Certified Medical Magazine by WMA, ACSA, HON

Fertility Madrid Support Group

Fertility Support Group
This clinic is part of the Fertility Support Group Program.
Health Center approved by the Spanish Ministry of Health - License number (CNN): 1328019580

Get Answers from Fertility Madrid

What is the main indication for IVF with ICSI?
By Óscar Oviedo Moreno. Last Update: 01/07/2022

There are two types of in vitro fertilization techniques; IVF itself and intracytoplasmic sperm microinjection. The main indication for IVF is a motile sperm count above 3 million. Therefore, any semen sample below this count will be indicative of ICSI (severe male failure).

Other possible indications for ICSI would be a previous IVF fertilization failure, semen samples with teratozoospermia or patients requiring preimplantation genetic diagnosis treatment.

What requirements must a woman in her late 50s meet to be accepted for fertility treatment and become pregnant?
By Óscar Oviedo Moreno. Last Update: 12/13/2021

There is a consensus among the Spanish Fertility Society and experts in Reproductive Medicine in our country to set an age limit of 50 years to start an Assisted Reproduction treatment.

In order to be able to treat a woman of this age, she must be in optimal health, without any pathology that could complicate gestation.

Can I know which woman or couple my embryos go to if I donate them to other patients?
By José Luis de Pablo. Last Update: 09/28/2021

One of the possibilities within the Informed Consent is to donate your embryos to another patient/s for reproductive purposes. These embryos become part of the Centre's own embryo bank. The donation of embryos will be made by the Centre to the recipient patient/couple, who will be reminded of the free, secret and anonymous nature of embryo donation and its nature as a voluntary, altruistic and disinterested act. Likewise, in your case, you will not be able to know to whom the embryos have been donated.

What are the benefits of endometrial scratching?
By Dra. Lydia Pilar Suárez. Last Update: 06/07/2021

Endometrial scratching is a relatively new, simple technique that provides good results in assisted reproduction techniques.

It is applied mainly in patients diagnosed with recurrent implantation failure to improve the reception site of a new embryo.

The objectives of endometrial scratching are:

  • To produce a small lesion in the endometrium that causes growth factors, hormonal and chemical factors to be released, so that the newly growing endometrium becomes more receptive.
  • Potential activation of molecular/genetic factors involved in implantation that would not be activated in a normal transfer.

At present, scratching is considered to be a good solution for patients with previous implantation failures in order to increase their gestation rate, although there is still no evidence for its routine recommendation.

What is the EndomeTRIO test and what results does it offer?
By Óscar Oviedo Moreno. Last Update: 11/28/2019

The EndomeTRIO test is used to find out more about the patients' endometrium. It is a complete analysis of endometrial health that includes the following tests: ERA, EMMA and ALICE.

The ERA test analyses endometrial receptivity, the EMMA test analyses endometrial microbiota to increase reproductive success and the ALICE test detects the bacteria that cause chronic endometritis.

Numerous studies show the importance of a good endometrium as one of the fundamental keys to assisted reproduction treatment, as it is known that 20% of infertility is due to an endometrial factor.

Read more

When should childbirth classes begin?
By Óscar Oviedo Moreno. Last Update: 11/27/2019

Childbirth preparation courses usually begin around the 6th-7th month of pregnancy, although they also can be started at the first pregnancy trimester.

They consist of a theoretical part and a prenatal gymnastics part.

The most common decision of couples is to carry out a course of 6/8 sessions during the last months of pregnancy.

How common are spontaneous multiple ovulations?
By Dra. Lydia Pilar Suárez. Last Update: 11/15/2019

Natural double ovulation is studied by the rate of spontaneous twin pregnancies that occurs in 1 out of 80 pregnancies.

In Spain the incidence of multiple ovulation in women is approximately 1.25%. However, there are countries, such as Nigeria, where the incidence is higher and others, such as Japan, where it is lower.

What does a negative ovulation test mean?
By Dra. Lydia Pilar Suárez. Last Update: 11/14/2019

When a woman takes an ovulation test and the result is negative, she may think that something is not right and/or that she has problems ovulating. However, a negative ovulation test can also be due to the following reasons:

  • The woman does it with the first urine in the morning or without following the instrucitons correctly.
  • The patient is tested too far in advance of the LH peak (e.g. patient with long cycles).
  • The LH peak can be short (2 hours) and when the patient is tested, too much time has passed for the test to be positive. It is therefore advisable to do it twice a day.
  • The sensitivity of the test used is low and does not detect the specific LH peak of the patient studied.

Read more

What risks or complications could episiotomy involve?
By Dra. Lydia Pilar Suárez. Last Update: 09/24/2019

An episiotomy is a minor surgery that may result in the following complications:

  • Enlargement of the cut, into the vagina including the anus- rectum.
  • Bleeding or bruising.
  • Infection, due to the fact that many bacteria live in the genital area.
  • Edema.
  • Painful cicatrization: the points that are applied for the closure "pull" and bother the patient.
  • Dyspareunia: pain during sexual intercourse time after complete healing.

Read more

What preventive measures are most important to prevent listeriosis?
By Dra. Lydia Pilar Suárez. Last Update: 09/24/2019

Listeriosis is caused by Listeria monocytogenes, which is transmitted through contaminated food and causes fever and a flu-like illness.

The most frequently contaminated products with which the pregnant woman must take special care are precooked meat, unpasteurized milk and/or dairy products, and shellfish.

It is recommended to cook raw foods of animal origin (meat, fish...) at high temperatures (> 50ºC) and avoid drinking milk without heat treatment. Carefully wash raw foods (vegetables, fruits...). Wash hands after handling raw food and wash kitchen utensils after handling raw food and before using cooked food.

Do not mix raw and cooked or ready-to-eat foods in the refrigerator and clean the refrigerator often.

Once opened, do not store too long cold cuts that require storage in the refrigerator (ham, turkey sausage, pork tongue, gelatin...).

Food leftovers and ready meals should be carefully reheated (> 50°C) before consumption.

What is triple negative breast cancer?
By Dra. Lydia Pilar Suárez. Last Update: 09/24/2019

A classification of breast cancers is based on the receptors it expresses. Three main receptors are studied: ER or estrogen receptor; RP or progesterone receptor; and HER2.

Triple negative breast cancer is cancer in which the hormone receptors, estrogen and progesterone receptors, and HER2 are negative.

Consequently, this type of cancer is more resistant to pharmacological treatment as it does not respond to hormone therapy (such as tamoxifen or aromatase inhibitors) or to therapies aimed at HER2 receptors, such as Herceptin (generic name: trastuzumab), with other treatments such as surgery (lumpectomy or mastectomy), radiotherapy and other chemotherapies other than Herceptin taking on special importance.

About 10-20% of breast cancer cases are triple negative, and due to their resistance to treatment they are also more aggressive.

How is tokophobia treated in a pregnant woman?
By Óscar Oviedo Moreno. Last Update: 07/04/2019

Tokophobia is defined as the irrational fear of pregnancy and childbirth. Like any other phobia, it can be treated by putting yourself in the hands of the right specialist. Psychological help, understanding of the couple and family support are essential to overcome it.

Why can't the GnRH hormone be detected in blood?
By Óscar Oviedo Moreno. Last Update: 04/15/2019

Gonadotropin-releasing hormone (GNRH) is a hormone released by neurons in the hypothalamus in a pulsatile form. It stimulates the release of gonadotropins (LH and FSH) by the adenohypophysis.

This hormone is rapidly metabolized and for this reason cannot be quantified in the blood.

What are the signs and symptoms of placenta previa during pregnancy?
By Óscar Oviedo Moreno. Last Update: 04/15/2019

Placenta previa is a pregnancy problem in which placenta grows in the lower part of the cervix causing a complete or partial obstruction of its opening.

The main symptom is sudden painless vaginal bleeding. It is detected by ultrasound, which shows the position of the placenta.

It is convenient to have an exhaustive ultrasound control in these cases in order to avoid premature birth.

Sometimes it may be necessary to perform an emergency caesarean section.

I don't get my period after using three-month Decapeptyl. Can I be pregnant?
By Óscar Oviedo Moreno. Last Update: 01/31/2019

The probability of being pregnant is minimal, as decapeptyl is a medication that inhibits ovulation at a central level, making it virtually impossible for ovulation to occur.

The ideal thing would be to do an ultrasound scan to confirm that there is no pregnancy.

How many IUI cycles should you do before moving on to IVF?
By Óscar Oviedo Moreno. Last Update: 09/24/2018

In couples with a good prognosis, that is, under the age of 37, with a normal sperm sample, we recommend 4 IUI attempts before moving on to IVF. In the case of single women or donor insemination cycles, up to 6 attempts are recommended. It depends on the clinical history of each patient, though.

How is a Hysterosalpingogram performed?
By Óscar Oviedo Moreno. Last Update: 09/24/2018

A HSG is a type of x-ray examination that aims to examine the presence of pathologies in the uterine cavity, and well as tubal patency. It is recommended to evaluate potential causes of primary sterility. It involves inserting a cannula until the entrance of the uterus, through which a special radio-opaque contrast material dye is inserted. The contrast material dye will fill in the cavity and the tubes. Then, a series of x-rays will be done to detect potential abnormalities or blockages in the different structures. It is a simple procedure that is typically done in the first 10 days of the cycle. During its performance, the woman may feel period-like symptoms. Hospitalization is not required, and its duration ranges between 15 and 30 minutes approximately.

What is a therapeutic abortion?
By Óscar Oviedo Moreno. Last Update: 09/24/2018

A therapeutic abortion is a type of abortion that is performed for medical reasons. Common basic medical causes include:

  • In case a pregnancy is a life-threatening condition for the mother.
  • To protect the physical and/or mental health of the mother.
  • When there exists risk of birth defects or genetic disease.
  • In multiple pregnancies, it is possible to perform a selective reduction or multifetal pregnancy reduction (MFPR) to a number of fetuses that removes serious risks and makes the pregnancy a viable one.
  • When there is a serious risk for the life of the developing baby, either because there exists a malformation, or because there is a high risk of being born dead (stillbirth) or death right after being born
Is Klinefelter syndrome a genetic disease?
By José Luis de Pablo. Last Update: 09/21/2018

Klinefelter syndrome or 47,XXY is a genetic abnormality that occurs as a consequence of an incorrect division of homologous chromosomes during meiosis, which give raise to the gametes of one of the parents. It can also occur during the first divisions of the zygote.

Males affected by it suffer from hypogonadotropic hypogonadism, gynecomastia, learning disabilities, and infertility. It is the most common genetic disease in males. Some men, however, do not have symptoms, and they don't know that they have this condition until they are adults and have infertility issues.

Is a zygote a fertilized egg?
By Aitziber Domingo Bilbao. Last Update: 09/21/2018

An egg is the female reproductive cell, which is fertilized by the male reproductive cell, that is, the sperm. Gametes are haploid cells (23 chromosomes), that is, they have half the number of chromosomes than other cells, which are diploid (46 chromosomes). The fusion between both reproductive cells (male and female) gives raise to a zygote (diploid cell, 46 chromosomes), in which we can find a female pronucleus (23 chromosomes) and a male pronucleus (23 chromosomes).

Which one do you recommend in patients with HIV? IUI or IVF?
By Aitziber Domingo Bilbao. Last Update: 09/21/2018

When a man is affected by HIV, the first thing we would do is washing the semen sample, which removes the seminal plasma, so that the sample contains spermatozoa only. Thanks to this technique, we are able to remove the virus from semen samples. After the washing, we examine the sample to detect copies of the virus using the PCR (Polymerase Chain Reaction) test. If the PCR is negative or the number of copies is low, the sample can be used for a fertility treatment. In this cases, we recommend patients to choose ICSI, as a sperm washing affects the sperm count and motility.

How do I know if I have hypospadias?
By José Luis de Pablo. Last Update: 09/21/2018

Hypospadias is a birth defect that affects male babies. With this conditions, the urinary meatus is located in a place other than the external urethral orifice, such as the scrotum. There exist various types of hypospadias, from mild to most severe.

I have a history of recurrent miscarriage, when should the embryo transfer be done in my case?
By José Luis de Pablo. Last Update: 09/21/2018

The fact that a woman has had repeated miscarriages in the past has nothing to do with the day of the embryo transfer. In most of the cases, it is associated with the chromosomes of the embryos. Keeping this in mind, ideally the best treatment option in these cases would be IVF with PGD (Preimplantation Genetic Diagnosis). With PGD, we examine 6-8 cells of each embryo. It allows us to find out which embryos are genetically norma and which don't.

What are the advantages and disadvantages of ICSI over IVF?
By Aitziber Domingo Bilbao. Last Update: 09/21/2018

Both techniques are reproductive technologies, and as such, we cannot say that one is better than the other. Actually, it depends on the diagnosis of each couple. In the case of conventional IVF, we put the oocyte in contact with a determined concentration of sperm, so that the sperm itself fertilizes the egg, which resembles natural fertilization to a large extent. In many cases, sperm quality is altered, in which case using the sperm won't be possible. In such situations, we use ICSI. It consists in microinjecting the sperm, which is subjectively selected by the embryologists, into the oocyte.

Can alterations in the cervical mucus lead to female infertility?
By Óscar Oviedo Moreno. Last Update: 09/20/2018

Yes, alterations in the cervical mucus can are a common cause of female infertility. The cervical mucus is a secretion produced before ovulation and it disappears after the woman ovulates. It has a sticky texture, and its mission is to pave the way for sperms toward the tubes. It is, in fact, a good indicator of female fertility.

What are the success rates with blastocyst embryo culture?
By José Luis de Pablo. Last Update: 09/13/2018

By blastocyst culture we refer to keeping the embryos in the incubator until day 5-6 of development, that is, until they reach blastocyst stage. By doing this, we perform a much more thorough embryo selection process. The fact they they are capable of making it to blastocyst means that they have a greater implantation potential, as it was able to stay longer in the lab. Pregnancy success rates depend on age, though.