Reproductive medicine

Counselling, demystification and safe environment.

In this functional unit, we attend to transgender or trans people, starting with reproductive counselling. Based on stringent scientific evidence and with the utmost respect and empathy, we offer advice and support to transgender people at all reproductive stages, from assessing the need, if any, to preserve their fertility to the preconception and perinatal stage.

We also aim to demystify some established beliefs regarding hormone therapy and fertility in transgender people, as well as to create a safe environment for query resolution with regard to their sexual and reproductive health.

The WHO estimates that between 0.3 and 0.5% of the world's population is transgender, which means that in Spain there are between 14,000 and 25,000 transgender people. In spite of this figure, transgender people often do not feel comfortable, well cared for or in a safe environment when attending medical appointments. Sometimes, they are not asked about their present and future reproductive desire, which leads to confusion, fear and uncertainty regarding this issue.

Fundació Puigvert, together with Hospital Sant Pau, broke new ground by including the Preimplantation Genetic Diagnosis (PGD) technique in the public healthcare system in 2002, within the framework of the Hospital Sant Pau – Fundació Puigvert Assisted Reproduction Programme.

Since then, we have given more than 600 couples at risk of having children with a serious diseasethe opportunity to have healthy offspring using their own reproductive cells.

Hormonal changes, fertility and menstrual cycle alterations.

Reproductive Endocrinology covers everything related to hormonal changes that concern the reproductive system, either during the process to become pregnant or outside of it. The cases we most often deal with are alterations of the menstrual cycle due to missing menstrual periods or very irregular cycles, which implies the lack of ovulation and can be the cause of sterility.

This may be due to Polycystic Ovary Syndrome (PCOS), hypothyroidism, an excess of prolactin in the blood (hyperprolactinemia), etc. Other less frequent causes may be primary ovarian insufficiency, genetic alterations of the adrenal glands, pituitary tumours or of the hypothalamus, Kallman syndrome, chromosomal anomalies, such as Turner syndrome.

To be able to correctly assess these cases, the team of professionals must have good knowledge of gynaecology and endocrinology. We also rely on diagnostic tests, such as hormone analyses, vaginal ultrasound and brain imaging techniques, if need be, among others.

Cross-sectional response, natural reproduction and assisted reproduction.

The aim of this unit is to provide a cross-sectional response to the diagnosis and treatment of reproductive function in patients with endometriosis. We medically and/or surgically treat other involved areas as well, such as urology or the digestive tract. All of this allows for a global approach to this disease.

Endometriosis is defined by the presence of endometrial glands and stroma outside their usual location in the uterine cavity. It can occur in varying degrees of severity and is thought to affect about 3-10% of the population. It mostly occurs in the 25–35 age group and in up to 10% of women of childbearing age.

Endometriosis has a negative impact on both natural and assisted reproduction and can affect ovarian reserve, endometrium and implantation. The monthly fertility rate is 2-10% lower in patients with endometriosis, whereas the cumulative spontaneous conception rate (at 3 years) is reduced to 55% in severe endometriosis.

This Unit is part of the Functional Unit, which is shared with Hospital de Sant Pau, and features specialists in gynaecology, surgery, urology, radiology, anatomical pathology, anaesthesiology, nutrition, digestive system, alternative medicine and case management.

Egg freezing, ovarian tissue cryopreservation and chemoprophylaxis.

The Fertility Preservation Programme was established in 2009 to offer the option of freezing eggs to all those patients of reproductive age who had to have gonadotoxic treatment, for example after oncological processes, but also to those who, for other reasons, such as an autoimmune disease, had to undergo treatment that would affect their ovarian reserve.

We offer all available techniques to achieve the maximum therapeutic options for our patients(egg freezing, ovarian tissue cryopreservation and chemoprophylaxis).

In recent years, we have expanded the indications for fertility preservation to pathologies as important as endometriosis and to different genetic conditions, such as mutations in the BRCA (breast cancer) genes, Turner syndrome or fragile X syndrome, among others.

The increase in the incidence of cancer in women under the age of 40, together with the increase in survival and the decrease in mortality, as well as delayed childbearing in our current society, has led to an exponential growth in recent years. There is a greater activity of all scientific societies and a greater social awareness that increases the demand for fertility preservation.

Our laboratory is equipped with cutting-edge technology for the optimal performance of assisted reproduction techniques:

• State-of-the-art time lapse incubators (EmbryoScope and Geri) that represent a breakthrough in embryo development in the laboratory.
• Witness system: radiofrequency identification tool that ensures the traceability and control of each patient's biological material (eggs, sperm and embryos) and increases the techniques' safety, thus providing confidence to our patients.
• ICSI (Intracytoplasmic Injection)
• Advanced sperm selection techniques that increase the probability of successful fertilisation, such as Magnetic Activated Cell Sorting (MACS), ZyMot chip or PICSI.

Head of Unit:

Olga Martínez Pasarell

Team:

Elisabet Lancharro Muñoz
Silvia García Monclús
Noelia Moya Rodríguez
Blanca Secall Pérez
Ruth Calvete Fernández