FIRST VISIT
During the first visit, Fertty’s medical team evaluates the couple’s reproductive medical history. In this session, the tests already performed are reviewed and new tests are requested if necessary. The most common necessary tests in women are analytical tests to measure the FSH hormone concentration on the third day of the cycle and the concentration of the Anti-müllerian Hormone, as well as the count of antral follicles by ultrasound (follicles that can give rise to an egg). There will also be a transvaginal ultrasound. All these data are used to design a personalised follow-up of each case.
The donated semen sample will also be requested according to the phenotype characteristics of the couple or the patient.
OVARIAN STIMULATION
Normally women produce only one egg during a menstrual cycle. To optimise the chances of obtaining viable embryos, Fertty’s medical team administers hormonal medication to the woman providing the eggs by means of injections so that several eggs are produced in the same cycle.
This process lasts between 8 and 11 days, during which ultrasound and sometimes analytical controls are performed in our centre. Once the ovarian follicles have reached a size which indicates that the eggs are mature, a final injection of hCG (Gonadotropin hormone) is given to induce ovulation.
OOCYTE RETRIEVAL
Just 36 hours after the last hCG hormone injection, the eggs can be aspirated into the ovary. To do this, a small puncture is made through the vagina. The medical team attaches a needle to the transvaginal ultrasound machine, and in this way guides it to the ovary, where a gentle aspiration is performed to retrieve the available eggs. The process lasts about 20 minutes during which time the patient is mildly sedated for their comfort.
At the same time, the previously allocated sperm bank sample will be thawed and processed in the laboratory for the insemination of the eggs.
Before leaving the centre, the couple are informed of the number of eggs collected. The mother will also be instructed to begin progesterone treatment to improve the chances of the embryo attaching to the uterus.
EMBRYONIC DEVELOPMENT
Fertty’s team of biologists attaches the egg to the sperm so that fertilisation occurs spontaneously. In cases where fertilisation failure is suspected, a sperm is manually introduced into the egg. This procedure is known as Intracytoplasmic Sperm Injection (ICSI).
EMBRYO SELECTION
Our team of embryologists regularly monitors the embryo or embryos obtained to check that they are developing properly and that their cells divide properly over a period of 3-5 days.
The speed of division, the number of cells and their symmetry allows our team to select the highest quality embryos so that pregnancy can occur. If the woman has a genetic disease, repeated miscarriages, or age-related infertility, consideration may be given to the possibility of performing a Pre-implantational Genetic Diagnosis (PGD) to select the healthiest embryo. During this process our Fertty team of biologists keeps the couple or patient informed at all times of the evolution and care of the embryo.
EMBRYO TRANSFER
Three to five days after egg retrieval, the embryo or embryos are transferred into the uterus of the recipient mother. This simple procedure is performed in our laboratory, using a catheter to introduce the embryo or embryos through the cervix. This technique does not cause any pain and does not require anaesthesia. The woman is able to leave the clinic within a few minutes, and she is able to carry out normal activity from the following day onwards.
Pregnancy actually occurs when implantation of the embryo in the uterus is confirmed. Embryos that are not transferred will be frozen for future occasions.
AFTER THE TRANSFER
To help implantation to occur, progesterone continues to be administered to the patient for a further two weeks. In addition, a blood pregnancy test is performed a few days after the embryo transfer. If this test is positive, progesterone is continued until our medical team confirms the pregnancy by ultrasound, another two weeks or so later.
If pregnancy is not confirmed, the couple will decide together with their gynaecologist to start a frozen embryo transfer or repeat a new IVF cycle, depending on the case.