a contrast liquid being injected into the neck of the uterus and which allows us to evaluate the uterine cavity and the permeability of the Fallopian tubes. A blockage in both tubes would impede the process of natural fertilisation. This test takes place after menstruation but before ovulation. It is a very important test especially before artificial insemination is carried out.
Hysteroscopy: A hysteroscopy is an endoscopic examination where an optical tube is inserted through the neck of the uterus in order to visualise the uterine cavity (hysteroscope = mini camera), and provides a direct and precise view of both the cervical canal and the inside of the uterus.
A hysteroscopy is carried out in order to diagnose possible alterations to the inside of the uterus and in some cases it explains why the embryos do not attach to the uterus, or the reason for repeated miscarriages.
Biopsy of the endometrium: This is carried out through aspiration of the endometrial mucous using a tube which is inserted unto the uterus via the cervical canal. It is sent to the laboratory and studied to see if there are any infections or anomalies of the endometrium.
Karyotype: This can reveal chromosome anomalies and explain sterility or infertility. It is done through a blood analysis.
Seminogram (analysis of the semen): Due to its simplicity, this is the first test carried out on the couple. The seminogram evaluates the production of sperm in the seminiferous tubules of the testicle. In the seminogram the parameters of quantity (concentration), quality (motility) and morphology are studied.
Capacitation test (or MTC): This is a study which is complementary to the seminogram and consists of “washing away” all the fluids and substances from the semen and leaving only the sperm, which is then put in a medium rich in nutritional substances. The number of motile sperm obtained (MSC) in this test allows us to know the quantity that will be viable to use in Assisted Reproduction techniques.
Bacteriological and biochemical examinations: A more detailed examination (semen culture or blood analysis) to detect infections which alter the quality of the semen.
Testicular biopsy or epididymal punction: These techniques are used to collect the sperm found in the testicles. They are used when the semen cannot be obtained by ejaculation.
Hormonal: Used to detect anomalies in hormone levels using blood analysis (FSH, LH, testosterone).
Karyotype: This can reveal chromosome anomalies or damage and thereby explain sterility or infertility.
Why do patients from all over the world come to our clinic in Spain?
Foreign patients come to Spain to carry out Assisted Reproduction for several reasons.
A particular marital status: In some countries, a single woman, either without a male partner or with a female partner or even an unmarried couple, cannot undergo an Assisted Reproduction Treatment. In Spain, the marital status or sexual orientation of the patient is not taken into account.
Age of the patient: In some countries, IVF with the recipient’s own eggs is not carried out on patients over 40-41 years of age and egg reception cannot be carried out on patients over 45. At EUGIN Clinic we accept patients for IVF with their own eggs up until the age of 46 and egg reception up until 50 years of age. It is worth noting that in Spain there is no age limit for recipient patients, however at EUGIN Clinic our Ethics Committee have weighed up the medical advantages and disadvantages and have taken the decision to limit the age to 50.
Difficulty or restriction in carrying out the technique in the patient’s country: In some countries the reception of donated eggs is a long and complicated process, or even a prohibited process.
In Spain, human reproduction is constituted within the law 14/2006 related to Assisted Reproduction Techniques:
The basic end result of Assisted Reproduction Techniques is a medical treatment for human sterility. This technique is used when other therapeutic measures have shown inadequate or inefficient results.
Assisted Reproduction can also be used to prevent and treat genetic or hereditary illnesses. This procedure is used when there is sufficient diagnostic and therapeutic guarantee of a successful outcome which is medically recommended.
There are chances of a successful result, which do not involve a serious risk for the woman or the possible children. Women donors must be over eighteen and in good physical and mental health.
How does gamete donation work in Spain?
- What does Spanish legislation say about gamete donation?
- What tests are carried out on donors?
- What type of treatment do gamete donors follow?
- Does the donor’s ovarian stimulation pose any risks to her future fertility?
Egg or semen donation are procedures that have been regulated by Spanish legislation since 1988, which guarantees, at all times the ethics of the medical and biological processes involved, as well as the health of both the donors and the embryos produced from the donations.
Gamete donation is voluntary, altruistic and anonymous.
Oocyte donors must be aged between 18 and 35.
Semen donors must be aged between 18 and 50.
ALTRUISTIC: The commercialisation of gametes and embryos is prohibited by Spanish law; the eggs or semen sample must be used exclusively to help a woman have the baby she wants. The National Human Assisted Reproduction Committee, a body set up in order to advise in the development of the law, recommends that donors receive an economic compensation for the dedication and time required to complete the donation.
ANONYMOUS: The law specifies that there must be no contact between the donor and the recipient at present or in the future. This implies that the woman can never meet, see, or choose the people who will give her their gametes. The donors sign a contract where they accept to give their gametes to a woman trying to have a baby and that they will never be involved in the future of the child.
Theoretically, there is no limit to the donations that can be made but the maximum number of children born from one donor is six (including their own children).
Both sperm and oocyte donors are selected using a strict medical evaluation. Before being able to give their eggs, the donor must have various tests done to confirm her correct ovarian function and the absence of infectious diseases and genetic problems:
For eggs donors:
Blood analysis: Serology (Hepatitis B and C, HIV and Syphilis, rubella), blood group determination, a Karyotype test to rule out chromosome anomalies, genetic analysis to rule out carriers of cystic fibrosis and electrophoresis of the haemoglobin to rule out hereditary anaemia.
Gynaecological examinations: cytology, cervical cultures for Gonococcus and Chlamydia, gynaecological ultrasound.
Interviews with the Doctor to confirm the absence of genetic diseases in their personal or family background, with the Psychologist to evaluate the mental health of the donor and, with the nursing team to explain how the treatment will be carried out.
For semen donors:
Blood analysis: Serology (Hepatitis B and C, HIV and Syphilis, Chlamydia and Cytomegalovirus), blood group determination, a Karyotype test to rule out chromosome anomalies, and a cystic fibrosis study.
Six months after the sample is frozen, the donor must repeat the Serology tests to confirm the negative results and ensure that there was no latent infection present at the time of the donation.
Examination of the sample: Seminogram (complete study of the motility, concentration and morphology of the sperm).
Interviews with the Doctor to confirm the absence of genetic diseases in their personal or family background and to evaluate the mental health of the donor.
For eggs ocyte donors:
EUGIN Clinic has its own egg donation programme.
Several visits, prior to the donation cycle: the donor receives detailed information about the donation (finality, legal aspects, tests to be carried out, ovarian stimulation, side effects, obtaining the eggs, type of anaesthesia to be used).
Stimulation phase: The stimulation is done by means of daily, subcutaneous injections.
The Follicular punction: The Follicular punction is carried out under ultrasound control and post-punction monitoring: After a check-up, if the donor feels well, they are discharged with post-operative instructions to follow. After 12 hours, they are contacted by telephone to confirm that everything is ok and they are offered telephone assitance for the next 24 hours. Later, a check-up appointment is scheduled.
For semen donors:
EUGIN Clinic uses one of Barcelona’s semen banks if they need semen samples from a donor for a specific treatment.
The donors do not follow any treatment. They just have to maintain sexual abstinence for 3 to 5 days before the donation.
Egg donation has no negative effects on the donor’s fertility. In general, a healthy woman has about 400,000 eggs in her ovaries from birth (immature forms of future eggs).
Out of those 400,000, only 400 reach maturity and the possibility of being fertilised, a number which corresponds to the quantity of ovulation cycles during the woman’s long fertile period (more or less between the ages of 13-45).
The rest simply do not mature, so the ovarian stimulation performed during the egg donation process is nothing more than a way of taking advantage of some of the eggs that the woman will never use.
At EUGIN Clinic, the donors receive mild stimulation during the treatment, at low doses, to avoid obtaining an excessive number of eggs, prioritising quality over quantity, and trying to diminish the possible and occasional side effects (such as bloated sensation, liquid retention or abdominal pains).
Once the egg extraction has taken place, the donor will go back to ovulating normally and will be able to have her own child if desired. There are a large number of donors who have participated in the Eudona programme and have become mothers after the donation. Many of them have returned to egg donation after giving birth.
How can I follow the assisted reproduction treatment from my home?
This is one of the characteristics of EUGIN Clinic. With our proven management system and multidisciplinary team, you will be supported at all times and will have instant access to all matters relating to your treatment.
At the EUGIN Clinic we excel in dealing with multicultural patients, both Spanish and International. This is one of the main reasons we employ medical professionals who speak Castilian, Catalan, French, Italian, English, German, Chinese and Japanese.
When you need to self-administer at home, and if you have any concerns, please be assured that we offer a step-by-step explanation of the procedure. In addition, we provide a follow up audiovisual service to support and help you throughout the process.
This approach allows you the flexibility to manage your schedule and lead a normal life.
How does the stimulation for insemination and IVF work?
- How does remote stimulation monitoring work?
- Why do I have to have an ultrasound and hormone study before every follicular control?
- Can I know in advance when I will need to go to Barcelona for my insemination or my follicular punction?
After your first visit, the doctor will give you a detailed written protocol with all the instructions on how everything works. During your stimulation cycle you will be in frequent TELEPHONE contact with the coordination team.
Before starting the treatment, both your medical and administrative dossiers must be complete and we recommend that you have all the medicines we have prescribed ready at home so you do not have any problems during the stimulation.
During the different stages, according to the treatment prescribed, you will need to administer subcutaneous injections to the abdomen. On the day of your first visit we will provide you with a pen drive or USB memory stick with a demonstration of how to prepare and inject the different medicines. You will also have to do several follicular controls (every 48-72 hours) so we can evaluate the ovarian response. These check-ups may be carried out at the clinic if you live in Barcelona or wish to stay in the city. Alternatively you may carry them out in your city and must communicate the results to be able to decide when is the right time for you to come to the Clinic.
To inform us of the results of the follicular controls from Monday to Friday we need you to telephone us before 18:00 so that the Clinic’s doctor can give you the instructions on the treatment you need to follow on that same day. At weekends or on bank holidays, the complete follicular control must be carried out before 13:00 (see “What are the normal business hours and bank holidays in Barcelona?”).
Once the ovarian response that is required for the desired technique has been achieved, we will tell you how and when to come to the clinic (around 48 hours between the last control and the day of the procedure).
Each follicular control consists of:
- An ultrasound to measure the diameter of each ovarian follicle and the thickness of the endometrium.
- An analysis to determine your hormone levels.
The ultrasound is a visual control which helps us to check that the follicles are growing correctly. With this analysis we are able to see how the follicles are maturing. During the long distance monitoring, we need these examinations to be carried out on the same day to help us to make exact decisions about the next steps (programming the technique, its cancellation in the case of anomalous development, etc…).
Each woman responds differently to each stimulation cycle. The treatment protocol is adapted according to the technique (AID/AIH or IVF), age, background, follicular reserves, etc, and we cannot predict with precision, or very far in advance, when you will have to come to the Clinic. Generally, the insemination treatment is shorter than IVF and by doing the follicular controls we will be able to give you more precise instructions.
How does egg donation work?
- How do we select the egg donors?
- How do we synchronize the hormone cycles?
- How many embryos do we transfer?
- When will my embryo transfer take place?
We work with a group of healthy donors aged between 18 and 35 and we select the donors according to their physical resemblance to the oocyte recipients. We compare the phenotype and physical characteristics of both parties using the colour photos which we ask you for, or that we take when you come to the clinic and the phenotype sheet filled in on the day of the first visit.
In accordance with the law, Eugin conducts a customised mapping between donor and recipient by trying to achieve the maximum phenotypic and immunological similarity. Egg donation is totally anonymous, but the law allows prospective parents to be provided with general information about the woman donor which does not reveal her identity.
Today, thanks to the existence of genetic tests, we can perform a mapping between sperm and donor eggs that minimizes the risk of transmitting genetic diseases to the future baby.
Education, intellectual level, religion, beliefs or physical or psychological abilities are not determining factors; we believe this is all a question of the personal education of the parents along with the social environment, and therefore we do not take them into account when we choose the donors.
After you have started your hormone treatment, several donors will initiate stimulation and once we consider your endometrium to be ready, we will assign you one of the donors, who coincides with your physical characteristics and we will inform you the day she is ready to carry out the punction. This waiting period varies and often depends on the duration of the donors’ stimulation.
This method allows the treatment to be carried out calmly as it does not depend on just one donor who may be cancelled during the cycle if she does not respond correctly to ovarian stimulation. This would be a problem for you as your hormone treatment would also have to be suspended. This system means the possible cancellation of your treatment and any unnecessary stress are avoided.
The donors follow a shorter treatment than you and start when your treatment is already underway. As you understand, we do not tell you the dates of the follicular controls of the donors, but only the day of their follicular punction.
Generally, we transfer two embryos when there is no health risk for the patient and we accept the possibility of twins.
As far as the evaluation of the embryos to be transferred is concerned, this is done in a laboratory and consists of a morphological evaluation of the different stages of the development and in which various parameters are taken into consideration. These parameters are: the number of cells, the size and symmetry of the cells, fragmentation… The biologists classify the embryos according to these criteria and deem them to be apt or not apt to be transferred. Only good quality embryos are transferred.
Spanish legislation permits the transfer of up to three embryos. However, at EUGIN Clinic we do not recommend that three embryos be transferred. In fact, the success rate observed is almost identical to when only two embryos are transferred, but there is a much higher risk of a multiple pregnancy (twins or triplets) which can cause problems during the pregnancy and birth:
For the babies, there is a higher risk of premature birth and its associated consequences.
For the mothers, there is a higher risk of premature birth, pregnancy hypertension, gestational diabetes,…
We do not want to put your life, or that of your child, in danger, and we want to avoid the need to carry out an embryo reduction which can be the cause of miscarriages or of psychological problems.
The clinic recommends that the transfers take place between days 12 and 60 of the oestrogen treatment, when the donor selected for her phenotype profile is ready for the oocyte punction. We will be able to inform you of this by giving you 2 days notice.
The majority of transfers take place between days 12 and 45 of the treatment.