Fertility treatments for couples: how to achieve pregnancy?

By BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and BSc, MSc (psychologist).
Last Update: 11/23/2021

According to the latest report from the Spanish Fertility Society (SEF), 149,337 in vitro fertilization (IVF) cycles and 24,100 artificial insemination (AI) cycles were performed in 2018, resulting in a total of 37,094 babies born.

This represents a 6% increase in the use of assisted reproductive techniques over the previous year, demonstrating that more and more couples need help to have the opportunity to become parents.

After one year of sexual intercourse without achieving pregnancy, a couple is considered to have infertility problems, so it is advisable to start diagnostic tests and determine the most appropriate assisted reproduction treatment in each case.

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.

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:

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?

FAQs from users

What tests are performed for fertility treatment?

By Sergio Rogel Cayetano MD (gynecologist).

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.

Imagen: test-treatment-fertility

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?

By Zaira Salvador BSc, MSc (embryologist).

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?

By Zaira Salvador BSc, MSc (embryologist).

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?

By Zaira Salvador BSc, MSc (embryologist).

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?

By Zaira Salvador BSc, MSc (embryologist).

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.

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.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

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.

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?'.

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Authors and contributors

 Marta Barranquero Gómez
Marta Barranquero Gómez
BSc, MSc
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
MD
Gynecologist
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
BSc, MSc
Psychologist
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman

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