1. Sexual Relations Counseling:

In cases of completely normal male factor and anatomical integrity of female reproductive organs, but with ovulation failures, medications are used to normalize the process and guidance is provided regarding sexual activity on the basis of ovarian response.

2. Assisted Insemination:

It consists of placing sperm in the female reproductive tract during the ovulation period, in an attempt to achieve pregnancy. Depending on the origin of the semen, it is designated as homologous or heterologous insemination.


2.1. Homolgous assisted insemination (Ho):

The semen from the partner is used in this type of insemination that is indicated especially in the following situations:

• Retrograde ejaculation
• Erectile dysfunction
• Anatomical penile abnormalities that prevent semen deposit inside the vagina
• Vaginism: A woman’s inability to have intercourse because of pain
• Mild to moderate sperm production abnormality that does not respond to treatment
• Certain ovulation disorders
• Mechanical or anatomical cervical or uterine problems
• Temporary absence of the partner during the ovulation period

2.2. Heterologous Assisted Insemination (He): 

Sperm used in this form of insemination comes from a semen bank. Donors are selected carefully according to age, physical characteristics (phenotype) and personal and family history with the help of laboratory testing (genetics, STDs, including HIV and others). It is indicated in the following cases:

• Absence of sperm (azoospermia) both in the ejaculate as well as in the testicular biopsy.
• In some cases of Rh incompatibility or genetically transmitted diseases
• When other assisted reproduction techniques have failed.
• Single women who wish to be mothers
• In cases of female homosexuality

3. In-Vitro Fertilization and Embryo Transfer (IVF-ET) or Test Tube Baby:

This technique enables fertilization outside the body in order to obtain embryos that can later be transferred to the uterine cavity for implantation and normal gestation. It is indicated in the following cases:

• Irreversible Fallopian tube damage
• Repeated assisted insemination failures
• Non-follicular Rupture Syndrome
• Cervical immune factors
• Endometriosis
• In cases of egg donation
• In cases of embryo donation
• Significant sperm count reduction (oligozoospermia)
• Significant sperm motility reduction (Astenozoospermia)
• Sperm migration abnormalities
• When a Pre-implantation Genetic Diagnosis (PGD) is required.

3.1. Intra-Cytoplasmic Sperm Injection (ICSI):

Using micromanipulation techniques: When sperm quantity and/or quality is not sufficient to allow spermatozoa to penetrate the ovum on their own. It is indicated in the following cases:

• Severe male factor
• Failure of sperm to penetrate the ovum (low acrosine)
• Prior failure with conventional IVF.
 

4. Mincroinjected Intra-Fallopian Transfer (MIFT):

This technique facilitates ovum-sperm binding (ICSI) outside the woman’s body but, unlike in-vitro fertilization, fertilization occurs inside the mother.  The initial procedure is exactly the same as ICSI but, in this case, microinjected oocytes (MIO) are transferred immediately to the Fallopian tube, their natural incubation site, where fertilization normally occurs.  The main indications are:

• At least one completely normal tube
• All the other indications for IVF and ICSI 

5. Pre-fertilization and Pre-implantation Genetic Diagnosis:

Our PGD program at Cecolfes started in 1995 when we achieved the first birth of a hemophilia-free male in Colombia. Several children free of genetic diseases have been born as part of this program, thus putting an end to the transmission chain of diseases such as hemophilia A and cystic fibrosis. We apply the use of polymerase chain reaction (PCR) and in-situ hybridization (FISH) techniques for diagnosing the couple, followed by pre-implantation genetic diagnosis (PGD) in embryos derived from assisted reproduction techniques (ART). We have ample experience and recognition in this area of pre-fertilization (oocyte and sperm) and pre-implantation (single-cell or blastomere) diagnosis using PCR for genetic abnormalities such as hemophilia A and B, cystic fibrosis, Y-chromosome microdeletions, spinal muscle atrophy, Rh incompatibility, AZFX / AZFY detection for sex selection, sickle-cell anemia; or FISH for aneuploidies such as X monosomy, trisomy 13, 16, 18 or 21 or Klinefelter syndrome, and structural chromosomal deletions (translocations). These tests are offered to women over 35 years of age, couples with a history of recurrent miscarriages, spermogram abnormalities, male factor of genetic origin because of Y-chromosome microdeletions. 

6. In vitro maturation of oocytes - IVM:

In vitro maturation of oocytes (IVM) is an in-vitro fertilization technique in which no exogenous drugs are used to stimulate the ovary but follicular aspiration of immature oocytes is performed.  These oocytes are then matured in the laboratory and later fertilized, and the resulting embryos are then transferred to the uterine cavity. Culture systems and follicular aspiration have been optimized for routine use, with a pregnancy rate of 25-35% and close to 300 babies born in the world in the past 5 years.  The main application of this technique focuses on patients with polycystic ovary (PCO) and patients with a risk of ovarian hyperstimulation.  Although it is not yet common practice in IVF laboratories, it promises to be a good alternative not only for PCO patients but also for all causes of infertility.  Also, although it is known that in-vitro maturation of oocytes derived without exogenous hormonal stimulation is still under development, and  that fertilization, cleavage and pregnancy rates vary among groups, it appears as if this technique could be of great benefit for patients, as demonstrated by the first two pregnancies obtained for the first time in our clinic.  


7. PICSI:

This technique was developed in order to select mature spermatozoa for ICSI and as a clinical andrological test.  Spermatozoa are bound to a solid phase hyaluronic acid (HA).  This acid is also present in the female reproductive tract and, consequently, selection is similar to that which occurs naturally.  Sperm-HA binding sites are associated with DNA integrity and sperm morphology, and this results in improved embryo quality and higher pregnancy rates, with lower loss probability.

After selection by PICSI, ICSI is then performed with the sperm selected in real time.  Case selection for this procedure focuses on male factor causes, especially when spermographic findings reveal a high incidence of morphological abnormalities (teratozoospermia) or in cases of unexplained infertility in prior in-vitro fertilization cycles with low embryo development.
Other support services: egg donation, embryo donation, gamete and reproductive tissue cryopreservation. 
 
 

Donor eggs are an option when a woman is unable to produce her own.  Donor oocytes are fertilized with the sperm of the woman’s partner and the resulting embryo is then transferred to the uterus of the user or recipient.  This procedure is indicated in the following cases:

• Absence of ovaries for developmental reasons or as a result of surgical removal
• Ovarian cancer
• After chemo and radio therapy
• Ovarian failure due to older age

• Premature ovarian failure
• Prevention of the transmission of genetic diseases.

Embryo donation refers to the transfer of embryos derived from IVF of a pair of donor gametes (ovum and spermatozoon) in cases where both partners in a couple have such severe gamete abnormalities that they cannot contribute them themselves.  These couples can become parents and the woman, in particular, can enjoy the privilege of a pregnancy, thans to the technology and the generosity of the donors. 

8. Cryopreservation of Gametes and Reproductive Tissues:

This technology allows for long-term preservation of reproductive material stored at very low temperatures (-196°C) using ultrafast freezing techniques that prevent damage to intracellular organelles.
 

8.1 Cryopreservation of testicular tissue:

In cases of obstructive azoospermia, spermatozoa are obtained from a testicular tissue sample.

8.2 Cryopreservation of oocytes:

Oocyte vitrification has shown to be the most reliable technique for the preservation of this gamete. It is achieved through ultrafast lowering of the freezing temperature. Its multiple indications include the following:

• Inadequate uterine receptivity at the time of egg retrieval
• In cases of severe Ovarian Hyperstimulation Syndrome
• Deferring motherhood for a later time
• Before chemo and radiotherapy
• In egg donation while timing the right moment for transfer to the recipient
• High performace atheletes exposed to the use of anabolic substances