The most outstanding adverse effect is a multiple pregnancy.

Indispensable Test Prior to an Insemination:

• Study of the ovarian function through hormonal analyses.
• Study of the tubal permeability.
• Seminogram.

Phases:

• 1. Multiple follicle development:
This consists of the administration of injected medication with the aim of obtaining the development of several follicles, within each one an ovule will mature. The control of this phase is done through trans-vaginal ultrasonography.
• 2. Induction of the ovulation (photo ultrasonography).
When the size of the follicles reaches the adequate diameter seen by ultrasonography, we proceed to provoke ovulation through the administration of an injection. Only at this time will the most ideal moment to practice the insemination be known.
• 3. Preparation of the semen (video pre- and post- capacity).
Between one and two hours before the insemination the sample of semen to be processed will be delivered to BIOGEST’s reproduction laboratory, in order to separate the mobile spermatozoids and, at the same time, to improve their mobility.
• 4. Insemination This is carried out in the doctor’s surgery, without the need for anaesthesia and without any kind of discomfort. After the semen has been deposited in the uterus using a plastic cannula, the patient can go home without the need to rest.

• 5. Luteal phase support. After the insemination, and if considered necessary, your gynaecologist can prescribe medication for administration by the vaginal route (pessary) or by the intramuscular route.

• 20.7% (results obtained in 2007). Although in principle it seems to be a low rate per cycle, it is approximately the same rate, in a natural cycle, as that of a couple with no fertility problems and who have had children in a natural way.

• It is recommended to carry out a maximum of 4 cycles.

• Out of every 100 couples who complete 4 insemination cycles, 40-50 couples have obtained gestation.

• We do not recommend more than 4 insemination cycles, since by increasing the cycles up to five or six practically no increase in the figure of 40-50% is obtained. In addition, the majority of couples obtain pregnancy through artificial insemination, or during the first two cycles.

2. Risks of the Technique:

• 1. Between 15-30% of gestations are twins.
• 2. A miscarriage rate of 15% (the same as for the general population).
• 3. Ovarian hyper-stimulation due to an exaggerated response to the medication.
• 4. Uterine infection after the insemination.

Indications of IVF:

• Bilateral tube obstruction.
• Male factor (low sperm quality, low sperm count) to carry out IUI.

• Severe male disorders (even for men suffering from azoospermia or severe oligospermia, sperm can be recovered from the testicles), conventional IVF failure.
• IVF failure.

• 1. Hypophysary inhibition. (this starts at 21 days from the previous cycle and lasts around 14 days).
  In this phase the hormone production of the patient is temporarily detained via the sub-cutaneous, nasal or intramuscular administration of medication.

• 2. Ovary stimulation.
(on average the duration oscillates between 8 and 12 days).
This consists of the administration of medication injected by the sub-cutaneous route, under strict ultrasonographic control, with the aim of obtaining a multiple development of follicles, in which the oocytes are found.
• 3. Follicle puncture. (this is carried out 36 hours after the stimulation has finished). Through an ultrasonographic intervention carried out in the operating theatre under sedation, the content of the follicles is aspired in order to locate the ovules in the laboratory. The average duration of this intervention is around 15 minutes, and after remaining in the clinic for around 2 hours, the patient is discharged and can go home.

• 4. Insemination of ovules in the laboratory (the same day as the follicle puncture). A sample of semen is requested and after being processed the insemination of the ovules is carried out via micro-injection of a spermatozoid into each ovule (ICSI) (Photo ICSI) , or by putting the two gametes into contact on a culture plate and allowing the fecundation to take place in a natural way (IVF) (Photo IVF).

• 5. Embryo transfer.
(2 or 3 days after the extraction of the ovules). This is done in the operating theatre due to the proximity to the laboratory, but this time sedation is not necessary since it is a painless process. Normally, at Biogest, we transfer 2 or 3 embryos, depending on various factors (patient history, age, quality of the embryo). The transfer is done through the trans-cervical route using a special embryo transfer catheter, into which the biologist loads the embryos and the gynaecologist deposits them deep into the uterus. After resting for approximately 15 minutes the patient can go home. It will take 12 days to know the results by making a blood analysis.
• 6. Extended (longer) culture up to blastocyst. It is advised, in cases of repeated implantation failure after IVF, in other words, after three unsuccessful embryo transfers of good prognosis, to practice an extension of the culture up to day +5 or +6 which is when the embryo has assumed the state of blastocyst and is ready to leave the zona pellucida surrounding it for implantation into the uterus endometrium. (Fhoto BLASTOCISTO). (Embryo leaving the zona pellucida). In this way the separation of the embryos that have the greatest capacity for implantation is obtained, since only 50% achieve the state of blastocyst.

• 7. Cryopreservation of embryos. When more embryos than those transferred are obtained, the remainder are cryopreserved and kept in the Biogest bank. If the couple decide to unfreeze them and make a new transfer, the patient only needs a simple endometrial preparation. If later the couple do not contact the Centre, after two years the person responsible for the bank sends a letter informing of the possible destination of the embryos permitted by law in order to regularize the situation.