IVF in Spain. In-Vitro Fertilisation IVF with donor sperm is a laboratory technique that involves fertilising previously extracted eggs with sperm from an anonymous donor.
Who is it recommended for?
• Women without a male partner.
• Women with a female partner.
• Couples who have undergone multiple unsuccessful attempts at in-vitro fertilisation with the male partner’s sperm if we suspect that the problems may originate from the male.
• If the male partner has azoospermia (no spermatozoa in his ejaculate and none are produced in his testicles), or in cases where his sperm has been used unsuccessfully.
• If the male partner has chromosome abnormalities and he may transmit serious hereditary diseases.
• Couples where the male partner shows serious or irreversible sperm abnormalities.
1. Ovary Stimulation
In-Vitro Fertilisation and Sperm Microinjection treatment usually begin by stimulating the ovaries using hormone medications that work in a similar manner to certain naturally produced hormones. The aim of this treatment is to develop several follicles with eggs growing inside of them. In order to avoid spontaneous ovulation, this treatment is used in conjunction with other hormone drugs.
2. Ultrasounds and Hormone Check-Ups
The ovarian stimulation process is typically monitored using blood tests to check the levels of certain ovarian hormones and/or transvaginal ultrasounds that tell us the number and the size of the developing follicles. Once the developing follicles have reached the appropriate size, different medications are administered to achieve the eggs’ final maturation.
Many of the medications are injectable and their formulation allows for self-administration. The doses and administration guidelines are adapted to the clinical features of each patient; response to the treatment may vary (normal or expected, high, or low). Occasionally, these are used in conjunction with other types of medication.
4. Follicular Puncture and Egg Retrieval
The eggs (or oocytes) are extracted through the vagina under ultrasound guidance by puncturing the ovaries and aspirating the follicles. This is generally an outpatient procedure that requires anaesthesia followed by a period of observation that varies in length.
The retrieved eggs (oocytes) are prepared and classified in the lab. The number of eggs retrieved during the follicular puncture, their maturation and quality cannot be precisely predicted; and it is possible that no (viable) eggs will be retrieved.
5. Oocyte Fertilisation
For In-Vitro Fertilisation (IVF), the eggs and the spermatozoa are jointly cultivated in a laboratory under conditions that favour spontaneous union (fertilisation).
For Sperm Microinjection (ICSI), each oocyte must first be “denuded,” i.e. removing all of the cells that surround them (cumulus cells). After this step, the eggs are classified according to their degree of maturity. Mature eggs (Metaphase II) are microinjected, meaning that a single sperm is inserted into each egg.
6. Embryo Incubation
The number of fertilised eggs will be determined 16-18 hours after the IVF or ICSI procedure, and these will be placed in an incubator for observation during the following days in which they will be cultivated using special techniques. Each day the number and quality of the developing embryos will be assessed. The embryos will be kept in the laboratory for 2 to 6 days after which they will be transferred and/or frozen in some cases.
7. Embryo Transfer
The embryo transfer is a simple and painless procedure that is performed with the help of an abdominal ultrasound. The process involves placing embryos in the uterine cavity using a thin cannula. A hormone treatment is also prescribed to create favourable conditions for embryo implantation.
It is important to drink several glasses of water beforehand so that your bladder is full, this makes it easier to see on the ultrasound exactly where the embryos are being placed. After the transfer, the patient will spend approximately half an hour resting in the room before she is discharged. Therefore, we recommend that the patient brings a nightdress or a dressing gown to be more comfortable during the wait.
The embryo transfer can be done 2 days after the puncture (48 hours after), 3 days after (72 hours), or 5 days after if a long-term culture and blastocyst transfer are being performed. The transfer day will depend on the patient’s individual circumstances and her cycle.
The Spanish Law on Assisted Reproduction allows for a maximum of 3 embryos to be transferred. To avoid a multiple pregnancy, at Clínica Tambre we usually transfer a maximum of two embryos and, in many cases, we recommend transferring only one.
Finally, if there are any viable embryos left over from an In-Vitro Fertilisation cycle these will be preserved by freezing or vitrification.
8. Pregnancy Test (beta hCG)
The pregnancy test will be performed 16 days after the follicular puncture. The test is used to determine the level of beta hCG hormone in the blood (which is why the days prior to the test are sometimes referred to as the “beta-wait”). This allows us to quantify this level and thereby know more precisely how the gestation is progressing.