What is infertility?
Infertility is the failure to conceive or to carry to term a pregnancy. Generally speaking, for women under 35, a specialist should be consulted after one year of unprotected sex. For women 35 or over, the time to wait is 6 months and at 40 or over 3 months. Couples with known fertility problems like Polycystic Ovarian Syndrome, male factor or endometriosis should consult as soon as they want to have children.
How frequent is infertility?
Conservatively speaking, it is calculated that 1 out of 8 couples will need medical help to conceive.
Why are there more fertility clinics now than before?
Social factors have changed over the past 20 years. Before couples used to get married young and had children at a much younger age than at present. Stress, jobs with travel, both members of the couple working full-time makes pregnancy more difficult. Also society changes and many times women who have had their tubes tied or men who have undergone a vasectomy and later decide they want children again.
Has fertility decreased over the past 20 years?
There are factors that have contributed to a decrease in fertility. Smoking, alcohol and drugs can decrease sperm counts and egg quality. It is thought that pollution and food with additives also influence in fertility.
Is it true that infertility is always the woman’s fault?
This is not true. First of all, we don’t like to blame anybody. The couple has to think that this is process that they have to get through together. The woman causes infertility in 30% of the cases, men in 30% and both have problems in 30%. Ten percent are cases of unexplained infertility.
How can I know if I ovulate or not?
In a 28 day cycle, ovulation takes place around day 14. About 24 hours later, the woman’s temperature rises if ovulation has taken place. At present, pharmacies sell ovulation kits and it is possible to check and see when the best time to have sex is.
In an assisted reproduction clinic, ovulation is monitored by transvaginal ultrasound scans and checking hormone levels in blood to see if the necessary hormone surges have taken place to ovulate.
My doctor says that I don’t ovulate every month, how can I have my period if I don’t ovulate?
Most women with a regular cycle (26-35 days) ovulate every month. To have regular cycles the hormones that make the endometrium grow and mature have to synchronize with ovulation in the middle of the cycle. Patients with longer/irregular cycles (30-90 days) bodies are secreting hormones all this time so that the endometrium grows. If ovulation does not occur, the endometrium sheds spontaneously. This process causes long and irregular cycles and sometimes in these cycles there is no ovulation.
How many times should we have sex around day 14 if we are trying to get pregnant?
It is calculated that once the egg has been discharged from the ovary it survives 48 hours. During these 48 hours the couple has to have sex so the egg can be fecundated by the spermatozoa.
I am worried that I have poor egg quality. How can I know if my eggs are good or not?
The most important factor that determines egg quality is age. As women get older, egg quality decreases, in other words, fertility decreases and miscarriages increase. A poor response to ovarian stimulation, previous ovarian surgery, shortening of menstrual cycles all can indicate low egg quality.
A transvaginal ultrasound scan on the day 3 of the cycle to see the ovarian reserve, FSH, estradiol blood tests (on the 2nd or 3rd day of the cycle) can give us an idea about egg quality, but sometimes poor egg quality is only seen after ovarian stimulation for IVF. In the lab, the way eggs react to semen can be seen and how and if the egg is fertilized and how and if the embryo develops.
I have been diagnosed with a low ovarian reserve, what does that mean?
A low ovarian reserve has important consequences in fertility treatments. This does not mean that conceiving is impossible. The age of the patient is important and if she is under 38, she has greater possibilities of getting pregnant than women over 38.
However if we compare 2 women the same age, one with a low ovarian reserve and the other with a normal ovarian reserve, the woman with a low ovarian reserve has a lower pregnancy rate and more miscarriages than a woman the same age with a normal ovarian reserve. If conventional treatments fail, egg donation is always possible with a pregnancy rate close to 50%.
I have been diagnosed with blocked Fallopian tubes, is pregnancy possible?
In Vitro Fertilization (IVF) is the correct treatment for blocked tubes. When IVF is performed, the Fallopian tubes are not needed to conceive. This process consists in stimulating the ovaries, egg retrieval, and fertilization in the lab of the egg by the sperm and 2 to 5 days later embryos are replaced. In this process the egg does not have to pass through the tubes and women with blocked tubes can get pregnant.
I had my tubes tied, is there any way I can get pregnant?
Life is unpredictable and sometimes a person who thought that they didn’t want to have any more children wants children but have had their tubes tied. The easiest option is to undergo In Vitro Fertilization. In this process, first the woman undergoes ovarian simulation, then egg retrieval, fertilization of the egg by sperm in the lab and then embryo replacement 2 to 5 days later. In this process, the egg does not have to go through the Fallopian tubes and the woman can achieve pregnancy with tied tubes.
I have a vasectomy; can I be a father again?
A testicular biopsy can be performed to see if there are any live sperm. If sperm are found, the testicular tissue is frozen. Then the couple undergoes an IVF cycle with ICSI . Generally speaking, the more years that have gone by since the vasectomy was performed, the more difficult it is to find live sperm.
I have a hereditary disease, if I undergo IVF am I guaranteed that my baby will be normal?
There is an assisted reproduction technique called Preimplantation Genetic Diagnosis. This technique helps select healthy embryos to replace after an IVF cycle.
A few years ago I had cancer and I needed chemotherapy, am I going to have problems getting pregnant?
The fertility specialist will first need a note from your oncologist saying pregnancy is safe for you. Fertility tests are performed and you will be informed on the probability of pregnancy. Many times after chemotherapy egg quality is poor, but there are many cases when pregnancy can be achieved.
Are there any immediate or long term secondary effects from the meds used in fertility treatments?
Generally speaking, patients usually do not complain about side effects of the medication although a small group of patients have headaches, leg heaviness and nausea. Many times it is difficult to know if these complaints are from the meds or from the stress of undergoing fertility treatment.
Long term effects that worry us are an increased rate of breast cancer, endometrium cancer or ovarian cancer in later life. There are preliminary studies that show the long term effects of the medication do not increase the probability of having any of these cancers. We will know in a few years with more comprehensive studies if there are any important secondary long term effects.
How often do I have to come into the office during an IVF cycle?
Usually every 2 or 3 days, but sometimes more frequent office visits are required.
Will I be able to give myself the shots?
We will teach you how to give yourself shots at the clinic and the first day you can give yourself the shot with us so we can tell you how you are doing.
How many days will I have to give myself shots?
For artificial insemination between 5 and 10 days and for IVF between 7 and 14 days, but the number of days is on the average 9 days for IVF.
Why is continuous monitorization with ultrasound scan needed during fertility treatments?
Ultrasound scans are performed to assure the correct growth of the follicles where the eggs are developing and to assess the number of follicles growing. According to the ultrasound scans the dosage of the medication is increased or decreased.
When can I start IVF treatment and how long does it last?
Once the necessary testing is concluded and the adequate treatment has been chosen, treatment can begin. Sometimes we prescribe the pill a month or more before starting treatment. Other times the pill is not necessary. The injections are given on the average of 9 days for ovarian stimulation, 2 days later the egg retrieval takes place and then the embryos are replaced 2 to 5 days later.
How many fresh embryos are replaced per cycle?
At present, the tendency is to replace fewer embryos. For women under 35, in their first IVF cycle, we recommend replacing 1 and no more than 2 high quality embryos. If the embryos are low quality, 3 embryos may be replaced. For patients 35-38 and women younger who have failed to conceive in a previous IVF cycle, 2 or 3 embryos may be replaced depending on the quality of the embryos. For patients over 39, 3 embryos may be replaced depending on the embryo quality. In our clinic we try to maximize pregnancy possibilities while minimizing multiple pregnancies.
What do you so with the embryos that are not replaced in the fresh cycle?
Embryos that are not replaced are frozen. The embryos are put in a special medium with cryoprotectors. They are stored in tanks of liquid nitrogen at -196ºC..
What is the probability that the embryo will survive the frozen and the thawing?
Around 85% of the embryos survive the freeze and the thaw.
What is the probability of getting pregnant with twins?
We are more and more conservative with the number of embryos replaced because lab techniques are improving constantly, but in general 80-85% of pregnancies are singleton, 14-17% are twins and less than 1% are triplets.
Does your clinic have egg donation? Is there a long waiting list?
In our clinic, we have an egg donation program. We do not have a waiting list: the time that you have to wait is logistical because we have donors but the correct donor must be found for each recipient. Sometimes it takes a few weeks to coordinate the donor with the recipient.
Can I choose my donor?
In no case can the recipient choose the donor- this holds true for both semen and egg donation. It is against Spanish law.
Is there a higher probability of congenital anomalies in children born from frozen embryos?
No, the probability of congenital anomalies is not higher in children born of frozen embryos than children born from other assisted reproduction techniques.
Is there a higher percentage of congenital anomalies in children born of Assisted Reprosuction Techniques tan in spontaneously conceived children?
At present this question is under debate. Some scientific reports find no difference between the 2 groups of children and others find a slight increase in children who were born after Assisted Reproduction. What is unclear is if the problem is in the gametes (the eggs or the sperm) of subfertile people or if it is due to lab manipulation.
Is it frequent that the couple or one member of the couple needs psychological support during the process?
Yes, psychological help is often needed to overcome stress, anxiety and loss of hope in the future. It is important to talk about these feelings so they don’t spin out of control. Support is sometimes a vital part of fertility treatments.
Is it possible to select the sex of my child?
In Spain, sex selection is only permitted in cases of genetic disease.
Does Spanish law contemplate the possibility of surrogate mothers?
In Spain, the law does not permit surrogate mothers.
