In Vitro Fertilisation (IVF) - ICSI

In vitro fertilisation treatment (IVF) consists on the retrieval of oocytes (eggs) from inside the ovaries which are then fertilised with sperm in the laboratory to create embryos. Afterwards, these are transferred back into the uterus. The sperm used can come from a partner or a donor.

In Vitro Fertilisation. Steps.

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Hormone therapy for IVF is more complex than the one used in artificial insemination procedures. From a hormonal perspective, the aim consists in stimulating the ovaries to produce as many mature eggs as posible, while preventing early ovulation to happen before egg retrieval. There are different medications and strategies that can be used to achieve both ovarian stimulation and ovulation control. 
A personalized treatment is planned based on patients´ diagnosis, taking into account their past medical history and relevant tests results. Given the wide range of therapeutic plans available, the lenght of a treatment will vary depending on protocols and patient´s response.

During the ovarian stimulation phase, ovarian activity is closely monitored through transvaginal ultrasound scans and hormonal blood analysis. The first scan is performed at the start of ovarian stimulation, with 2 to 3 subsecuent screenings over a period of 8 to 12 days, in order to monitor folicular growth. Gonadotropin hormone dosage is adjusted according to the results of these ultrasound scans and blood tests. When there is a poor response to hormone therapy, the treatment may be cancelled and resumed on the next cycle.
Egg retrieval can be scheduled when at least three follicles reach maturity. Full follicular maturity is triggered by a hCG injection, applied 36 hours before the punction.

Pick-up usually takes 5 to 10 minutes to be completed, but this may vary depending on the number of follicles. This procedure is performed using an intravenous mild sedation and painkillers which are administered by an anaesthesiologist and the patient is closely monitored throughout the process. It is important that you feel comfortable during the procedure and sedation is aimed to offer a positive and relaxed experience, reducing any discomfort.

During the procedure, a thin needle is passed through a guide attached to the ultrasound probe, which is inserted into the vagina. Like this, the fluid inside each follicle is aspirated through the needle. This fluid is examined by a biologist under the microscope to determine the presence of the oocytes, and assess their maturity and suitability to be fertilised.

Recovery time after egg retrieval procedures is 1 to 2 hours. Light spotting may occur, which is perfectly normal. Pelvic discomfort may persist until the following day, but it is typically controlled with oral analgesia (Paracetamol or Panadol®). Regular daily life activities can be resumed from the they after.

In the case of a fresh transfer, the male should attend to the clinic on the same day of the puncture to provide a semen sample. This is not necessary when using frozen sperm from a partner or a donor.


Classic IVF

Retrieved oocytes are placed in petri dishes containing a culture medium providing them with the nutrients needed to grow; then sperm is added to allow fertilisation to occur. These plates are then placed into an incubator. This is known as classic IVF. Another fertilization procedure, called ICSI, is detailed below.


ICSI
Nowadays, Intracytoplasmic Sperm Injection (ICSI) is the preferred technique used for egg fertilization. To begin with, sperms are selected following morphological criteria. Once this is done, each selected sperm is microinjected into each mature egg. ICSI is usually indicated when there is a low sperm count and/or low quality of the sperm, and in case of testicular biopsy or subsequent failures of classic IVF treatments and low fertilization rates. Regardless, ICSI is now a widespread technique and is used for the majority of fertilization treatments as it has proven a high fertilization rate.

Embryo transfer takes place 5 to 6 days after egg retrieval. The date of the transfer is assessed on a case-to-case basis, as it depends on the quality and quantity of embryos.

The number of embryos transfered is also assessed this way, since it depends on the age of the woman, her reproductive history, previous treatments outcome, and quality of the embryos. Advice regarding this matter is given at the beginning of the treatment and also before the transfer, and it is aimed to minimise the risk of multiple pregnancies while maximising the chances to conceive. 

At the time of the embryo transfer, the embryo(s) is loaded into a fine plastic catheter and inserted into the uterine cavity. This procedure takes around 15 minutes and it does not require anaesthesia since it does not cause any discomfort. After the transfer, the woman rests 15 minutes in her room and is able to resume her daily activities afterwards.

A pregnancy blood test is performed 12 days after an embryo transfer. An ultrasound scan is scheduled two weeks after a positive pregnancy test to confirm a pregnancy is in progress.

This technique is recommended when there are lesions in the fallopian tubes, severe male infertility, severe endometriosis, low ovarian reserve or when other treatments have failed.

IVF-ICSI cost

Phase

Previous Study
Stimulation
Follicular Puncture
Laboratory
Transfer
Post-transfer care

*Add on 435€ when donor´s sperm is required.

Services included

Case-oriented cycle planning and all consultations

HERES Carrier Screening test (16,592 mutations) both partners

Ultrasound scans (unlimited)

Hormonal screenings (unlimited)
Puncture - follicular aspiration
Preoperative evaluation - anaesthesia - sedation
Rest in clinic
Laboratory procedures
IVF - ICSI
Sperm selection techniques, when necessary (Fertilechip, MACS, PICSI, Microfluidic sperm sorting)
Assisted hatching included (when necessary)
Embryo culture (day 5-6) to blastocyst stage
Embryoscope+
KIDScore / IDAScore (AI for embryo selection)
Specific transfer techniques when required
Embryo transfer (1 or 2 embryos)
Rest in clinic
Vitrification of spare embryons (unlimited)
BHCG – pregnancy blood test (unlimited)
Two pregnancy check ups
Two years maintenance fee of vitrified embryos
Total amount     5.985€
  • Fixed Price: This is a fixed priced treatment that includes the services detailed on the cost breakdown. Supplementary tests may be required according to medical criteria, however, these will be notified in advance.
  • Additional stimulations (oocyte accumulation): When supplementary stimulations are needed, an additional cost of 2.485 € per cycle will apply.
  • Embryo devitrification: When an embryo transfer fails, an additional cost of 1.860 € will apply to subsecuent attempts.
  • Validity: The validity of this estimate is 6 months from the date of your first consultation.
  • Medication: Medication costs are not included. These will be assumed by the patient.
  • Cancellation by the patient: In case of cancellation of the treatment, the patient must pay the costs incurred until that point.
  • Transfer cancellation: When transfer needs to be cancelled due to embryos failing to evolve as expected, 220€ will be refunded.
  • After 2 years of embryo crypreservation: It will be your decision to either chose from one the authorised applications regarding embryo donation/destruction or the payment of a 435€ fee per year of conservation for future use. 
  • Sperm preservation: This has a cost of 250€, and 230€ per year of conservation.
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