EXPERIENCE, SIMPLIFICATION AND EFFECTIVENESS IN STERILITY TREATMENT
We are a team of dynamic professionals who are dedicated exclusively to the study and treatment of infertility. We have been pioneers in the application of many techniques such as sperm microinjection or embryonic biopsies. And through in-service training received at prestigious national and international facilities, we apply our knowledge on a daily basis to achieve the main goal of all: to help couples who rely on us to fulfil their dream of having a baby.
We have a very broad vision of all the state-of-the-art treatments and undertake the study of the couple together to make a right diagnosis that would allow us to apply the best, simplest and most suitable treatment in each case.
Our challenge is to pursue excellence on a daily basis and we are aware that the only way to do so is to combine our good pregnancy rates with a high degree of personal satisfaction of each couple.
FERTILITY PRESERVATION UNIT
There are two main areas of reproduction where oocyte freezing may be appropriate, and one of them is socially controversial.
Fertility preservation in cancer patients.
Elective fertility preservation.
PSYCHOLOGICAL SUPPORT UNIT
The number of people who are undergoing fertility treatment is greater day-by-day. This is due to medical and sociological factors (insertion of women into the workplace, delay in the childbearing age of women, lower sperm quality of the man, etc.).
Infertility problems are often accompanied by psychological distress. This discomfort may alter the emotional balance of couples and interfere negatively on the assisted reproduction treatment. It is demonstrated that the main cause of abandonment of treatments is owing to psychological reasons; therefore, providing support in this area is essential to obtain success.
Infertility is "per se" a stressful process, and Assisted Reproduction Treatments (ART) can cause discomfort in the patient's life such as diagnostic processes, coming and going to the facility, success rates, the feeling of lack of control, waiting for results, accepting that pregnancy is a reality and disassociate ourselves from treatment or accept its end and to explore other alternatives.
Our goal is to promote the success of ART by providing the necessary resources so that the path we are treading together is comfortable.
- Dr. Ramón Aurell Ballesteros
Medical Director - ARU Quirónsalud Barcelona
- Dr. Marta Moragas Solanes
Co – Director IVF Lab, ARU Quirónsalud Barcelona
- Ms. Mª José Torelló Ybáñez
Co – Director IVF Lab, ARU Quirónsalud Barcelona
- Dr. Silvia Grau Piera
Gynaecologist. Assisted Reproduction Specialist
- Ms. Georgina Millet Teruel
- Ms. Patricia Sanz
- Montse Roca de Bes
- Dr. Ana Mª Puigvert
- Comprehensive Study and Diagnosis of the Couple
When should a couple consult a specialist for fertility issues?
Those who do not get pregnant after a year of regular intercourse without contraception and for reproductive purposes. On all accounts, each case must be studied in a personalised manner as there may be circumstances such as the age of the spouses or the degree of anxiety of the couple that may force to undergo testing much before.
First visit to the Assisted Reproduction consultation room.
It is important that you provide all the tests and studies undertaken previously during this first appointment with us
A complete clinical history of both members of the couple will be performed in an integrated and simultaneous manner, which will allow us to make the right diagnosis and determine the most effective and appropriate treatment in each case
The first visit of the sterility study is essential to assess the pathology, indicate treatments and to establish a good doctor-patient relationship.
It is important to know if the couple has an intercourse rate that really allows achieving pregnancy and for how long they have been trying. Traditionally it has been considered that a couple should have at least tried to achieve pregnancy during 12 months to be considered sterile, but there are other parameters that can modify this time substantially such as the patients age (the older it is the less time we have to wait), the anxiety of the couple (it is not uncommon to find young couples who visit after trying for 4-6 months to become pregnant overwhelmed by family or social pressure) or the presence of a disease with a high rate of related infertility (chemotherapy in men, endometriosis or pelvic infections in women).
Clinical history of the couple
A good history enables to optimise the selection of diagnostic tests advancing some or avoiding others.
What tests are essential for the study of the infertile couple?
Harmone analysis (HA)
HSG is done to check the patency of the Fallopian tubes and it is important that it is performed correctly.
Hysteroscopy is performed to evaluate the uterine cavity.
This test is indicated when:
a) An abnormality in the morphology of the uterine cavity is suspected
b) There is proof of organic intra-cavitary pathology (polyp, myoma) in the ultrasound
c) An implantation study is carried out as a result of prior failure of IVF treatments.
This test is performed in a gynaecology consultation room by inserting a small camera to view the uterine cavity after distending with air or saline. The images are displayed directly on a screen and uterine diseases can be ruled out in real-time. Simultaneously endometrial samples may be taken to discard embryo implantation problems and infections.
- Diagnostic laparoscopy
Laparoscopy is a test that is performed in an operating theatre under general anaesthesia and involves inserting a small camera through the umbilical orifice to view the pelvis and all its organs.
- Assisted Reproduction Treatments and Techniques
- Assisted Reproduction Treatments
- Ovulation Induction
- Intrauterine Insemination from Partner (PI)
- Intrauterine Insemination with Donor Sperm (DI)
- In Vitro Fertilisation
- Donation Programme (ova and embryos)
- IVF Lab:
- Oocyte recovery
- Sperm microinjection (ICSI)
- Embryo culture up to blastocyst stage
- Assisted hatching
- Biopsy of early embryos and blastocysts
- Cell processing for PGD
- Cryoconservation Lab
- Sperm freezing
- Freezing of sperm from testicle tissue
- Vitrification of early embryos and blastocysts
- Vitrification of eggs
- Andrology Lab:
- Functional study of semen, Seminograms, cytomorphological test
- Sperm capacitation for artificial insemination (PI/DI)
- Treatment of samples from testicular biopsy
- Cytogenetic test: Sperm meiosis, FISH study of sperm
- Sperm bank
- Assisted Reproduction Treatments
- Preimplantation Genetic Diagnosis (PGD)
What is PGD?
Preimplantation Genetic Diagnosis (PGD) is a technique for the detection of genetic abnormalities prior to embryo transfer into the woman's uterus.
This is a technique used as a supplement to in vitro fertilisation (IVF). Your doctor may recommend PGD if there is a possibility that your embryos have certain chromosomal abnormalities. These abnormalities can prevent implantation of embryos, result in the loss of pregnancy or the birth of a child with physical and/or mental retardation. PGD can help prevent these adverse outcomes by identifying the affected embryos during their growth in the lab before being transferred to an IVF cycle. PGD technique is the result of the combination of 1) In vitro fertilisation, 2) Biopsy of embryonic cells via micromanipulation, and 3) Genetic diagnosis techniques.
The aim of this technique is to select and transfer only those embryos free of recognisable chromosomal anomalies to the uterus.
Who should use this technique?
PGD for aneuploidy is indicated in couples who start an in vitro fertilisation (IVF) cycle who meet one or more of these features:
- Maternal age above or equal to 37 years. Patients in this age group have a higher risk of miscarriage or pregnancy with chromosomopathy. PGD can reduce this risk and help embryologists to select those embryos that can lead to a pregnancy.
- Patients of any age with repeated implantation failures after several IVF cycles.
- Patients with a history of repeated spontaneous miscarriages, especially when infertility tests do not reveal a clear explanation.
- Patients who have had a prior pregnancy with an aneuploidy.
- Patients with abnormal karyotype.
It can also be used for the prevention and treatment of genetic or hereditary origin diseases, when it is possible to use them under enough diagnostic and therapeutic guarantee and are strictly indicated.
It can only be performed when there is a reasonable chance of success and does not pose a serious risk to the health of the woman or the future offspring.
- Fertility Preservation in Cancer Patients
The aggressive treatments to fight cancer are no longer an impediment to become parents after overcoming the disease. Thus, these men and women can be offered the possibility of freezing sperm, ova or ovarian tissue before being subjected to cancer treatment, so that they can conceive once they have overcome the disease.
What are the chances that can be offered for preserving fertility in women affected by cancer?
- Embryo freezing. It is the best option if you have a partner.
- Oocytes freezing. Vitrification is no doubt the most effective technique, the least compromised from a physical and moral point of view and the one which offers most realistic possibilities of getting pregnant after overcoming the disease.
- Freezing of ovarian tissue or complete ovary. It involves the extraction of ovarian cortex via laparoscopy and then it is frozen. When the patient overcomes the disease the cortex is reimplanted in the same place from where it was extracted.
- Providing ‘’Counselling’’or Support Advice
At the Quirónsalud Assisted Reproduction Unit we provide emotional support to all people who undergo treatment to prevent the stress associated with these processes as well as to help alleviate it, in cases where patients are already suffering from stress.
Our "Counselling" model or supportive therapy focuses on the patient and is directed primarily to detect which are the areas that produce stress. These range from social, work and family pressure to frustration as a result of unfulfilled desire, including the decision-making process of the different treatment options, and not overlooking the specific aspects of every person such as their history, relationship, sexual problems and other associated issues.
In the Patient Focussed Psychological Therapy Advice we aim to:
- Facilitate the expression of emotions,
- Check coping,
- Promote solving of problems.
We do this through empathy, by understanding the patient. Active listening, which many times are intimate issues that are often not shared with others and encouraging patients to express their emotions and they may be heard. Based on this listening we can differentiate between adaptive and unadaptive emotions, normalising, legitimising and dedramatising reactions. Through review of expectations we encourage hope and illusion within the actual odds.
In the training of "coping", we assess the resources the patients have and based on them we design the most appropriate strategies for each case: relaxation, breathing, review eating habits, exercise, food, thought detection, identification of irrational thoughts, cognitive restructuring, problem solution among others. All these will aid us to promote the correct coping techniques that will enhance the emotional well-being of people during the treatment.