We hear more and more about assisted reproduction: IVF or in vitro fertilization, inseminations, fertility clinics, egg preservation, donors, surrogates and many more concepts and treatments that are still not very clear to many. Unfortunately, according to the World Health Organization, infertility affects approximately 186 million people in the world. It is a growing problem and also a business that generates a lot of money. For this reason, we wanted to ask an expert questions and explain some of the concepts, techniques and advances in assisted reproduction.
There are medical treatments that can facilitate a pregnancy when it is not achieved naturally. (Image from Freepik)
What is assisted reproduction?
According to the CDC (Centers for Disease Control and Prevention) of the United States, the definition of assisted reproduction treatments includes all fertility treatments, where eggs or embryos are manipulated. It involves surgically removing eggs from the woman's ovaries, combining them with the male sperm in a specialized laboratory, and transferring these fertilized embryos into the woman's body or donating them to another woman.
ART or Assisted Reproduction Techniques are a set of medical techniques and treatments that can facilitate a pregnancy when it cannot be achieved naturally. The professionals: gynecologists and embryologists, intervene in the female or male reproductive system according to the cause of infertility to help achieve pregnancy. The objective is to overcome the barriers that arise naturally, using medication and techniques such as artificial insemination (AI), intracytoplasmic sperm injection (ICSI), embryo culture, IVF, etc.
Infertility affects approximately 186 million people in the world. (Picture of Freepik )
How can I find out which assisted reproductive technique is indicated for me?
Dr. Braulio Peramo Moya, Director of the Al Alain Clinic in Abu Dhabi recommends: "After trying to get pregnant naturally without success for a year or 6 months, if the woman is older than 35, it is necessary to visit a specialist to determine if the cause of infertility is male, female factor or both. Subsequently, the pertinent tests are carried out: in men: clinical history, physical examination and seminogram. In women: a hormonal study, result of the anti- mullerian hormone , an ultrasound and additional tests depending on the particular case. The technique indicated for each case will be determined, always starting with the least invasive and easiest method for patients.”
What is the difference between Artificial Insemination and IVF (in vitro fertilization)?
Artificial insemination is the simplest procedure, low in complexity and price. It consists of the introduction of spermatozoa in an unnatural way in the woman's uterus. It can be homologous, when samples from the couple are used, or heterologous, when samples from a donor are used.
Dr. Peramo reiterates: “It is a painless, fast and low-cost procedure, but the success rates are not very high and are cumulative, that is, they increase after the first attempt. However, each case is always evaluated individually. For example, when we talk about a woman without fertility problems and using donor sperm, we have very high success rates, but when we talk about couples with combined infertility, the rates are very low. The age of the couple, the causes of infertility, the financial resources and the expectations of each patient must be considered”.
IVF or In Vitro Fertilization
IVF or in vitro fertilization is a more complex treatment. It consists of stimulating the woman with hormonal drugs to produce more eggs, extracting them from the ovaries by means of a follicular puncture, fertilizing them in the laboratory with the sperm of the couple or a donor and, after observing the evolution of the embryos, transferring them to the woman's uterus in order to achieve pregnancy. It offers greater chances of pregnancy and has evolved a lot since its inception in 1978.
“Today, in vitro fertilization with the help of techniques such as ICSI (intracytoplasmic sperm injection), preimplantation tests such as PGT-A, individualized treatments, oocyte and embryo cryopreservation programs, nutritional supplementation, and alternative therapies has improved. the rates of implantation, term pregnancy and births of healthy babies” affirms Dr. Peramo.
Both techniques offer advantages and disadvantages, as well as possible risks, which is why we recommend that patients always evaluate all the possibilities with their specialist doctor.
Is there a maximum age to be able to do a fertility treatment in a clinic?
In principle, the law 14/2006 of assisted human reproduction in Spain, does not specify anything about the age to be parents. There is a consensus among professionals not to accept women over 49 years of age due to the risks it entails for the woman and the baby, but it depends on each professional and each clinic.
How does egg donation or sperm donation work?
Egg donation or egg donation is a process by which a woman can anonymously donate her eggs and allow a recipient woman to achieve a pregnancy. To be performed, the donor has to meet a series of legal, ethical and medical requirements. In Spain it is an altruistic and voluntary process. Donors only receive an amount of money to cover the costs of the process while their identity remains completely anonymous.
Many fertility clinics offer their own donor bank or work with a third party egg bank.
Similarly, sperm donation is anonymous, altruistic and voluntary. It is easier than egg donation since it does not require any surgical intervention.
Dr. Peramo tells us: "The donation of eggs or sperm allows to increase the success rates for couples with severe male infertility or patients without ovarian function, genetic anomalies or advanced ages, but it is a decision of each couple that must be taken carefully guided by your trusted doctor or clinic”.