Treatments & Prices
Reproductive Surgery
When a couple seeks for help for an infertility problem, they face with a number of examinations, treatments, and opinions that nowadays are an indispensable part of the process to study and treat an infertile couple. Although the idea of surgery can be frightening, reproductive surgery is one of the choices we currently count to know what is causing the problem and then make a specific treatment.
Today, the majority of reproductive surgeries are performed under the concept of short-stay surgery, either laparoscopic or hysteroscopic route. In fact, except for post tubal ligation anastomosis, almost the majority of procedures are performed endoscopically. Surgery remains an essential part of infertility treatment, an example of this are those cases where the uterus has an altered form, either by the presence of fibroids, polyps, congenital defects or by scars on the inside.
Surgery is also useful in cases in which you want to reverse a tubal ligation. It should be noted that not all tubal surgery is reversible, but many are, and there is an acceptable probability on achieving pregnancy,in selected cases and in patients younger than 37 years.Similarly we can mention that surgery generally improves the chances of pregnancy, in cases where the uterus presents defects, usually congenital, or by the presence of fibroids, polyps or adhesions. As mentioned previously, most of the procedures can be performed endoscopically, minimizing the possibility of adhesions and improving the recovery time. Some of the procedures that are used:
- Laparoscopy. It is performed as an ambulatory procedure (not requiring hospitalization) and under general anesthesia. Usually an incision is made in the umbilical scar umbilical (navel) of approximately 1.5 cm through which a lens is introduced that serves to visualize all abdominals pelvic structures. If necessary accessory incisions can be made where it is introduced small instruments that help us during surgery to establish the cause of the problem and treat, as could the adherenciolisis (removal of adhesions).
- Hysteroscopy. A tiny lens is introduced through the vagina and cervix, to finally reach the uterine cavity in order to assess their internal composition, the presence or absence of congenital malformations, the presence of polyps or fibroids. As in laparoscopy,instruments can be introduced to help us treat, in case of appearing, pathologies of the uterus.
Among the procedures included in Reproductive Surgery are:
- Tuboplasty (Surgery in the Fallopian tubes). For blockages in the Fallopian tubes either along the same or in the end (fimbria)
- Tubal reanastomosis. In pacients with a history of tubal ligation
- Correction of Congenital Malformations. These occur during the embryonic development and may be present in the uterus, fallopian tubes and / or vagina.
- Adherenciolisis. Removal of adhesions either by infectious process and / or inflammatory example. (sexually transmitted diseases, endometriosis) or by previous surgery.
- Myomectomy. Resection of fibroids (tumors of muscle tissue in the uterus, usually benign), approximately 30% of patients will have fibroids, which can cause recurrent abortions, pain and bleeding
- Evaluation and resection of Ovarian Tumors. The presence of ovarian cysts is very frequent in the reproductive age of the patients.
- Evaluation and resection of Endometriosis.This is a common cause of infertility, up to 40% of the cases of pacients with infertility suffer of endometriosis.
Semen Cryopreservation
Semen samples are frozen in liquid nitrogen at -196 ° C. This technique can be used by:
- Anonymous donors whose samples can be used for any method of assisted reproduction.
- Patients who have decided to freeze their sperm for reasons like cancer treatment, vasectomy or multiple trips.
In Vitro Fertilization Convencional (IVF)
Infertility is defined as the inability to conceive after one year of unprotected sex. Infertility is a problem of the couple and both members must be together for the treatment and to overcome the emotional stress involved. The techniques of Assisted Reproduction offer the best hope and probability of a pregnancy.
The in vitro fertilization and embryo transfer (IVF-ET) is an established method of assisted reproduction created to increase the probability of a pregnancy in couples facing infertility problems. Since its beginnings in 1979 the in vitro fertilization has helped millions of couples to achieve pregnancy.
The purpose of in vitro fertilization consists in the fertilization of the oocyte by the sperm outside the woman's body, when they are unable to make the fertilization in its natural place, the fallopian tube. When the fertilization is done, the embryos are transferred to the uterus. La fertilización In Vitro es un proceso relativamente complejo debido a todos los pasos que se requieren para lograrlo. El ciclo de Fertilización In Vitro requiere el monitoreo clínico de la paciente, asi como de estudios de laboratorio precisos. The In Vitro Fertilization is a relatively complex process due of all the steps required to achieve it. The in vitro fertilization cycle requires clinical monitoring of the patient, as well as precise laboratory studies.
In vitro fertilization (IVF) is recommended especially in cases of partial or total occlusion, or the absence of the tubes. In case of infertility, for unknown reasons, or bad quality of the sperm, where IVF has applied successfully. IVF has a great diagnostic value in the treatment of infertility. If the mature ova become fertilized, although pregnancy is not achieved, the future treatments make sense. If instead, the fertilization of the mature ova does not happen, the only treatment left , in most cases is intracytoplasmic sperm injection (ICSI).
In most cases, the IVF treatment requires hormonal stimulation, starting from day 1 to 3 of the cycle. The success of the IVF depends on many factors: it has to do with the quality of the sperm, the amount of mature ova, the amount of transferred embryos and the process of implantation of the embryo in the internal layer of the matrix (the endometrium). The bad sperm quality, usually low sperm motility or small amounts of spermatozoa, avoids in many cases a successful fertilization. The fertilization in normal cases does not exceed 30% (if the sperm is in normal parameters, the fertilization reaches a 80%).
Sometimes, women with severe hormonal disorders, develop only immature ova. These immature eggs or postmature does not have the same ability to fertilize. In these cases, the moment of union of the sperm and the ova is extremely important. Sometimes the upheavals in the maturation of the ova is managed through a protocol adapted in a next cycle of treatment. The implantation of the embryos in the internal layer of the matrix (the endometrium) is supported with hormones that optimize the process.
A great part of these embryos is lost because of poor conditions during the process of implantation in the endometrium. Another part of the embryos stops developing because there is probably a genetic damage. In these cases, the lack of a pregnancy is a mechanism of protection of the nature to prevent a malformation.
Artificial Insemination (AI)
The depositing of sperm in the vagina near the cervix or directly into the uterus, with the use of a syringe instead of by coitus.
It has three phases:
The ovary is stimulated with ovulation-inducing drugs. This method is very convenient to achieve the desired results. It involves the development of several eggs, which involves taking the risk of 15-20% of twin pregnancies, an issue that is important to know and discuss among patients with their medical team.
The preparation of the semen consists in select and concentrate the motile sperm, the low mobility is one of the factors that may adversely affect the achievement of a pregnancy. This samples are processed by techniques of sperm capacitation or seminal preparation .
The insemination is made in the doctor´s office, there is no need to apply anesthesia nor is annoying. The insemination is usually performed during two consecutive days after induced ovulation. For each of them it will be necessary provide the laboratory a semen sample. After being deposited semen, properly treated in the uterus, the woman must remain a few minutes in rest.
Semen donors are constantly studied to discard any type of transmissible disease, especially controlling the existence of HIV antibodies. A given sample of semen is frozen for 6 months before use. Only if the donor sample shows no HIV antibodies after those 6 months of quarantine, the sample is used. We also monitor the hereditary diseases that may have the donors or their close relatives. Keep in mind that some hereditary diseases are manifested at different stages of life, so you might not know about their existence at the time of the donation.
An insemination with donor semen provides pregnancy rates per cycle of 25% and 80% per patient with a maximum of 6 cycles. As far as results, the insemination with donor semen provides rates of pregnancy by cycle of 25% and 80% by patient with a maximum of 6 cycles.
Intracytoplasmic Sperm Injection (ICSI)
- ICSI is a highly specialized In Vitro Fertilization technique, which requires a single sperm to be microinjected into each oocyte (ovum), this is done with a micromanipulator. Biologists can hold a single egg on the tip of a suction pipette with a fine needle that is seven or more times thinner than a hair and penetrate it .This is done with a powerful microscope and microscopic instruments of manipulation.
- ICSI has been developed to treat infertility in patients with low sperm count, low sperm motility, and also in patients without sperm in the ejaculate (due to a blockage or some other testicular disorders) where sperm can be obtained from the testes and epididymis.
ICSI is recommended in the following cases:
- IVF cases where there was no fertilization
- Couples with two attempts at IVF with embryo transfer without pregnancy.
- Patients in those who the ovum recovery is low (four or less).
- Women over 40 years.
- Couples with genetic problems, whose embryos will undergo a preimplantation diagnostic
- Women must undergo the procedure of a controlled ovarian hyperstimulation and ovum production. As in IVF, the man must provide a semen sample. The selection of spermatozoa is crucial for the success of ICSI. In cases of severe male infertility it is recommended human karyotype to discard an hereditary disease.
- The rate of pregnancy by ICSI is 50% in women under 38 years.
Sperm recovery techniques
- ESAM: epididymal sperm aspiration by microsurgery.
- TSEB: testicular sperm extraction by biopsy. It is a method to collect sperm in which a needle is used to remove a small piece of tissue containing sperm directly from the testicles.
Ovum donation
Cuando no se logra el embarazo con la las técnicas de reproducción asistida convencional, debido a una pobre fertilización ovular repetida o fallo en la fertilización, anomalías genéticas ovulares, falla ovárica prematura o se tiene el deseo de maternidad en la etapa post-menopáusica; se puede considerar la alternativa de la donación ovular.
When the pregnancy is not achieved with the conventional assisted reproduction techniques, due to a repeated poor fertilization or failure in the fertilization, ovular genetic abnormalities, or premature ovarian failure or has the desire of motherhood in the post-menopausal; it can be considered the alternative of ovular donation.
The reasons why a woman can't use her own eggs are variouss. Among them they emphasize when the ovaries stops producing ova for natural reasons in patients over 40 years (menopause) or minor under 40 years (premature menopause), when the patient had had both ovaries removed or even when those ovulate, the quality of your eggs is low. There are also some diseases of chromosomal type that women can transmit it in case of using her own ova, in this case it is preferable the donation.
Characteristics for the ovum donator:
The women who donate ova should have several features, among them are: to be under 35 years, to have a poor record ofgenetic transmited diseases, good intellectual level and psychological stability.
In addition, studies are realized to verify their good physical and mental state, including chromosomal analysis (karyotype),test for infectious diseases such as AIDS (HIV) and hepatitis B and C, psychological assessment, among others. Of course, major physical characteristics of donor and recipient donor must agree. The donors receive a treatment directed for the formation of several ova with a protocol in which three types of drugs are given. The first drug is to control ova from all internal stimulus and to obtain them before they are released. The second drug is in charge of stimulating the ovary more than usual, in order to obtain several ova in one cycle of treatment and to have greater chances of pregnancy in the recipient. The third completes the ova maturation.
The donors are valued by several ultrasounds to check the number and size of follicles that contains the ova. When they are mature, the extraction is performed by vaginal ultrasound-guided puncture in the operating room with the patient asleep under anesthesia or mild sedation. Once retrieved the ova, they go into the reproduction laboratory for identification, cultivation and insemination with partner's semen of the recipient.
Once obtained and fertilized they remain in the laboratory from two to five days inside incubators to assess their development. Embryo transfer is a simple procedure and usually does not require the use of anesthesia.
The chances of pregnancy with this technique are very encouraging, since between 40 and 50% of the women succeed in every attempt or transfer. If they do not success the first time, they can try again without a limit. After four attempts most of them achieve their goal. From all the pregnancies that are achieved, 10% will be multiple, reason why it is important not to transfer an excessive amount of embryos to avoid higher order pregnancies (triplets, quadruplets, etc.).
Preimplantational genetic Diagnosis (PGD)
PGD is useful because it offers the possibility to analyze the presence of chromosomal and genetic abnormalities in embryos before being transferred to the uterus and, therefore, before implantation has occurred before a pregnancy has taken place with a baby with some of the analyzed alteration . It is an alternative to prenatal diagnosis in couples with high risk of transmitting chromosomal abnormalities or genic to their descendants.
These patients will be benefited:
- The patients over 37 years in whom the risk of Down syndrome and other disorders is higher, the clearest manifestation is the increase in abortions and children with problems at birth, this trend increases even more after age 40.
- Patients with recurrent abortions and / or unexplained miscarriages
- Patients at risk of transmitting any abnormality to their descendants
- Patients in which assisted reproduction treatments have had implantation failure.
- The Genetic Counseling in preimplantation genetic diagnosis is the backbone of treatment since the experience and knowledge of each of the diseases explained by the treating physician will help you make that decision with your partner because in some cases, it delays the disease, gives you a reproductive advice, improves the therapeutic treatment and the most important thing: gives you a better personal and family planning but even if you have a sick child at home.
PGD consists in the following points:
Embryo Biopsy
Involves extracting 1 or 2 cells of an embryo using micromanipulation techniques. To do this, specialists make a small hole in the outer shell of the embryo, the zona pellucida, which allows the introduction of a thin micropipette to aspirate the embryonic cell. The removed cell is processed for subsequent genetic or chromosomal analysis and the embryo continues its normal development.
Chromosomal or genetic Análsis:
- Two techniques are done depending on what we are searching, one of them considers the main chromosomes involved in the most common chromosomal abnormalities such as trisomy 21 (Down syndrome), 13 (S. of Patau), 18 (S. Edwards) or alterations in the sex chromosomes (S. Turner or Klinefelter S.) and other numerical abnormalities that cause repeated abortions or descendants with anomalies. This technique allows us to identify the sex chromosomes X and Y to determine the sex of embryos in sex-linked diseases (more than 300 diseases), for example, hemophilia or Duchenne muscular dystrophy.
- This diagnosis also allows the study of other structural chromosomal abnormalities, called translocations. In parents that carry an alteration of this type we can select normal or balanced embryos to be transferred. The second technique helps us to assess the presence of specific genes that cause monogenic diseases which as its name implies, are those involving a single gene.This type of diseases are transmitted from generation to generation and its prevention is possible through genetic diagnosis. Examples of such diseases are
- Huntington's chorea, cystic fibrosis and Fragile X Syndrome, among others. In InteraFertility we have the possibility of preimplantation genetic diagnosis for these diseases.
Embryo Transfer:
While performing the analysis to the cell of the embryo, this continue in cultivation and two days later, when the results are shown, normal embryos are transferred to the patient and the rest are cryopreserved.
Sperm Bank
InteraFertility makes available to its patients a certificated sperm bank, where in case of requiring you will find national and imported samples, which have been selected by international quality standards.
The use of donor semen samples are in the following cases:
- Heterosexual couples with both absence of sperm in the ejaculate or directly in the testis and / or epididymis.
- In the possibility of transmission of genetic disorders or contagious diseases by using conjugal semen.
Women without a partner.
The semen donors are young, healthy students and volunteers that go disinterestedly to the bank.
Qualifications needed to donate sperm:
- Ages between18 and 35.
- Well mentally and physically.
- The donor, or their family members can´t have major genetic disorders or hereditary diseases such as asthma, diabetes, epilepsy or hypertension.
Negative results for the following tests:
- Antigens of Hepatitis B.
- Hepatitis C antibodies
- Anti-HIV 1 / 2.
- Chlamydia.
- Herpes antibodies virus
- Syphilis.
- Gonorrhea.
- Cytomegalovirus.
Not to be subject of detectable bacterial infections in blood, urine and semen. To have a high quality sperm (aprox. 4.5 times better than average). The sperm should have a good survival rate for the freezing and thawing process.
Sperm preservation
InteraFertility makes available an option for your future reproduction. The freezing or cryopreservation of sperm is a process so that in future you can use it to reproduce. After freezing the sample they are deposited in a tank at low temperatures to be able to preserve it during an indefinite period
A very easy procedure is which it consists in:
- Give a semen sample
- The laboratory will analyze the sample and after they will determine if the sample can be frozen or not, depending of the quality.
- The sample is frozen low temperatures to be able to preserve living the spermatozoa
- Keep the samples in special tanks
- The sample is stored indefinitely and can be used in future when the patient requires it for his reproduction.
Freezing is a preventive medicine, because when freezing a sample you are insuring your reproductive future in case you have a disease, an accident or any other situation.
Oncology patients
Freezing semen is a solution for future reproduction for those cancer patients. This option is very important for those patients suffering from cancer since they subdued to various treatments during their disease as it is radiotherapy and chemotherapy, their sperm can suffer alterations and altering the patient's future reproduction. With this option you can assure your reproduction in a very easy and inexpensive way.
- The samples can be frozen as long as desired, since at 196 ° C the cells are unable to carry out metabolism and therefore the airtime stops. There has been cases of pregnancy with successful results on samples frozen up to 15 years.
- Everyone concerned about their future reproduction are candidates for the cryopreservation
As well as the following patients:
- Patients suffering from a disease like cancer, they will be subject to processes such as chemotherapy and radiotherapy, so even if his sperm suffers through this process, a sample will be kept healthy and so the patient may be reproduced in the future.
- Patients that will have a vasectomy
- People at high risk in the work they perform.
Freezing ovarían tissue
One option for your future reproduction
Ovarian tissue transplantation is a "simple" technique that involves removing ovarian cortex of the patient, which is where ovarian function. This ovarian tissue is preserved frozen in liquid nitrogen at -196 ° C in the tissue bank, and thereafter as required, this is re-implanted into the patient.
Freezing ovarian tissue brings us many benefits such as:
Delay Your Pregnancy
It is very common for women to postpone their pregnancy until they are over 35 years, but this decision is accompanied by a decline in egg quality. Various statistical analysis have shown that egg quality is dropping over the years and this can cause genetic syndromes as well as infertility or repeated abortions, therefore, the option to freeze ovarian tissue (with ova inside) opens the door to the search for fertility in patients of advanced reproductive age. For example, if you freeze ovarian tissue (with ova) at age 25 although you will use them at the age of 35, your ova age remains 25. The recommended age for this procedure is 20 to 30 years
Delay your Menopause
Other advantages of freezing ovarian tissue is the power to postpone the menopause, this causes the symptoms of menopause are presented later. Remember that having adequate hormone levels you will have younger skin, better sex life, an absence of the symptomatic condition and especially your mood will be optimal.
Oncology Patients
This option is very important for cancer patients undergoing some type of treatment as it is radiotherapy and chemotherapy, the freezing of ovarian tissue prior to such treatment allows women from childhood to adolescents can be mothers in the future. Ovarian frozen tissue is stored indefinitely by the process of freezing, tissue can last an indefinite number of years until it is used.
Assisted Hatching
This technique involves the thinning and opening a small hole in the zona pellucida of the embryo, in order to promote its implantation.The assisted hatching , or the assisted eclosion is recommended for patients over 38 years with elevated FSH, highly fragmented embryos , with several unsuccessful IVF attempts or who have embryos whose zona pellucida is thickened.
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