Procedures

Intrauterine Insemination (IUI)

Procedure consisting of the placement of trained, selected sperm inside the uterine cavity. By doing this, the possibilities of achieving pregnancy increase for couples who have not been able to achieve it using other simpler methods. In order to perform an IUI, it is INDISPENSABLE for the woman to have at least one permeable and normal Fallopian tube.

The most frequently used methodology includes ovulation induction using one or several drugs for the purpose of developing one or two follicles. It is not recommended to develop more than three eggs or follicles due to the high risk of a multiple pregnancy. The control of ovulation is done through follicular monitoring using vaginal ultrasound.

On the day of the insemination, the semen sample goes through a sperm training procedure where the sperm are washed and the best sperm are selected to be placed inside the uterus at a later time. Through insemination, the pregnancy success rate is between 20% and 25% per attempt.

In-Vitro-Fertilization (IVF)

Consists of the fertilization of an egg by a sperm in the gamete and embryo laboratory. This technique exists since 1978 and was developed by Dr. Steptoe in England. The primary application in those days was on patients whose Fallopian tubes were obstructed or damaged. The IVF process consists of 5 different stages:

1. Ovarian stimulation. This enables us to obtain several eggs in the same cycle, which increases the possibility of achieving pregnancy, since there are more embryos to choose from when embryos are transferred to the uterine cavity. Strict monitoring is very important at this stage; it is done using ultrasound and verifying hormone levels, primarily seric estradiol, to prevent complications like the ovarian hyperstimulation syndrome.
2. Follicular Aspiration. This is carried out when the eggs are already mature and it is done through the vagina, using ultrasonographic guide and sedation of the patient. These eggs are classified by the embryologists’ team from the gametes lab, and they are prepared for insemination with the sperm.
3. Egg insemination. Based on the treating physician’s criterion, and in coordination with the gametes lab, a decision is made on whether the best procedure to perform in each particular case is conventional In-Vitro-Fertilization (the sperm is allowed to penetrate the egg by itself) or Intracytoplasmic Sperm Injection (injecting the sperm into the egg using a special technique). Once this is done, the inseminated or injected eggs are left in special culture mediums for 18-20 hours, and then they are checked to see if fertilization took place.

Intracytoplasmic Sperm Injection (ICSI)

The injection of one sperm in the egg is a form of In-Vitro-Fertilization, except that with this technique one live sperm is needed for each egg. For this reason, this technique is recommended for cases where the man’s sperm count is very low (fewer than 3 million/ml and/or low sperm quality: little motility and/or a low percentage of normal forms). In cases where the man does not produce sperm during ejaculation, it is possible to apply sperm aspiration at the epididymis (PESA) or even perform a testicular biopsy (TESE).

The embryologists from the gametes lab have been trained to select, mature, and train the sperm obtained by these methods.

In cases where the woman has fewer than 5 mature eggs, the recommendation is to practice an ICSI.

Embryonary Culture

The embryos are kept in a culture medium for two to three days. This is decided based on the characteristics of each embryo’s cells and their growth speed.

On occasions, it may be advisable to leave them 5 or 6 days for them to evolve; this stage is called blastocyst.

Embryo Transfer

In most cases, the appropriate moment to transfer the embryo into the mother’s uterus occurs on day 2 or 3 after the follicular aspiration. In some cases it can be performed on the fifth day after the eggs were inseminated. There are several types of catheters because the uterus and the cervical canal are not the same for all patients. For this reason, a transfer test must be performed using different catheters in order to determine the ideal catheter type for each patient.
Our results are similar to those obtained at world-class centers in other countries, such as the US, Canada, or Europe.

Diagnostic Hysteroscopy

Diagnostic hysteroscopy is a commonly performed gynecologic procedure to evaluate the endometrial cavity.

Operatory Hysterocopy

Operative hysteroscopy is a minimally invasive gynecological procedure in which an endoscopic optical lens is inserted through the cervix into the endometrial cavity to direct treatment of various types of intrauterine pathology.

Diagnostic Laparoscopy

Diagnostic Laparoscopy is only diagnostic procedures were performed with the laparoscope. Using a two-puncture technique for the placement of the laparoscope and a rigid probe to manipulate the reproductive organs, pathologic abnormalities were characterized but rarely treated. In the last decade, use of the laparoscope has expanded. Now various reproductive disorders are diagnosed and treated primarily with the laparoscope including pelvic adhesions, endometriosis, and disorders of the Fallopian tubes.

Operative Gynecological Laparoscopy

Surgical procedure that involves inserting a lens (laparoscope ) to the abdominopelvic cavity ports and accessories (small cuts) for treatment of uterine pathology, and ovaries salpinges such as endometriosis, ovarian cyst, adhrenciolisis, among others. It is considered a minimally invasive procedure with less hospital stay, less pain and faster than with open surgery recovery.

Freezing and Thawing of Embryos

In our reproductive center, only three embryos are transferred in each cycle; the remaining embryos are frozen and kept to be transferred at a later time, in case the patient does not become pregnant. These embryos are kept in storage until the couple decides to use them. When we transfer frozen embryos, patients do not have to go through the entire protocol of ovulation induction, only the uterus is prepared using oral medications in order to prepare the uterus to receive the embryos. It is important to emphasize that, under no circumstances, these embryos are donated for study or research purposes, and are not discarded either.

Egg Donation

There are several reasons for a couple to consider using an egg donation program.

• Premature menopause (Premature Ovarian Failure)
• Surgical menopause: when both ovaries have been removed.
• When the woman has chromosome anomalies with a high risk of transmitting them to her offspring.
• When her ovaries, even using the ovarian hyperstimulation protocol, do not respond and do not produce – or hardly produce – eggs in sufficient amounts and/or with good quality.

This type of programs gives couples the opportunity to become parents, from a biological, social, and legal perspective. From a genetic point of view, the child will have genetic information from the father only, but not from the mother. The donor must have certain physical characteristics (like having a similar appearance to that of the receiver), be young (less than 23 years of age), and be a mother already, in addition to having all kinds of lab test done, especially those related to sexually transmitted infections, hepatitis B & C, drug use detection, karyotype, and visiting a geneticist and a psychiatrist.

Pre-implantation Genetic Diagnosis (PGD)

In cases of suspected genetic anomalies or risk of transmitting genetic disorders, as well as in cases of repeated implant failure and/or recurring gestational loss, a PGD must be applied to determine the etiology of the failure for the purpose of achieving pregnancy. There are only two centers in the country capable of offering the PGD. The only one in our country’s northern region is the Reproductive Medicine and Surgery Clinic.

Each case can be jointly analyzed by a scientific committee that includes the Clinic’s Director, the treating physician, the gametes lab, and the genetics department to evaluate and decide which is the best option for each particular case.

In cases where a PGD will be performed, an ICSI will also be performed, regardless of the egg number and their characteristics, and/or the quality of the semen sample. On day 2 or 3 after the aspiration, a one- or two-cell sample is taken from each embryo (known as blastomeres during this development stage). The chromosome content of the sample is analyzed using various techniques. The embryo continues its development until it reaches the blastocyst stage (day 5 or 6 after the follicular aspiration), which is when the embryo is transferred to the uterine cavity (the genetics results are usually ready by the morning of day 4 or 5).