Egg Vitrification

Fertility preservation through egg vitrification is a procedure that allows women to freeze and store their eggs for future use.

This is useful for those who wish to postpone childbearing for social or medical reasons.

Frozen eggs can be thawed and fertilised in the future to achieve pregnancy.

This treatment makes it possible to postpone motherhood without the passing of time being detrimental to the future possibilities of becoming a mother, as the deterioration of the quality of the oocytes means that from the age of 35 onwards the chances of pregnancy suffer a notable decrease.

Artificial Insemination with Partner Semen

Artificial insemination with partner’s sperm is an assisted reproduction procedure that involves the introduction of the male partner’s sperm into the woman’s uterus during ovulation, with the aim of facilitating the fertilisation of the egg.

This procedure is used when there are difficulties in conceiving naturally, but where the partner’s sperm is not severely altered.

Artificial Insemination with Donor Semen

Artificial insemination with donor sperm (AIS) is an assisted reproduction procedure in which donor sperm is introduced into the woman’s uterus to facilitate fertilisation of the egg.

This procedure is ideal for women facing single motherhood, couples of women or heterosexual couples where the man has severe fertility problems and we must resort to donor sperm.

In Vitro Fertilisation (IVF)

In Vitro Fertilisation (IVF) is an assisted reproduction technique that consists of the insemination of eggs with sperm in a laboratory, generating embryos that are subsequently transferred to the uterus.

This treatment has a variable success rate depending on the age and characteristics of the women or couples.

It is recommended for couples with difficulties in conceiving naturally and can help to overcome fertility problems for both men and women.

The aim of this treatment is to obtain embryos that will later be used to create a pregnancy. The process begins with ovarian stimulation and subsequent egg retrieval. These eggs are fertilised in the laboratory with the partner’s or donor’s sperm, generating embryos. The embryos are cultured until they reach a stage of embryonic development called blastocyst. This stage is usually reached 5/6 days after fertilisation.

Once the blastocyst stage is reached, the best quality embryo is usually selected for transfer to the woman’s uterus. This is known as a fresh transfer and is carried out 5 days after the egg retrieval. If there are any embryos left over, they will be frozen for further attempts at pregnancy.

In some circumstances (high response, refractory endometrium, presence of polyps, embryo/endometrium asynchrony…) it may be indicated to freeze all embryos and defer transfer of the first embryo.

Natural IVF

Natural IVF is a type of In Vitro Fertilisation that uses the natural monofollicular maturation carried out by the woman’s own cycle, without the need for ovarian stimulation by means of medication.

This treatment is indicated for women with low ovarian reserve, cases in which medication cannot help to generate more oocytes.

It is useful for couples who have difficulty conceiving naturally, helping overcome both male and female fertility problems.

Natural IVF is a fertility treatment that is performed without ovarian stimulation medication. It is recommended for women with very low ovarian reserve, as the administration of medication will not increase the number of eggs available. The aim is to obtain a single oocyte from the woman’s natural cycle.

The process begins with the monitoring of the menstrual cycle by ultrasound, without medication. When the egg reaches maturity, ovulation is induced and the egg is extracted by ovarian puncture.

With the retrieved oocyte, the laboratory creates embryos that are cultured until the blastocyst stage, usually 5-6 days after fertilisation. If the embryo reaches this stage, it is transferred to the woman’s uterus.

Mild IVF

Mild IVF is a type of in vitro fertilisation in which ovarian stimulation is performed with low doses of medication, so that the woman’s natural cycle is respected to a greater extent.

It is indicated for women with low ovarian reserve, cases in which the use of high doses of medication would not generate a greater number of oocytes.

In some cases, it can also be performed in patients with a good prognosis and a high ovarian reserve. It is useful for couples who have difficulty conceiving naturally, helping to overcome both male and female fertility problems.

Mild IVF is IVF where ovarian stimulation is performed by means of a medication that promotes multifollicular development (more than one egg) but in a way that is more respectful of the woman’s natural cycle. This type of stimulation is known as mild stimulation. It is indicated in patients with low ovarian reserve where the use of high doses of medication usually used in conventional stimulation would not generate a greater number of oocytes. Thus, this type of stimulation allows us to obtain the same or better results than conventional cycles with greater comfort for the patients and reducing economic costs.

The process begins with ovarian stimulation by administering low doses of hormones (ovulation inducers and gonadotrophins) for 9-15 days. During this stage, the patient must visit the clinic every 2-3 days for ultrasound monitoring. Once the oocytes reach maturation, they are extracted by ovarian puncture under sedation.

With the recovered oocytes, the laboratory will generate embryos that are cultured until they reach the blastocyst stage, usually 5-6 days after fertilisation. The best quality embryo is selected for transfer to the woman’s uterus. If there are any surplus embryos, they will be frozen for further pregnancy attempts.

In some cases, such as the genetic study of embryos, all embryos generated are frozen, with the first embryo being transferred in a subsequent cycle.

Egg Reception

Egg reception is an assisted reproductive treatment in which donor eggs are used to be fertilised with the sperm of the male partner or a donor. 

The resulting embryos are transferred into the uterus of the recipient woman. This procedure is suitable for women who cannot use their own eggs due to various medical reasons.

Embryo Adoption

The adoption of an embryo, also known as embryo adoption, is an advanced assisted reproductive technique that provides couples and single women with the possibility of receiving embryos donated altruistically by other couples.

These donated embryos are transferred into the uterus of the recipient, with the aim of achieving a successful pregnancy. Embryo donation is a viable option for those who face fertility problems and cannot use their own gametes (eggs and/or sperm).

It is also an alternative for those who prefer not to resort to double donation, i.e. the creation of embryos from scratch using donor eggs and sperm.

The aim of embryo reception is to provide viable embryos to people who cannot conceive with their own gametes.

The process begins with the selection of donated embryos, which have been previously cryopreserved after a successful in vitro fertilisation (IVF) cycle of another couple. The selected embryos are thawed and prepared for transfer to the recipient’s uterus.

The woman who is to receive the embryo must prepare her uterus (endometrium) for the transfer. The doctor will indicate the best way to do this in her case. During the days of endometrial preparation, the woman will have to attend consultations to evaluate, by means of ultrasound, that the endometrium is in optimal conditions to receive an embryo.

When the endometrium is optimal, the embryo is thawed and transferred to the uterus. This is a painless procedure in which the embryo is positioned in the most suitable place in the uterus, guided by ultrasound.

Embryo transfer takes place at a stage of embryo development known as the blastocyst, which is reached approximately 5-6 days after fertilisation.

 

IVF with Smart PGT-A Plus

IVF with pre-implantation genetic testing for aneuploidy (or PGT-A) is an assisted reproductive technique that genetically analyses the genetic make-up of embryos before transfer.

It helps to select healthy embryos, which improves the chances of evolutionary pregnancy. It is indicated for couples with a history of recurrent miscarriage or high chromosomal risk, as well as in women over 37 years of age or in case of genetic alterations in the sperm. It has a 60-70% success rate per transfer.

IVF with PGT-A is an assisted reproductive treatment in which embryos are generated and, once generated, are genetically tested to find out whether they have a chromosomal abnormality. For this purpose, an IVF treatment is carried out, with ovarian stimulation and subsequent oocyte retrieval. Embryos generated from these oocytes and left in culture. When these embryos reach the blastocyst stage, an embryo biopsy is performed for carrying out the genetic study.

In this treatment, once the chromosomally normal embryo is obtained (euploid), the uterus is prepared for placement (embryo transfer). After obtaining a euploid embryo, the rate of gestation by embryo transfer is 60-70%.

Difficulties with this treatment are due to advanced maternal age and low ovarian reserve. For this reason, in some cases, your doctor may recommend embryo banking.

At Fertty, we use Smart PGT-A plus technology, which provides ample information compared to other PGT-A technologies. In addition to being able to detect alterations in the number of chromosomes (and parts of chromosomes), it can also detect whether there is an extra or missing endowment of the whole chromosome set, known as ploidy alteration. But in addition to the extended diagnosis, this analysis can detect contamination in the samples analysed and allows us to confirm the kinship between embryos, which adds to the safety and reliability of the test.

 

IVF with Smart PGT-M Plus

Preimplantational Genetic Testing for monogenic diseases
IVF with preimplantation genetic testing for monogenic diseases (or PGT-M) is an assisted reproductive technique that genetically tests embryos before transfer.

It helps to select healthy embryos, which prevents the birth of a baby with a genetic disease inherited from its parents.

It is indicated for women or couples carrying genetic mutations that cause an inherited disease. It has a success rate of 60-70% per transfer.

This assisted reproduction treatment begins with a review by an ethics committee and a prior informativity study to ensure that the mutations responsible for the genetic disease can be detected with current techniques.

Once the method for diagnosis has been confirmed, embryos are created and tested for the genetic mutations associated with the disease. For this, IVF treatment is performed, which includes ovarian stimulation and egg retrieval. These eggs are fertilised in the laboratory, and the resulting embryos are cultured until they reach the blastocyst stage. At this point, a biopsy is performed to study their genetic make-up. In addition to checking for the presence of the disease-causing mutation, we also analyse all the chromosomes of the embryo to ensure that there are no other abnormalities affecting its viability. To do this, we combine the PGT-M study with the Smart PGT-A Plus technology, which offers more complete information than other PGT-A tools.

When a healthy embryo is found, the uterus is prepared for transfer. In cases where the embryo does not have the disease and its chromosomes are normal, the pregnancy success rate is 60-70%. However, in situations such as advanced maternal age or a low ovarian reserve, it can be difficult to obtain a healthy embryo, so it is sometimes recommended to accumulate several embryos.

 

IVF with Smart PGT-SR Plus


Preimplantational Genetic Test for structural rearrangements

IVF with preimplantation genetic study of structural rearrangements (or PGT-SR) is an assisted reproductive technique that genetically analyses embryos before transfer.

It helps to select healthy embryos, which improves the chances of evolutionary pregnancy.

It is indicated for people with a chromosomal rearrangement in the karyotype.

It has a success rate of 60-70% per transfer.

In this assisted reproduction treatment, embryos are created and undergo genetic analysis to check for any chromosomal abnormalities. This is done by IVF treatment, which involves stimulation of the ovaries and subsequent egg retrieval. The eggs are fertilised in the laboratory and the resulting embryos are cultured until they reach the blastocyst stage. At this point, a biopsy is performed to study their genetic make-up.

When a chromosomally normal (euploid) embryo is obtained, the uterus is prepared for embryo transfer. If the embryo is euploid, the chances of pregnancy by transfer are 60-70%. However, in cases such as advanced maternal age or low ovarian reserve, obtaining a healthy embryo may be more difficult, so the doctor may recommend cumulating several embryos.

At Fertty we use Smart PGT-SR Plus technology, which provides more detailed information than other testing methods. It detects alterations in chromosome number, but also if there is an extra or missing set of chromosomes (known as ploidy alteration). In addition, this analysis is able to detect possible contaminations in the samples and confirm kinship of the embryos, which provides extra security and accuracy in the results.

 

Endometrial Preparation with Substituted Cycle

Endometrial preparation is an essential process in assisted reproduction treatments, which aims at preparing the endometrium (the inner layer of the uterus) to receive an embryo and favour its implantation.

It is used in cases where the embryo has already been generated in a previous cycle (cryopreserved embryo transfer), in the reception of donated embryos, or in the generation of embryos from a synchronous egg donation cycle.

This procedure can be performed using different approaches, depending on the individual needs of each patient.

In case of Substitute Cycle preparation, external hormones are used to prepare the endometrium.

This method is ideal for women with irregular cycles, who do not ovulate, or require a more precise treatment schedule.

 

Endometrial Preparation with Natural Cycle

Endometrial preparation is a fundamental process in assisted reproduction treatments, which aims at preparing the endometrium (the inner layer of the uterus) to receive an embryo and favour its implantation. 

It is used in cases where the embryo has already been generated in a previous cycle (cryopreserved embryo transfer), in the reception of donated embryos, or in the generation of embryos from a synchronous egg donation cycle.

This procedure can be performed using different approaches, depending on the individual needs of each patient.

In the case of the Natural Cycle preparation, the woman’s own menstrual cycle and therefore her endogenous hormones are used to prepare the endometrium.

This approach is suitable for women with regular cycles. It is more comfortable as no medication has to be taken, but because it depends on the woman’s cycle, we cannot schedule the procedures in advance.

 

IVF with embryo prioritisation based on embryo genetics (EMBRACE)

In cases where a good response to stimulation and a high number of embryos are expected, we offer the Embrace technique, a powerful prioritisation system based on embryo genetics.

DNA released into the culture medium enables us to obtain probability that the embryos are normal.

Thus, we transfer the embryos with the greatest potential first, reducing the time needed to achieve an evolutionary pregnancy.

In this assisted reproduction treatment, embryos are generated and, once the embryo culture phase is completed, the culture medium in which the embryos have developed is analysed.

This technology is based on the fact that embryos release part of their DNA to the outside. By studying this genetic material, we can infer the chromosomal status of the embryo, i.e. the probability that this embryo is chromosomally normal. It enables us to obtain this information without needing to manipulate the embryo by performing an embryo biopsy, as would be the case in PGT-A.

For this purpose, an IVF treatment is performed, where ovarian stimulation and subsequent oocyte retrieval is carried out. Embryos are generated from these oocytes, which develop in culture individually. When the embryos reach the blastocyst stage, they are vitrified and the culture media are then collected. These media will be analysed to obtain a prioritisation score for embryo transfer.

Once the score is obtained, the uterus is prepared for the placement (embryo transfer) of the embryo with the highest probability of being euploid, i.e. not presenting chromosomal alterations, which correlates with the probability of evolutionary pregnancy. In embryos with the highest score, i.e. those with the highest probability of being chromosomally normal, a gestation rate of 60-70% per transfer is estimated.

 

Time-lapse (EmbryoScope+™) and embryo selection by artificial intelligence (iDAScore™)

In cases where a good response to ovarian stimulation or IVF with donor eggs is expected, we offer embryo culture in incubator with time-lapse system (EmbryoScope+™) and embryo selection by artificial intelligence (iDAScore™).

This innovative tool helps us to select the best embryo to transfer first and thus achieve gestation in the shortest possible time.

In this assisted reproduction treatment, time-lapse technology is incorporated in the culture of the embryos generated in vitro and artificial intelligence for their selection.

For this, an IVF treatment is performed, either with the patient’s own eggs or donor eggs. Once the eggs have been extracted, they are inseminated with the seminal sample of the couple or of a donor. From this moment on, the embryos are introduced into an incubator with a time-lapse system (EmbryoScope+TM). This technology allows us to obtain images of the entire embryonic development, which translates into more information on the evolution of each embryo and fewer environmental changes, since it is not necessary to remove the embryos from the incubator for their evaluation.

When the embryos reach the blastocyst stage, we use the iDAScore™ artificial intelligence software, which provides us with a score for each embryo within its cohort.

The advantage of using artificial intelligence is that the system is able to analyze a large number of morphological and kinetic characteristics of the embryo and correlates them with implantation and evolutionary gestation data much faster than traditionally.
The embryo with the highest score will be the first to be transferred into the maternal uterus and the rest will be vitrified. Future embryo transfers will follow the order of prioritization provided by the artificial intelligence system.

 

Ovarian activation with platelet-rich plasma (PRP)

Ovarian activation with Platelet Rich Plasma (PRP) is an innovative technique aimed primarily at patients with low ovarian reserve. Its objective is to increase the number of oocytes obtained after a cycle of ovarian stimulation for In Vitro Fertilisation (IVF). The process is based on the extraction of a blood sample from the patient, from which a platelet-rich plasma fraction is obtained which, after specific preparation, is injected directly into the ovaries.

Although the technique of ovarian activation with PRP shows potential, it is still considered experimental. Currently, there is not enough data available to provide accurate success rates, suggesting that more research is needed to determine its potential benefit.

Treatment with ovarian PRP aims to increase the number of oocytes recovered after ovarian stimulation for IVF in women with low ovarian reserve and, therefore, improve the prognosis of their treatment.

The most suitable profile for this treatment is that of a patient with an ovarian reserve of no more than approximately 8 oocytes and aged under 40 years. Indeed, this treatment does not manage to improve the quality of the oocytes obtained and, therefore, can be a good strategy to address low ovarian reserve but not age-related loss of oocyte quality.

The treatment procedure is as follows: once established that the patient qualifies for PRP treatment, a blood test to measure anti-Müllerian hormone (AMH) levels and an ultrasound scan to perform an antral follicle count (AFR) should be performed. This will allow subsequent assessment of the response to treatment. On the day of the PRP, the patient is scheduled for a peripheral blood draw. This blood sample will be processed according to a standardised protocol to separate the platelet-rich plasma fraction from the rest of the blood components. A few hours later, the patient will be escorted to the operating theatre where she will be prepared in the same way as for a follicular puncture procedure to retrieve oocytes. An anaesthetic technique of sedation will be used so that the patient does not feel any pain and, by means of ultrasound visualisation and the use of an ovarian puncture needle, previously activated PRP will be injected into the ovaries.

After the intervention, an analytical follow-up with AMH determination and ultrasound with RFA will be performed to assess response to treatment. When indicated, ovarian stimulation may be initiated to recover oocytes for IVF.

Bear in mind that, as this is a technique that uses biological material obtained from the patient herself, it is considered to have a very low risk of adverse effects. It should also be noted that this is an experimental technique, which makes it difficult to estimate the extent of the treatment and that it may not have any effect at all.

 

Endometrial Enrichment


Platelet-rich plasma (PRP) treatment for the endometrium

Platelet Rich Plasma (PRP) treatment for endometrium is an innovative technique aimed primarily at patients with thin endometrium and/or diagnosed with recurrent implantation failure. Its objective is to increase the thickness of the endometrium and/or improve its receptivity in order to favour embryo implantation.

The process begins with the collection of a blood sample from the patient, from which a platelet-rich plasma fraction is obtained through a specific preparation process. The PRP is then administered to the endometrium in several sessions.

The PRP is prepared in a single day and the sample is kept frozen. Subsequently, the different plasma fractions are thawed and administered during the patient’s endometrial preparation for embryo transfer.

Endometrial PRP treatment aims to increase endometrial thickness and/or quality in patients with thin endometrium and/or a diagnosis of recurrent implantation failure. This treatment is especially aimed at patients in whom an adequate endometrial thickness is not achieved despite having applied different oestrogen administration protocols and/or in those patients who have undergone several good quality embryo transfers without resulting in pregnancy.

Once established that the woman qualifies for endometrial PRP treatment, she is scheduled for preparation, which consists of a peripheral blood draw. This blood sample will be processed according to a standardised protocol to separate the platelet-rich plasma fraction from the rest of the blood components and frozen in different fractions (the total number may vary depending on the total volume of plasma obtained).

Afterwards, the patient will start the endometrial preparation for the embryo transfer according to the protocol determined by her doctor. During this same process, and taking advantage of the visits for ultrasound checks, the PRP will be administered at endometrial level as in an artificial insemination (AI) procedure. The patient will be placed in gynaecological position in the consultation room, a speculum will be used to visualise the cervix and, using an AI catheter, a previously thawed fraction of PRP will be introduced. This procedure does not require anaesthesia and is repeated a total of 3 times. From this point on, when the doctor considers the patient ready, the embryo transfer is scheduled according to the established protocol.

Bear in mind that, as this is a technique that uses biological material obtained from the patient herself, it is considered to have a very low risk of adverse effects. It should also be noted that, although an increase in endometrial thickness is not always achieved, the best results observed in patients with the aforementioned pathologies are thought to be due to a qualitative improvement at the molecular level in the endometrium.

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