Frequently Asked Questions

Fertility study

Gynaecology

Fecundación In Vitro FIV

SOFT-FIV

Egg donation

Embryo freezing

Oocyte cryopreservation

Embryo Adoption

Homologous Intrauterine Insemination

Intrauterine insemination of donor sperm

Gynaecological check-up

Contraception

Menopause

Obstetrice

How long do I have to wait before seeing a doctor if I don’t get pregnant?

In general, if there is no medical reason for a couple not to be able to conceive and the couple have been trying for a baby during a period of 12 months, then it is recommended that they see a doctor. This 12-month time period should be halved if the woman concerned is older than 35 years of age.

What are the reasons for infertility?

There are several causes and it is for this reason that a detailed study of the problem should be carried out on both members of the couple concerned. For men, a low number, low mobility or lack of spermatozoids could be to blame. In the case of women, the lack of ovulation, or irregular ovulation, or the obstruction of the Fallopian tubes could be reasons for infertility. In addition to this, leaving pregnancy to later in life, or general stress levels in both men and women in today’s society could be to blame. Other factors like obesity, anorexia, complex illnesses, thyroid disease, drug and alcohol abuse and addiction to pharmaceuticals or tobacco can have an extremely negative effect on fertility.

To what extent does age affect female infertility?

The best years to get pregnant have been shown to be when a woman is twenty-five to thirty years old. This is due to her physical and psychological state during those years. Today, however, women have decided that they can still be fit enough to get pregnant after the recommended age. The downside is that after the age of thirty-five, a woman’s fertility levels decrease gradually.

When is the best cycle to become pregnant?

At the time of ovulation. Ovulation or a woman’s fertile period occurs half-way through each cycle, more or less on day 14 of a normal 28 day cycle.

Is it true, that after a long time taking oral contraceptives a woman can find it difficult to coenceive?

It is generally thought that women who have been taking contraceptives orally for a long period of time can then be at a higher risk of not developing normal periods after stopping the pill. However, this is false.

Do women who use IUD (Intrauterine contraceptive device) as a contraceptive have more difficulties in getting pregnant?

Women who have more than one sexual partner or suffer from sexually transmitted diseases present a higher risk of developing a pelvic inflammatory illness and therefore creating a blockage of the Fallopian tubes. There are no other issues relating to sterility.

Which tests are completed during the first visit?

There are no set rules but we examine both the male and female factor.

What factors must we take into account while choosing a fertility treatment?

The main factors are the ages of the couple and the time they have invested in trying to have a baby. The case of a couple of 38 years old with 10 attempts at getting pregnant is clearly not the same as a couple of 25 who have only had 2 attempts.

What is the success rate of fertility treatments?

The success rate varies depending on many factors. However, the general success rate is 60% per cycle.

Does chemotherapy end fertility?

Yes, and is in some cases permanently irreversible. However it is not impossible for a woman to experience a recovery of fertility once chemotherapy treatment has ended. We advise the patient to preserve oocytes, sperm or embryos before starting chemotherapy.

Can a couple undergo assisted reproduction techniques after tubal ligation or vasectomy?

Yes, because these procedures are reversible.

If I am menopause can I get pregnant?

Yes, today it is possible to have a baby after a physiological menopause, or if menopause has already occurred or you have experienced early ovarian failure.

Does it take long to get pregnant using assisted reproductoion methods?

We can not generalise, but realistically, if couples were more persistent and continued trying, 90% would be successful.

Is it necessary to try each assisted reproduction technique several times?

Each couple represents a different case, therefore we can not generalise.

Can we choose our baby’s gender?

Spanish Law only allows this for medical reasons.

Does Spanish Law allow single women to undergo assisted reproduction treatments?

Yes, the main requirements are to be over 18 years of age and be psychophysically healthy. This also applies to heterosexual and homosexual couples.

Does each country have a different law or legislation regarding assisted reproduction?

The more permissive countries are Greece, Spain and the United Kingdom, that hold specific legislation regarding human reproduction. In Europe, France and Holland allow human embryo donation. In the United States, couples are the ones who decide without any state interference.

Can the remaining embryos be frozen after an effective treatment?

Yes, in Spain all remaining embryos are frozen and are at the couples disposal during the rest of their fertile life.

Is there a waiting list for oocyte donation?

At Instituto Bernabeu we have over 15 year’s experience concerning ovodonations, performing hundreds of cycles per annum. There is no waiting list.

Can we know who the donor is?

No, donations are anonymous and Spanish Law strictly protects data concerning donor’s identity.

How do you select donors?

Donors are healthy individuals who are over 18 years of age and who volunteer and then go through a very strict selection process. At our centre we include: physical examination, psychological evaluation, hormonal tests and karyotype, hereditary illness screening (cystic fibrosis), screening for infectious deseases, etc.

How does an oocyte or semen sample get selected for donation?

We take into account the couple’s physical characteristics i.e.: blood type, facial features, biotype, etc.

Where do the donated embryos come from?

Every couple undergoing an IVF treatment has to sign an informed consent form where they have to specify what to do with the remaining embryos, if any. Most of these couples donate their embryos to other couples in their situation.

What advantages are there to freezing embryos?

Freezing embryos allows couples to become pregnant:

  • If the first transfer has been unsuccessful
  • If it was successful but they would like to try for a second child

In both cases long and costly pharmaceutical courses of treatment are avoided. The recipient mother need only undergo endometrial preparation prior to the transfer. Please bear in mind that the success rates for frozen transfers are lower than the transfer of fresh embryos.

Who can be an oocyte or sperm donor?

Oocyte donors are healthy young women who would selflessly like to help other women to become mothers. Most of them are professionals with a high I.Q. Others are university students.

Requirements are, to be between the ages of 18 and 35, hold a negative family record of genetically transmitted illnesses, normal karyotype, negative screening of genetic illnesses, negative comprehensive study of sexually transmitted illnesses (HIV/AIDS, Hepatitis B and C, Syphilis), normal reproduction system, mentally and physically healthy, medical history of fertility or adequate response to ovary stimulation treatment, and normal body mass.

Semen donors are young healthy males who donate their semen voluntarily in order for it to be used by couples who are undergoing assisted reproduction treatment.

Requirements are, to be between the ages of 18 and 35, psychophysically healthy, not to have any personal or hereditary illnesses which could be passed onto descendants, like diabetes or epilepsy, not to be infected or carry any hepatitis B antigens, hepatitis C antibodies, anti-AIDS ½ antibodies or syphilis, not to be a carrier of any kind of infections, posses a 4.5 times over the normal level of semen quality, and to have semen that can survive the freezing and defrosting process, as well as normal karyotype.

Is donation anonymous?

Yes. Spanish Law states that the donor’s identity must be kept in the strictest confidentiality.

Can donors know the identity of any children born through their donation?

No. Law states that donation is an anonymous action, and therefore, donors have no right to know the identity of any children born through their donation. In the same way, donors can not be identified by children born through the same process.

How can I become a donor?

In the case of oocyte donors, after getting in touch with our centre, an interview will take place in order to establish whether or not the above mentioned requirements are met. If the interview goes well then a gynaecology test and a medical examination will be performed. At the same time, a blood test will be carried out. Once the results are known, and a positive outcome is established, treatment will commence after the first day of menstruation.

For semen donors, after contacting us, a first interview will take place. If all requirements are met, then a first semen sample can be taken. Subsequently, a second semen sample is taken to cross check the results with the first one. If all results are in order then a freezing and defrosting test of the second sample will be carried out. If these tests go according to requirements, a third semen sample is taken along with a blood test. The third semen sample will be kept frozen in our semen storage bank. It will also be kept in quarantine for the stated time until all results and studies are received. After this process, the donor can come to our centre on a weekly basis.

Do donors receive any kind of monetary compensation?

Donation is an altruistic act; nevertheless we compensate any transport fees paid to come to our centre, any wages missed due to a day off work, etc. At our centre, the compensation is €900.00 that is paid once the donation process is complete

Is there a limit to donations?

According to Spanish Law, a person who has donated can only do so until a maximum of six children have successfully been born.

Is Oocytes donation a painful process?

No. For the majority of young donors who have done it, the experience has been a positive one; they feel very satisfied and proud repeating the process.

Can oocyte donation affect my ovarian reserve?

No, in each cycle hundreds of oocytes are lost naturally. These oocytes can not be used. Our treatment collects these oocytes which otherwise have been lost. In many cases, the fact that a complete gynaecological examination has been performed beforehand means that we can advise you on any future fertility issues.

When is a donor rejected?

When semen quality, once tested, does not permit freezing or when after being frozen, it doesn’t survive as per our standards.

When periodic blood tests reveal any type of abnormality.

What is Assisted Embryo Hatching (AH) and Embryo Defragmentation?

One of the strategies used to increase the potential of fragmented embryos is to make a hole in the zone pellucida of the embryo. This is done through the use of chemicals (tyrode’s acid), mechanical agents (micropipettes) or laser. We then pick up the maximum number of cell fragments. This technique is called Embryo Defragmentation.

What are the advantages of oocyte or embryo vitrification?

Vitrification is an advanced cell-freezing technique, which allows a higher survival rate after thawing due to the fact that high concentrations of cryoproctectors are used along with reduced volumes and timings. Thus, the formation of intracellular ice crystals is prevented, which are responsible, in most cases, for provoking irreparable cell damage.

The vitrification process is used to freeze oocytes or embryos and it guarantees a survival rate of more than 80%. This technique enables the vitrified oocytes which have survived the thawing process to have similar attributes to fresh ones. They are then able to be fertilized by the spermatozoids. The generated embryos can then be implanted and develop into healthy children. Although the implantation rate is lower than with fresh embryos, frozen embryos, once thawed, achieve a normal pregnancy.

How to conduct a breast self examination?

A good moment for a self examination is a week after menstruation. If you no longer have your period, it can be carried out during the first week of every moth. The necessary steps:

VISUAL INSPECTION

Naked from waist up, stand in front of a mirror and have a look.

First, with your arms down

 

 

 

 

and then with your arms up.

 

 

 

 

It is necessary to observe that the breast is not oddly shaped, or has any blemishes, lumps, depressions... Squeeze your nipple slightly in order to ensure there is no secretion.

 

 

 

 

 

PALPATION

You should be lying down. The arm next to the breast to be explored needs to be placed behind your head. You should palpate your the breast using the opposite hand while stretching your fingers open.

 

If you find something unusual, please examine the opposite breast at the same point and compare them both. Please do not forget to palpate the armpit area as well in order to observe if there are any lumps, even if they are small.

If during this palpation any anomaly is found, please do not panic, but get in contact with your gynaecologist.

Can we become parents if my partner has ejaculation problems or impotence?

Today the masculine factor represents 40% of all causes of infertility. There are treatments available to correct impotence problems and allow a natural conception (Viagra, Cialis, etc.). These treatments should be prescribed and monitored by a urologist.

On the other hand, if the issue is with semen quality and depending on the intensity of the problem, different therapeutic options are available, including artificial insemination, IVF, microinjection of spermatozoids and even the use of sperm from an anonymous donor.

No spermatozoids can be detected in my ejaculate. What can be done? Is it permanent?

The absence of sperm in ejaculate is called azoospermia and is generally caused by an obstruction in the seminal tracts or a problem with spermatozoid production in the testicles.

This could be a temporary situation or a situation that is evolving. For that reason we always require at least two samples for confirmation purposes.

If azoospermia is confirmed as the cause, further detailed study must take place (hormonal, genetic, and urologic) to be able to evaluate the origin and prognosis.

If testicular spermatozoid production is still active, or at least partially, one option is IVF with microinjection of spermatozoids collected from a testicular biopsy or sperm extraction using anaesthesia.

Can we become parents if my partner is HIV+ or has another contagious illness?

Spanish Law provides for the protection of the unborn child and therefore strict monitoring is put in place so that no illnesses are transmitted to offspring.

When the male partner has an infectious disease, like HIV, the semen can be “washed” of the virus, frozen and then used in an IVF cycle using microinjection using a spermatozoid free of the virus. When the female partner has the infectious disease, the ability to use assisted reproduction techniques depends on the stage of the infection and the viral load.

Can the assisted reproduction techniques damage my ovarian reserve?

During each menstrual cycle the ovaries initiate the development of hundreds of eggs, of which generally only one is released to allow fertilisation. With assisted reproduction techniques we only recuperate some more of the hundreds which would otherwise be lost and therefore ovarian reserve is not affected.

Is IVF, Egg donation or other assisted reproduction techniques painful?

Assisted reproduction techniques can be unpleasant as they involve the stimulation of the ovaries via injected hormones either subcutaneously or intramuscularly.

The most unpleasant procedure is the egg retrieval for IVF which is carried out using transvaginal ovarian puncture guided by ultrasound scan but a light anaesthetic is used to avoid any discomfort.

On average how many eggs are usually retrieved? How many embryos per cycle?

The average number of eggs will depend above all on the age of the patient taking the IVF treatment. Generally speaking a good number is approximately 8 eggs. In Egg donation cycles there is generally a higher number, around 10-12 eggs. This is due to Spanish Law only allowing young women to donate (18-35 years of age).

The average pregnancy rate is between 65-70% which will also depend on the quality of the sperm sample.

What do I need to become a single mother?

You should be in good physical health both generally and gynaecologically. You should not have any serious illness which could worsen during pregnancy or have an infectious disease which could be transmitted to the foetus (syphilis, Hep B&C, HIV).

What is endometriosis? How does endometriosis affect my fertility?

Endometriosis is a chronic yet benign illness which is characterised by the presence of endometrial tissue (which produces menstruation) in ectopic zones such as the ovaries, Fallopian tubes or peritoneal cavity, producing internal menstruation and cysts made up of menstrual blood in the ovaries (chocolate cysts).

Endometriosis affects the quality of the eggs when located in the ovaries and also the functioning of the Fallopian tubes, producing adhesions in the interior of the abdominal cavity.

What is a polycystic ovary? How does a polycystic ovary affect my fertility?

Polycystic ovary is a metabolic illness which is characterised by ovaries which are slow or “lazy” in their performance as well as producing more male hormones (androgens, which can produce an increase in hair, obesity, acne, etc.). This slowing-down of the ovary is associated with late menstruation (sometimes months) and therefore difficulties in becoming pregnant. For example, if a woman with a normal cycle ovulates once a month, she’ll have 12 chances to conceive during a year. A patient with a polycystic ovary and a cycle every three months will only have 4 ovulations and 4 chances to conceive during the year.

I have blocked tubes. Can I get pregnant?

When a patient has bi-lateral tubal obstruction due to infection, a surgical procedure or tubal ligation, the only possible treatment to conceive is via IVF which has a high pregnancy rate

My periods and ovulations aren’t regular. What can I do to become pregnant?

If your menstrual cycle isn’t regular, and in that case neither your ovulation, in the first place the ovarian pathology should be determined (disovulation, early ovarian failure, polycystic ovaries, hyperprolactinaemia) and thereafter treat the specific problem if one exists. If no pathology is found, ovarian stimulation can be used to overcome the problem.

Can we become parents if my partner is HIV+ or has another contagious illness?

Spanish Law provides for the protection of the unborn child and therefore strict monitoring is put in place so that no illnesses are transmitted to offspring.

When the male partner has an infectious disease, like HIV, the semen can be “washed” of the virus, frozen and then used in an IVF cycle using microinjection using a spermatozoid free of the virus. When the female partner has the infectious disease, the ability to use assisted reproduction techniques depends on the stage of the infection and the viral load.

If I don’t become pregnant, how long should I wait before going to see a doctor?

85% of couples who have regular sexual intercourse become pregnant within a year. If there is no precedent which could lead to a possible problem (ovarian or testicular surgery, chemotherapy, etc.), it is advisable to seek medical advice after one year of having sex without contraceptive protection. For women older than 37-38, it is recommended to go and see a doctor after 6 months of trying as the ovarian reserve decreases as the woman gets older.

When is my most fertile day and how can I find out?

Patients who have a regular cycle of 28-30 days, ovulation takes place on day 14 to 15 from the start of menstruation (day 1 of the cycle). There are physical signs which can help you know your most fertile day. For example, a greater mucosity and quantity in vaginal flow, discomfort and a feeling of heaviness in the lower abdomen. An ovulation urine test is also available which can detect when the LH hormone is at its peak which triggers ovulation.

For patients with irregular cycles it is more complicated and frequent sexual intercourse is recommended, every 2-3 days, in order to have the gametes there (egg and spermatozoid) when ovulation takes place.

Will I always be treated by the same gynaecologist at Instituto Bernabeu?

At Instituto Bernabeu each couple is assigned a gynaecologist. He or she will monitor your progress and also the assisted reproduction techniques involved.

How long does the treatment take?

For the more frequent assisted reproduction techniques, Egg donation and IVF, 2-3 months is needed for preparation and the carrying out of the treatment.

How many visits to the clinic are required?

First of all 1 to 2 consultations are required in order to establish pathology and complete all the complimentary tests (serology, spermiogramme, etc.). During the treatment phase, if it is IVF a further 5-6 visits are required. For Egg donation only 2-3 more

What can I do to reduce stress and nerves?

First of all, you should get clear information on all the assisted reproduction techniques you are going to undergo. Secondly, you should trust the team who are going to be caring for you during the procedures. And finally, if necessary, psychological and psycho-pharmaceutical support is available.

How long should I wait after IVF or Egg donation treatments before having sexual intercourse?

After embryo transfer you will only have to wait a few days before taking a blood or urine pregnancy test to know the results of the treatment (The blood test can be taken earlier).We recommend that you shouldn’t have sexual intercourse as a precaution until 3-4 days after the embryo transfer.

How much time will be devoted to my treatment?

Each couple, each treatment and each procedure requires a different length of time in order to achieve the best results possible

At what age do fertility levels diminish?

When a girl is born she already has all her eggs stored in her ovaries. With time this store is reduced so that between the ages of 37- 38 the quantity and quality is reduced as well as the chances of becoming pregnant, both naturally and with the use of assisted reproduction techniques.

Could fertility problems have a genetic origin?

To be able to diagnosis fertility problems there are a number of test that allow us to know if there is a genetic cause responsible of the fertility problem. For the study of the masculine factor, the karyotype study, microdelection of the Y chromosome and cystic fibrosis study could justify the low number or the absence of spermatozoids. For women, the karyotype study, the screening of the Fragile X Syndrome, those could be the cause of repeated miscarriages and low ovarian reserve, respectively.

What does it mean to have an altered TUNEL?

The TUNEL study is a fairly new technique for the analysis of the spermatozoids. To have an altered TUNEL means that there is greater number of spermatozoids with a fragmented DNA than the general population, making gestation more difficult, being responsible for implantation failures, miscarriages, etc.

Which are the options if I have an altered spermatozoid TUNEL?

Recent investigations propose that antioxidant treatments could reduce the rates of fragmented DNA in spermatozoids. For those cases when this treatment doesn’t work, a testicular puncture could be an effective solution.

Can we prevent repeated miscarriages?

Yes, we can. It is estimated that about 50% of the repeated miscarriage cases are cause in the embryo and not in the couple. An abnormal number of the chromosomes or an altered structure of the chromosomes is the explanation for most cases of repeated miscarriages. The PGD technique allow us to select the embryos free of structural or numeric abnormalities and this way we can achieve a normal pregnancy.

Why is it important to study the result of a miscarriage?

In most cases the miscarriages are cause by chromosomal abnormalities in the embryo. To be able to have biological material from the miscarriage give us the opportunity to carry out karyotype studies and help us to identify if that is the cause and be able to determine the possible implications in the future regarding fertility.

Before eggs freezing do I have to have a check-up? What type?

The whole process can be completed during one visit. The medical examination usually consists of no more than a gynaecological scan and a blood test.

If my eggs are deemed to be not viable, is freezing avoided?

Once the eggs have been retrieved they are studied and analysed by our embryologists. In the majority of cases the eggs are suitable for freezing and the patients are informed of the amount to be frozen. In extreme cases where there is doubt as to whether the eggs would survive the freezing process, a decision is made in conjunction with the patient.

What does the egg retrieval process involve?

The retrieval technique is very simple and is completed via vaginal scanning, does not involve general anaesthesia and is over in 10 minutes. During the aspiration of the eggs the patient is lightly sedated so as not to feel any discomfort. Once over, recuperation is quick such that the majority of patients can leave the clinic with one to two hours.

What is the recommended age for egg freezing?

Prior to the application of the freezing process, we meet with the patient in order to clarify all issues before starting the treatment. We look at all data and evaluate for each individual case the possibility of success which depends on the age of the patient and that condition of her ovaries. The prognosis is better for women who are younger than 35 who have ovaries which have not undergone any type of surgical intervention and who do not suffer illnesses such as endometriosis. Nevertheless each case should be evaluated individually before taking a decision.

If I decide in the future that I no longer want my frozen eggs, what happens to them?

Once the freezing process is complete, the frozen eggs remain in our banks at the patient’s disposal for an indefinite time (currently 50 is the maximum age limit that the eggs can be used). If the patient decides to get rid of her frozen eggs, they can be donated to another woman or simply destroyed as per the patient’s wishes

Can we identify chromosomal alterations in the baby before birth?

Through the corial biopsy in the weeks 10-12 of pregnancy or amniocentesis in the weeks 15-20, the baby’s cells can be obtain for study so we can determine if there is any alteration in the chromosomes.

Is it necessary to wait 15 days to know if our unborn bay has Down Sindrome?

No, it is not. Recent cytogenetic techniques (FISH) allow us to know in just 24h if the baby has a trisomy of the 21 chromosome (Down Syndrome). With this test we can also know other frequent chromosomal abnormalities such as Tuner Syndrome, Edwards Syndrome, Patau Syndrome, etc

Can I know my genetic predisposition to breast cancer?

One out of eight women will contract breast cancer during our lives and a large majority of the cases have a genetic component. Thanks to genetics we can study if you have a predisposition and so can then take preventative measures. IB BIOTECH is a pioneering centre in the study of these linked genes.

Genetics is an essential tool in medicine due to the fact that a considerable percentage of human health issues have a hereditary component. Any genetic-based illness can be diagnosed via techniques in molecular biology

The majority of breast cancers are sporadic cancers, i.e. there is no indication to hereditary susceptibility to developing the illness. But there is a group, estimated at 10%, where a hereditary predisposition to cancer plays its part. A third of hereditary breast cancers are due to mutations in BRCA1, a further third are because of mutations in BRCA2 and the rest are due to other genes. Breast cancers associated with mutations in BRCA1 arise in pre-menopause (average age 42) and the development of contralateral breast cancer within 5 years is approximately 30% in women who are carriers of the mutation in BRCA1. Alterations in the gene BRCA2 are linked to male breast cancer.

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¿Puedo conocer mi predisposición genética a tener cáncer de colon o cáncer gástrico difuso?

Colon cancer is the second most frequent cause of cancer death in the West and 5% of the population will develop it.

Luckily at IB BIOTECH we can complete a study of all of the affected genes involved in the development of the illness and therefore rule out hereditary colon cancer or be able to take preventative measures in order to correct the predisposition.

The exact causes of colorectal cancer is unknown in the majority of cases although it is known that risk factors exist which favour its apparition. Some genetic syndromes increase the risk of developing colorectal cancer. The most well-known are “Colonic polyposis” and hereditary nonpolyposis colorectal cancer or Lynch Syndrome.

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