Welcome to Fertility Experiences blog

Hi all,
This is a space I have opened to tell you about all our everyday experiences in a Sterility Clinic and to present several debate topics. We are very interested in your opinion and comments, which is why we encourage you to participate in it.

What is the Meaning of Music?

At Institut Marquès we are conducting a very important line of research on the effect of music on humans, which goes from the day we become an oocyte until the moment we’re born.
I’ll inform you about these discoveries as we’re publishing them. Some of them are so amazing that I had to read theories about the origin of life in order to understand their meaning.
I want to share with you the summary of my conclusions. Bear in mind that they’re only my personal suggestions after asking myself about the significance of music. Why has music always been present throughout history?

Using music to communicate

Music is the most ancient form of communication between humans, communication using sounds, gestures and dances preceded the spoken language. The first language was more musical than verbal, and, nowadays, we instinctively keep on talking to babies with a high tone and melody because we know it’s the way they understand us better (as they realize that we want to communicate with them).
With the natural selection, the humans that survived were the ones that developed better communication skills. These skills were necessary to live in groups that were becoming bigger and safer every day.
For that reason, biology strengthened the human singing abilities: the musical ability was an adaptation imposed as a method to improve survival.
Music is the greatest incentive that humans have to communicate, more than the language. The reason is because it induces emotions; allows us to pass a message that has emotional charge.

Music that moves us

In addition, music is a universal language of emotions; the ear is sensitive to tones and melodies that cause the same determinate moods to different people. The human perception of determinate musical sound patterns causes the same feelings of happiness, sadness or fear to all of us. An Asian person feels happiness with ascending tones of music played on the Spanish guitar, and sadness with descending beats.
This ability of inducing an emotional mood that is common to all of us fosters relationships, cohesion and social bonds.
Why do we play the anthem of a team before the match? Every time we gather for an event, music is present: weddings, funerals, university graduations, military parades, sport events, prayers, romantic dinners or when a mother gently rocks her baby. Nowadays, in the modern societies, we listen to music and we value the dance but we barely sing or dance. I think we’ve replaced the music as a way of communication and instead, we write, make phone calls, send emails, etc. We use music as an instigator of pleasure and it’s considered culture and art.

Music to learn

According to some theories, the development of music was evolutionary because it stimulates the learning process. It stimulates the attention and memory systems; we all know that it’s easier to learn the times tables with music and also how we remember the lyrics of a song even after many years without hearing it.

Apparently, without the ability of musical hearing we wouldn’t be able to learn a language.

Music and matching

With the evolution of mankind’s verbal communication, the sexual courtship went from fighting to nonviolent persuasion using songs or one’s physical appearance.
The purpose of music in the sexual selection also exists in other species like birds; the males are capable of composing new melodies and the longer and elaborated the repertoire is, the faster the female ovulates.
Music allows showing the sexual aptitudes. Tribal dances are based in good muscles and energy (physical health), the rhythm (mental health) and the singing (creativity). Anthropologically, these were the male characteristics that attracted women because they represented the signs of protection and food for their children. Miller, from the University of California, explains that women maintain these sexual likings in their genes and according to his research, women (during their ovulation) have the same preferences as prehistoric women.

There are studies that confirm that rock singers are the men who have more relations –regardless of their physical appearance, women want to have sexual relations with them without getting married. Sex and maternity has been separated, women want them for sex but not as fathers. Nowadays, we’ve other social and cultural conditions, and according to authors like Miller, the father selection is more associated to the economical capacity of the male.
Music as a courtship method is especially obvious during adolescence –these instincts are stronger when the body is getting ready for reproduction.

Music and pleasure

Without doubt, music is a stimulus of pleasure. The “nucleus accumbens” is formed by a group of neurons of the encephalon, his stimulation produces dopamine –a substance that makes us feel good. This nucleus is the center of pleasure for sex, food, cocaine, heroin, nicotine, game addictions and, since 2013 is known that it’s also the center of pleasure for music (Valorie Salimpoor).

Anthropologically, sexual pleasure (which only exists in human and dolphins) can be explained as an incentive for reproduction. Let me explain:
If the early man, who didn’t have much food, had not obtained pleasure as a reward of sexual relations, he would have avoided wasting his energy, which would have endangered the evolution of the specie.
The same for the woman: she would have avoided having children if she didn’t have any pleasure during sex. That’s the reason why I said that sexual pleasure is an incentive for reproduction. In addition, it generates a desire of repeating these actions!
I suppose that in order to reinforce all the important actions for survival, our brains develop mechanisms to encourage and reward these behaviours.
Humans have learnt to pass over the original activities to access directly the reward system. We eat, just for pleasure, foods without any nutrients, we have sex without procreating or we listen to music without company –the center of pleasure of the limbic system cannot distinguish these actions.

That means that it’s possible that the theories regarding the origin of music are true. That, during evolution, the music has been kept as a courtship instigator and as a communication tool between members of the tribe. And in modern times we don’t need it anymore for that purpose, but we still use it to stimulate the receptors of pleasure in our brain.

Perhaps, music keeps on waking up the same old reactions in the nucleus of our brains.

Concert for embryos

Antonio Orozco gave a private live concert to the very fortunate 380 embryos that were in process of development, at the time, at our in vitro fertilization laboratory. I would like to share this video with all of you because the experience has been exciting!

His first song was called “I’m made of tiny pieces of you”.

Antonio Orozco is a sensitive and committed person, who decided to be part of the Institut Marquès’ line of research on the benefits of music during the embryonic and foetal development. We’re delighted to have his collaboration because we share the desire to improve and passion for our jobs.

It was a very special moment of connexion between the music and the beginning of life.

Fertility Clinics: Why are some more expensive than others?

I have been asked on my blog by different people why prices in fertility clinics are so different -I will give you an answer.

It concerns me that every day we receive more patients with previous reproductive treatments wrongly advised and badly performed. The reason for that is the proliferation of low cost fertility clinics. Some are new and others worked well but, faced by a recession, they lowered the prices and with it, the quality of care.

Today, as a doctor and also as general director of Institut Marquès, I will share with you my opinion on this subject, based on the data I have on financial management of medical centers.

The biggest expense in assisted reproduction clinics comes from the personnel. The best doctors and biologists are in the best centers. That happens in many other places: the best Formula 1 pilots are in the best teams, the best football and basketball players are in the first division teams. The best professionals look for the best salaries, the standing and security of a good brand.

We, as health professionals, are also looking for ethics, projection, innovation, working with the best technologies, participating in congresses in order to keep our knowledge up to date, being part of a team with specialists in all areas and having all the time we need to look after our patients.

That translates into a bigger financial cost, not only for the salaries, but clinics with teams of that caliber need more personnel in order for them to invest part of their time in scientific research, be part of congresses and seminars, projects, etc.

However, in low budget centers there are doctors and biologists with less experience or a lower professional capacity. They only assess the number of patients that they can visit per session and that they follow the administrative guidelines of the company. They do not demand anything else. In general, they are looking only for short-term profitability, as in many cases, the owners are investors from venture capital firms. They have profits and then they sell –quality, complaints and reports do not make any difference as the business will be closed within three o four years.

Other financial costs can receive more or less budget and the level of quality will depend on them. I am talking about facilities, the number of people dedicated to patient care, equipment, training, research, constant innovation and providing all services in the clinic itself even though they may not be profitable.

How all this has an impact on the patients?

The consequences affect the patients when it comes to advice the right treatment in their particular case, the results of the cycle, safety in the laboratory during the treatment and the matching of the egg or sperm donor.

Advising the right fertility treatment

In low budget centers, the doctors and biologists do their best and not always what is best for the patient.

We encounter cases in which an assessment by andrologists or geneticists would have been required, and it was not performed because the center in particular did not have the specialists in their team.

We see 40 year old patients that had and In Vitro Fertilization treatment, they had 8 embryos and 4 transfers of 2 embryos each, and on the last one a pregnancy that lead to an abortion due to a chromosomal anomaly that was detected at amniocentesis. That could have been avoided by performing a genetic test, but the center didn’t advice it because they didn’t have the facilities themselves. If they had requested an external laboratory their income would have been much lower, the center would have had to pay the external laboratory and they would have lost the income from all the frozen cycles.

The patients that come to us for the first time have, on average, four previous failed treatments. In many cases these cycles were well performed, but more and more frequently we come across treatments that had barely any chances of success, which made waste the time, hope and money of the couple. I.e. especially In Vitro Fertilization pick-ups with one single follicle and/or hormonal tests that show very poor egg quality.

The success of the cycle depends, in many cases, on other well assessed supplementary techniques (PGD, IMSI, Embryoscope, Polarized light, etc). The centers that don’t have them or don’t know how to perform them, they simply don’t advice them even thought the consequences.

In addition, in good centers there are medical sessions where the different specialists take part and each case is better assessed. The doctors do not have the pressure of having to perform a cycle regardless of the prognosis.

Fertility clinics and results

The results of each clinic depend on the expertise of the biologists and in the fact that there are biologists specialized in each technique. In low budget centers, the same biologist hast to do everything.

It also depends on the culture media and all the equipment used in the laboratory, as there is a wide range of prices.

The ovaries and embryos do not take into account bank holidays or good clinics either; their activity is the same every day. When a center tries to save money they avoid having doctors on duty and work in the laboratory at the weekends –to pay less extra hours–, and this has an effect on the end result, showing important oscillations. I know centers that they only retrieve eggs some particular days of the week!

The results depend also on the work load of each biologist. All processes with oocytes and embryos require precise times. If on one particular day there are many cases or, for instance, they retrieve many eggs during the puncture, they will need the help of more biologists.  If there aren’t enough biologists, then there’ll be delays.

Another important factor is the quality of the laboratory equipment and the controls on its environmental conditions (temperature, gases, culture media, pH, etc). An IVF laboratory can be installed with very little money and you can make it work, but not at the same level as one with the best technology. The embryos don’t have the same good sleep in a one star hotel than in a five star hotel. This requires continuous investment and in economical terms is not profitable. In addition, patients don’t see that. That’s why, to offer quality standards, there is an Assisted Reproduction Laboratory certification, UNE-179007 which only a small number of laboratories have. It requires a big effort in terms of human and financial resources to put it in place, but is a guarantee of quality and that is the reason why our clinic has this certification.

Safety in the IVF Laboratory

Some people think that the worst that can happen is that the pregnancy test result will turn out negative. But this is not true, there are worst scenarios.

To make sure that we inseminate each oocyte with the right sperm or to transfer the embryos of each patient without any possible mistakes, in high standard centers we work in couples. Each biologist hast to monitor the other biologist. We don’t allow the biologist to do any task by him/herself, not even at the weekend –there is always another biologist supervising. This is very expensive but it minimizes the risk of error.

Embryos are very sensitive to environmental physical conditions around them. Although there are mandatory controls to detect contamination in the laboratory that have to be in place, many other control measures, in terms of air quality, temperature, humidity, etc., are also necessary. There can always be an inevitable accident, for instance, a water pipe leak or contaminated equipment that enters the facilities, but what differences one laboratory from another is the capacity to detect it, and solve it without affecting the embryos that are in culture on that particular day.

I remember that, at one stage, I had to confront some of my team colleagues when I decided that we should have two laboratories, separated by an armored door, because the investment and maintenance were twice as much –for instance, two external air renewal and filter systems instead of only one. Short after, we had a situation with the humidity levels in the air and, thanks to this measure, we were able to move the culture dishes containing the embryos into the spare laboratory right away and nothing happened. As you know, sometimes cheap turns out expensive.

The safety measures of the embryo and sperm tanks are highly valuable in order to avoid robbery, sabotage, misconduct, etc.

If you are sure that you are doing your job properly then you can be transparent (good restaurants show their kitchens). We came out with the idea of offering patients the option of seeing their embryos from home –they see a live video of the Embryoscope. This idea has not been followed by other centers, which cannot believe that we are offering this service. We are asked if we do not have medical-legal consequences. The answer is no. We didn’t have any, on the contrary, our patients value and appreciate it because is a way of showing transparency, of sharing information and enthusiasm and because we do not have anything to hide.

There is a very concerning statistic data, in cheaper centers they never cancel cycles due to bad response and there are always embryo transfers, even though these have bad quality.

Investment in safety is expensive and is proportional to the price of the cycle. All these extra safety measures are not mandatory. The situation I mentioned above can happen even when the requirements by the health authorities of a particular country are met.

Choosing Egg and Sperm donors

When a donor sperm is needed, the patient is told by the gynecologist that a donor with similar characteristics to her husband/partner will be chosen. In the case that the patient is a single woman the gynecologist will designate the one that she/he considers more suitable. If the center has its own bank, the gynecologist will see all the characteristics of a particular donor and she/he will have a big selection to choose from. A lot of care and resources have been needed to choose all these donors. Bear in mind that, for instance, at Biosperm –our Sperm Bank– only 4% of the candidates are accepted as donors! In the contrary, if a center hasn’t its own bank, the gynecologist won’t be able to choose the donor him/herself, and it will be requested to an external bank. In financial terms, a sperm bank is not profitable.

Egg donors prefer to go to centers that look better, more luxurious. Each center rejects more or less candidates depending on its own quality criteria; i.e. a person with myopia or very small, cultural level, drug consumption, etc. The rejected candidates will then go to another center where the selection criteria are less demanding.

Designating an egg donor can be done in different ways, but it will be done better if, as a doctor, you can choose from a big selection and, especially, if you can dedicate time and enthusiasm. And even better if your center allows you to choose two donors for each patient, in case one of them has to be cancelled (e.g. low response, flu, personal matters, etc).

Knowing how important the selection criteria of donors are, sometimes I ask myself, how come some people –even for this type of treatment– choose the cheapest center? What will you do after, if it doesn’t work? In my opinion, egg donation treatments have to be performed in a clinic you fully trust as –as you can see– there are many factors that you cannot control.

I think that medical centers should be well managed to be able to have the best professionals, the best facilities and equipment with the only goal of treating the patients. It shouldn’t be a business in which some groups invest in, with the only intention of making profit and, on top of that, in a short-term basis.

I am appalled to see how they try to draw people who have little resources to achieve their dreams –they do not have a second thought on giving deceiving results and costs. We often accept the fact that cheaper centers offer less quality but we should bear in mind that all the services will also have a lower quality. If you don’t have somebody who can look after you when you have a doubt or a problem, the same will happen to your embryos.

As a doctor I’m ashamed of all this.

Oocyte Vitrification

Recently it was announced that Apple and Facebook will pay the costs of egg freezing to female employees that decide to delay motherhood and put their professional career first.

Oocyte vitrification is an incredible advancement when carried out properly –i.e. when performed at the right time while the oocyte quality is good and carried out by professionals in an experienced laboratory.

The aim is to vitrify oocytes that will allow us to delay motherhood without having to turn to donor eggs. It is important to clarify that it is a possibility and not a security, as there are many other factors taking place –the quality of the sperm that will be use for fertilization, implantation capacity of the embryos, etc. 

That is the reason why we do not know the exact number of oocytes that we need to retrieve. Generally we advice to vitrify 10-12 oocytes, which is the equivalent of having the oocytes of a full year vitrified.

For a healthy woman younger than 35 years old, the chances of monthly pregnancy with normal sperm are approximately 20% and for a 40 year old woman 5%.

Therefore, the best time for oocyte vitrification is between 30 and 36 years of age –because it is not the same to have vitrified your eggs from when you were 35 years old than those from when you were 40 years old.

In any case, the ovarian age does not always correspond with the biological age; often it has a variation of three years. The ovarian age can be determined by studying the Anti-Müllerian hormone in blood (and making an assessment once the test results have been obtained).

Many women only consider vitrification when it is too late and, during the consultation, we advice against it for ethical reasons –we do not want them to have a false relief.

The majority of cases in which we vitrify oocytes in our clinic, have a very similar profile: women between 35 and 38 years of age, with a high socioeconomic and cultural status, who want to have children but they do not have a partner. They hope to build a family and conceive naturally but they want to have vitrified eggs in case their fertility decreases.

One cycle of oocyte vitrification costs around €3.000 and the maintenance per year, until their use, is around €400.

Although, Facebook and Apple’s initiative could be good news for their employees who were planning on vitrifying their oocytes, in my opinion it is a way of rejecting motherhood and therefore I am explaining the following arguments:

1. Who would dare to not delay motherhood or to say that there is a baby on the way in this type of company?

2. It seems that, companies offer it as a special incentive package to attract talented people. It seems that they make clear that they want clever woman but who defer motherhood. They want young people. After a few years when these women want to have children, the company will decide if they are still interested in them or if they prefer to fire them.

3. As I mentioned before, oocyte vitrification is normally based on a personal decision, not a work one. Generally, at the age of 30, professional education is completed. From that age, when a woman is working, you can find situations where a woman has a special professional project or, for work reasons, needs to go to another country for a year but, in most cases, they are temporary situations that force you to delay pregnancy one or two years, not to vitrify the oocytes.

Almost at the same time that this news was announced, a study was published concluding that women are more productive in their professional careers if they have children. Perform better than women without children and excel over men.

What do you think about it? Do you think it is a good idea that Apple and Facebook economically help their female employees to vitrify their oocytes? I heard different answers and most of them were well reasoned. What is yours?

Reasons to be an Egg Donor

Egg Donation is finally allowed in Italy!

Italian women have a reason to celebrate but at the same time they are waiting to see what will be next, as they suspect it will not be an easy journey.

This month, Institut Marquès is opening a center in Milan to offer our experience and help.

Infertility is a taboo subject in some European countries and Italy is on top of the list with 71% of Italian couples experiencing social rejection when it comes to this matter. This data is based on a study made with patients from 10 European countries –presented by Institut Marquès at the last European Fertility Society Conference– where patients had to answer questions related to the social acceptance of infertility and whom they have told about their infertility (friends, family, colleagues, etc.)

See their answers:

EN- grafica donacion ovulos

The social acceptance or rejection of infertility is linked to the cultural and religious tradition of a particular country and also by its legislative framework. Egg Donation is now accepted by law but still treated with distrust and prejudice in society.

This environment is probably not the best for a woman to decide to donate her eggs and the Italian government has already announced that compensation is not allowed. In France, the law is similar, anonymous and without compensation, and there are barely any donors.

I would like to share with you the letter I received from a patient who gave birth to her daughter thanks to an egg donor:

Dear donor, thanks to your help, our dream came true and we have been blessed with an adorable girl, her name is Lorena. After many years of grief and suffering, we finally have fulfilled all our wishes and dreams with the most beautiful girl we could have ever imagined. We will never be able to thank you enough for having shared with us the miracle of life. You will always be a treasure to us. Thank you from the bottom of our hearts, you are a very special person who has completed our life. Thanks to your effort, I gave birth to our little daughter Lorena.

Egg and Sperm Donors

Today I will explain how our team matches the egg and sperm donors with our patients.

But before you keep reading, I would like you to write down what do you most value in a person and in yourself.

When you read back your list, you will see that the traits you wrote down can be classified in three different groups: character (positive thinking, tendency to help others, friendliness, kindness, strength, determination, commitment, etc.); intellectual capacity (intelligence, mental agility, etc.) and physical appearance (beauty, style, elegance, etc.).

Now imagine that you need eggs or sperm from a donor in order to have children. How would you like this person to be like? Would you give the same answers?

What do our patients value the most?

This week we have analyzed a survey on hundreds of patients from our clinic. We asked them to rank the traits that they value the most from an egg and/or sperm donor.

It turned out that the most important trait for our patients is the physical appearance –51% – followed by character –31%–  and cultural level –16% –.

The answers –referring to both egg and sperm donors– are the same regardless the nationality of the patients.

Women and men give the same answers and there is no significant differences to the answers from a single women that undergoes an artificial insemination or an In Vitro Fertilization treatment with sperm bank.

Are you surprised? What do you think about it? I assume that they put the appearance first as many people think is mostly inherited. Let’s see if that is really the case.

What traits do we inherit and which ones do we acquire?

It is true that the appearance has an important genetic factor, even though is also true that genetics are whimsical and there is an enormous number of combinations. Height, hair and eye colour, facial features, etc., are determined by genetic inheritance but, apparently, also by the facial symmetric percentage –which can make a person more attractive than another. Take a look at this photograph of Claudia Schiffer and her sister and you will understand what I mean. 

03_galeria_portrait

The physical appearance is also influenced by the environment of the child. The body movements, the way she/he smiles and looks, i.e. the movements are learnt, the child copies the people around her/him.

The attitude is also very important, and it depends on the personality. Look at the images of the American photographer Gracie Hagen; they show how the same body can look attractive or not depending on the attitude. 

Intellectual capacity, not long ago, studies on children’s IQ held that 50% of intelligence was inherited. With the improvement of the genetic development analysis –which studies the gene effect in a person’s life time– it has been shown that the genetic contribution for intelligence is manifested during a long period of time and it reaches 80% in adulthood.

Studies on identical twins that grew up in different families show a great number of intellectual similarities between them, regardless of the different environments they had been living in.

Character, emotional and social intelligence, i.e. how she/he feels, acts, thinks and interacts. There has been always a debate on what percentage of a particular trait is inherited or acquired. Nowadays, there is the tendency to think that some traits are mostly inherited; other traits are linked to the environment and the last group of traits which can be manifested or not –depending on the home environment, culture, education and circumstances.

The five personality traits that are considered inherited:

  1. Level of extraversion and introversion.
  2. Level of emotional stability. Tendency to bad temper, depression, anxiety, anger, etc. versus emotional control.
  3. Level of interest in new experiences, curiosity, imagination, creativity, etc.
  4. The level of interest in others, altruism, kindness, empathy, etc.
  5. Level of self-discipline, responsibility, capacity to follow rules, organization, perfectionism, etc.

Twins have a more similar character than brothers, and identical twins even more –although they had been brought up in different places. That being said, from the moment identical twins are born, they show differences in their characters as, apparently, some individual experiences are acquired during pregnancy.

Knowing all that, how do we match our donors?

Appearance: we know them perfectly and we study in detail their features to match them with those of the patients who will be the recipients of the gamete.

Intellectual level: we only organize informative campaigns in universities –not because is a requirement, i.e. if a non-university friend comes along we will accept her/him– only because we know that there are more candidates. Donors usually have a higher level of education –in environments with a lower educational level donation is not well accepted.

Last but not least, the personality: our psychologists interview the donors and get tests done to discard possible pathologies. We cannot know what their personality is like (sociable, shy, etc.) but we do know their habits –they have strong commitment traits, emotional stability and strength. And apparently these traits are inherited!

We consider the matching of the donor extremely important. It is a feeling of responsibility and honor created by the trust our patients place in us.

Infertility and Chemical Substances (Endocrine Disruptors)

A historical event that caught the media’s attention took place this week: based on the research made by Institut Marquès, a judge from Tarragona initiated proceedings to investigate the chemical substances emitted by the chemical plants in the province of Tarragona.

As mentioned in previous posts –Why is male fertility decreasing? and Toxics in Maternal Milk– we are very aware of this fact.

In 2002, we did our first study on this subject in males from the province of Tarragona and the results were a big concern. It was discovered that more than half of the men do not meet the parameters set by the World Health Organization. According to WHO, e.g., more than 25% of the sperm has to move properly, but the results show that the average in this province is 6.8%. In the following study of 2004, we compared this data to the males from the province of La Coruña –where there are barely any chemical plants– and the semen results were normal –i.e. 28.7% of the sperm moved properly.

Finally, in 2011, we analysed the toxic endocrine disruptors in the maternal milk from both provinces. In Tarragona we found DDT in all the samples, and none was found in La Coruña samples.

In 2010, an environmental organization from Tarragona filed a complaint in court, which was based on the data from our study, to investigate the causes of the poor quality of semen. The purpose was to know if the chemical plants in the region were the main factor of the sperm quality and, if that was the case, report the companies responsible for the pollution. It was a legal process similar to the one in the US against the tobacco industry, in which people affected could make collective claims.

In 2011, the judge decided to dismiss the complaint, but the Provincial Court of Tarragona gave support to the public prosecutor in the appeal and I was called to testify. It seems that our study –and me as the main researcher– are the only things that the prosecutor presented. So far, I have been called twice. They still drop their jaws in awe when I tell them that the chemical substances emitted and the abundant waste in this region, full of chemical plants, are the responsible for many of their medical problems: infertility, children born with genital anomalies, miscarriages, etc.

In 2013, the case was closed again. But now, by request of the environment public prosecutor, the judge has reopened it and started the investigation. He asked the Spanish Police to “identify all the companies from the province of Tarragona that emit –as a base or waste product– the substances mentioned in the Institut Marquès study”.

In the last decades, many chemical substances and man-made materials made our life much easier: pesticides, plastics, paints, varnishes, carpets, detergents… but nature cannot break them down and, on top of that, they behave as female hormones in animals and humans. A piece of plastic in the sea will never disappear, and its components will accumulate in the fish that we will consume after.

In my opinion, these substances have been created to improve our quality of life. Sofas, e.g., have been made with flame retardants to reduce the risk of fire –its effects were not known and therefore nobody was guilty. But a change was imposed since the moment its harmful effects on health were known. This change has to be part of the environmental politics worldwide and within us all. It serves no purpose of the EU prohibiting a substance if then we buy products from the countries who allow the substance. In a globalized trade environment, if a particular pesticide is prohibited and then we eat fruit from another country, it does not solve the issue.

We also need information about the products that we consume. We have the duty and the right to know what our food, cosmetics or baby bottles are made of. We have the right to know that baby bottles contain Bisphenol-A, a synthetic compound that leaves traces when heated. You only want the best for your baby, and without realizing it, you are doing something harmful to her/him. We need the truth in order to start considering the alternatives.

People like me, who have more information related to this subject because of the type of job that we are in, need to spread the word. In 2010, Institut Marquès sponsored the Spanish participation in the North Pole Marathon. The athlete Lluís Pallarés took part in the marathon dressed as a spermatozoid to protest against the fact that even in the Arctic, a place that seems unspoiled and unexploited, you can notice the effects of pollution –the ocean currents have transformed it into the landfill of the planet. I would have loved taking part in the marathon myself, dressed as an oocyte, but when I saw the intense training of Lluís, running inside a walk-in cooler at the High Performance Sport Centre, I changed my mind. Besides, I have not even run a hundred meters!

I am a member of the Team of Experts in Endocrine Disruptors initiated by Vivo Sano Foundation, and with them I take part in different initiatives, e.g. a documentary called Small Print (La letra pequeña). Unfortunately, we get less support since the start of the recession as it is not considered a problem that has to be solved right away.

In this post, I have focused on the effects of the disruptors in male fertility –cause of miscarriages, genital deformities and testicular cancer– but they also affect female fertility –can lead to precocious puberty and some types of cancer, especially thyroid and breast cancer. As time goes by, we keep on finding more harmful effects.

This investigation is good news, at least to make the authorities and entrepreneurs aware of the problem. I will make my best to keep you up to date.

Destination of Frozen Embryos

What destination would you give to your frozen embryos if you did not wish to have any more children?

Please imagine the following scenario: you have two children born after an IVF cycle and you do not want to have any more children, but after the cycle there are still three frozen surplus embryos. Let us suppose that because the treatment was performed in Spain, you can also choose all the possible destinations for the embryos.

What would you choose?

I shall clarify the law and what our experience is following the answers from our patients.

At the beginning of an IVF cycle a consent form should be signed in order to decide the destination of the surplus embryos that will not be transferred. At this point in time, most of the patients keep them for themselves, thinking that they may not achieve pregnancy with the fresh embryos or that they may want more children.

Every year they receive a letter from our clinic to validate or change their decision.

In accordance with the Spanish Law on Assisted Reproduction, Law 14/2006, Chapter III, Article 11:

“The possible destinations of cryopreserved pre-embryos, as well as, where applicable, semen, oocyte and cryopreserved ovarian tissues, are the following”:

 a. Their use by the woman herself or her spouse

This is possible for the duration of the reproductive life of the woman up until, for medical reasons, the woman can no longer be the recipient of an embryo.

It is difficult to know when the reproductive life ends as the law does not give an age limit neither specifies the medical pathologies that may contraindicate pregnancy.

38.8% of patients decide to keep the embryos for themselves. It should be noted that 91% of these patients have finished their reproductive project, they do not wish to have more children, but they prefer to maintain the embryos because they cannot make a decision between the other options.

b. Embryo donation for reproductive purposes

At Institut Marquès only 4.7% of the letters we receive consider this option. When I ask them why they do not want other couples in the same circumstances to be the recipients of the embryos, they answer that they are afraid that their children will meet their brothers or sisters. Then I tell them that the assignment system does not allow this to happen as the recipients are from other countries, but they do not change their mind and still prefer to maintain the embryos for themselves.

Some couples decide to donate the embryos, but in some cases we cannot fulfill their wish as their embryos do not meet the requirements to be donated -for instance if the woman is over 35 years old-.

 c. Donation for research purposes 

Patients must receive and sign a letter from the Clinic, which specifies the research project where the embryos will go to. Patients must also refuse any economic compensations coming from the research project.

3.9% of patients donate their embryos to research. Patients do not like this choice because they think terrible things will happen to their embryos.

The problem is that there are hardly any lines of research with embryonic stem cells. At Institut Marquès we have not yet sent any embryo to this purpose even though we have offered ourselves.

d. Termination of the conservation without any other use

In the case of the cryopreserved pre-embryos, this last option is only applicable once the preservation time limit established by this law comes to an end -and when their destination has not yet been decided.

Only 4.7% of patients choose the termination of the embryos. Patients say that they feel sorry to destroy them.

In this case it is necessary to get a medical report written by doctors from other clinics proving that the reproductive life of the woman has ended. This requirement is the reason why we only have destroyed one third of the embryos -as we do not receive these reports from the patients.

47.9% of the patients do not reply to our letters and the reason is that making this important decision brings emotional distress.

According to legal regulations, if patients do not answer two notifications the embryos will be considered abandoned and will be kept in the custody of the clinic. As you know, the embryos that meet the medical requirements to be donated will be assigned to our Embryo Adoption Program.

In conclusion, despite having a law that allows all possible options, most of the embryos are abandoned. Only 13.3% of people who have frozen embryos decide their destination. 86.7% do not answer the enquiries from the clinic or they keep the embryos even though they do not wish to have any more children.

What do you think about this?

Which decision would you take?

The Embryo Adoption Increases

Every year more patients come to our clinic to adopt embryos. In 2013 we doubled the number of cycles performed in 2012 and it keeps on increasing. I think this is due to the following facts:

1 – Restrictions on international adoptions of children. Over the last few years there has been a constant decrease in the number of children adopted in other countries. According to data, this is happening worldwide except in Italy. Many countries have closed the program for adoption of children to foreigners, some have over five-year-long waiting lists, other countries only allow adoption of 6 year old children or older, or children with disabilities and some ban adoption to homosexual couples. In short, there are fewer children in adoption and many couples do not even try to adopt. Some countries where they used to adopt children have changed their child protection policy and they improved their healthcare system. That improved the access to contraceptive methods and also increased significantly the number of abortions.

2 – Many couples cannot afford the cost of adoption of a child or fertility treatments. The decision of donation/adoption of embryos is usually taken by the patients themselves, despite the fact that even in the case of abnormal oocytes or abnormal semen that cannot be treated, the medical advice is to proceed with IVF with donor eggs and sperm donation, but the cost is much higher.

3 – The Law on assisted reproduction in Spain is more liberal than in other countries. Every day there is more information regarding the adoption of embryos and people from over 33 countries have already come to us to adopt embryos: Albania, Germany, Andorra, Algeria, Argentina, Austria, Australia, Belgium, Bulgaria, Canada, Denmark, Spain, Finland, France, Gabon, Wales, Greece, Guatemala, Holland, Italy, Ireland, Libya, Morocco, Mexico, Norway, New Zealand, United Kingdom, Sweden, Switzerland, Romania, Russia, USA, Venezuela, etc.

4 – I reviewed the profile of all the patients that took part in our Embryo Adoption Program since the date we started -10 years ago. 72% are couples with infertility problems that undertook other treatments that failed, with an average of 4.1 years trying for a baby and 4.4 failed attempts. 19% are single woman, this percentage increases every year. The rest are people that go directly for the embryo adoption since they do not consider an assisted reproduction treatment for ethical or religious reasons. Approximately one third of these people thought about adopting a child or had already begun the process.

Transfers of adopted embryos are very special. The wish of conceiving a child and the idea of leaving behind the treatments -or not having contemplated them for moral reasons- comes together. They are the nicest transfers as there is happiness in the air.

We are very happy because thanks to the improvement of freezing techniques the successful pregnancy rate per transfer of adopted embryos in 2013 has been 50.6%.

From each child born, we could write a book about love, dedication and gratitude to life -the chapters about biological origin, the development as an embryo, fate and destiny would be exciting.

Ovulation: Myths and False Beliefs

When a woman wants to get pregnant, ovulation becomes a passionate matter. Something that wasn’t important, suddenly becomes a goal. “Am I certain that I ovulate? How do I know on which day I ovulate?” These are frequently asked questions.

That is why I would like to talk about some of the false beliefs we often encounter in our consultations.

Is it true that every month, ovulation happens in only one ovary?

Actually no, it isn’t, even though it is written in school text books.

The oocyte is a cell contained inside the follicle. Both develop simultaneously.

The follicles go through the following stages: primordial, primary, secondary and finally tertiary, when they have become mature.

The primordial follicles, during the first stage, lie in the ovary, until three months before the cycle in which ovulation takes place several start to grow and become primary follicles. This process is called recruitment.

Of all these follicles, only a few eventually become secondary, many atrophy and are left behind. This is called atresia process. Finally, only one among the secondary ones will become tertiary, measuring at that point 2 or 3 cm in diameter. If instead of being one they are two, the result is a twin pregnancy.

Throughout this process, the dominant follicle produces substances which inhibit the development of the other follicles. This occurs in all ovary tissue, it does not matter if it is on the right or left ovary. When a woman only has an ovary she always ovulates from this ovary. If she has two this process is randomized, which means she can ovulate from one ovary for several months in a row.

What if I don’t ovulate?

Many women fear not knowing whether they ovulate. I can tell you that, if menstrual cycles are regular, which means you have your period each month, it is certain that you ovulate.

Women who do not ovulate are those who don’t get their period, have it every several months, or have irregular cycles.

To know on which days you ovulate, it is enough to observe the usual length of your cycles. We know that 14 days go by from ovulation to the following period. Thus if your cycles are of 28 days, you will ovulate most likely on the 14th day of your cycle. And if they are of 27 days, you will ovulate on day 13th.

Although it is not always exact, you don’t need an ovulation test. It is more practical to have sexual intercourse between three days before and one day after you expect to ovulate. We know that sperm can remain alive, waiting for the oocyte for up to three days on the fallopian tubes, and that the oocyte can be fertilized within 24 hours (it degenerates one day after ovulation).

Ideally you should have sexual intercourse on these days, but not necessarily on all these days. Even if you have a mission, try to keep a bit of romance!

You should know that sperm moves from the vagina to the tube with a speed of 2-3mm a minute. Therefore, from the moment ejaculation occurs until the sperm reaches the oocyte, approximately 45-60 minutes go by… Only a few hours after sexual intercourse, you may already be pregnant!

Ovulating doesn’t mean you can get pregnant 

During the last 8 or 10 years of menstruating, a woman cannot have healthy children. The physiological system which separates the chromosomes in the oocytes ages, and becomes ineffective. Thus, as time passes, the oocytes present alterations which prevent fertilization to take place, or which may lead to miscarriages.

This aging process is caused by the passing of time. Some believe that during pregnancy, or while taking contraception, oocytes are preserved, but this is not true. It is like thinking that while we sleep we do not age.

Another common misconception is believing that, if you have been taking contraceptive pills for a long time, you should wait several months before getting pregnant.

This is untrue, you can seek pregnancy from the moment you stop taking the pill. I guess this false belief is based on the fact that when ovulation does not occur over many cycles, it is frequent that it can be delayed.

What happens to the unfertilized oocytes?

The unfertilized eggs are microscopic cells that are eliminated by a type of white blood cells called macrophages, which are part of our cellular cleansing system. They are not eliminated throughout the period but recollected by these lymphocytes and brought to the blood stream.

Is fertility inherited? 

We know some aspects related to fertility are genetically determined and for this reason some families are more fertile than others. Therefore, the number of oocytes and of primordial follicles when a baby girl is born can be approximately 2 to 3 million. This is related to heredity linked to the X chromosome.

Our patients often tell us: I will probably start menopause at the same age my mother had it or a bit later. In industrialized societies this is changing. Since toxic substances, which are endocrine disruptors, get collected on the fat of the mother, the number of these cells is reduced along with the fertile age. This also occurs in men and for this reason male fertility decreases in areas contaminated by environmental toxics.

Finally, it is very typical to hear: “I had my first period at a very young age so this means I will reach menopause early”. This is not true. The age of menopause is not linked to the age of the first menstruation.

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