What is ART?

The ART (Assisted Reproductive Techniques) legislation are the laws that aim to regulate the application of scientifically proven to work ART, to regulate the application of ART in the prevention and treatment of diseases of genetic origin (PGT), and to regulate the assumptions and requirements for the use of cryo-conserved human gametes and pre-embryos.

Is the legislation in Spain similar to other country’s legislation?

These laws differ from country to country, which leads patients from various places to travel more in the hopes of finding the proper treatment and care possible. Spain has updated ART legislation several times to adapt to the new circumstances and problems patients face while offering the best possible treatment. Assisted reproduction law in Spain is relatively permissive; we can make all kinds of treatments but gender selection or surrogacy. That means we can treat heterosexual couples, woman-women couples and single women. Apart from that, Spanish AR law differs from some other countries on gamete regulation. Gamete donation (eggs or sperm donation) is completely anonymous in Spain.

What ART can be performed in Spain?

• Ovulation induction
• Intra Uterine Insemination
• In Vitro Fertilization
• Fertility preservation (egg, sperm, testicular or ovarian freezing)
• Pre-implantation Genetic Testing (PGT- aneuploidies, PGT- monogenic diseases, PGT- reorganizations of the chromosomes)
• Egg donation
• Shared motherhood*

What ART can't be performed in Spain?

• Gender selection
• Surrogacy

What does the legislation say regarding egg and sperm donation in Spain?

The clinician who's going to do the procedure must secure that the donation is anonymous, which means that you can know the identity of your donor neither participate in the selection of the donor. The donor won't know your identity as well. The second important thing is that donation is an altruistic act, which means donors get compensation for all the days that they have to come to the clinic to do tests, but it's not a lucrative thing as it might be in other countries. And the third important aspect is that under Spanish legislation, the medical team is responsible for selecting the donor to look for the maximum phenotype and immunological similarity between the donor and the person who's going to receive the eggs. For sperm donation is the same situation. It is also anonymous, altruistic and it is also the medical team who must make the selection of the donor, according to the phenotype and immunological similarity.

What are the criteria that donors must have before we can accept them for an egg donation program?

The egg donors must be healthy women, and the sperm donor must be healthy men. This entails that women must be between 18 and 34 years old, but men have a wider window of time in which sperm can be used. A very exhaustive medical and family history are run to make sure that are no problems. We run a complete familiar history to discard any familiar condition disease.

From the genetic perspective, the karyotype test checks for alterations in the structure of the chromosomes. It is able to detect small changes in the chromosomes that might affect the offspring. Donors must have a normal karyotype to be accepted. There is another kind of genetic test that checks for monogenic diseases. Human beings can be carriers of genetic diseases that are not affecting them, would affect their child if he/she was conceived with someone who carries that same disease. The panel of recessive diseases checked includes cystic fibrosis mutation, muscular spinal atrophy, and X-fragile syndrome.

One of the things that can be done is genetic matching, which means that we would select the donor according to the physical characteristics and the genetic information that we verified out of that test.

Apart from that, we would also have to do some lab test and fertility tests. For both male and female, we screen for an extensive battery of infectious diseases panel. In female donors, we must check AMH levels, the ovarian reserve, pa-smear test, do an intravaginal scan to ensure that there is no alteration in anything that might counter-indicate the donation. In sperm donors, we must do a semen analysis, check for morphology, vitality, motility, progressive motility, volume, concentration, and count.

Is there a donor registry in Spain?

Yes, there is a National Donor Registry, still in the implementation phase, called Assisted Human Reproduction Information System (SIRHA). SIRHA connects the fertility clinics in Spain to better control de reproductive outcomes provided.

This system helps the healthcare professionals get an overall view of what to improve. Mistakes are reported, ineffective testing or treatments are reported, unsuccessful attempts are registered, all in the hopes of enhancing the chance of future positive results, that is, alive and healthy baby, healthy and happy parents, healthy and happy donors. Donors can only be accepted until 6 babies are born in Spain, and the SIRHA platform regulars and controls that.

Spanish fertility centres must report their results to the Spanish Fertility Society. And in Catalonia, results are also reported to the OCATT. The report of results guarantees control, quality transparency, security, and traceability.

What’s the Spanish legislation about embryo adoption?

It is anonymous and altruistic, just like egg and sperm donations. There are some medical criteria to make sure that the embryo can be used by someone else. To be able to donate an embryo, both genetic progenitors of the embryo must fulfil all requirements for gamete donation selection criteria by law.

How long can embryos, eggs or sperm be frozen in Spain?

There is no storage limit time defined by law. What is defined by law is the use of these biological samples. For women will be until her reproductive life ended or a medical condition that would counter-indicated its use or she is over 50yo. Sperm can remain frozen during the whole life of the man.
The possible destinations of the frozen embryos, oocytes or sperm are also something to consider as it defines the amount of time the samples will be frozen for. The law contemplates the following:

• Save them for their own use.
• Donate them for other couples to use.
• Donate them for medical research and cessation of the conservation without further help.

Dr Esther Velilla
CEO at Reproclinic

If you are thinking about going to Spain for fertility treatment, Reproclinic can help you. From assigning you a personal assistant, nurse and doctor who speak your language and will help you with the logistics to a tailored treatment programs focused on your needs. Get in touch with Reproclinic.

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* Shared motherhood is a treatment offered to same-sex couples. Women, for instances, who want to undergo fertility treatment and wish to participate in the treatment have the following option. One of them undergoes hormonal stimulation as if she were about to do the IVF cycle to do the egg collection. These eggs and donor sperm are then used to create the embryos. Those need to develop until they reach the blastocyst stage. In the meantime, the other woman does an endometrial preparation, and once she's ready, the embryo transfer takes place. That way, both can participate in the process.