IVF patient new era. Patient-centered fertility care. What should you expect?

Estela Tanco
IVF Patient Coordinator

IVF Abroad

What you should expect from patient centered fertility care?
From this video you will find out:
  • What is the consultation and IVF process at Equipo Juana Crespo in Spain?
  • How long is the fertility journey?
  • Fertility Online Consultation – what does it look like?
  • What are the advantages of online medicine?
  • What after the patient is confirmed pregnant?



What should you expect from patient-focused care in Spain?

In this session, Estela Tanco, IVF Patient Coordinator at Equipo Juana Crespo, Valencia, Spain has been talking about the process every patient has to go through before starting their IVF journey, what questions you need to ask and how it all works, also if you’re coming from abroad.

Estela Tanco talked about the patient needs demand from fertility clinics in particular. Before patients undergo treatment at a fertility clinic, they need to do long research and preparation to organize their first visit to the chosen clinic. There are many factors that all patients need to consider before choosing a clinic that will be suitable for them and their particular situation. After their research is done, they make first contact with a clinic to obtain information also on the location, prices, opinions, but also first impressions. Once the first contact is made, and the clinic’s staff received all necessary documentation, the staff takes over to organize their comprehensive first fertility online consultation to give a pre-diagnosis and treatment strategy without necessarily having to travel abroad.

At Juana Crespo, the main goal at this stage is to understand and have a clear picture of the patient’s specific needs to design their treatment strategy to ensure fluid communication as well as support throughout the journey. Patients get a designated coordinator who will be their go-to person. Direct communication with different departments is possible, but the patient coordinator will not only give medical care guidance and advice, but will also be the link to an overview of the entire process.

Fertility Online Consultation

How does the whole process of specialized online medical care in IVF treatments begin? It all starts with the documentation and the patient’s medical records. Once these documents are received by the team member, it is possible to organize the first online medical visit. This first contact is made with a doctor’s nurse who will be a support point for the patients in the clinic in it the medical history is taken into consideration, family history, previous diagnosis, previous treatments, etc., it is very important that the medical history provided is very detailed and it is necessary to provide the details of the previous treatment on medication dose, number of days, levels of hormones, and results.

When all the information has been provided, the medical team will be able to have a broader view of the couple’s current situation, and the doctors will be able to study all the tests and data provided to arrive at an optimum diagnosis and treatment for each couple or patient. After that, a new online visit is then organized together with the doctor and the support nurse, which takes approximately 2 weeks. During this consultation, patients have all the significant information about their treatment and what to follow, depending on the diagnosis, protocol, or instructions. They will have all the information about vitamins to be taken, diet to be followed, recommendations, analysis tests to be carried out, approximate period, prices, and contact information for the clinic and the patient’s peace of mind it is significant to indicate that as a general rule all diagnostic and analytical tests can be carried out in their home countries. They can send it online. Tests can also be done at the clinic or partner centres once the doctor creates your customized treatment, it will be designed according to your specific situation and needs every step of the way.

Patient case

If we look at the generalized case of a patient who requires treatment including ovarian stimulation and endometrium surgery. The first online visit will be scheduled with the nurse and the second one with the nurse and the doctor. After that, when there is a diagnosis, it’s possible to proceed with the stimulation process, so all guidelines will be organized by telephone or email. The ultrasound scans requested during the simulations are carried out in the patient’s home country, the patient may have to undergo 2 or 3 scans. After that, the patient is asked to come for a visit for an ultrasound scan before the egg retrieval, the scan will be performed plus a hormone test will be done. If everything is ready, the egg retrieval will be organized 48 hours later, therefore, the patient needs to stay for at least 3 days after the retrieval, all necessary diagnostic exams will be requested, for example, the MRI, or Hysterosonography to study what needs to be repaired during the surgery. Then the procedure is organized by telephone or email. All the instructions are provided, and the patient only needs to come on the day of the operation.

It is recommended that the patient remains at the location of the clinic for a couple of days, just in case there is any kind of complications or discomfort. Approximately 2 months after the surgery, the real transfer is organized, the patient comes to the clinic on the day of the transfer and can stay for only that 1 single day, on this day an ultrasound scan is performed in the morning to reconfirm that everything is fine and embryo transfer is done in the afternoon. In total, patients with a highly complex case that requires surgery will need to come to the clinic a maximum of 3 times.
When the patient confirms that she’s pregnant, a complete follow-up is carried out until the 9th week of pregnancy. During that time, 2 or 3 ultrasound scans are requested to control that everything is fine.

- Questions and Answers

Do you send the ultrasound machine to the patients’ house?

We are working on it, we are trying to solve that kind of issue because we’d like to do it right. We are going step by step with this, we will do it, but for now, we need to work on that.

What is the basic process for egg donation treatment?

When we’re doing an egg donation treatment, we are looking for an egg donor that is more or less physically the same as you, as the patient. We will look for the same physical characteristics, and if you want to have the same blood group, and when we have that egg donor, we will proceed with your treatment. It depends on certain things like if you need surgery, we will just follow the steps I’ve mentioned before, we will organize the surgery with the previous diagnostic test, and after the surgery, two or three months after that, we will organize embryo transfer as if those were your own eggs, so it’s the same, and if you don’t need surgery, it’s just organizing the embryo transfer with the correct preparation for each case, and it will be the same.

The telemedicine that you offer at the clinic (Equipo Juana Crespo) is only for online visits?

We do want to expand it with the ultrasound machine so that the patients could do ultrasounds themselves in their own houses, but we have to go step by step, as I’ve mentioned. We will obtain it, but for now, when we are talking about telemedicine, we mean that we offer skypes and online consultations.

If surgery is not needed, I would still have to travel 3 times to Spain, or it can be less?

If the surgery is not needed, we will need you to come to the clinic at least twice. Once for the egg retrieval and then for the embryo transfer.

Is it possible to stay in Spain between egg retrieval and transfer? During those Covid-19 times.

Yes, you can stay, of course. If surgery is not needed and we do the egg retrieval, and all follow up with embryo transfer, fresh embryo transfer, of course, you can stay here without any problem.

Is embryo adoption possible in your clinic?

Yes, it is. You can adopt an embryo and go ahead with embryo transfer. The embryo is already formed, there is no waiting time. If the patient’s requirements fit the embryo that we have, we will go ahead instantly.

What is the situation in Spain regarding COVID-19? Is your clinic operating as before?

We are working 100% like always. We are doing PCR COVID tests in case we need to do them, and for sure, if we go ahead with embryo transfer, we will ask the patient to do that test, but obviously, we are taking care, and we are taking the necessary measures to be safe, and we definitely make sure that the patients are also safe. We are receiving a lot of international patients, we are starting with online skypes, consultation, so every day, we are having new patients and undergoing treatments and organizing egg retrievals, and embryo transfers, and surgeries.

What information do we get to find out about the donor, and at what stage? At my previous clinic, the only thing we got to find out was her blood group at 14 weeks pregnant.

The only information that we can say about the egg donor is the age and the blood group, that’s all.

The patient coordinator will inform the patients frequently or only if I have questions for the doctor?

No, but it depends on the stage of the treatment. As a patient coordinator, we are not going to call the patient every day, but if you have any questions, we will answer you as soon as possible, and in every step in the treatment, we will speak with the doctor, we will talk to the patients, and we will be informing them about everything.

Is it possible to move an embryo from another clinic in Spain to you

We can transfer an embryo from other countries, so that’s not a problem. If you have embryos frozen in other clinics and if the doctors confirm that we are able to move it, we will do it, of course.

Do we have 1 coordinator to contact, or do we speak to or email anyone there?

We would like for all the patients to have just one patient coordinator, but that’s quite impossible because we can’t be there 24 hours per day, so you will have one patient coordinator that is your go-to person, but if, for example, I’m that person, and I’m not at the clinic, and you have any questions, one of my colleagues will answer that for you or they will call you and help you with anything you need.

Can I ask why is the COVID-19 test required specifically for transfer rather than in other parts of the IVF process? Is this due to the risk of health with the virus impacting the success and health of a baby?

It has been studied with different organizations that COVID-19 is not found in eggs, or sperm samples, so we don’t ask for the test unless we want to do the embryo transfer to a patient because we don’t want a patient that is going to be pregnant to have any temperature because that may not be really safe for the baby, but that’s not because of the COVID-19. It’s because of the temperature, so we don’t want that, and that’s the reason why we prefer doing the test before that moment.

In those recent days is a quarantine demanded upon arrival in Spain? I realize the situation is fluid and changes.

As you’ve already written, it is changing every day, and for now, we don’t need a quarantine. You just come here, and there are no restrictions on going to Spain and travel between the cities, so, for now, it’s not demanded. We will see how this develops, but for now, it is okay to come.

You mentioned that the Doctor will make a treatment plan based on the patient’s circumstances. You also mentioned that they will recommend a diet. I like the sound of this as there are so many things that I’ve read that can affect IVF. Is that correct?

There are so many things that can impact this kind of problem, and that also helps patients with going ahead with IVF treatments. Food and vitamins and the hormone levels, all of that can be really important, so of course, we will recommend doing some kind of changes in your diet or maybe in your daily life.

Are there any studies at this time as to the impact on fertility of patients who had COVID-19?

As I said, I’m not a doctor. What I can say is that in sperm samples and women’s eggs there is no possibility to have COVID-19 in those aspects as of now. That’s why we are studying it daily, and all the news about this virus that we have. We will see, but for now, that’s all that I can say, we need to wait for some more evidence.
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Estela Tanco

Estela Tanco

Estela Tanco is part of Medical Care Unit at Eguipo Juana Crespo. Estela Tanco is responsible for guiding and giving support to our patients worldwide, throughout their treatment journey, solving all their medical questions. She holds a bachelor degree as Laboratory Technician for Clinical Analysis and Quality Control and is bilingual Spanish-English. She is delighted to help and accompany our patients in the adventure of undergoing this type of treatment, always hand in hand with Dr. Juana Crespo's entire medical team.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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