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Ambulatory major surgery
Some fertility problems may require surgical treatment; among them, the most frequent are malformations of the genital tract, alterations of the uterine cavity, blockages in the reproductive ducts, or other conditions that develop over time such as endometriosis or fibroids.
At Inebir, we have an innovative, accredited surgical area for major outpatient surgery and a highly qualified multidisciplinary team of surgeons, anesthesiologists, and nurses, allowing us to treat patients without requiring hospital admission. We utilize minimally invasive surgical techniques that facilitate a rapid return to normal life for the patient.
Your doctor may recommend one of the following procedures before advising you to undergo a specific fertility treatment:
- Hysteroscopy
- Laparoscopy
- Laparotomy
- Fertiloscopy
- Testicular biopsy
- Micro TESA
- NOTES surgery (Natural Orifice Surgery)
- Radiofrequency treatment of fibroids
Hysteroscopy
What is hysteroscopy?
Hysteroscopy is a procedure that allows the gynecologist to observe the inside of the vagina, the cervical canal, and the uterine cavity.
It is considered a NOTES (Natural Orifice Surgery) in which natural orifices are used, which means that no incision is made in the skin.
What is the purpose of hysteroscopy?
This intervention is used to diagnose and treat some of the problems that cause infertility (miscarriages, uterine adhesions, abnormal menstrual bleeding, scarring in the uterine cavity from previous surgical procedures, uterine polyps, fibroids, endometritis, isthmocele, etc.).
What does the procedure involve?
Hysteroscopy gets its name from the instrument used to visualize the uterus. The hysteroscope is a very thin, metal tube with a built-in viewing device that is inserted through the vagina and cervix into the uterine cavity. The uterine cavity is a virtual cavity, so to dilate it, a fluid is injected under pressure, allowing for a clear view of the internal structure, the uterine walls, and the patency of the fallopian tubes. This procedure is performed in the operating room, generally under local anesthesia or sedation to make it as comfortable as possible for the patient.
Laparoscopy
What is laparoscopy?
A diagnostic laparoscopy is a procedure in which the doctor examines the organs and tissues inside the abdomen.
What is the purpose of laparoscopy?
Diagnostic laparoscopy is recommended for examining the uterus, fallopian tubes, ovaries, and pelvic area. In some cases, patients with fertility problems require this procedure for a comprehensive evaluation.
It is generally performed after a standardized fertility evaluation, when the presence of chronic pain, a history of pelvic inflammatory disease, or an abnormal ultrasound may indicate the need for further clinical evaluation before making a definitive diagnosis. Surgical laparoscopy allows for the treatment of conditions such as adhesions, fibroids, or endometriosis. Occasionally, diagnostic laparoscopy may be converted into surgical laparoscopy, allowing for diagnosis and treatment in a single procedure.
What does the procedure involve?
Laparoscopy is performed using the instrument that gives the procedure its name: the laparoscope. It is a thin metal tube with a very light and tiny camera at the end, connected to a high-resolution monitor so that the surgeon and their assistants can monitor the procedure at all times. It is considered major outpatient surgery.
Laparotomy
What is a laparotomy?
Exploratory laparotomy, or surgical exploration of the abdomen, is recommended to diagnose an abdominal disease that cannot be determined by other methods.
What is the objective of a laparotomy?
This procedure aims to obtain an accurate diagnosis of the inside of the abdomen in order to correct anatomical and functional abnormalities in the cavity in cases where laparoscopy cannot be used.
What does the procedure involve?
This procedure is performed under general or epidural anesthesia. Through an abdominal incision, the abdominal cavity is examined. The incision or laparotomy required will depend primarily on the anatomy of the abdominal wall and the specific characteristics of the condition requiring surgery. If any abnormalities are detected during the examination, the surgeon will attempt to correct them immediately. Tissue samples may also be taken for later biopsy.
Fertiloscopy (transvaginal hydrolaparoscopy)
What is Fertiloscopy?
This is a diagnostic and therapeutic method that allows for the evaluation of the female pelvis without skin incisions. In a single procedure, through the vagina and posterior vaginal fornix, it allows for the exploration of the uterine cavity, fallopian tubes (performing both salpingoscopy and microsalpingoscopy), and pelvis.
It allows the treatment of minimal endometriosis, adhesiolysis, and treatment of polycystic ovary syndrome by ovarian drilling.
Testicular biopsy
What is a testicular biopsy?
Testicular biopsy is an outpatient surgical procedure used to address various testicular problems such as reproductive duct abnormalities, severe semen quality defects, absence of sperm in the ejaculate, or fertility preservation.
What is the purpose of a testicular biopsy?
This procedure is primarily performed to extract sperm when a man suffers from azoospermia, which is the absence of sperm in the ejaculate. There are two types of azoospermia depending on the cause of the lack of sperm: secretory azoospermia (also called non-obstructive azoospermia), in which the testicles are unable to produce sperm, and obstructive azoospermia, in which the testicles do produce sperm but there is a problem with the epididymis or vas deferens, which are responsible for transporting them.
What does the procedure involve?
A small incision is made to remove internal testicular fragments, which are then examined for sperm. While the surgeon removes these fragments, an embryologist examines them under a microscope, searching for sperm. Once the embryologist has found enough sperm, the incision is closed. The procedure is performed under local anesthesia and sedation. The patient can return home a few hours after the procedure, following the doctor's instructions.
Once the sperm have been found, the most suitable reproduction treatment is In Vitro Fertilization with ICSI, a technique that allows the selection of the sperm(s) with the best morphology and injection into the egg(s), making fertilization as easy as possible.
Micro TESA
What is Micro TESA?
Micro TESA is a minimally invasive surgical technique developed to improve sperm detection in patients with azoospermia with a poor prognosis, such as men diagnosed with Klinefelter syndrome. It has been found that many men diagnosed with azoospermia without a medical solution may still retain small areas of sperm production within the testicle.
What is the objective of performing a Micro TESA?
Our challenge is to locate areas within the testicle containing sperm and extract them for use in in vitro fertilization (IVF) treatment. This technique allows us to examine all testicular tissue under a microscope without damaging it and to target the biopsy to the areas of the testicle with the highest probability of containing sperm, removing minimal tissue volumes and causing less damage than a conventional testicular biopsy. Micro TESA is currently recognized as the best method for finding sperm in men with secretory azoospermia.
What does the procedure involve?
Using a surgical microscope to examine the vas deferens, the best tubules are selected during the testicular biopsy. Once the sample is extracted, the tubules are opened into a Petri dish containing sperm washing medium, and the search for sperm begins by examining the sample under the microscope. It can take up to 5 hours to locate sperm. Once the sperm are found, they are incubated for induction into eggs or cryopreserved for future use.
NOTES Surgery
What is NOTES surgery?
The concept of NOTES (Natural Orifice Surgery) is a term that encompasses different concepts but essentially refers to a surgical procedure performed through a natural orifice without the need for skin incisions, allowing for highly complex surgeries without hospital admission.
The most common transvaginal procedures are myomectomy, adnexectomy (removal of the ovary), hysterectomy (removal of the uterus), treatment of malformations of the genital and urinary system, salpingectomy (removal of the fallopian tube), release of adhesions, ovarian drilling (a procedure in which small perforations of the ovary are made with a laser or electrosurgical instrument in the context of polycystic ovary syndrome), transvaginal sampling, cholecystectomy, appendectomy, and hybrid laparoscopic colon resections with transvaginal sampling.
Radiofrequency treatment of fibroids
It is a minimally invasive technique that does not require hospitalization. It involves applying heat inside the fibroid using a radiofrequency electrode guided by vaginal ultrasound. It is performed under sedation or regional anesthesia.
Treatments
and units
There are many variables that can influence each case, and it's not always the case that matters. Assisted reproduction It's the only solution. At Inebir, we want you to have access to all the possibilities that reproductive medicine currently offers and to be able to address your problem from different perspectives. Furthermore, we have our own research program to contribute to the advancement of medicine and embryology.
Units
Polycystic Ovary Syndrome Unit
Ambulatory major surgery
Gynecology Unit
Endometriosis Unit
Pelvic pain unit
Multidisciplinary Pelvic Floor Unit
Unit for assistance to transgender people and gender identity
High-complexity diagnostic unit
Human Genetics Unit
Andrology Unit
Cryobiology Unit
Psychology Unit
R&D&I Unit
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