Here we will provide answers to many of the questions that tend to arise regarding assisted reproductive technologies, fertility testing and the terminology associated with this field. We will also answer questions regarding the functioning of our centre and our medical appointment system.
This section is constantly updated due to the questions and queries that we receive by phone, email and social networks.
When is it time to see a specialist in reproduction?
If you are unable to get pregnant after trying for one year (this means maintaining sexual relations about 2-3 times a week without protection), it is recommended that you see a specialist in reproduction. If the woman is over the age of 37, we advise waiting no more than six months before seeing a specialist given that age negatively affects female fertility.
It is estimated that between 15% and 20% of couples in prime reproductive age have sterility problems. According to epidemiologic data, between 600,000 and 700,000 couples in Spain are going to need the help of assisted reproductive technologies in order to get pregnant.
What is infertility?
Primary infertility refers to couples who are able to get pregnant but cannot maintain the pregnancy.
Secondary infertility refers to couples who have been able to get pregnant and have had a child at least once, but are now unable to bring a pregnancy to term.
What is Sterility?
Primary sterility refers to couples who have not been able to achieve pregnancy after one year of trying without the use of contraceptive methods (WHO).
Secondary sterility refers to couples who have had at least one child, but now have been unable to achieve a new pregnancy.
What causes sterility?
Approximately 40% of sterility cases are due to the male: alterations in semen, blocked ducts, prostate disease, ejaculation problems or erectile dysfunction, etc.
The other 40% of cases are due to the female: ovarian failure, endometriosis, fallopian tube blockages, problems with ovulation, etc.
Another 10% can be attributed to a combination of reasons, and the other 10% is due to causes of unknown origin.
What are assisted reproduction centres?
A centre for assisted reproduction is a medical centre specialised in reproductive technologies and diagnostic methods. These clinics employ highly trained and specialised healthcare personnel who utilise the latest technologies. If you have fertility problems, we recommend seeing a specialised gynaecologist given that sterility studies are very complex and involve tests that are not carried out during a routine gynaecological exam.
What is involved in the initial sterility consultation?
During the first consultation we will generate a detailed medical history in which we will take into account both the couple’s personal and family medical histories. We will also take into account environmental and behavioural factors such as lifestyle, exposure to toxins and other factors that can be causes for sterility.
Both the male and female will undergo a medical examination in order to try and evaluate whether or not their sexual organs are in normal working conditions. With this information, the physician will proceed to complete an initial evaluation of the case, as well as request any necessary additional tests (hormone study, semen analysis, karyotype, etc.) in order to complete the diagnosis. Each case study is tailored to the specific needs of the couple, meaning that some cases won’t require all of the normal tests, while other cases may require other specific tests.
In cases in which the couple already has certain test results from previous studies in their possession, it is a good idea to bring these documents to your first appointment. These documents could help your physician to get a better look at your case and therefore speed up your diagnosis, as well as avoid repeating unnecessary testing.
For more information, take a look at the section “Your First Appointment”.
What’s next after we have completed our first appointment and have received our test results?
Once you have received the results from the tests that your specialist requested, you and your partner will visit with your doctor once again. During this second visit, the doctor will be able to indicate which technique is most suitable for you and your partner based on the results of the test and analyses you have undergone. If your doctor does not feel comfortable making a diagnosis just yet, he will request additional studies in order to be sure. Although it may sometimes seem as though there is still a long way to go, it’s important to remember that a good, individualized diagnosis is key for providing the most appropriate treatment and maximizing chances for a successful pregnancy.
What are the main tests involved in a male fertility study?
This is usually the first test carried out on males. After having refrained from sexual activity for a period of three to five days, a sample of semen will be collected by means of masturbation. The sample will then be handed over to our Semen Laboratory.
This test helps us to determine whether or not we can rule out the possibility of male factor infertility. It is recommended to repeat this test – especially if the results were abnormal the first time – given that factors such as fever or certain medications can temporarily influence test results by giving abnormal results.
The semen analysis evaluates the production of sperm in the testicles, their motility and shape. The test also makes sure that the accessory glands – such as the prostate and seminal vesicles – are functioning properly, and in turn allows the doctors to determine whether or not the seminal ducts have any abnormalities.
An additional study to analyse semen is the Sperm Capacitation test. This test involves removal of the sperm’s plasma membrane before transferring the sperm to a suspension rich in nutrients. The gynaecologist performs a sperm count to determine how many sperm are motile, and depending on the number obtained we can determine which assisted reproductive technology is most appropriate for the couple.
Depending on the patient’s medical history and on any discoveries made during the male infertility testing, it may be necessary to carry out some of the following tests:
1. Biochemical and bacterial analyses of the male’s semen in order to determine whether or not he has any infections. Semen cultures.
2. Karyotype to look for chromosome anomalies. Genetic testing.
3. A serological study to investigate antibodies.
4. FSH, LH, testosterone, E2, Prl and Inhibin B hormone levels.
5. Testicle biopsy.
6. Prostate ultrasound.
What are the main tests involved in a female fertility study?
Baseline Hormone Study (Estradiol, FSH, LH, Prl):
These hormone analyses evaluate whether or not a woman’s ovarian and pituitary functions are working normally. The hormone testing should be carried out at the beginning of the female’s cycle, between days two and four of her period.
This test is carried out around the time of ovulation (between days 10 and 12 of a 28-day cycle). The couple will maintain sexual relations on the night prior to their visit with the doctor. In the clinic, the doctor will then collect a sample of the woman’s cervical mucus to be studied under a microscope. The cervical mucus will be evaluated for its quality (ovarian function) as well as for the number and motility of sperm present.
This test uses sound waves to obtain information about the structure of the uterus, the ovaries, and occasionally, fallopian tube pathology. This test allows us to see how the ovaries and endometrium respond during ovulation.
Phase II Hormone Study:
In this study we take a sample of the female’s blood in order to measure the progesterone that is secreted by the corpus luteum in the ovary. The results of this test reflect the quality of the ovulation process, and an abnormal value would indicate an absence of ovulation. This test is carried out between 20 and 24 days following the first day of the woman’s period.
Endometrial Biopsy (biopsy by aspiration):
This test allows us to see how the endometrium changes and prepares as a consequence of ovulation. The endometrial mucus is aspirated or suctioned by introducing a flexible tube into the cervical canal. This test should be carried out between days 20 and 24. To date, this procedure has been extremely useful.
The ‘Clomid Challenge’:
A test to measure a woman’s ovarian reserve.
An HSG is an x-ray using dye which is introduced into the woman’s cervix in order to evaluate her uterine cavity and to check for blockages in her fallopian tubes. A blockage in both fallopian tubes would prevent the process of natural fertilization from occurring. This test is performed on the sixth or seventh day of the woman’s cycle and only when there is zero risk of having a vaginal infection.
A laparoscopy is a surgical procedure that allows the doctor to look directly at a female’s genital tract by using a tiny video camera that is passed into the abdomen (around the belly button area). By injecting a coloured dye into the female’s cervix area, the doctor can see if the fallopian tubes have any blockages, thus making this method complementary to the HSG. In some cases, this method can be used for the removal of ovarian cysts, uterine fibroids and tubal adhesions which could be the cause of the patient’s sterility.
This test is also complementary to the HSG given that it allows the doctor to look directly into a female’s uterine cavity. A small camera is guided up into the cervical canal and helps the doctor to identify any anomalies and any necessary treatments.
The Karyotype Test:
This test is necessary for the diagnosis of chromosome anomalies.
Pap smear and culture:
This test is necessary in order to rule out cervical cancer as well as the possibility of any infectious disease. The latter can be confirmed by collecting a culture from the patient.
When will we know what treatments we need to undergo?
Once a personal diagnosis has been completed, the gynaecologist will explain to the couple what is involved in assisted reproductive technologies, what risks are associated with it and what success rates to expect. Furthermore, the gynaecologist will give the couple an informed consent that must be read, accepted and signed before treatment can begin.
Is there a waiting list for the treatments?
No, there is no waiting list for assisted reproduction treatments.
When In Vitro Fertilization cycles with donated eggs are involved, however, the wait time corresponds to the minimum amount of time it takes us to find an egg donor whose phenotype matches the recipient’s. This wait time is usually between three and four weeks, except with rare phenotypes.
However, any treatment can be scheduled for the day that is most convenient for the patient.
In the case of patients who live abroad, it is possible to schedule cycles and make arrangements for travel dates to our centre despite the distance.
What risks exist?
Although they are minimal, there are some risks involved as with any medical intervention.
The most commonly experienced side effect is Ovarian Hyperstimulation Syndrome (OHSS) which occurs when a woman’s ovaries experience an intensified response to the ovarian stimulation treatment. This syndrome can be classified into three categories: mild, moderate and severe. A severe case of OHSS is extremely unusual and would require hospitalisation and medical-surgical treatment. In very rare instances a woman may be advised to interrupt her pregnancy.
Nowadays, however, we have ways of preventing this complication in patients, meaning that the number of cases is extremely low. In the Gutenberg Centre URE we have never had a patient who experienced severe complications.
The occurrence of a multiple pregnancy (two or more fetuses) is another possible risk that happens in about 25% to 30% of cases. Since this complication means that physical strain is put on the mother and the fetuses, we are increasingly recommending a “selective” transfer of just one embryo (although this is not possible with all cases) during In Vitro Fertilisation treatments involving a woman’s own eggs or donor eggs. This recommendation is set in place to avoid the risk of a multiple pregnancy.
Will I always be treated by the same specialist?
All patients can request an appointment with a specific specialist and we will try to make sure that the same gynaecologist treats you during the entire process. However, on account of scheduling, work organisation and our specialists’ on-call shifts we cannot always guarantee that the same doctor will be treating your case.
However, what we can and do guarantee is team work. The Gutenberg Centre Reproduction Unit is made up of a team of professional specialists who perform and execute all medical activities as a coordinated team. Due to the characteristics of each specialty and shift rotations, all of the physicians on the team will have access to all information contained within each patient’s medical records. Furthermore, the medical team holds regular meetings in order to evaluate all current cases. This way, all members of the Reproduction Unit’s Medical Team are fully able to attend to your case without sacrificing professionalism or care.
Are the treatments uncomfortable?
The discomfort experienced with artificial insemination is minor given that the hormone therapy administered is very mild and causes barely any side effects. However, the side effects can vary from woman to woman depending on how one’s body reacts to the medications.
In Vitro Fertilisation treatments, however, require undergoing a somewhat stronger hormone therapy meaning that the female could experience some minor discomfort.
At any rate, these are all considered normal reactions to the treatments and are well-tolerated.
Will I need to take off many days from work?
It is not really necessary to take off days from work, but it is necessary to have a somewhat flexible timetable when it comes to attending brief medical appointments for each treatment.
The ovarian stimulation phase, or preparation for artificial insemination treatments, tends to last about five to seven days. There will be about two or three doctor’s visits during which we will perform ultrasounds, and on occasion, a hormone analysis in order to monitor follicular growth. These visits will be brief and don’t tend to last more than ten or fifteen minutes.
On the day that the artificial insemination is to be carried out it is necessary that both the patient and her partner are present, except in the case of artificial insemination with donor sperm. This day, the patient’s partner or spouse will provide us with a sample of his semen which will be processed in our laboratory. The insemination process lasts about ten to fifteen minutes. Afterwards, the patient will be able to return home or to work and carry on a normal day.
The ovarian stimulation phase during In Vitro Fertilisation treatments tends to last between ten and twelve days and calls for a total of five or six visits to our centre. During these visits we will perform ultrasounds on the patient and will occasionally carry out a hormone analysis in order to monitor follicular growth. These visits are brief and usually last about ten to fifteen minutes.
Follicular aspiration procedures are scheduled for first thing in the morning. This intervention will be carried out in the Operating Room and lasts about twenty minutes. Although the patient will be able to return home approximately three hours after the intervention has been completed, we do recommend that she rests and take it easy for twenty-four hours following the procedure. In regards to the male, he will need to provide us with a sample of his semen (except in cases of using a frozen sample or donor semen) on the day of the follicular aspiration after the egg retrieval has been completed.
The embryo transfer is normally performed three days following the follicular aspiration. This is a painless, outpatient procedure that does not require sedation or hospitalization. It is carried out in the Operating Room and lasts about 10 minutes. We recommend resting and taking it easy for approximately twenty-four hours following the procedure.
Unless there are any other medical orders, the patient will be able to carry on normally – without overexerting herself – until the day of the pregnancy test.