In general terms, it is considered that 90 percent of fertile couples seeking a child, achieve pregnancy within a year, that is why it is recommended not to consult before 12 months. After a year of not achieving pregnancy, it is recommended to visit the specialist since it is likely that there is a disorder that causes infertility.
However, when the woman is over 35 years old, it is recommended that she consult the specialist if she does not achieve pregnancy in six months of searching.
It is recommended to expedite the consultation if there is a history in one or both spouses of fertility problems, such as irregularities in the menstrual cycle in women, painful menstruation, history of abdominal surgical operations in women, or mumps with inflammation in the testicles, testicles not descended at birth, blows in the inguinal area, in the male.
In many cases, the current lifestyle, in which couples are established at older ages or women who prioritize their professional career, are the factors that delay the decision to seek pregnancy and this happens at the moment in which the Natural fertility begins to decline.
The biological cause of the infertility can reside in the woman, in the man or in both. To determine this, it is necessary to perform medical and laboratory tests. In any case it is advisable that both spouses attend the consultation for a better understanding and mutual support.
Through medical examinations it will be possible to determine if:
The woman ovulates regularly in the middle of the cycle.
Man produces sperm in sufficient quantity in the ejaculates. The woman has healthy tubes that can capture the ovum and allow it to be fertilized.
The uterus is normal and healthy, so that the embryo can be nested and gestated for 9 months.
It is also recommended to immediately consult the specialist if a spontaneous abortion occurs for the second time, regardless of the woman’s age
It is essential to conduct studies in the couple to find the probable cause of infertility. This diagnosis will allow to establish the appropriate treatment. This first stage of studies should not require more than a month.
To understand the possible causes of infertility, it is necessary to know the process of reproduction:
The man to ejaculate in the vagina of the woman, deposits his sperm near the neck of the uterus, where they will then ascend. At the moment in which the woman ovulates a characteristic mucus is produced that serves to protect them in their migration to the cavity of the uterus and then to the Fallopian tube where they will find the ovule to fertilize it.
They are, in turn, several factors that allow conditions to be given in ovulation: at the beginning of the cycle on the first day of menstruation, the pituitary gland releases a hormone called FSH, which makes the follicle of the ovary grow. This, in turn, releases estrogen that favors the production of cervical mucus and the preparation of the endometrium to nest the blastocyst.
In the middle of the cycle the follicle reaches its maximum development and the pituitary releases another hormone, called LH, which is responsible for finishing the maturation of the oocyte and blowing up the follicle to release it. The oocyte will then be captured by the fallopian tube, where it will await fertilization. When the oocyte is penetrated by the sperm, it completes the formation of the ovule and fertilizes it. The first stages of the egg occur in the tube and continue its way to the uterine cavity, where it will be implanted six or seven days after the blastocyst has hatched.
When the follicle bursts, releasing the oocyte, it becomes a gland called the yellow body, which produces progesterone, a hormone necessary to maintain pregnancy until the formation of the placenta, which will continue to maintain pregnancy. There are many causes that can alter the reproduction process: the absence of sexual relations in the fertile period of the woman, an adverse mucus, the lack of ovulation, the absence or obstruction of the fallopian tubes or an altered uterine cavity that prevent the implantation and development of pregnancy. In males, sperm are produced in the seminiferous tubules of the testes. Its development is controlled by the release, by the pituitary gland, of two hormones: FSH and LH. Once the sperm are produced, they are stored in the epididymis, where they complete their maturation
Once mature, they pass to the seminal vesicles and to the prostate, through the vas deferens, whose fluids contain nutrients and enzymes to protect them and form part of the ejaculate. The ejaculate propels the sperm through the vas deferens and sends it to the urethra, to be then deposited in the vagina and from there ascend to meet the egg in the tube and produce fertilization
Failures in the process of sperm production, can result in a low number of sperm in the ejaculate or poor quality of sperm, which fail to reach the oocyte to fertilize
It is a complete checkup that begins with a detailed history of personal and family history that will allow to detect a history of infertility. For what it will be required to know the age of beginning of the menstruations, its rate, suffered illnesses, surgical operations if there were them, the sexual and affective history of the couple.
Through a gynecological examination, alterations that could prevent pregnancy, from the absence of organs, to malformations in the vagina, cervix and uterus, will be ruled out.
If the woman has regular cycles between 25 and 35 days with a simple calculation of subtracting 14 she can know the most likely day of ovulation. Therefore it is recommended that three or four days before and after the probable date of ovulation have at least one sexual relationship without a condom. In this way the oocyte is prevented from aging before being fertilized and the sperm have not started with the process of apoptosis that occurs with prolonged ejaculatory abstinence.
Complementary exams are also carried out, such as:
Insemination test: the couple must have sex in the middle of the cycle. Between 2 and 20 hours later, a drop of mucus from the cervix will be extracted with a pipette to be observed under a microscope. At least five mobile sperm should be found per field.
Laboratory tests: Hormonal dosages: Follicle stimulant FSH, Luteinizing LH, Prolactin Prl, Estradiol E2, Inhibin B, antimullerian hormone HAM, thyroid profile to see if there are abnormal concentrations of thyroid hormones: Thyrotrophin TSH, Triiodothyronine T3, Thyroxine T4, Antibodies anti microsomal fraction AFM. Androgen dosages: Dihydroepiandrosterone DHEA and testosterone T. Hysterosalpingography: an x-ray of the female genital tract that allows us to appreciate the uterine cavity and the tubes. It does not require anesthesia, although it can cause some discomfort. It is performed with an empty bladder, after placement of a speculum, the cervix is canalized with a catheter and a visible substance is injected to the X-rays. X-rays are then taken to demonstrate the filling of the uterine cavity and the passage to through the fallopian tubes and their exit. This test is done in the first half of the menstrual cycle, after the menstrual bleeding stops.
Hysteroscopy: it allows to examine the uterus and in case of confirming any abnormality, it is possible to correct it surgically at that moment. It is usually done under general or local anesthesia
An optical fiber is used that is introduced into the uterus vaginally. Always when removing the hysteroscope, an endometrial biopsy is taken to confirm if the day of the menstrual cycle matches that reported by the patient. During hysteroscopy, polyps can be corrected, a septum (piece of tissue that divides the uterus) and fibroids (tissue in the wall of the uterus). After the procedure, patients usually experience a discomfort that quickly results in medication.
Falloscopy: is a specialized technique used to examine the internal light of the fallopian tubes. It is done under anesthesia and an optic fiber is placed in the tube vaginally.
Laparoscopy: allows to inspect the inside of the abdomen and the internal genital apparatus. It is performed under general anesthesia, the abdomen is insufflated with carbon dioxide, to separate the organs and make them more visible. It is a minor surgical procedure that requires an incision to place the optical fiber and another to place an auxiliary hand in case of wanting to repair abnormalities. It allows to visualize the tubes, uterus and ovaries and perform biopsies, suction adhesions, electrocoagular foci of endometriosis, etc. It is completed with the introduction of a vaginal dye to detect blockages.
Endometrial biopsy: performed in the office and involves removing a small sample of endometrium (glandular tissue that covers the inner walls of the uterus). It serves to diagnose ovulation and to know if the hormonal levels of the second half of the cycle coming from the yellow body are sufficient to maintain the pregnancy initially. It also helps to know if the uterus is free of infection or inflammatory reaction.
Once the specialist arrives at the diagnosis of the cause of the infertility, the next step is to look for the medical solution, this may require a surgical treatment or an assisted fertilization.
Treatment of ovulation: one of the most frequent disorders is the failure of ovulation that is revealed by the hormonal dosages and the endometrial biopsy. The use of ovulation inducers is then indicated to produce it. The most commonly used are clomiphene and human gonadotrophins. These hormonal treatments must be rigorously controlled with clinical, laboratory and ultrasound exams.
Hostility of the cervical mucus: in the cervical mucus that the woman produces in the middle of the cycle, the spermatozoids improve their quality, then ascend until reaching the tube and fertilize the egg. For infections or hormonal dysfunction, the mucus can be altered and become hostile to sperm. In case of infections, a germ culture and an antibiogram will allow to detect the nature of the infection and determine the appropriate antibiotic. Sometimes the woman may have an allergic reaction to the semen and produce antibodies that attack the sperm.These cases are treated with corticotherapy, while the sexual relationships with condoms allow to reduce the concentration of antibodies
Endometriosis: is the presence of islets of endometrium in places where they normally should not exist, such as, for example, fallopian tubes, ovaries, ligaments, vagina, etc. These endometriotic foci, like the normal endometrium, suffer the modifications imposed by the hormones, bleeding periodically and producing inflammation with the consequent fibrosis of the affected area, thereby altering the mobility and texture of the tubes, ovaries, etc. and preventing ovulation, fertilization and nesting. The treatment can be medical, with the administration of hormones that atrophy and make disappear the endometriotic foci, or surgical, which consists of its fulguration or extirpation.
Surgical treatment of peritoneal tube factor: in those cases in which tubal obstructions, previous infections or previous operations are verified, surgical techniques of adhesion release (adhesiolysis) or microsurgeries are performed to treat the tubal blockages so that they return to be permeable
Start with a thorough history of personal and family history. Therefore it is important to know, for example, if the patient had mumps with inflammation of the testicles, hernias, testicles not descended at birth, traumas in the area, diabetes, urogenital infections, work environment, if you are a smoker, drinker, etc. You should also inquire about sexual aspects.
In addition, the physical examination is very important, it will allow to verify minimal alterations not previously diagnosed, such as the size of the testicles, the consistency, the presence of varicoceles, etc.
The complementary exams include:
Spermogram: is the basic test with which the studies and treatments in the male are initiated and controlled. It serves to know the amount of sperm, its mobility and morphology. It also provides information on the seminal vesicles and the prostate.
Semen is considered normal when it has:
- More than 15 million sperm in a cubic centimeter.
- At least 39% of progressive sperm
- At least 4% of sperm with normal shape and size.
Semen is considered abnormal when it has:
- Absence of sperm: Azoospermia.
- Decrease in the number of sperm: Oligozoospermia.
- Decreased mobility: Astenozoospermia.
- Alteration of the morphology: Teratozoospermia.
- Alteration of the three parameters: Oligoastenoteratozoospermia
In case of Azoospermia, it should be recorded if the ejaculate was centrifuged at 2,000 g.
Seminal plasma biochemistry: It informs the functionality of accessory sex glands. The determination of citric acid for the evaluation of the prostate, that of fructose for the evaluation of the seminal vesicles and that of L-Carnitine for the epididymis.
Presence of leukocytes: The peroxidase test is used to differentiate round cells from semen. The leukocytes are positive peroxidase, while the immature germ cells and the male genital tract are negative peroxidase. It is considered leukocytospermia to more than one million leukocytes per milliliter indicating a probable infection.
Microbiological studies: Study the presence of common bacteria, gonococci, mycobacteria, mycoplasmas and chlamydia. In case of infection, antibiotics are indicated to the couple.
Testicular biopsy: It is a minor intervention that consists of a small incision to extract a piece of testicular parenchyma to be studied histologically or genetically. The histological study shows the conformation of the seminiferous tubules, their diameter, the thickness of the tubular wall, the germinal epithelium and whether the spermatogenesis is complete. The genetic study will allow to verify the chromosomal constitution of spermatogonia, primary and secondary spermatocytes
Sexual chromatin test: it is usually performed with the scraping of the buccal mucosa. It serves to detect the number of X chromosomes that a male has. The normal male has negative sexual chromatin. Approximately 15% of males with azoospermia have positive sexual chromatin.
Study of the karyotype: It serves to know the chromosomal constitution of the individual. As there is a relationship between the severity of the spermogram and chromosomal abnormalities, its determination is important in males with abnormal semen of idiopathic cause. It is usually done in peripheral blood lymphocytes
Chromosome study of sperm: When the male has an abnormal spermogram, especially those who have very few sperm and poor functionality, it is convenient to know their chromosome constitution prior to treatment in order to know the reproductive genetic risk and act on consequence.
When the male has a normal karyotype in blood, chromosomes 13, 16, 18, 21, 22, X and Y are usually studied. On the other hand, when the karyotype in blood shows a balanced rearrangement between two or more chromosomes, in addition to the Chromosomes mentioned must be studied to those involved in the chromosomal rearrangement.
Especially indicated to know the risk of abnormal sperm formation in males with chromosomal rearrangements
At present, there is the possibility of carrying out the molecular karyotype of spermatozoa with both aCGH and NGS techniques.
Study of azoospermia genes (AZF): It is the molecular study of a family of genes, located in the long arm of the Y, which are associated with the spermatogenic process. Up to 30% of severe Azoospermic or Oligozoospermic males with normal karyotype have microdeletions that are associated with abnormalities of spermatogenesis
Study of mutations of the CFTR gene: Males with abnormal spermograms are more likely to be carriers of mutations of the CFTR gene of cystic fibrosis. 80% of men with azoospermia of the obstructive type or by agenesis of the deferent are carriers of mutations of the aforementioned gene that generally have good sperm production but the disadvantage is that they can not ejaculate.
These males currently with the aspiration of epididymal or testicular sperm can have genetic offspring. As most men with bilateral agenesis of deferent are carriers homozygous or heterozygous for some of the mutations of cystic fibrosis and given the high frequency of these mutations in the Caucasian population it is convenient to analyze these mutations in the male and in your partner to know if the couple is at increased risk to have children with that pathology. In case of having higher risk, they could resort to the genetic diagnosis of the embryos before being transferred
Study of CGT triplet repeats: CGT triplet repeats are expanded in myotonic dystrophy, which is an autosomal dominant genetic disease, therefore, the affected are both women and men and the risk of transmission for the offspring is 50% .
The frequency of this mutation is relatively high: one every 80 of the general population. Affected males are characterized by having abnormal spermgrams. If these men are helped with the ICSI procedure they could benefit from the genetic diagnosis of the embryos prior to their transfer
Study of the repeats of the triplet CAG: The males with expansion of the triplet CAG linked to the X chromosome have the risk of transmitting it to 50% of their daughters. In contrast, males as they inherit the Y chromosome from the father are not at risk.
Because male carriers are characterized by having abnormal spermgrams, asserting or ruling out such expansions could prevent future grandchildren from their daughters from having Kennedy’s disease if they resort to the genetic diagnosis of the embryos prior to their transfer.
Hormonal endocrine profile: The hormones FSH, LH, TESTOSTERONE, E2 and thyroid profile, allow to know the hypothalamic-pituitary-gonadal axis
Immunological studies: The presence of immunoglobulins A, G and M on the surface of the sperm can cause infertility. IgA antibodies are produced locally in the genital tract of the male as in that of the female, while IgG and IgM are circulating.
When these antibodies exist, they bind to the surface of the sperm and hinder their mobility, penetration into the cumulus, in the zona pellucida of the oocyte, in the egg-sperm interaction, in fertilization, as well as in the destruction of sperm by the immune system
Doppler study: Determines the direction of venous flow. It is useful in the diagnosis of varicoceles.
Defecto-vesiculografía: It is used to evaluate the permeability of the vas deferens and the state of the seminal vesicles. It is indicated in the suspicion of obstruction of spermatic pathways
Transrectal ultrasound: it is useful in the study of the prostate and patients with small volume of ejaculate.
Semen processing for mobile sperm recovery: Fundamentally there are two methods: swim-up and gradient migration of Percoll (swim down). Both procedures indicate the functionality of the sperm and are used therapeutically in inseminations in vivo or in vitro
The quantity and / or quality of the sperm can be insufficient for various reasons that can be treated with hormones, medications, surgical corrections or assisting with fertilization. As in women, hormonal treatments should be controlled by the specialist.
Surgical correction of the varicocele: The varicocele consists of a varicose dilation of the venous plexus that surrounds the vas deferens, which receives blood from the testicle and the scrotal sacs. These dilatations cause a local increase in temperature that can interfere with the quality and quantity of sperm
This pathology is surgically corrected to abolish this varicose vein. It can be done on an outpatient basis by laparoscopy or with traditional or microsurgical surgical technique under general anesthesia. One year after varicocele ligation, an improvement in the quality and quantity of sperm occurs in almost 60% of patients.
Vasovasostomy and epididymovasostomy: The sperm produced in the testes may be unable to reach the urethra to be ejaculated. This may be due to an obstruction of the vas or an obstruction in the union of the vas deferens with the epididymis. Obstructions along the vas can be corrected microsurgically with the technique called. During surgery, a dye is injected into the vas and with X-rays the position of the obstruction is visualized. In both procedures, sperm can be collected and frozen. If, after surgery, the ejaculate is not good enough to achieve a pregnancy, the thawed semen can be used to fertilize the ovules using special techniques
Sperm aspiration: It is a technique to collect sperm from the vas deferens, the epididymis or the testicle, in case of obstructions, degenerative agenesis or in secretory azoospermia, respectively.
Once the sperm are collected, fertilization will be achieved with ICSI (intracytoplasmic sperm injection). The aspiration is performed under anesthesia, with a gentle suction with a needle, in an ambulatory manner or during a surgical procedure of vasovasostomy or epididymovasostomy. Each sample is examined under a microscope to verify the presence of sperm and can be frozen and processed later. If sperm are not obtained with aspiration, a sample of testicular tissue may be taken. The disintegration of the tubules will allow to obtain immature spermatozoa, which can mature in vitro for a few hours to be used later with the ICSI.
When we think about infertility, we place the biological in a relevant place. We know that important technological advances in the service of assisted reproduction try to reverse or avoid the failures of bodies that do not manage to get pregnant. Now, becoming parents, conceiving a “child”, goes beyond bodily functions
Desire, as a search engine, gives rise to filiation, in which psychic and cultural aspects intervene. So when pregnancy does not occur, a series of emotions and affections linked to sadness, disillusion, which in some cases reach feelings of frustration. The way through new reproductive technologies, imply a particular way of becoming a father and mother.
The emotional and affective disposition is very important; Even patients are often faced with decision-making on novel issues
The current procedures propose alternatives on which we must reflect, avoiding prejudices, ambivalences and questions. Parallel to the search for pregnancy, expectations, illusions and disappointments arise. The rhythm according to the biological processes, implies following the times that mark the cycles of ovulation or follicular development, which promote a speed that differs from that of the psychic processes.
The incorporation of psychologists specialized in fertility within the framework of the institution, promotes the interdisciplinary approach that favors the psychophysical integration of the patient. The activities proposed by the psychological team tend to promote spaces of exchange in order to put words to the experiences that are going through, providing support and support to accompany the desire to become parents.
Much has been published about how male age influences the achievement of pregnancy naturally without medical help or assisted reproduction. There are scientific articles that show a decrease in the quality of semen and less chance of pregnancy as the age increases, and others that do not find any relationship, that is, the quality of the semen does not decrease with the age of the male, nor the age of the semen. The male influences the results of assisted reproduction, both in the possibility of achieving pregnancy and in the percentage of abortions. Therefore, men, even though they are over 40 years old, have the same chance of getting pregnant as young people. As for natural pregnancies, it should not affect either, but it happens that older men have other problems, such as erectile dysfunction, among others, that it would affect sexual relationships, but not the possibility of pregnancy because sperm they do not change with age.
Unlike the male, the quality of the oocytes greatly influences the achievement of an evolutive pregnancy.
The difference is that the woman is born with a certain number of follicles with their ovocytes configured from the intrauterine life, which mature in each cycle, which can lose the embryogenic capacity with the passage of time. On the other hand, the process of sperm formation is always continuous and four spermatozoa originate from a mother cell in a period of 75 days. Therefore the age of the sperm do not have the age of the male, whereas the oocytes do have the age of the woman.
Oocytes with increasing age are more likely to have an abnormal number of chromosomes
In contrast, the production of sperm with an abnormal number of chromosomes is always constant and not greater than 1 percent, while in women it increases every year and in the 40 reaches 75 percent
At what age should sperm freeze for future paternity?
Although there is no increase in the percentage of aneuploid sperm with increasing age, it is convenient before age 40, because of the increased chances of mutations in the stem cells that cause sperm
Between 15 and 20 percent of pregnancies of women under the age of 35 result in spontaneous abortions. As the age increases, the risk of this happening also increases: in 40-year-old women, approximately 50 percent of pregnancies end with a miscarriage.
In turn, the risk of losing the pregnancy is greater when it occurs repeatedly. For example, every woman under the age of 30 has a 16 percent risk of losing her first pregnancy, but the risk will be 17 percent if she tries her second pregnancy after losing the first one. For the third pregnancy the risk will be 38 percent.
As this risk is so high, it is advisable to study the couple after two abortions, regardless of the woman’s age.
There are two major causes in recurrent abortion, one is pregnancy poorly generated by a chromosomal abnormality (genetic cause), which selectively slows its development. Most losses occur before the ninth week.
To know if an embryo is poorly constituted, the aborted product should be studied chromosomally. If this is not possible, the couple’s karyotyping is a valid alternative because what matters is whether the couple has a higher risk of generating poor quality pregnancies and if they have a chance of normal pregnancies.
The other major cause of recurrent miscarriage is the environment in which the pregnancy develops. Hormonal, anatomical, infectious and immunological problems can lead to pregnancy loss.
Immunological cause of the lack of implantation and loss of pregnancy: may be due to an abnormal immune response of autoimmune or alloimmune type
Since pregnancy represents a mixture of chromosomes, originating half of the mother and the other half of the father, women with autoimmune disorders can reject pregnancy, this is because they reject their own proteins. In contrast, in the alloimmune disorder, the mother rejects the proteins produced by the genetic contribution of the husband
Both types of disorders can be detected with blood tests. The autoimmune disorders in women are discarded with the determinations of antibodies: antiphospholipids, antithyroid, antinuclear and lupus anticoagulant.
Alloimmune disorders with the detection of blocking antibodies, of the natural killer cells and with the embryotoxic test
If any positive antiphospholipid antibody is detected in the woman, it indicates that it could have a risk of miscarriage, second trimester loss, intrauterine growth retardation, or preeclampsia.
In addition, these women may have endometriosis, premature ovarian failure, repeated failures of F.I.V. or unexplained infertility. With appropriate treatments, the rate of successful births increases 70 or 80 percent.
Treatments of immunological factors
Autoimmune: includes Heparin between 5,000 and 10,000 units every twelve hours subcutaneously, Aspirin 100 mg / day and Prednisone 40 mg / day. Another successful option is intravenous immunoglobulin therapy, which is very effective but expensive.
Alloimmune: Blocking antibodies: women with alloimmune problems may not recognize pregnancy or develop an abnormal immune response.
To avoid recognizing pregnancy as a stranger, you must make blocking antibodies. These antibodies react specifically with the antigens of the genetic material of the father of the developing embryo, protecting it
Women who do not have blocking antibodies can be immunized with white blood cells of the husband or with immunoglobulin administration or immunized twice a week with seminal plasma eggs of the husband from before conception until 28 weeksNatural Killer: natural killer cells produce a substance called TNF (tumor necrosis factor), which is toxic for the development of the fetus
Therefore, patients with high levels of these cells are at risk of implantation failure and abortion. The proportion of these cells is determined by determining the reproductive immunotype (RIP) by investigating the CD56 + marker.
Patients with high activity respond very well to intravenous treatment with immunoglobulin Ig IV.
Embryotoxic test: blood cells produce cytokines, some of which stimulate cell growth and others inhibit it
The embryotoxic test is aimed to detect cytokines that inhibit embryonic growth. Treatment with 500 mg / kg body weight per month of immunoglobulin IVIG from preconception to 28 weeks of pregnancy can be effective.
When the woman produces an exaggerated number of good quality eggs and the male produces a good quality semen, the number of ovules can be limited to inseminate, to avoid the risk of multiple pregnancies. There is the possibility of cryopreservating the ovules that are not inseminated, then thawing them and
use them in other cycles.
When the woman produces an exaggerated quantity of oocytes whose quality is doubtful, or, the man produces a semen of doubtful quality, so the number of oocytes that fertilize can not be predicted, all the aspirated ovules are inseminated and if, exceptionally, it
It obtains an important number of fertilized eggs, these can be cryopreserved to be used in later cycles.
They can be frozen in different stages: from pronuclei to blastocysts. The survival rate once thawed depends on the stage at which they were frozen. If it was in pronuclei it is 50 percent, whereas in blastocysts it is almost 100 percent.
The pregnancy rate with defrosted blastocyst blastocysts is very good, being equal or superior to that achieved with fresh blastocysts.
In any case, cryopreservation will be a decision of the couple.
La donante de óvulos puede ser conocida o anónima. Debería tener menos de 35 años y no tener ni enfermedades de transmisión sexual ni antecedentes genéticos relevantes. Los óvulos donados son inseminados con el semen del varón de la mujer receptora. Los huevos fecundados serán transferidos en la mujer receptora que desea obtener el embarazo, previa preparación de su endometrio para que se puedan implantar los embriones.
En caso de que los dos miembros de la pareja no produzcan gametos podrán acceder a la donación de óvulos y de espermatozoides o bien recibir embriones descongelados en donación, provenientes de las parejas que desisten a su transferencia, pero en nuestro país todavía no se puede efectivizar hasta que se regule la ley de FIV.
La principal característica de nuestro programa de ovodonación es que las donantes son mujeres sanas, fértiles y menores de 30 años, que fueron chequeadas previamente desde el punto de vista infectológico y genético. Las mismas son voluntarias y se comprometen a donar su material en forma anónima, por lo que no conocerán la identidad de la receptora, como tampoco la receptora conocerá a la donante.
Las donantes son seleccionadas de acuerdo con las características físicas de la receptora, por lo tanto se tienen en cuenta la talla, la contextura
Como las donantes son mujeres jóvenes y fértiles la tasa de embarazo es muy buena, del 80 por ciento o más. Todos los óvulos son destinados a la receptora y si se obtuviera un excedente de embriones, los mismos se pueden congelar para una transferencia posterior y así tener más descendientes con el mismo material genético.
El programa de espermodonación es relativamente más sencillo, debido a que los espermatozoides se pueden congelar y la pareja no necesariamente debe recurrir a una fertilización in vitro, excepto que la mujer no tenga las trompas permeables.
Fecunditas cuenta con un banco de semen que está conformado por donantes voluntarios sanos, jóvenes, fértiles y chequeados genética e infectológicamente. De esta manera, si la mujer es fértil, se precisa el momento de su ovulación y es inseminada con el esperma descongelado elegido de acuerdo con las características físicas del esposo.
Al igual que en la ovodonación, la pareja puede conservar el mismo material genético para futuras inseminaciones.
Cuando ambos miembros no producen gametos, podrían acceder al programa de embriodonación. La finalidad es lograr embriones a partir de gametos de donantes concordantes con la pareja receptora.
The two main complications are ovarian hyperstimulation and multiple pregnancies.
Ovarian hyperstimulation occurs when the response to injections to stimulate egg production is much greater than normally expected. Symptoms usually begin 3-5 days after aspiration. The picture can be mild, moderate or severe.
The latter form occurs in less than 1 percent of stimulated patients. Patients with this condition manifest abdominal discomfort and nausea. When it is more severe they may have respiratory problems and anuria
As the picture could be aggravated by pregnancy, it is advisable that they not be transferred in that cycle.
The obtained embryos are frozen and transferred in another cycle.
Regarding multiple pregnancies, these are increased due to the transfer of more than one embryo, which is currently justifiable only in cases where the quality of the embryos originated does not allow selecting the best ones. If you can select what is advisable, do not transfer more than two. The day of the transfer is also very important. On day 2 or 3 you can transfer up to two, but on day 5 the recommended thing is a single blastocyst, due to the greater possibility of twinning.
- Basal temperature
- Post-coital test
- Anti-sperm antibodies
- Endometrial biopsy
- Follicular ultrasound
- Thyroid profile
- HAM antimullerian hormone
- Induction of Ovulation
- Laparoscopy and surgical correction
- Hysteroscopy and surgical correction
- Conventional medical-surgical andrological treatment
- Inseminations with husband and / or donor semen
- Genetic study
- Immunological study
- Study of genetic and acquired thrombophilias
- In vitro fertilization (IVF)
- In vitro micro-fertilization (ICSI)
- Assisted Hatching or Assisted Hatching
- Preimplantation Genetic Diagnosis
- Subrogated uterus
- Donation of ovules / sperm / embryos
The fundamental objective of the evaluation at the basic level is to know if the woman ovulates, if she has the permeable tubes and if the uterus can gestation at term of the pregnancy and if the man produces a semen of good quality. If the evaluation is normal, the days of greatest fertility will be indicated. Failure to achieve pregnancy after 3/5 cycles will go to the level of greatest complexity (inseminations).
Specific treatments will be implemented according to the diagnosis. Failure to achieve pregnancy after 3 cycles will go to the level of high complexity (Assisted Reproductive Technology).
If the basic evaluation in the woman was normal and that of the husband abnormal, the same will be referred to the andrólogo for corresponding medical treatment or will go to the techniques of assisted reproduction of high complexity.
The purpose of the specific and / or empirical treatment is always to reverse the infertility condition and give the couple a chance similar to that of fertile couples. But not all fertile couples achieve pregnancy in the cycle they try.
The pregnancy rate per cycle is around 20 percent and the cumulative rate of pregnancy after one year is 90 percent, meaning that those who are lucky will achieve it in the first months. Something similar happens with fertility treatments
Before making the decision to attend a certain center, it is advisable to obtain as much information as possible about the center’s trajectory, the suitability of the professionals, the availability of services, experience with the different methodologies, pregnancy rates and of births, costs and finally evaluate if it suits you or not.
Credibility is very important. Since Fecunditas opened its doors in 1989 with the clear objective of providing its patients with the most modern tools of science and the best emotional containment to achieve the desired dream of having a child; the institute stands out in all the benefits related to the counseling, diagnosis and treatment of women, the man or the couple with reproductive problems becoming a center of reference in our country and Latin America.
This is because their mentors were pioneers in In Vitro Fertilization in Argentina in the 1980s. These same professionals were also responsible for the creation of the first semen bank in the country and the Preimplantation Genetic Diagnosis program for gene and chromosomal diseases.
More than twenty years later, they constitute the group of specialists with the most experience and experience in highly complex assisted reproduction.
Given the complexity of new reproductive methodologies, bioethics emerges as a space for interdisciplinary reflection about the values that come into play in the different dilemmatic situations that arise. It is not only the technological progress that seems irrepressible, the one that promotes a bioethical reading, but rather the social demands unthinkable until now, which encourage a deeper analysis.
Faced with this reality, Fecunditas decided to convene by the end of 1998 professionals from outside the institution interested in the subject to form in 1999 the first Bioethics Committee dedicated exclusively to the problem of human reproduction in the country.
This interdisciplinary space of ethical reflection fulfills a triple function:
Consultative: Analysis and guidance on dilemmatic cases that are presented to the consultation.
Educational: Internal and external training “educate outwards”, that is, the reproduction centers, the relevant professional associations and society in general on bioethical issues. This involves providing knowledge, developing skills and fostering attitudes.
Regulations: Projection of certain institutional norms that indicate courses of action in case of similar dilemmatic cases.