IVF in Cuba. Strong scientific approach
Infertility treatment is associated with a high risk of neonatal morbidity and mortality basically with prematurity and a low birth weight increasing markedly in newborns conceived by this procedure of assisted reproduction. In Cuba they carried out a huge amount of research to identify the morbidity and mortality of this group and the differences in some indicators of hospital morbidity with those naturally conceived. A transversal, prospective and descriptive study was conducted including 49 neonates conceived by in vitro fertilization (IVF) technique. As a result rate of multiple pregnancies and of cesarean section was high in those conceived by IVF compared with remainder live births (27% versus 1.4%; p < 0.000 and 97.3% versus 40.9%; p < 0.000, respectively). Most of neonates were term born (71.4%), with a good weight (61.2%) and with a eutrophication nutrition assessment (85.7%). The 28.5% showed morbidity with predominance of a severe icterus 20,4%); the 6.1% deceased (two from hyaline membrane disease and one from intraventricular hemorrhage). There was a higher ratio of prematurity, low weight, restricted intrauterine growth, hyaline membrane disease, congenital malformations and neonatal mortality in those conceived by IVF ( p < 0.05) in all of them. Key advantage for an IVF treatment in Cuba is that the newborn artificially conceived have significant influence in hospital indicators related to neonatal morbidity and mortality of institutions where they are seen, thus, hospitals with this responsibility need a logistic support and differentiated health objectives.
All about Infertility treatment to time-schedule the trip and stay in Cuban clinic
Although only one stage comes to mind when infertility treatment is mentioned, the journey on which people embark with the goal of bringing a "live baby home" is comprised of various stages. Here are all the processes that take place in infertility treatment from the very first test to determining the pregnancy and the actual birth. Treatment for infertility should first address any underlying medical condition that may be contributing to fertility problems. Drugs, surgery, or both may be used to treat these conditions. Surgery may also be used to repair blockage in fallopian tubes.
Fertility Treatment Approaches
Several approaches are used to treat infertility:
· Lifestyle measures (healthy lifestyle, planning sexual activity with ovulation cycle, managing stress and emotions)
· Drugs to induce ovulation, such as clomiphene and gonadotrophins
· Assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)
When investigating the causes of infertility whether ovulation is taking place must first be established. A variety of tests are used to determine this. One of the indications of ovulation is regular menstruation cycles. However measuring the progesterone (the sex hormone that is secreted from the ovaries) level on the 21-24th day of the cycle produces a clearer result. Then whether or not the uterus and fallopian tubes are anatomically normal must be established and in order to do this ultrasonographic examinations and x-rays of the uterus can be used.
The first of the tests that can be run on men, which is the spermiogram, counts the sperm and examines their mobility and structure. These assessments give information about the male's infertility. If problems are detected in the couple, various treatments are given accordingly.
When the IVF is applied
When one or both individuals in the couple have infertility issues it is necessary to start IVF treatment. Here are some such causes:
The Ovarian reserve: The ovarian reserve in women begin to decline after 30 years of age. This speeds up after 35 and increases as of 40. In order to examine the ovary reserve, a measurement of FSH and E2 hormones can be done on the third day of a period and of AMH hormone on any given day of the period. Also an ultrasound can count antral follicles (ovarian cysts). Patients with an advanced case of decreased reserves must start IVF without delay.
Ovulation disorders: When a variety of ovulation treatments that are applied for a certain amount of time towards ovulation disorders do not result in achieving a pregnancy, IVF can be resorted to.
Unexplained infertility: When the reason for the infertility is not known, taking into account the woman's age and degree of infertility either intrauterine insemination is applied first or IVF is applied directly.
Male infertility: Sperm concentration, mobility and structure are examined and intrauterine insemination and IVF are applied to those who do not respond to urological treatment.
Stages of IVF treatment
The first stage in the in-vitro treatment is to stimulate the woman's ovaries. During this method that is called "Controlled ovarian hyperstimulation" the ovaries are stimulated to develop follicles. The stimulation, which is achieved through various agents and protocols, lasts about 8-14 days in the short protocols that are frequently applied today.
Later the eggs are triggered by the HCG hormone to mature. 34-36 hours after the HCG hormone injection, the eggs are harvested. This process is done by the transvaginal method entering the patient's ovaries with the help of an ultrasound and aspirating the follicles with a special needle. Embryologists examine the aspirated follicle liquid in the laboratory and determine the number of eggs that have been harvested.
On the same day that eggs are harvested from the woman, sperm is taken from the man. After this sperm sample goes through a special cleansing process the best sperm are singled out.
The maturation of the eggs is assessed. The mature eggs in the "Metaphase 2" period are fertilizable. The selected sperm are injected into these eggs by microinjection. While in previous years the sperm had been left next to the egg for fertilization to take place, in the present days the microinjection method called ICSI is preferred. The sperm cells are placed directly inside the egg under a microscope.
The fertilized eggs are placed in an incubator that provides the conditions and heat that they need to develop. The gas and humidity is adjusted and the eggs, which are placed inside a special liquid, are monitored. 16-18 hours must go by before it can be determined whether the insemination has been successful or not. The results can be obtained from the first check that is done at the end of this period.
If the insemination is successful, it is followed by the cell division of embryo. The embryo consists of about 4 cells in 36-48 hours and 8 cells in 72 hours. On the fifth day the embryo is classified as a blastocyst.
The embryo transfer is usually done on the third or fifth day with the help of special catheters but recently the fifth day is being favored. The reason for this is that the rate of selecting the best embryo and the rate of the embryo in blastocyst stage latching onto the uterus is higher. However if not enough good quality embryos have been achieved there is no need to wait for the fifth day. The process of positioning the embryo in the uterus can also be done with three-day embryos that have shown sufficient development.
Once the transfer is completed the female patient is released after a 30-60 minutes of bed rest. During this period patients are warned not to do anything that requires a lot of physical effort, not to lift heavy items or do high impact exercises. The patient must use the medications that have been prescribed on time, eat well and drink plenty of fluids.
11-12 days after the transfer blood tests are done to detect pregnancy. Women who test positive for Beta HCG are tested again in a few days to check the increase of the hormone level. Later an ultrasonography is done. In 7-10 days after the test it is possible to see a gestational sac in the cervix using an ultrasonography. Thus the clinic can determine whether the pregnancy has taken place or not.
Success rates in IVF
Presently a success rate of about 55-60 percent per transfer can be achieved in IVF, but of course the real success is regarded as the rate of actually "taking home a live baby". This rate varies by age. It is 40-45 percent in women under 30, 30-35 percent in women 35 to 37 years old, 20-25 percent in women aged 38-40, 12-15 percent in women 41-42 and 4-5 percent in women over 42.
Choosing a Fertility Clinic
Some doctors recommend that if a couple fails to conceive after 1 - 2 years of frequent unprotected sex, they should consult a fertility expert. Women who are 35 or older, however, may want to begin exploring their options if they do not become pregnant within 6 months to a year.
Choosing a good fertility clinic is important. Those offering assisted reproductive techniques are not always regulated by the government, and abuses have been reported, including lack of informed consent, unauthorized use of embryos, and failure to routinely screen donors for disease.
The clinic should always provide the following information:
· The live-birth rate (not just pregnancy success rate) for other couples with similar infertility problems. (Multiple births, such as twins or triplets, are counted as one live birth.)
· Such statistics should include high-risk women, such as those who are older or fail to produce eggs. (Some disreputable clinics give success percentages that exclude high-risk women from their total, thereby making the percentage of success much higher.)
Advanced fertility procedures and medications are extremely expensive and often not covered by insurance. Couples should be cautious about offers of rebates in the event of failure; the clinics offering them are often significantly more expensive than those that don't offer such gimmicks.
Contacting Cuban Clinic
Some particular topics you would like advice on need a consultation by a professional. We encourage foreign patients to contact Cuban clinics directly avoiding middlemen. There are four high-end fertility treatment centres all over the island. However we advice foreign couples to pick up a clinic of your choice in Havana.
Erectile Dysfunction (ED) Treatment in Cuba
Erectile malfunction is difficulty experienced by an individual during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. The dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of 6 months (excluding substance or medication-induced erectile dysfunction). These dysfunctions can have a profound impact on an individual's perceived quality of sexual life.
Erectile Dysfunction treatment program in Cuba can also be performed as an outpatient service.
Evaluation of male sexual dysfunction program includes:
- 4 nights of hospitalization (The Hospitalization will include accommodation in a private room, nursing care and medical assistance, evaluation and preparation of medical history, as well as three course meals).
- Specialized medical Interconsultation of psychology
- Clinical laboratory studies:
–Erythrocyte sedimentation rate (ESR).
–Follicle stimulating hormone (FSH)
–Luteinizing Hormone (LH)
–Penile-brachial index at rest and after exercise
–Penile Doppler with prostaglandin
-conduction velocity of dorsal penile nerve
Special Considerations for Patients with Cancer
Women who are undergoing cancer treatments and who want to become pregnant should see a reproductive specialist to discuss their options. According to the American Society of Clinical Oncology's guidelines, the fertility preservation method with the best chance of success is embryo cryopreservation. This procedure involves harvesting a woman's eggs (oocytes), followed by in vitro fertilization and freezing of embryos for later use. Other treatments under investigation include egg preservation, collecting and freezing unfertilized eggs, removing and freezing a part of the ovary for later reimplantation, and using hormone therapy to protect the ovaries during chemotherapy. Women may be able to access these investigational approaches through enrolling in clinical trials.
Some Gynaecological and Urological Minimum Access Surgeries Costs in Cuba
Minimum access surgery technique that consists in performing the operative surgery through small orifices to extirpate several organs and carry out a number of surgical procedures, without making a large surgical wound.
|Pathology||Intervention||Stay at hospital||Anesthesia||
|Bilateral varicocele||Ligation of spermatic vessels||3||GA||
|Suprarenal tumor||Videoendoscopy Suprarenalectomy||12||GA||
|Uterine pathology due to various causes||Laparoscopy-assisted vaginal hysterectomy||7||GA||
|Paraovarium cyst||Exeresis of the cyst by unilateral laparascopic surgery||3||GA||
|Multicyst ovaries||Section of ovaries by laparascoy||3||GA||
|Ovaran tumor||Unilateral oophorectomy||3||GA||
|Pelvic endometriosis||Contrasted videolaparoscopy. Vaporization of the endometrium foci by Argon plasma||3||GA||
|Unilateral hydrosalpinx||Unilateral salpingectomy||3||GA||
|Bilateral hydrosalpinx||Bilateral salpingectomy||3||GA||
|lnfertility of tubal origin||Contrasted videolaparoscopy with unilateral plastic surgery of tubes||3||GA||
|lnfertility of tubal origin||Contrasted videolaparoscopy with bilateral plastic surgery of tubes||3||GA||
|Anterior tubal sterilization||Contrasted laparoscopy. Terminoterminal anastomosis of tubes by microsurgery||7||GA||
|Multiparity||Sterilization by laparascopy||2||GA||
|Ectopic pregnancy||Videolaparoscopy with unilateral salpingectomy||3||GA||
|Study of infertility in female||Contrasted videolaparoscopy||5||GA||
|Study of infertility o male||Outpatient||GA||
|GA:||General Anesthesia||LA:||Local Anesthesia||RA:||Regional Anesthesia|
Gynaecology Specialized consultation
This checkup is carried out in out-patient consultation for a promotional price of $320.00 CUC and includes:
Clinical Laboratory Investigations:
Quantitative Serology (VDRL)
Microbiological and Gynaecological investigations
Simple Vaginal Exudate
MENOPAUSE CHECK UP IN CUBA:
Women over 45 should carry out regular specialized checkups to ensure the health of reproductive system, even when the reproductive years are over. Natural hormonal changes can mask the onset of diseases that once diagnosed early, can be easily treated or cured. If symptoms of menopause are a concern for you, Cuban specialists can provide treatments and alternatives than will help ease you through this stage of your life.
This checkup is carried out in out-patient consultation for a promotional price of 600.00 CUC and includes:
Gynecology Specialized re-consultation
Clinical Laboratory Investigations:
Quantitative Serology (VDRL)
Microbiological and Gynecological investigations:
Simple Vaginal Exudate
Ultrasonographic Bone Densitometry|
Diagnostic transvaginal ultrasound
Ultrasound of Breasts and mammogram