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Frequently asked questions

At VITA you have at your disposal a great medical team specialized in reproductive medicine that will offer you, without any commitment, an individualized initial orientation, prior to the first appointment. However, here you can consult the most common questions about fertility and assisted reproduction treatments.

In Vitro Fertilization IVF-ICSI

What is ovarian puncture or oocyte retrieval?

The steps to follow are the same as for an in vitro fertilization cycle, except that at a certain moment in the cycle, a biopsy must be performed on the eggs or embryos to extract the genetic material. This material is analyzed in order to find out which ones are healthy from a genetic disease.

What is embryo transfer? Number of embryos to transfer?

Once we have the embryos prepared in the laboratory in the most optimal conditions, they will be transferred to the maternal uterus. On the day of the transfer, the appropriate number of embryos to be transferred will be decided, and it cannot be more than three per cycle, according to Spanish law.

The gynecologist will use a small catheter to guide the embryos through the cervix to place them there. The embryo transfer procedure lasts a few minutes and the patient’s recovery time is minimal.

What is a blastocyst?

It is an embryo with a complex cellular structure (a cavity, the blastocoel; the internal cell mass that will give rise to the future fetus, and the trophectoderm that will give rise to the placenta). It is made up of approximately 150-200 cells. It forms about five to six days after a sperm fertilizes an egg. The blastocyst stage is the stage of development prior to implantation in the uterus.

Is it necessary to rest after undergoing an in vitro fertilization cycle?

If your gynecologist does not specify it, it is not necessary to rest after an assisted reproductive technique. There is no study that shows that resting increases the chances of getting pregnant.

Usually after the embryo transfer, the patient waits for about an hour in the hospital room. Then, once at home, the woman can lead a normal life. It is advisable to lead a calm life, no weightlifting or intense physical activity, avoid counterproductive foods and drinks during pregnancy.

Are there differences between a pregnancy achieved by assisted reproduction and a natural pregnancy?

Once the pregnancy is confirmed after an assisted reproduction cycle, its development is similar to one achieved spontaneously.

The typical symptoms of pregnancy, such as nausea, heartburn, drowsiness, tiredness, breast tension, are normal and will disappear in a few weeks. It is advisable that if you have other symptoms or pain appears, go to your medical center to rule out possible complications.

The risk of miscarriage is similar to that of the general population (15-20%), always taking into account that the older the patient, the higher the risk.

How does age influence the chances of getting pregnant?

A woman is fertile from her first menstruation, but her capacity decreases with age. From the age of 35 the oocyte reserve decreases drastically, becoming much more accentuated from the age of 38-39, until it is almost non-existent from the age of 43-44. To this we must add that over the years the best quality oocytes are used up and those with the greatest accumulation of genetic errors remain.

According to the latest data published by the Spanish Fertility Society (SEF), a couple has between a 20-25% chance of achieving a pregnancy per month of regular and unprotected intercourse. After one year, between 80-85% achieve pregnancy and 90% achieve it after two years. For this reason, it is recommended to start with a sterility study if, after a year and a half of trying to conceive, pregnancy has not been achieved. If the woman is over 35 years old, it is recommended to start the study at 6-8 months.

In the case of men, sperm production is also diminished over the years, but in their case it occurs later and is less pronounced.

How long should I wait to start a new treatment after an unsuccessful IVF?

In IVF cycles in which a new stimulation has to be performed, the moment in which the ovary is in the best situation to be stimulated again is controversial. However, according to the latest published studies, no differences have been found in the results when stimulation is started immediately or when several cycles are left to rest. Therefore we can plan the stimulation with the next menstruation after the beta result or wait until the patients are ready again.

In treatments where it is not necessary to stimulate the ovary, but only to prepare the uterus for implantation (treatments with frozen embryos or egg donation), the treatment can be scheduled immediately after the beta test result.

What risks and/or complications does in vitro fertilization have?

The main problems that we can find with assisted reproductive techniques are coming from ovarian stimulation or pregnancy:

• Infections: It occurs in less than 0.1% of cases per cycle.
• Allergies: Although the possibilities are very low, some cases of allergy to the components of the sperm wash have been detected.
• Immunological reactions: The probability is less than 5% and can only occur in those women with pre-existing titers of antisperm antibodies.
• Ovarian hyperstimulation syndrome: Sometimes the ovarian response to treatment is excessive and a large number of follicles develop. It is characterized by fluid accumulation in the abdomen and even in the thorax, renal and/or liver function abnormalities, respiratory failure, or coagulation disorders.
• Risks of anesthesia.
• Multiple pregnancy: It occurs between 15-30% of the cases, being more frequent in young women.
• Miscarriage: The incidence of abortions is slightly higher than the one corresponding to the general population.
• Ectopic pregnancy: It consists of the implantation of an embryo outside the uterus, usually in the fallopian tubes. It occurs in 3% of cases.
• Discomfort or side effects: Swelling and pain in the abdomen, discomfort in the uterus.

Other risks and complications that can exceptionally occur:

• Adverse reactions or intolerance to medication.
• Peritoneal infection.
• Follicular puncture complications.
• Ovarian torsion.
• Cancellation of ovarian stimulation due to absence or inadequate follicular development or excessive response to treatments.
• Failure to obtain oocytes during the puncture.
• Absence of fertilization.
• Failure to obtain viable embryos.
• Physical impossibility of transfer due to anatomical alterations of the uterus.

Egg donation

Can recipient patients choose the characteristics of gamete donors?

The choice of donors can only be made by the medical-biological team that carries out the process, in no case may it be personally selected by the recipient patients. The medical team will try to ensure the greatest phenotypic and immunological similarity with the recipients. Remember that the law defines the donation of gametes and pre-embryos as a free, formal and confidential contract concluded between the donors and the authorized center.

Can I know the identity of my egg donor?

According to law 14/2006, egg donation is anonymous. Both the donor and the recipient will not know the identity of each other. Likewise, donors do not have the right to know the identity of the child born and there is also no possibility that the child born by these techniques knows the identity of the donor.

Specific information about the donor can be provided for the correct follow-up of the pregnancy, such as age and blood group.

Are there waiting lists for egg donation?

There is no waiting list for oocyte donation cycles. What takes the longest is to select and prepare the optimal donor for each recipient patient, but once we have identified a compatible donor, the preparation time is from 6 to 8 weeks.

Should I rest after the embryo transfer?

If your gynecologist does not specify it, it is not necessary to rest after the transfer. There is no study that shows that resting increases the chances of getting pregnant.

Usually after the transfer, the patient waits for about an hour in the room at the assisted reproduction medical center. Then, once at home, the woman can go back to normal life.

What risks and/or complications does oocyte donation have for the recipient patient?

Egg donation treatment does not require ovarian stimulation, sedation or anesthesia. It is a painless, non-aggressive process and does not require changes in the daily habits of the patients. Thus, the main problems that we can find come from pregnancy:

• Multiple pregnancy.
• Ectopic pregnancy: It consists of the implantation of an embryo outside the uterus, usually in the fallopian tubes. It occurs in 3% of cases.
• Miscarriages: The incidence of miscarriages is slightly higher than the one corresponding to the general population.

Other risks and complications that can exceptionally occur:

• Failure to obtain oocytes during the puncture.
• Absence of fertilization.
• Failure to obtain viable embryos.
• Physical impossibility of transfer due to anatomical alterations of the uterus.

Maternity ROPA Method

What is the ROPA technique?

It is a technique that enables two women who have married to be legal mothers of their children. There is a genetic mother and a gestational mother after both have given their consent. Therefore, one provides the oocytes, which are inseminated with anonymous donor sperm, and the other receives the embryos and carries the pregnancy.

Can the female recipient choose the characteristics of the male donor?

The choice of the semen donor can only be made by the medical-biological team that carries out the technique, in no case may it be personally selected by the recipient woman. The medical team will try to ensure the greatest phenotypic and immunological similarity of the available samples with the recipient woman. Remember that the law defines the donation of gametes and pre-embryos as a free, formal and confidential contract concluded between the donor and the authorized center.

Can the cryopreserved embryos that we have from our ROPA treatment be transferred to the other female member of the couple or do they have to be transferred to the same female who received them the first time?

The embryos can be transferred to either of the two female members of the couple, as being married, the embryos belong to both female members of the couple.

Embryo adoption

Can I know the identity of my embryo donors?

According to Law 14/2006, gamete and embryo donation is anonymous. Both the donors and the recipients will not know each other’s identity. Likewise, donors do not have the right to know the identity of the child born and there is no possibility for the child born by these techniques to know the identity of the donors.

Specific information about the donors, such as age and blood type, can be provided for the correct pregnancy follow-up.

Where do donated embryos come from? How does it differ from egg donation??

Donated embryos come from couples who have undergone assisted reproduction treatments and who, after achieving their desire to be parents, decide to donate the remaining embryos to be used by other couples. These embryos are cryopreserved, and whenever possible, the patients who receive them will be as phenotypically and immunologically similar as possible.

In egg donation treatment, a woman between 18-35 years old who is phenotypically and immunologically compatible with the recipient patients is selected. At Vita egg donation is exclusive, and it is not shared with multiple recipients during the same cycle. At Vita we use fresh oocytes opposed to vitrified oocytes.

What risks and/or complications are associated with receiving donated embryos?

Embryo adoption treatment is simple and minimally invasive since ovarian stimulation is not needed to obtain your own eggs. The recipient patient only requires prior endometrial preparation.

The main problems that can arise are related to the pregnancy:

• Multiple pregnancy.
• Ectopic pregnancy: It consists of the implantation of an embryo outside the uterus, usually in the fallopian tubes. It occurs in 3% of cases.
• Miscarriage: The incidence of miscarriage is slightly higher compared to the general population.

Other risks and complications that can exceptionally occur:

• Non-survival of the embryos after the devitrification process.
• Physical impossibility of transfer due to uterine anatomical alterations.

Should I rest after insemination?

Should I rest after insemination?

Unless your gynecologist specifies otherwise, there is no need to rest after artificial insemination. There is no study demonstrating that rest increases the chances of achieving pregnancy. Typically, after insemination, women can resume their normal activities.

What risks and/or complications are associated with artificial insemination?

Artificial insemination is a simple and safe technique but may involve certain complications, albeit rarely:

• Infections: It occurs in less than 0.1% of cases per insemination cycle.
• Allergies: Although the possibilities are very low, some cases of allergy to the components of the seminal wash have been described.
• Immunological reactions: The probability is less than 5% and can only occur in those women with pre-existing titers of antisperm antibodies.
• Ovarian Hyperstimulation Syndrome: The risk is minimal in artificial insemination and can be resolved by canceling the insemination cycle.
• Multiple pregnancy: It occurs between 15-30% of the cases, more frequently in young women.
• Miscarriages: Most miscarriages happen in the early weeks of pregnancy, with an incidence of 20%.
• Ectopic Pregnancy: Statistics indicate that 4 out of 100 women undergoing artificial insemination may have an ectopic pregnancy.
• Discomfort or side effects: Swelling and pain in the abdomen, uterine discomfort

Single Motherhood

Which Assisted Reproduction Technique Is Most Effective in My Case to Become a Mother?

Single motherhood can be achieved through artificial insemination, in vitro fertilization, or egg donation, all using donor sperm, or by adopting embryos. Before making a recommendation, the specialist in reproductive medicine will ask you a series of questions and conduct tests to assess your situation. Typically, a basic evaluation is performed, which includes:

• Hormonal analysis: measuring FSH, LH, estradiol, and progesterone levels. This analysis is conducted between the 2nd and 5th day of the menstrual cycle.
• Transvaginal ultrasound: visualization of the uterus, endometrium, and ovaries.
• Karyotype: a blood test which examines an individual’s chromosomes for any anomalies that might explain fertility issues.
• Hysterosalpingography: a test to assess the uterine cavity and the patency of the fallopian tubes. This test is crucial when considering artificial insemination since tubal obstruction can prevent sperm from reaching the egg for natural fertilization.
• Hysteroscopy: performed to diagnose potential uterine abnormalities and, in some cases, to explain why embryos fail to implant or the cause of recurrent miscarriages.
• Endometrial biopsy: a sample of the endometrium is aspirated and analyzed in the laboratory to check for infections or genetic abnormalities that might impede embryo implantation.

How does age affect the chances of getting pregnant?

A woman is fertile from her first menstruation, but her fertility diminishes with age. After the age of 35, the oocyte reserve starts to decrease significantly, intensifying even more from the ages of 38-39 and becoming nearly nonexistent from the ages of 43-44. Additionally, as the years pass, the eggs of higher quality are used up, leaving those with more genetic errors.

According to the latest data published by the Spanish Society of Fertility (SEF), a couple has a 20-25% chance of getting pregnant per month with regular unprotected intercourse. After one year, 80-85% achieve pregnancy, and 90% do so within two years. Therefore, it is recommended to undergo a fertility evaluation if pregnancy is not achieved after one and a half years of trying. If a woman is over 35, it is advised to start the evaluation after 6-8 months.

In the case of men, the decrease in the generation of spermatozoa is also diminished over the years, but in their case it occurs later and is less pronounced.

Can the female recipient choose the characteristics of the male donor?

The selection of a sperm donor can only be made by the medical-biological team performing the procedure and cannot be personally chosen by the recipient. The medical team will aim to ensure the highest phenotypic and immunological similarity of the available samples with the female recipient. It is important to remember that the law defines the donation of gametes and pre-embryos as an unpaid, formal, and confidential contract established between the donor and the authorized medical.

Fertility preservation: oocyte cryopreservation

At what age is it recommended to undergo a fertility preservation cycle?

According to Spanish law, a person must be of legal age to undergo assisted reproduction treatment, and this can be done as long as the medical team deems it appropriate. However, it is true that after the age of 35, the ovarian egg reserve starts to decrease significantly, intensifying even more from the ages of 38-39 and becoming nearly nonexistent from the ages of 43-44. Additionally, as the years pass, the eggs of higher quality are used up, leaving those with more genetic errors.

Does cryopreserving my eggs affect my future fertility?

No, cryopreserving your eggs through an ovarian stimulation cycle does not affect your future fertility. Under normal conditions, the ovary has a sufficient reserve of oocytes.

How long can my frozen eggs be stored?

Indefinitely, since once we have vitrified the oocytes, they do not deteriorate over time since they remain in the same conditions as when they were vitrified.

Until what age can I use my cryopreserved eggs to become a mother?

Currently, the maximum age is considered to be around 50 years.

What is the survival rate of eggs after thawing?

Thanks to vitrification, the survival rate is around 90-95%.

Does egg vitrification have any side effects on the baby?

Based on the findings to date, babies born through vitrification do not have any more problems than those conceived naturally.

Why is fertility preservation so important for cancer patients?

Nowadays, with increasing frequency we encounter young women who are diagnosed with some kind of cancer and who, after undergoing chemotherapy or radiotherapy treatments, will face infertility issues due to the oncological treatment.

Before undergoing such aggressive treatments, these patients can undergo ovarian stimulation and preserve their eggs, so that once they have recovered and when they desire, they can use these eggs and have the opportunity to be genetic mothers.

What risks and/or complications are associated with oocyte vitrification?

The main problems that can arise are related to ovarian stimulation:

• Ovarian hyperstimulation syndrome: Sometimes, there is an excessive ovarian response to the treatment, leading to the development of a large number of follicles. It is characterized by the accumulation of fluid in the abdomen and even in the thorax, kidney and/or liver function abnormalities, respiratory insufficiency, or coagulation disorders.
• Anesthesia risks.

Other risks and complications that may rarely occur:

• Adverse reactions or medication intolerance.
• Peritoneal infection.
• Complications from follicular puncture.
• Ovarian torsion.
• Cancellation of ovarian stimulation due to absence or inadequate follicular development or excessive response to treatments.
• Failure to obtain oocytes in the puncture.

Egg Donation

Can I know the identity of the recipient of my eggs or the identity of those born?

According to Law 14/2006, gamete donation is anonymous. Both donors and recipients will not know each other’s identity. Donors do not have the right to know the identity of the child born through these techniques, and there is no possibility for the child born through these techniques to know the identity of the donors.

Specific data about donors, such as age and blood type, can be provided to recipients for proper pregnancy follow-up.

Can an egg donation cycle affect my future fertility?

No, fertility is not affected by performing an ovarian stimulation cycle. The ovary, under normal conditions, has a sufficient reserve of oocytes.

What is ovarian puncture or oocyte retrieval?

Under sedation to ensure no pain or discomfort, a fertility specialist extracts mature oocytes via follicular puncture. The procedure is done through the vagina. Oocyte retrieval is a minimally invasive procedure that usually lasts less than 15 minutes. Typically, patients can resume normal activities the next day.

What risks and/or complications are associated with oocyte donation?

The main problems that can arise are related to ovarian stimulation:

• Ovarian hyperstimulation syndrome: Sometimes, there is an excessive ovarian response to the treatment, leading to the development of a large number of follicles. It is characterized by the accumulation of fluid in the abdomen and even in the thorax, kidney and/or liver function abnormalities, respiratory insufficiency, or coagulation disorders.
• Anesthesia risks.

Other risks and complications that may rarely occur:

• Adverse reactions or medication intolerance.
• Peritoneal infection.
• Complications from follicular puncture.
• Ovarian torsion.
• Cancellation of ovarian stimulation due to absence or inadequate follicular development or excessive response to treatments.
• Failure to obtain oocytes in the puncture.

Sperm custody

How long can my spermatozoa be frozen?

Indefinitely, since once the spermatozoa are frozen, they do not deteriorate over time since they remain in the same conditions as when they were frozen.

Does thawing affect the survival of my spermatozoa?

In the freezing and thawing process, there is typically a loss of around 20-30% of spermatozoa. Normally, a thawing test is performed to ensure that not all sperm are affected by this process.

Why is male fertility preservation so important for cancer patients?

Nowadays, with increasing frequency we encounter young men who are diagnosed with some kind of cancer and who, after undergoing chemotherapy or radiotherapy treatments, will face infertility issues due to the oncological treatment.

Before undergoing such aggressive treatments, these patients can preserve their spermatozoa, so that once they have recovered and when they desire, they can use them and have the opportunity to be genetic fathers.

Sperm donation

Can I know the identity of the recipient of my spermatozoa or the identity of those born?

According to Law 14/2006, gamete donation is anonymous. Both donors and recipients will not know each other’s identity. Donors do not have the right to know the identity of the child born through these techniques, and there is no possibility for the child born through these techniques to know the identity of the donors.

Specific data about donors, such as blood type, can be provided to recipients for proper pregnancy follow-up.

Preimplantation Genetic Diagnosis (PGD)

Can I have a healthy child if I have a genetic disease?

If you are affected by a genetic disease or you are a carrier, you can turn to gamete donation or undergo preimplantation or prenatal genetic diagnosis so as not to give up on biological motherhood or fatherhood.

What are the differences between preimplantation diagnosis and prenatal diagnosis?

With preimplantation genetic diagnosis, you can determine whether the embryo is healthy or affected by a disease that one of the parents has before transferring it to the uterus, thereby avoiding the interruption of the pregnancy. Prenatal diagnosis involves analyzing the baby’s DNA after a pregnancy has been achieved, through procedures like amniocentesis or chorionic villus sampling. If the baby is found to be affected, the pregnancy should be terminated to prevent the birth of an affected child.

Can PGD harm the embryo?

The risk of accidental harm to the embryo during cell collection is very low, less than 1%. The biopsy of one or two cells of the embryo does not affect its subsequent development or the future fetus.

Are there legal limitations to perform the PGD?

According to Law 14/2006, PGD can only be performed for the detection of serious hereditary diseases, of early onset and not amenable to postnatal curative treatment in accordance with current scientific knowledge, in order to carry out the embryonic selection of the unaffected pre-embryos for transfer, or for the detection of other alterations that may compromise the viability of the pre-embryo.

Can all genetic diseases of the embryo be analyzed with PGD?

PGD or preimplantation genetic diagnosis is a technique used in assisted reproduction to ensure that the embryos transferred to the uterus are free of hereditary diseases, whether of chromosomal origin, affecting one or several chromosomes, or of genetic origin, affecting one or more genes.

However, “de novo” alterations that an embryo may have are very difficult to diagnose, as well as many diseases whose origin is still unknown.

What risks and/or complications are associated with an IVF cycle with PGD?

In an in vitro fertilization cycle with PGD, we can encounter problems related to ovarian stimulation, pregnancy, or the genetic analysis technique itself:

Problems related to ovarian stimulation or pregnancy:

• Multiple pregnancy.
• Ovarian hyperstimulation syndrome: Sometimes, there can be an excessive ovarian response to the treatment, leading to the development of a large number of follicles. This is characterized by the accumulation of fluid in the abdomen, and in some cases, in the thorax, as well as kidney and/or liver function abnormalities, respiratory insufficiency, or coagulation disorders.
• Ectopic pregnancy: Involves the implantation of an embryo outside the uterus, usually in the fallopian tubes. It occurs in 3% of cases.
• Miscarriage: The incidence of miscarriages is slightly higher than that of the general population.
• Anesthesia risks.
• Other risks and complications that can exceptionally occur:
  • Adverse reactions or intolerance to medication.
  • Peritoneal infection.
  • Complications of follicular puncture.
  • Ovarian torsion.
  • Cancellation of ovarian stimulation due to absence or inadequate follicular development or excessive response to treatments.
  • Failure to obtain oocytes during the puncture.
  • Absence of fertilization.
  • Failure to obtain viable embryos.
  • Physical impossibility of transfer due to anatomical alterations of the uterus.

Problems derived from the genetic analysis technique:

• Risk in embryo biopsy: The risk of accidental harm to the embryo during cell retrieval is very low, less than 1%. The biopsy of one or two cells of the embryo does not affect its subsequent development or the future fetus.
• Error in the diagnosis: There is a certain margin of error in the diagnosis that needs to be evaluated according to the type of PGD. For this reason, it is always recommended to perform confirmation techniques (amniocentesis) if pregnancy occurs.

Genetic compatibility test (GCT)

What is the genetic compatibility test?

The Genetic Compatibility Test (TCG) is a study to identify mutations in the genes responsible for recessive diseases. Through a blood sample, it determines the risk of transmitting these diseases to our children, and we can take action to prevent it.

When is GCT recommended?

The Genetic Compatibility Test is recommended:

• When a couple has a family history or are carriers of a genetic disease (one or both members of the couple) and plans to start trying for a pregnancy naturally or through assisted reproduction treatment with their own gametes.
• When there is a consanguineous relationship between the couple (blood relatives).
• When assisted reproduction treatment involving donor gametes (oocytes or sperm) is to be initiated.

What can be done if there is a genetic incompatibility in the couple?

We have several options in the case of a genetic incompatibility in the couple.

The first thing is to turn to an In Vitro Fertilization treatment and perform a Preimplantation Genetic Diagnosis (PGD) on the embryos obtained in order to transfer the ones which are free of the disease to the uterus.

Another possibility is to turn to gamete donation, where we will select a donor free of the same disease as the female patient.

Is the GCT also recommended for couples seeking to become parents naturally and not through Assisted Reproduction techniques?

It is recommended to do the GCT when a couple has a family history or are carriers of a genetic disease (one or both members of the couple) and plans to start trying for a pregnancy naturally or when there is a consanguineous relationship between the couple (blood relatives).

Freezing of Embryos. Cryotransfer

Why aren’t all the ‘surplus embryos’ from an in vitro fertilization cycle suitable for freezing?

Not all embryos have the appropriate quality for transfer and cryopreservation. It’s essential to consider that the freezing-thawing process for embryos is an aggressive procedure that only high-quality embryos can withstand. Therefore, it is crucial to be very strict when deciding whether the ‘surplus embryos’ from an IVF cycle should be frozen or not, to avoid creating false expectations for the couple.

What are the chances of my embryos surviving the freeze-thawing process?

Approximately 95% of embryos survive this process, provided they are of adequate quality.

How long can my frozen embryos be stored?

Indefinitely, as once they are frozen, they do not deteriorate over time because they remain in the same conditions as when they were frozen.

Until what age can I use my cryopreserved embryos to become a mother?

Currently, the maximum age is considered to be around 50 years.

Is there any risk to the health of the baby coming from a previous cryopreservation?

According to the findings that we have up to now, babies born thanks to vitrification do not have more problems than those conceived naturally.