According to the latest report of the Spanish Fertility Society (SEF), 167,195 in vitro fertilization (IVF) cycles and 31,635 artificial insemination (AI) cycles were performed in 2022.
This represents an increase in the use of assisted reproduction techniques over the previous year, which shows that more and more couples need help to have the opportunity to become parents.
In the case of heterosexual couples, after one year of sexual intercourse without achieving pregnancy, a couple is considered to have infertility problems. At this point, it would be advisable to start diagnostic tests and determine the most appropriate assisted reproduction treatment in each case.
If instead of being a heterosexual couple, it is a female couple or a woman who wishes to become a mother alone, the time to see a fertility specialist would be when they feel ready and want to become a mother.
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What does a fertility treatment consist of?
Fertility treatments are different techniques and procedures that allow many people to fulfill their dream of becoming pregnant.
There are two different situations that make it necessary to resort to fertility treatment to achieve gestation. On the one hand, there is infertility, i.e., when patients are able to achieve pregnancy, but the pregnancy does not go to term.
However, there are situations of sterility. In this case, it consists of the inability to achieve pregnancy, either for anatomical reasons, absence of gametes, etc.
In any case, an assisted reproduction treatment is to be performed when there are problems that hinder pregnancy, either due to infertility or sterility. In addition, a couple's fertility problems can have their origin in the man in 30% of the cases, in the woman in another 30% or have a mixed origin.
However, there are also 20% of situations in which fertility alterations have an unknown origin.
Taking into account the origin of the problems, AI or IVF will be chosen. In addition, sometimes the option of embryo adoption can also be considered. Other times it will be necessary to resort to gamete donation to carry out assisted reproductive techniques.
Personalized fertility treatments
Something very important in assisted reproduction is to be clear that not all people are the same. Therefore, fertility treatments to achieve pregnancy cannot be the same for everyone but must be individualized reproductive treatments.
There are many factors that can influence the success of fertility treatment: age, cause of infertility, hormonal values, semen quality, previous surgeries, etc.
Therefore, the first step before starting the whole process is to conduct a comprehensive interview, medical history, and a series of tests on both the man and the woman to make a personalized diagnosis of the couple's fertility.
Once all the results have been obtained, they are analyzed together and advice is given as to which fertility treatment is the most appropriate for each patient.
AI and IVF are the most commonly used techniques to try to achieve pregnancy, but it should also be noted that there are variants or complementary techniques that can be applied, such as intracytoplasmic sperm injection (ICSI), gamete donation or preimplantation genetic diagnosis (PGD) to transfer only healthy embryos without genetic alterations.
Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.
Artificial insemination (AI)
AI is the simplest assisted reproductive treatment after programmed intercourse. This is a low-complexity and more economical reproductive technique.
To perform an AI, a gentle ovarian stimulation is performed on the woman to allow the ovulation of one or two mature eggs. The capacitated semen from the male is then introduced into the uterine cavity through an insemination cannula.
Depending on the origin of the sperm used for insemination, there are two types of treatment:
- Artificial insemination by husband (AIH), if the semen comes from the male partner.
- Donor artificial insemination (DAI), also called heterologous AI.
You can obtain all the information about this technique (indications, requirements, success rates, prices, etc.) in the following post: What is artificial insemination?
In vitro fertilization (IVF)
IVF is a more complex and expensive treatment than AI, as it requires stronger ovarian stimulation and the need to extract the woman's eggs for fertilization in the laboratory.
This is why IVF is indicated in the most severe cases of infertility, such as low ovarian reserve or poor seminal quality.
Once the embryos are obtained after fertilization of the gametes in the laboratory, embryologists carry out an exhaustive control of their development and quality. The objective of this evaluation is to select the best embryo for transfer to the maternal uterus and thus achieve pregnancy.
In case a gamete exchange is necessary, IVF can also be classified into the following modalities:
- IVF with sperm donor.
- IVF with egg donor.
- IVF with double gamete donation.
Regarding the complementary techniques that can be used in the course of IVF, two of the most important ones are detailed in the following sections.
ICSI
ICSI is a more invasive in vitro fertilization technique since, once the eggs have been obtained in the laboratory, the embryologist selects the spermatozoa under the microscope and introduces them directly into each egg with a microinjection.
Thanks to this method of fertilization, it is not necessary for the sperm to move correctly, since it is the embryologist himself who introduces the sperm into the egg. This ensures that each egg interacts with sperm and promotes fertilization.
ICSI is especially indicated in severe cases of male factor, although nowadays it is routinely used in IVF treatments.
If you want to continue reading about this topic, we recommend you to access the following post: What is ICSI?
PGD
Preimplantation genetic diagnosis is a complementary technique that can be performed during the course of IVF to analyze the genetic material (DNA) of the embryos created.
Its purpose is to be able to make a better embryo selection for transfer, as well as to avoid the transmission of chromosomal anomalies or hereditary genetic diseases. In this way, only healthy embryos without genetic alterations are transferred to the woman's uterus and, therefore, with a greater probability of implanting in the uterus and giving rise to a pregnancy.
To perform PGD, it is necessary to perform an embryo biopsy and extract one cell from each embryo in the culture. This technique is considered invasive, but the embryos can continue their development and their viability is hardly affected.
If you are interested in reading more about this, you can click on the following link: What is PGD?
Adoption of embryos
Embryo-adoption or embryo adoption is a fertility treatment in which use is made of the embryos left over from another IVF treatment that other patients have undergone. This means that there are patients who decide to donate their surplus embryos so that others can achieve the desired pregnancy.
As with egg and sperm donation, embryo donation is also completely anonymous and altruistic.
This is a much cheaper reproductive alternative to IVF with oocyte donation or IVF with double donation, but its success rates are also lower.
If you want more information about this assisted reproduction treatment, you can visit the following link: What is embryo donation and adoption and when is it recommended?
FAQs from users
What tests are performed for fertility treatment?
The basic study consists of the following tests:
- Basal hormone profile
- FSH, LH, Estradiol and Prolactin. All of these provide information about the woman's ovarian function.
- Edometrial receptivity test
- to assess the precise moment when the endometrium is receptive and can accept embryos for implantation.
- Laparoscopy
- direct visualization of the abdominal cavity, uterus and ovaries. If any abnormalities are noted they can be corrected on the spot.
- Hysteroscopy
- Direct visualization of the uterine cavity. Abnormalities can be corrected on the spot.
- Hydrosonography
- special ultrasonography for study of the uterine cavity using fluid as contrast, which increases the ultrasonographer's ability to detect pathologies.
- Immunological study
- in case of repeated miscarriages or alterations of the immune system.
- Thrombophilia study
- process in which a greater than usual ability to clot blood is observed, which is associated with repeated miscarriages and implantation failures.
- Thyroid study
- alterations at this level have been associated with implantation problems and miscarriages.
- Seminogram progressing
- parameters such as apoptosis and double- or single-chain fragmentation studies can be important in the assessment of semen, where semen that at first appeared normal may be the cause of infertility or infertility in the couple.
These are some of the many tests that exist to assess a couple's fertility and determine the best treatment for each situation.
How much do fertility treatments cost in Spain?
Prices vary greatly from treatment to treatment, and even from clinic to clinic. In general, the cost of IUI can range from €500-€1,000, whilst IVF cycles are usually €3,000-€5,000. These estimated costs increase if donor sperm, donor eggs, or both are needed. Moreover, medications are rarely included in the initial cost.
Which fertility treatment is right for having twins?
The fact that the probability of twin pregnancy increases after fertility treatment is due to the transfer of two embryos instead of one. This happens with conventional in vitro fertilization or ICSI, when a greater number of embryos are obtained after stimulation.
Is there a maximum age to undergo fertility treatment in a clinic?
Yes and no. In principle, Law 14/2006 does not state anything about a maximum age to become a mother. However, there is a consensus among assisted reproduction professionals in Spain not to accept women over 49 years of age due to the risks involved in such a pregnancy for the mother and the future baby. However, nowadays there are a few clinics that accept women up to 53 years of age if they are in good health.
Are fertility treatments covered by Social Security?
Yes, but it is necessary that the couple meets a series of requirements to be able to access them, since the waiting lists in public hospitals are very long and time is a very important factor in terms of the success of the treatments.
In general, a woman must be under 40 years of age to undergo assisted reproduction treatment and not have had any previous children with her current partner.
Although it depends on each Autonomous Community and each center, Social Security usually covers a maximum of 4 cycles of AI and 3 cycles of IVF.
Recommended reading
If you are still looking for a clinic to start fertility treatment, the following article may be of interest to you: How to choose the best-assisted reproduction clinic for me?
If you wish to learn more about fertility treatments indicated in the case of male infertility, do not miss the following reading: What is the treatments for male infertility?
Nevertheless, if your problem is related to female sterility, the most recommended article is the following: Techniques and treatments to combat female infertility.
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References
Harper J, Geraedts J, Borry P, Cornel MC, Dondorp WJ, Gianaroli L, Harton G, Milachich T, Kääriäinen H, Liebaers I, Morris M, Sequeiros J, Sermon K, Shenfield F, Skirton H, Soini S, Spits C, Veiga A, Vermeesch JR, Viville S, de Wert G, Macek M Jr; ESHG, ESHRE and EuroGentest. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. Hum Reprod. 2014;29(8):1603-9.
Pellicer A, Alberto Bethencourt JC, Barri P, Boada M, Bosch E, Hernández E, Matorras R, Navarro J, Peramo B, Remohí J, Riciarelli E, Ruiz A y Veiga A. Reproducción Asistida. En: Documentos de Consenso SEGO 2000:9-51.
Sociedad Española de Fertilidad (SEF) (febrero de 2012). Saber más sobre fertilidad y reproducción asistida. En colaboración con el Ministerio de Sanidad, Política Social e Igualdad del Gobierno de España y el Plan de Calidad para el Sistema Nacional de Salud.
Sociedad Española de Fertilidad. Registro Nacional de Actividad 2021-Registro SEF. (View)
Neri QV, Lee B, Rosenwaks Z, Machaca K and Palermo GD. Understanding fertilization through intracytoplasmic sperm injection (ICSI). Cell Calcium. 2014; 55(1): 24–37.
Stern HJ. Preimplantation Genetic Diagnosis: Prenatal Testing for Embryos Finally Achieving Its Potential. J Clin Med. 2014; 3(1): 280–309.
FAQs from users: 'What tests are performed for fertility treatment?', 'How much do fertility treatments cost in Spain?', 'Which fertility treatment is right for having twins?', 'Is there a maximum age to undergo fertility treatment in a clinic?' and 'Are fertility treatments covered by Social Security?'.
Authors and contributors
More information about Cristina Algarra Goosman
Hi, last week I went for the first time to an assisted reproduction clinic and they advised me and recommended an AI because of my age (29 years old), they explained to me how everything was going to be and did not tell me at any time that they were going to do tests, is that normal?
Hello Carole,
In the first visit to an assisted reproduction clinic, they establish if possible, according to the diagnoses and personal characteristics the treatment that best suits your needs as well as an initial recommendation on what test you will need done. In subsequent consultations, the necessary routine tests will be performed to perform the recommended treatment.
In your case you have been recommended AI, I leave you an article where it explains step by step what to expect in front of an artificial insemination: The Intrauterine Insemination (IUI) Process Step by Step.
I hope I have helped you.
Best regards.
Hi, I am trying to get pregnant, I am 42 years old and I am going to use both donor sperm and donor eggs, my husband and I have had two failed IVFs and the doctors have told me that they have to do a hysteroscopy, I am very scared, will it hurt a lot?
Hello Starqq1,
After a couple of failed treatments and if there is suspicion that there may be a problem in the womb gynecologists usually perform a hysteroscopy.
There are two types of hysteroscopy, diagnostic and surgical. There is no pain, it is uncomfortable and resembles period pains. Depending on the type of hysteroscopy that you will be performed will be a procedure or another. I recommend you read the following article which explains what hysteroscopy consists of: Endoscopic Surgery: Hysteroscopy & Laparoscopy.
I hope I have helped you.
Best regards.