Regardless of the causes of infertility, the truth is that when a woman or couple has been trying to get pregnant for some time without success, some concern or anxiety may emerge.
In this situation, the first thing that should always be recommended is to remain calm. Infertility is much more common than one might think. And fortunately, reproductive medicine has developed a variety of treatments to achieve pregnancy in the vast majority of cases.
The ideal thing, therefore, is to go to a specialist in assisted reproduction, who will be able to provide better guidance on the case in order to know all the alternatives according to your condition and desires. There are numerous techniques that can help achieve pregnancy, which we detail below. It should be noted that in many cases where the ovarian reserve is low, time is a crucial factor, so treatment should be started as soon as possible.
- Artificial Insemination (AI). This is a first-line technique based on natural fertility. It consists of introducing a previously prepared semen sample into the uterus in the laboratory. It can be performed during a spontaneous cycle or with gentle ovarian stimulation, and can be conjugal (when the semen of the partner or spouse is used) or with donor semen. It is generally recommended for a maximum of 3-4 treatment cycles after which the next therapeutic step would be IVF. It is indicated for simple fertility problems or as a first option in cases of sterility of uncertain origin, and provided that the woman is not older than 35/37 years.
- IVF/ICSI. This is a technique that allows eggs to be fertilised outside the uterus. Eggs are obtained by hormonal stimulation of the ovaries so that as many follicles as possible develop, in order to obtain the largest number of eggs. These are extracted by ovarian puncture, a quick and painless technique, under sedation. It is important to know that sometimes the follicles do not contain an egg and that the eggs obtained may not be mature. Immature eggs cannot be used in IVF-ICSI.
A sperm is injected into each mature egg in the laboratory. Once the eggs have been fertilised, one of the resulting embryos is implanted in the woman’s uterus and the others are vitrified for later transfer.
There are different medications and strategies that can be used to achieve ovarian stimulation. A personalized plan and choice of medications is made depending on the results of the different diagnostic tests of the woman (and her partner, if any) and her personal history. Since there is a wide variety of plans, the duration of the treatment will depend on the protocol chosen and the patient’s response. - Oocyte accumulation. This is used in cases where IVF/ICSI is to be performed but the woman does not produce enough oocytes in a single cycle of hormonal stimulation. It consists of the accumulation of oocytes, that is, performing several stimulations, over different cycles. The oocytes thus obtained in each puncture are vitrified, until an optimal quantity is obtained (8 or more) before performing IVF-ICSI. In fact, it is statistically much more difficult to obtain embryos for transfer (on day 5 or 6, at blastocyst stage), if there are not enough eggs at the beginning.
- Preimplantation Genetic Diagnosis (PGD). This is a procedure performed as part of IVF-ICSI before the transfer to rule out embryos with genetic alterations, and to transfer only healthy embryos. This helps prevent possible blockages in embryonic development (which would result in negative pregnancy tests or miscarriages) or genetic alterations in children. Therefore, this optimizes the success of the pregnancy.
It is highly recommended in cases of a history of genetic diseases or chromosomal abnormalities, but also in women over 39 years of age and with a low ovarian reserve, since oocyte quality is often compromised in these cases. - Egg donation. This is the assisted reproduction technique with the best success rate. Recommended for patients with poor oocyte quality or over a certain age (40/42 years). It consists of receiving oocytes from a donor. These are inseminated with sperm from the recipient’s partner or from a semen donor. Then, one of the embryos generated in the laboratory is transferred to the woman’s uterus, and the others are vitrified for later use.
La donación y recepción de ovocitos es un acto secreto y anónimo que se realiza en mujeres en las que esté clínicamente indicada, como en aquellos casos en los que por baja reserva ovárica y escasa calidad ovocitaria no es viable usar los óvulos propios. Esta técnica no está permitida por ley en algunos países, que son muy restrictivos con las prácticas de reproducción asistida. Otros casos, como España, cuenta con marcos legales más modernos y liberales.