Techniques of assisted reproduction

The assisted reproduction in Girona can be performed using different techniques. The most appropriate one in each case will depend on the disorders and circumstances of each couple.

Ovulation induction(OI)

The ovulation induction (OI) is a technique that treats mild alterations of the menstrual cycle. Undergoing a hormone treatment in low doses and with the help of the ultrasound scan it is possible to monitor the patient’s ovarian stimulation. The gynaecologist will indicate when to have sexual intercourse coinciding with the patient’s most fertile days.

Artificial examination by husband (AIH)

The objective of artificial examination is to increase the likelihood of a pregnancy by both stimulating the menstrual cycle and improving the characteristics of the husband’s semen sample. The gynaecologist monitors the ovarian stimulation with the help of a transvaginal ultrasound scan. Once the ovaries are ready, the ovulation is induced and the insemination process is scheduled. On the same day of the insemination, a semen sample from the husband is obtained and processed in the laboratory in order to select the best quality spermatozoa. Once the sperm has been selected, the gynaecologist will place it inside the uterus through a very simple and painless process that will take place in the same clinic. After 10 minutes, the patient will be allowed to leave the clinic and lead a totally normal everyday life.

Artificial insemination by donor (AID)

The preparation process for the artificial insemination by donor is the same as in the previous process but the semen sample is frozen and obtained from a semen bank (sperm donor) in Girona. This technique is appropriate for:
  • Cases of severe male factors
  • Single women
  • Women with female partners

In vitro fertilization (IVF)

In vitro fertilization (IVF) is indicated in couples with various causes of sterility: endometriosis, fallopian tube obstruction, male factors, AIH treatment failures, age factors or sterility of unknown origin. The IVF process has different stages:

1 / Ovarian hormonal stimulation

The first step is to start a hormonal treatment to induce a hyperstimulation of the ovaries which is monitored with ultrasound scan and hormone tests. When the stimulation of the ovaries is optimal a follicular puncture is performed. This first process lasts for 10 to 12 days.

2 / Follicular puncture

It is a painless process as it is performed under sedation in an operating theatre. It takes about 15 minutes. From this puncture the gynaecologist obtains the follicular liquid in which the embryologist identifies the eggs. On the same day of the puncture, a semen sample from the husband is obtained to inseminate the eggs

3 / Insemination

It is a process by which the oocytes are put in contact with the spermatozoa. This process can be performed in two different ways depending on the case. In vitro fertilization (IVF) The oocytes (eggs) obtained from the puncture are put together with an appropriate amount of spermatozoa so that the normal course of fecundation takes place.

Intracitoplasmatic sperm injection (ICSI)

With the help of a micromanipulator a single spermatozoon (sperm) is injected into an ovum (egg). The spermatozoa are obtained either through ejaculation or from a testicular biopsy in case of absence of spermatozoa in the semen.

4 / Embryo culture

On the day after the insemination the fertilised eggs are identified. They are now embryos. These will be cultivated in an in vitro culture medium in the laboratory so that they start to develop (embrionary division).

5 / Embryo transfer

On the second or third day after the follicular puncture the embryo transfer is performed. In this process, 1 or 2 embryos are placed in the patient’s uterus through the vagina with the help of an ultrasound scan. It is a short painless process which does not require any sort of anaesthetics. After the embryo transfer, the patient will have to remain in the clinic, resting for about 20 minutes, before she will be allowed to go home. It is recommendable to lead a restful life until the pregnancy test that will take place 12 days after the transfer.

6 / Embryo Cryopreservation

The remaining embryos that are not placed in the patient’s uterus on the day of the embryo transfer will be frozen. These can be used later in case the pregnancy is not achieved in the first cycle or for a later second pregnancy. The embryos will be stored in the embryo bank of our laboratory at GIREXX.

Egg reception

When the sterility is due to either the low quality of the patient’s eggs or because of the impossibility to obtain them, the only way to achieve a pregnancy is through an egg donation/reception programme. Nowadays, IVF using eggs from a donor is the ART (assisted reproduction technology) with the highest success rate, approximately 60 %. The law establishes that to all intents and purposes the egg recipient will be the legal mother of the conceived child. At GIREXX we make a special effort to make this process as simple as possible. To avoid unnecessary visits to the clinic, we have concentrated all the treatment in only two appointments.

First visit

  • Interview with the gynaecologist.
  • Assessment of the recipient’s personal and family medical history.
  • Exploració ginecològica completa.
  • Complete gynaecological examination.
  • Analysis of medical tests. A Patient’s Restricted Area is available to GIREXX patients through which you can send to us all the required documents in a totally confidential manner.
  • Detailed explanation of the donation process and the tests performed on donors.
  • Information about the treatment (synchronisation with the donor).
  • Seminogram and semen cryoconservation.

Second visit

  • Embryo transfer: In this process, 1 or 2 embryos are placed in the patient’s uterus through the vagina with the help of an ultrasound scan. It is a short painless process which does not require any sort of anaesthetics.
In some cases (double donation, embryo adoption …) when foreign patients with up-to-date gynaecological checkups already have all the required medical tests, the whole process can be performed in only one visit to the clinic.

Frozen embryo transfer

The objective of this technique is to attempt a new pregnancy with a single IVF cycle. It is also available for couples in our embryo donation programme. Before the embryo transfer the patient will have to follow a simple hormonal treatment to make the uterus especially receptive. The embryos will be thawed and cultivated in a culture medium for a few hours before the transfer. Some of the frozen embryos will inevitably be lost during the thawing process. The Embryo transfer is a short painless process which does not require any sort of anaesthetics. After the embryo transfer, the patient will have to remain in the clinic, resting for about 20 minutes, before she will be allowed to go home. It is recommendable to lead a restful life until the pregnancy test that will take place 12 days after the transfer.

Donated embryo reception

This technique is recommendable for patients whose sterility cause makes it impossible to obtain their own viable embryos. In this process, the embryos come from couples who own frozen eggs from a previous IVF cycle and who authorise their donation because they have fulfilled their wish of a pregnancy. Before the embryo transfer the patient will have to follow a simple hormonal treatment to make the uterus especially receptive. The embryos will be thawed and cultivated in a culture medium for a few hours before the transfer. This is a short painless process which does not require any sort of anaesthetics. After the embryo transfer, the patient will have to remain in the clinic, resting for about 20 minutes, before she will be allowed to go home. It is recommendable to lead a restful life until the pregnancy test that will take place 12 days after the transfer.

Preimplantation genetic diagnosis(PGD)

Preimplantation genetic diagnosis is a technique that combined with in vitro fertilization enables doctors to diagnose genetic and chromosomal disorders in the embryos before they are transferred into the patient’s uterus.

Who can benefit from a PGD?

  • Patients with genetic disorders and who want to prevent its transmission to the foetus.
  • Carriers of translocations, inversions and other chromosomal disorders.
  • P Infertile patients who have had miscarriages repetitively.
  • Patients with implantation failures in previous IVF cycles.
  • Patients over 35 years of age who have already undergone IVF treatments with more than 3 embryo transfers and with repetitive implantation failures.
  • Carriers of oncogenes (BRCA I, II, etc…) who want to prevent their transmission to the foetus.

How is a PGD performed?

After an IVF cycle, a PGD is carried out by performing an embryo biopsy when it has a size of 7 or 8 cells. The extracted cell is studied to determine whether it is affected by the suspected genetic abnormality. After this process, only healthy embryos will be transferred into the patient’s uterus.