Assisted Reproduction
Assisted Human Reproduction (AHR) is the set of techniques and treatments that replace the natural process of reproduction in order to achieve and carry a pregnancy to term, giving birth to a live and healthy offspring.
The Community of Madrid is progressively increasing the age of access to assisted reproduction treatments in regional public health, previously established at 40 years, with the aim of increasing it progressively to 45. As of July 1, 2023, this limit is established at 43 years.
In addition, free choice has been established, so that women can decide between the centers where this type of treatment is carried out, previously requesting it in Primary Care.
Definitions and previous study
Definitions
esterilidad
It is defined as the difficulty that a couple has to achieve pregnancy after a year of trying to maintain regular sexual relations. The limit established in one year of attempt is modified in cases of women over 35 years of age, or with a medical pathology that may lead to a worse reproductive prognosis (previous oncological processes, previous gynecological surgeries...), in which case it would be necessary to assess before.
Infertility
It is a term that refers to those couples who achieve pregnancy, but in which it does not reach term, presenting recurrent pregnancy losses.
Both criteria are sufficient to be referred to a consultation for evaluation and reproductive advice, as well as indications for fertility preservation.
Diagnostic tests
The basic fertility study consists of the evaluation of both members of the couple in cases of sterility, performing a gynecological and ultrasound examination of the woman, as well as a blood test for hormonal determinations and serology of sexually transmitted diseases, mandatory before carry out any reproductive process.
For the male, a seminogram will be requested, along with a blood test for serology as in the case of women. With this, it is intended to know the state of the ovarian reserve of the woman and the existence of a seminal sample suitable or not for one type of reproductive technique or another.
If the couple's prognosis is good after the basic study, a tubal permeability test will be performed to verify the integrity and permeability of the internal genital tract, and if so, the start of reproductive treatment will be chosen, if the couple so wishes. through artificial insemination.
In cases of infertility with women over 38 years of age, in cases of infertility with a diagnosis of severe male factor, tubal factor or after failure of artificial inseminations, reproductive treatment through In Vitro Fertilization will be considered.
In cases of women without a partner, or with a same-sex partner, wishing to become pregnant (with or without previous sterility), the same basic study described above will be carried out on the woman who is going to be the one to carry out the treatment and future pregnant woman. for women with infertility prior to the start of treatments.
Types of techniques
Assisted human reproduction techniques:
- Artificial insemination: It consists of the artificial deposit of spermatozoa in the female reproductive tract, and thus facilitate the meeting between oocyte and spermatozoon. Within artificial insemination (AI), two types can be distinguished: artificial insemination with the partner's semen (IAC) and artificial insemination with donor sperm (IAD). It is generally performed after pharmacological ovarian stimulation.
- In vitro fertilization - embryo transfer: with or without Intracytoplasmic Sperm Injection (IVF/ICSI), consisting of the effective union of oocytes and sperm in the laboratory in order to obtain a suitable number of embryos available for transfer to the maternal uterus. Ovarian stimulation is performed for multiple follicular development, ovarian puncture for oocyte extraction, in vitro fertilization with or without microinjection of sperm from the partner's or donor's semen, followed or not by embryo transfer:
- With own oocytes: fresh or vitrified.
- With donated oocytes.
- Embryo cryotransfer: deferred transfer of vitrified embryos after embryo genetic study.
Preimplantation genetic diagnosis: procedure intended to determine the genetic characteristics of the embryos obtained through in vitro fertilization, using molecular genetic diagnosis techniques, before proceeding to the embryo transfer.
Fertility preservation: Its purpose is to achieve a pregnancy, but not immediately but postponed over time, preserving the germ cells or embryos through a freezing process (vitrification) for later recovery.
- Seminal preservation.
- Oocyte preservation.
- Embryo preservation.
- Preservation of ovarian tissue.
oocyte donation: Any woman between the ages of 18 and 35 and in good physical and mental health can donate. Like the sperm donation, it is anonymous and altruistic.
Conditions of access to programs in the Madrid Health Service
Assistance through assisted reproduction(1) It is aimed at reproductive projects that require attention in the different family models and at people who wish to preserve gametes, ovarian tissue or embryos, who meet the admission criteria described by the Madrid Health Service and have a medical indication.
GENERAL INCLUSION CRITERIA
1. Target population: the person must be in one of the following situations:
- Existence of a documented disorder of reproductive capacity, verified after the corresponding diagnostic protocol and not amenable to medical treatment, or after its evident ineffectiveness.
- Lack of achievement of pregnancy after a minimum of 12 months of sexual intercourse with vaginal intercourse without the use of contraceptive methods, if the woman is under 38 years of age, or 6 months if she is older than this age.
- Women without a partner.
- Transsexual people who retain the ability to gestate.
- Women with a same-sex partner.
2. Age: women over 18 years of age and under 43 years of age (43 years + 364 days) and in the case of having a male partner, that he be over 18 years of age and under 55 years of age, at the time the patient began the study.
3. Previous descent: people with a maximum of one previous living and healthy affiliated child. In the case of couples, existence of a maximum of one previous living and healthy affiliated child in common.
SPECIFIC CRITERIA
There are more specific criteria for each technique, which will be informed in the consultation.
EXCLUSION CRITERIA
Previous voluntary sterilization: tubal sterilization by any technique in the case of women and vasectomy in the case of men.
(1)The conditions of access to these programs are defined by the Royal Decree 1030/2006, of September 15, which establishes the portfolio of common services of the National Health System and the procedure for its updating and by the Resolution 555/2022, of the Vice Ministry of Health Care and Public Health, for the implementation of measure 10 of line of action 2 of the "Strategy for the Protection of Maternity and Paternity and for the Promotion of Birth and Reconciliation 2022-2026", regarding the relaxation and extension of the criteria for access to assisted reproduction treatments.
where to go
At present, in the Community of Madrid there are a total of 17 public hospitals accredited to develop techniques and activities of Assisted Human Reproduction:
Eight hospitals are accredited for performing techniques of In Vitro Fertilization (IVF):
- San Carlos University Clinical Hospital
- University Hospital October 12
- University Hospital Gregorio Marañón
- Hospital Universitario La Paz
- Alcorcón Foundation University Hospital
- Jiménez Díaz Foundation
- Prince of Asturias University Hospital (Alcala de Henares)
- Rey Juan Carlos University Hospital (Mostoles)
In addition, there are ten other hospitals, with accreditation to carry out Artificial Insemination (AI) techniques:
- University Hospital Ramón y Cajal
- Severo Ochoa University Hospital (Leganes)
- Getafe University Hospital
- Fuenlabrada University Hospital
- Puerta de Hierro University Hospital (Majadahonda)
- Torrejón University Hospital
- University Hospital of Móstoles
- Infanta Sofía University Hospital (Saint Sebastian of the kings)
- General University Hospital of Villalba
- Infanta Elena University Hospital (Valdemoro)
Of these ten hospitals that perform Artificial Insemination (AI) techniques, there are seven that perform techniques with both partner semen and donor semen and another three that only have authorization for AI techniques with partner semen, which are the HU Fuenlabrada , the HU Infanta Sofía and the HU Puerta de Hierro.
Sanitary measures of the Maternity and Paternity Protection Strategy.
The Governing Council of the Community of Madrid approved in its session on January 26, 2022 the STRATEGY FOR THE PROTECTION OF MATERNITY AND PATERNITY AND PROMOTION OF THE BIRTH RATE AND CONCILIATION 2022-2026.
Among the 80 measures contemplated in said Strategic Plan, there are measures in the health field that have an impact on directly in assisted reproduction programs, aimed at improving accessibility, reducing delay times, allowing free choice, making access criteria more flexible and broadening, and activating the oocyte bank.
The development of these measures has made it possible to improve the coordination of the care offer and access to programs, establishing a unified consensus protocol.