In Vitro Fertilisation (IVF)

In vitro fertilization (IVF), the main treatment for infertility, allows for higher rates of pregnancy than natural conception.

In Vitro Fertilisation (IVF)
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What is in vitro fertilization?

In Vitro Fertilization (IVF) is a technique whereby egg fertilization takes place outside the woman’s body. Embryos are created in the laboratory and then placed in the woman’s uterus to stimulate development and achieve pregnancy. This process involves several steps which need to be adequately coordinated. Designing made-to-measure treatment for the patient’s needs, team quality and the clinic’s technology are key to success.

IVF Process

Phase 1

1 day

Study and preparation of the patients

Study and preparation of the patients

Every patient is a unique individual. For this reason, our treatments at Bernabéu Institute are tailored to every one of our patients. Our goal is to locate the source of infertility among couples and select the most effective treatment. The male’s sperm and hormone levels are analyzed and, if necessary, a urological assessment is performed.

In the case of women, their cervical canal and endometrial cavity are examined, as well as possible alterations in their fallopian tubes and their menstrual cycle patterns. These are accompanied by detailed assessments of the couple’s sexual health.

This process ensures that IVF is the correct solution to the patients’ infertility problems and that they are physically and psychologically ready to begin the cycle. If this is not the case, the patients are offered other treatment options.

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Phase 2

~ 8/12 days

Ovarian stimulation

Ovarian stimulation

In order to maximise the possibility of pregnancy, we need to obtain more than one oocyte, which is the number a woman’s ovary normally produces.

In order to stimulate production of several oocytes and guarantee their quality, we administer a combination of pharmaceutical drugs. Response is monitored using vaginal ultrasound scans and timely blood analyses: ovulation induction.

The whole process lasts approximately between 8 and 12 days, depending on each case. The treatment can be cancelled if a low or exaggerated ovarian response is observed.

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Phase 3

1 day

Egg retrieval

Egg retrieval

Once the oocytes are mature, we retrieve them with the guidance of a vaginal ultrasound scan under local anaesthesia and light sedation so that it is a completely painless. This process only takes 15 minutes and does not require an operation, being hospitalised, stitches or the use of general anaesthesia.

Sperm capacitation

Sperm capacitation

At the same time, the semen is activated to improve its fertilisation potential.

Laboratory fertilisation

Laboratory fertilisation

The retrieved eggs are taken into the IVF laboratory where they are prepared for insemination. 

Oocytes and spermatozoids are placed together for several hours within an incubator which provides the ideal conditions for fertilisation to take place and the subsequent development of pre-embryos. The number of fertilised eggs will not be known until the next day

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ICSI (Intracytoplasmic Sperm Injection)

ICSI (Intracytoplasmic Sperm Injection)

ICSI is performed on oocytes when the reproduction biologist in charge deems it necessary or when it has been previously agreed upon.

The Intracytoplasmic Sperm Injection (ICSI), consists in the introduction of a single spermatozoid inside a mature egg to achieved fecundation.

ICSI proved to be a revolution in assisted reproduction techniques, as it overcomes most male infertility problems. This technique is used in fertilization when sperm suffers from low count, an abnormal morphology, poor motility or when the sperm is unable to fertilize through IVF. It can also be used with patients suffering from a blocked sperm duct. In this case, a puncture is made in order to extract sperm directly from the testicles.

This procedure is performed using a microscope. Micromanipulation equipment is also used, allowing us to stabilize the egg softly and subsequently place the sperm inside it. Sperm selection is essentially guided by morphological features, although other methods (MACS, IMSI, PICSI) can also be used.  More information.

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Phase 4

3/5 days

Culturing the embryos

Culturing the embryos

Fertilisation is followed by development in a culture medium that provides everything that is needed for growth. The embryos are assessed during development.

Growth is periodically assessed because not all human embryos reach blastocyst stage.

It is important to keep in mind that not all of them will fertilise and become viable embryos. There will be good and poor quality embryos and others that will simply block.

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Phase 5

1 day

Transferring the embryos

Transferring the embryos

Once the blastocyst stage has been reached, embryo transfer takes place. It is an essential stage during treatment. It entails placing the embryo in the mother’s uterus. 

The procedure is performed using an abdominal ultrasound scan. The culture medium containing the embryo is positioned inside the uterus. It is a quick and painless procedure.

Embryos that have not been transferred and wish to be preserved, after vitrification, proceed to storage. After identification, they are deposited in an exclusive location in the cryogenic tanks of our laboratories. For complete security, this location is not shared with other samples, nor with other patients, to protect them from potential cross-infection or inaccuracies.

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Phase 6

10/12 days
later

Testing for positive pregnancy

Testing for positive pregnancy

13/14 days after the progesterone medication began, a blood sample is taken from the patient in order to determine if she is pregnant or not. It consists of detecting beta-hCG levels in blood since this hormone is produced by the embryo and passed on to the mother. It is the first measurable sign sent by the embryo.

If the patient is not pregnant, the medical team involved in the course of treatment assesses the causes and decides what steps need to be taken. The patient is given an appointment in order to be able to tell her about the team’s evaluation of the situation.

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Phase 7

15 days later

Pregnancy ultrasound

Pregnancy ultrasound

If the result of the pregnancy test is positive, the patient has an ultrasound scan around two weeks later. Performing this scan any earlier would lead to confusion and doubts since the results are generally not conclusive at this stage.

FIV is a highly flexible procedure. It is possible to use the patient’s eggs or a donor’s. Likewise, it is possible to use your partner’s sperm or a donor’s. This technique has made it possible for women without a partner or with a same-sex partner (Reception of Oocytes from Partner, ROPA) to become pregnant. Furthermore, FIV allows patients to take preimplantation genetic diagnosis and this way reduce dramatically the risk of giving birth to children with genetic disorders. 

Indications for in vitro fertilization

Benefits of IVF

In vitro fertilisation is the most common type of reproductive medicine treatment. It means ova can be fertilised by spermatozoa outside the woman’s body. Embryos are then transferred in order to facilitate implantation.

  • IVF is a versatile procedure. The ova that are used can be sourced from the patient or from a donor. The semen can be the partner’s semen or donor semen.
  • The technique has made it possible for single women or women in a same-sex relationship to get pregnant (ROPA).
  • It makes it possible to perform pre-implantation genetic diagnosis, a procedure that reduces the risk of giving birth to children with genetic disorders.
  • Success rates are high. (see: statistics in Instituto Bernabeu

Technology and specific treatment units

Our own cutting-edge technology and specialised professionals for every technical need:

Secondary effects and disadvantages of IVF

On the whole, patients can return to their daily routine the day after ova extraction or transfer. Rare side effects include slight bloating, increased sensitivity in the patient’s breasts, colic and constipation. 

In terms of disadvantages, it should be pointed out that there is a low risk of complications. These include ovarian hyperstimulation syndrome and multiple pregnancies. Learn more about possible IVF complications

Requirements for IVF

An analysis of the couple is performed and the quality of the male partner’s semen is evaluated. The female partner must also generate ova and be free of abnormalities in the uterus. 

At Instituto Bernabeu the fertility study is carried out in a personalized manner in order to tailor the treatment for each patient and thus optimize the result. Find out more about:

Post-cycle delayed transfer of frozen embryos:

Usually, the transfer of embryos resulting from the in vitro fertilization process was carried out in the same stimulation cycle after embryo development. However, it has been proven that in many cases this is not the most convenient for gestational nesting: the development of several follicles in the ovaries when receiving different stimulation, as well as hormonal medication, can de-structure the endometrium and disturb its implantation capability.

Therefore, in certain patients it may be indicated to freeze the embryos and postpone their transfer to a subsequent cycle (cryotransfer) once the endometrium has recovered. This strategy is increasingly used, and not only in patients with implantation failure, which is a primary indication.

TFROZEN EMBRYO TRANSFER IN NATURAL CYCLE:

The transfer can be carried out in a natural cycle by coinciding the cryotransfer after ovulation – as long as the patient has regular menstrual cycles, as her ovary will be able to prepare her endometrium in a natural way just as her uterus is prepared each month for a theoretical implantation of the embryo. Learn more.

TRANSFER OF FROZEN EMBRYOS IN SUBSTITUTED CYCLE:

The substituted or “artificial” cycle consists of performing the cryotransfer once endometrial receptivity has been optimized with the administration of estrogens and progesterone. It is indicated in anovulatory patients, with irregular cycles or without ovarian function. Although it may also be advisable in certain norm ovulatory patients. Learn more.

IVF success statistics at Instituto Bernabeu

Statistics refer to overall data and should not be extrapolated to any one particular case. It is important to keep in mind that it is essential to always establish a personalised prognosis. The data reflects statistics without PGS (CCS) and elective vitrification.
The cumulative pregnancy rate is indicated below (it refers to pregnancies achieved following the egg retrieval/collection procedure. This includes transfer of fresh embryos and a possible transfer of cryopreserved embryos when the objective is not achieved in the first transfer).

SUCCESS RATE STATISTICS FOR IN VITRO FERTILISATION (IVF) AT INSTITUTO BERNABEU 2021

Patient age
Success rate
Positive pregnancy test <35 years of age
59,1%
Cumulative positive pregnancy test <35 years of age (1 fresh transfer plus 2 cryotransfers, with no PGD and elective vitrification)
88,4%
Positive pregnancy test 35-39 years of age
45,5%
Cumulative positive pregnancy test 35-39 years of age (1 fresh transfer plus 2 cryotransfers)
87,8%
Positive pregnancy test ≥40 years of age
27,7%
Cumulative positive pregnancy test ≥40 years of age (1 fresh transfer plus 2 cryotransfers)
72,3%
Embryo quality
Success rate
Global % of embryos that reach the blastocyst stage
61,3%
Transfer performed during blastocyst stage (day 5)
89,3%
Overall % of cycles in which embryos are frozen (All age ranges are included in courses of treatment with no pgd and elective vitrification)
66,1%

SOFT-FIV

El stands as an alternative to conventional ovarian stimulation. Its goal lies in limiting the number of eggs to be retrieved and therefore alleviate the burden of the treatment for the patient without compromising the options accumulated to become pregnant. SOFT-FIV requires much less medication and, unlike traditional stimulation, cannot be injected yet. The fundamental difference with FIV is found in the ovarian stimulation stage, as the procedures that follow are similar.

The main advantages are:

  • Much less medication is needed and unlike the classic protocols, not all medication has to be injected.
  • Fewer visits to the clinic are required.
  • It produces less discomfort and side effects from ovarian stimulation as it is a lot gentler.

It is indicated for:

  • Women under 35 years of age with good ovary reserve and good prognosis.
  • Previous exaggerated ovarian response that should be avoided.
  • Patients at risk of ovarian hyperstimulation.

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