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.

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.

A Love Story

I would like to share with you this letter from a patient that I have received today.

It is a story of love, struggle and hope that deserved this happy ending.

Enjoy it every second. As it deserves to be.

We are not yet aware of what is happening. It has taken us a lot to get here.

We felt this was not for us. We thought that we were meant to be happy, but “differently”.

Monday 3rd March 2014. My husband and I went to the clinic for a pregnancy test as if we were going to a routine visit to the doctor for a cold. No nerves, not expecting any new news that were going to surprise us.

During the few minutes we waited since we arrived and we sat on the couch in the back of the hall, I visualized what would happen minutes later. We would go to the consultation room and a member of our doctor’s medical team would tell us very carefully, but openly, that regrettably it had not worked this time either.

My heart did not skip a beat by having that thought. I felt I knew what was going to happen and waited with resignation and serenity. The repeated failures had left their mark on me without being aware of it.

Suddenly, we see our doctor approaching us in the hall with her best smile and opening her arms to embrace us. At that moment, she said “You’re pregnant, congratulations”. I sceptically embraced her as if I had not understood what she had just said. Like when you hear something in lower voice and you cannot move and need someone to repeat it to make sure you heard it right.

I think that I told her: “But, how? That is not possible”. And, still smiling, she says, “Yes, you’re pregnant. The test was positive immediately. Let’s go to the consultation room”. All at once, as she hugs my husband, my voice-over tells me: “It cannot be, you have not come here to hear that you are pregnant. You have come to hear that we would need to try again”.

We are on our way to the office and we meet almost everyone: the nurse who accompanied us on the day of the transfer, the nurse’s doctor with whom we have some confidence and appreciation after the time spent, the reception desk girls that are always interested in how things are going. It’s inevitable that they know that: we are pregnant!

We go inside the consultation room still astonished. I don’t even know where I drop my jacket and I sit on a chair next to my husband.

The doctor tells us in more detail the joy with which they have started the day she and her team, after seeing the positive result in my urine test.

“It’s about time!” she said, “It had to be your turn now”.

My husband and I look at each other and I ask her again: “But, is it sure that I am pregnant? Is it possible that the medication I am taking has given us a false positive? As soon as I finish the sentence I feel ridiculous.

The doctor, without losing her smile, tells me: “You’re pregnant. The values ​​have been very high. There is no doubt about it”.

“I cannot believe it,” I reply. “I have been feeling menstrual cramps for days”, I insist. To which she replies, “Those are spasms of the uterus that is widening for the embryo to be able to grow”.

Incredible, we could not believe it yet. I spent the last few days saying to my husband that I felt the same than the other times: the body preparing for the menstruation. My husband is still astonished but confesses at that moment that he had never completely lost hope.

The doctor asks us to do a blood test, rather than to confirm the pregnancy, to know how all the values are. And we go back home to wait for the results.

The first song playing on the car radio is “Happy” from Pharrell Williams. It is as if fate suddenly talked to us and told us: “Wake up from the nightmare, guys. Your time has come. You have been given what you wished for so long and you thought you could never get”.

At that moment, it came to mind the last day we met with our doctor. After the last failure.

I talked to her honestly: I told her that I did not believe anything would work for us. That something was happening to me that was not yet studied enough and therefore no embryo could feel comfortable inside me. And for all that, we should start thinking about beginning the process of adoption.

The doctor calmed me down. She repeated that she understood what was happening but she was sure that there were still chances for us. I think that it was her who convinced us to go for another attempt.

We left the consultation room really touched. Life had not been easy since we started to consider the possibility of parenthood. Many emotions, fertile time and lost money that had brought us to the limit emotional and economically and without any solution on short or medium term. In short, we were completely exhausted.

The doctor, aware of that and of our resources, and committed in every way to us from the beginning, did not want us to leave that day without the conviction that we would try again. And so we did, thanks to her.

What a joy and excitement I feel when I remember all this now and that hug as she told me: “You’re pregnant, congratulations!” I think that I will always remember that moment. It is as if suddenly the Three Wise Men had come, we had won the lottery, the pools, all at the same time.

My husband and I are living a dream ever since. It is too soon to know how everything will evolve as we still have to go through most of the pregnancy. But I definitely think it has given us back that feeling that stimulates us all day by day, which is to fight for what we love, for what we want, and that we, more myself than my husband, had already lost without the possibility of getting it back: HOPE.

Without any doubt, that day we got back the excitement for fighting for our baby.

What will happen from now on with the pregnancy, we do not know it yet. But, we are sure that the last visit with our doctor before the last attempt and the courage with which she faced our disappointment, brought back to life all our feelings of struggle that we thought we did not have anymore. And we are very grateful for that.

This letter is dedicated to our doctor to whom we will never be able to thank enough for what she has done for us and to all those couples with repeated failures that have lost the hope of becoming parents.

The most important for success, as this struggle is often long and very painful, is to be in a good clinic such as the Instituto Marquès and trust that you are in the best hands, as it happened to us since the first consultation when we met our doctor. We trusted her good judgment and here we are, with a 7 weeks positive!

If your Doctor, in whom you trust, recommends you to go forward, do not be overcome by the fear of another failure. Trust his/her words. If he/she was not convinced of it, he/she wouldn’t take the risk to let you go through another disappointment.

And if in doubt about which clinic to choose, do not hesitate: the Instituto Marquès gives that touch of distinction, where you will always feel in confidence and in the best hands.

All my best wishes to you.

(Calella, April 2014)

The First Consultation on Sterility

“I have always wanted to be a mother, I waited until I had all I considered necessary to offer to my child. At the age of 33, with a lot of enthusiasm, a daily pill of folic acid and a calendar, I stopped using contraceptive methods, with the hope of becoming pregnant the same month. I have now been trying for more than one year without any success. How is it possible?”

Dr. López-Teijón

Look, Lourdes, after one year of trying only half of the couples your age will obtain a  pregnancy. After the second year, another 30%, while only a further one out of five will become pregnant after seeking medical help. I don’t know why you did not get pregnant, however we will now begin to investigate your sterility problem.

Lourdes

Sterility? (outraged and surprised)

Dr. López-Teijón

I know it is a shock to learn that trying one year without becoming pregnant is called sterility. It is a horrible word which can cause very negative feelings.

Lourdes

I have never thought this could happen to me, that you are saying that I am sterile… Moreover, in the last months I haven’t been well, every time I have the period I feel it like a failure, my world is sinking down.

Dr. López-Teijón

Lourdes, we will find the cause and its solution but today, besides prescribing some tests, I want to talk about how you feel and how all this can be a positive experience.

Lourdes

The experience hasn’t been good so far. My husband thinks some days I reject him while others I look for him, and never knows how to react. Of course, I am scheduling our sexual intercourse around ovulation. He says I no longer enjoy sex and he is partly right.

Dr. López-Teijón

It is very important not to neglect your relationship, you should continue as you always have. Nowadays it is known that some days of abstinence are not convenient to improve sperm quality; in fact it improves the amount of sperm ejaculated, but negatively affects other parameters, such as DNA fragmentation. The ideal thing would be to keep the same frequency as always, and make sure you have sexual intercourse on the 13th day of your cycle. Also, I would suggest that you spend no more than 15 minutes each day talking about it.

Lourdes

If I follow your recommendations I am sure he will be very happy; moreover you told me the only thing he has to do is a sperm analysis. On the other hand, I have to do hormonal tests, scans, checking my Fallopian tubes, and I don’t know what else.

One month later Lourdes comes back with Andrés, who is very anxious to know the results of his sperm analysis.

Dr. López-Teijón

The sperm test shows all is normal and the same for the fallopian tubes test. What is striking is that your ovarian age is greater than expected, as if you were 40 years old, which means your fertility is reduced.

Andrés

This means I am well and Lourdes can stop telling me not to drink, (not) to smoke, to stress me and all this.

Lourdes

Andrés, you make me feel guilty. It looks like I have only got the problem and you don’t have anything else to do. Congratulations, I am happy for you.

Andrés

Doctor, please tell her something, she keeps blaming me, and acting like she is the victim. It looks like she has become obsessed with pregnancy and that it is the only thing that matters.

Dr. López-Teijón

You should be more united and support each other now more than ever. Everyone will react his or her own way to this situation, depending to his or her own personality, the same as you would deal with every problem in your life. I would suggest you take it as a challenge, as a process that can bring you closer if you approach it with a healthy dose of irony, love and romanticism.

Now I will explain how we will do the In Vitro Fertilization, and how we will find your best oocytes.

Lourdes

We will do it because we don’t have a choice, but it seems all so unnatural. My sister has a 6 months old baby; it took two years for her to get pregnant and she recommends me to wait and see if I get pregnant without undergoing an IVF.

Dr. LT

You are right, but nature also expects us women to have our children before we are 30 years old, and with men who have an excellent semen.

It is very important for you to know that during the time we look for a pregnancy until we actually get there, our relationship with our loved ones can change. Your sister loves you but she doesn’t know how her comments can hurt you.

Lourdes

My mother is constantly telling us “all you think of is traveling and going out with your friends” and it really hurts me. Now I told my parents and my sisters and they give me advice all the time.

Dr. López-Teijón

It is a good thing people around you know it, but the best would be to ask them to be silent. Do not allow them to talk about anything related to fertility treatments or telling you what you should and should not do.

Also you should avoid going out with friends with kids or who are pregnant. It is normal that you felt uncomfortable when your sister was pregnant, surely all she talked about was this, and now she is only talking about her baby.

This will also happen to you, however for the moment it will be better not to spend time with friends with kids, or who are pregnant.

Lourdes

What else can I do to not keep thinking about this day in and day out?

Dr. López-Teijón

I think you should concentrate on keeping busy, with your work, your personal interests, etc, filling up you free time. And then spend five minutes of every day thinking about this, your objective, and on how you will feel when you have your baby in your arms, please, think only of this.

This conversation repeats itself during the consultation. A sterility diagnosis is followed by feelings of suffering, negativity, anger, fear to have high hopes, fear of not achieving what you desire, and anxiety. But, with current scientific advances, 95% of women who undertake fertility treatments get pregnant, and so, it is good to know, accept these emotions and know that they are only temporary, that your most intimate, deep and beautiful wish, is about to be fulfilled.

Fresh or frozen embryos? Which is best?

Today Dr. Esther Velilla, Director of our Laboratory, presented the results from last year and I am really amazed, because the pregnancy rate per transfer were the same regardless whether fresh or frozen (vitrified) embryos were used.

And that is including embryos that have been frozen twice! This occurs when we defreeze more embryos than the actual ones that end up being transferred. In these cases they are left in a culture medium and, if they continue to develop up to a blastocyst stage, they will be frozen again.

Honestly, I never thought I would witness something like this in my professional life. It is a huge a medical breakthrough for the following reasons:

  • Greater possibilities of pregnancy for each cycle. We speak of a cycle whenever there is an oocyte retrieval. This means that in many cases we do not have to repeat egg retrieval when a second pregnancy is sought.
  • Reduced number of multiples pregnancies. It often happens that, although our patients prefer a single pregnancy, they ask us to transfer more embryos to avoid the loss of quality when frozen.
  • If, after the egg retrieval, the patient cannot continue the treatment due to  medical or personal reasons, it no longer matters if we do not perform a fresh embryo transfer.  This is of great importance for women with polycystic ovaries, as those run a risk of hyperstimulation.
  • This year several studies highlight that results with frozen embryos can be even better since the endometrial preparation is more physiological. They suggest to freeze them all and not to do a fresh transfer. I do not expect that much, since that would also delay and make the process more expensive. 

At the moment patients do not believe it at all. Last week a very nice husband of a patient told me: “How can it be the same?  It is like with fresh and frozen fish!”. So, I thought, we have to make it known.

The great challenge of vitrifying blastocysts. 

I have already told you how frozen embryos live. The vitrification of blastocysts has been the greatest challenge for biologists. Blastocysts are embryos which are 5 or 6 days old.  They have a mass of 200 cells which generates all the structures of the embryo called internal cellular mass. The other cells, called trophectoderm, form the placenta. Moreover, they have a very big “lagoon” of water which is called blastocoel and an outer membrane which is at the point of collapse, since the blastocyst is the next stage of the embryo prior to implantation in the uterus.

EN-Leyenda

The difficulty when freezing  blastocysts consists mainly in the quantity of water they have. For example, at home it is easy to freeze a chicken but we cannot freeze an egg.

In order to vitrify blastocysts successfully, biologists previously remove their water through a pinch, or as we do in our laboratory, they can surround them with a chemical solution  which absorbs the liquid without, as you may see, affecting them.

Since there is no video available to describe this process, I have requested our embryologists to record a video when putting the  blastocysts in the Embryoscope.

Firstly, we can observe how it is left without water and then how it is rehydrated to be vitrified.

These are images in fast motion, but this process may take hours.

 

We keep on with your genetics

Also you are carrying genetic mutations that predispose you to have serious diseases. Would you like to know which ones?

Nowadays, you have the possibility to know the degree of genetic predisposition that you have to develop diseases such as Alzheimer’s, cancer, heart attack, multiple sclerosis, etc. They are responsible for most natural deaths in developed countries.

Look at the following chart. It could belong to any of us. Your report would be like this one but varying the specific risk for each disease. It’s highly likely that the cause of your death is written in the first five lines. What a shock, isn’t it? Isn’t it unbelievable? Clearly, we are all going to die. This report tells us the cause of our death.

The risk of contracting almost all the diseases is given by the genetic predisposition as well as by the environment and it is very interesting how this proportion varies according to each disease. For example, it is estimated that Alzheimer’s has a 75% genetic basis and a 25% environment / lifestyle basis. In the coronary artery disease, we speak about a 50% of each.

These analyses are done on a DNA sample. The most common way to obtain it is by rubbing with a cotton swab the inside of the cheek inside the mouth. They are usually carried out in a clinical laboratory but nowadays they can also be done online. From an online lab, they send you home a kit for the sample collection that you need to return to them and, in about 2 weeks, they send you the result by e-mail. The price is about 300 Euros.

There are people who say they would not do it because they would live in great anxiety and apprehension.

Others say that they would do this test if this information would give them the opportunity to undergo preventive medicine programs or early diagnosis tests of diseases presenting a high genetic risk.

Let’s imagine that you have done it. You are going to come across that neither the Public Health System nor a private insurance will cover for most of the tests that you have to perform regularly. Thus, the economic aspect is something you should consider.

Recently, Angelina Jolie’s case has been discussed. Approximately 10% of women who develop breast cancer are carriers of genetic mutations. These genes predisposing to cancer are called BRCA1 and BRCA2, and are inherited from the parents. 50% of the children carry them, which means that there is a family history of breast or ovarian cancer before the age of 50. They usually have a grandmother, a mother, sisters or aunts affected. The man, if he is a carrier, transmits those to 50% of his offspring; that is why they can skip a generation.

If a woman carries the BRCA1 gene, it is considered that the probabilities of developing breast and ovarian cancer are 80% and 60%, respectively.

A woman carrying the BRCA2 gene, has 85% probabilities of developing breast cancer and 23% probabilities of developing ovarian cancer.

Angelina Jolie is a carrier and she decided to have a bilateral mastectomy and have her ovaries removed.

This is a rather special situation because you can make a very effective prevention, but this is not possible in most diseases: you cannot remove the liver, the lung, the bladder…  In most of the cases, the only thing you can do is to have tests done in order to have an earlier diagnosis.

Are you willing to take a “look at your future”?

Would you perform it on your child?

Do you think that, in the future, life insurance companies might ask for it?

Hereditary diseases. Would you like to know which ones you can transmit?

You’re carrying between 5 and 20 severe recessive mutations. Let me tell you about it:

Mutations are changes that occur in the genetic map of every living being, some are transmitted to children and others are not, depending on the affected cells.

In theory, they are necessary for the evolution of the species (we descend from the chimpanzees so imagine how many mutations have occurred up to now!) but too often nature makes a mistake and errors take place that cause or predispose to more or less serious diseases.

Being a carrier means that you have one of the two copies of this gene altered but you are not sick because the healthy copy performs its normal function.

1.8% of the children are born with genetic diseases. They may be inherited or occur spontaneously, we call it de novo. The most common hereditary diseases are cystic fibrosis, fragile X syndrome and spinal muscular atrophy, among others.

Right now, scientists have developed genetic tests allowing us to find out what hereditary diseases we are carriers of. They are useful to provide us with our “gene card” as well as our partner’s before having a child because, should he be a carrier of the same mutation, the children will have a 25% chance of showing that disease.

There are different kits that study a greater or lesser number of diseases, around 1.000 – 2.000 mutations related with the 200-300 most common hereditary diseases. (There are more than 6.000 hereditary diseases, but most of them are very rare).

These tests are done on a blood sample and have an approximate cost of 500 Euros. We can have the result in 2-3 weeks and it should always be explained by an expert.

If it turns out the two partners have the same mutation, we can perform an In Vitro Fertilization with Preimplantation Genetic Diagnosis (PGD) to transfer only the healthy embryos or perform a study about the disease in the embryo during the first months of pregnancy.

The economic implication has different points of views. Some North American insurance companies include it in the coverage of the future parents because it is cheaper for them to pay for this test than to finance the diagnosis and treatment of a child with a serious chronic disease.

The cost of an In Vitro Fertilization with PGD for these kinds of diseases is high. The cost for the diagnosis of the foetus is cheaper but if it is affected, it implies the termination of the pregnancy.

I have asked many people these days and now I ask you if you would like to get to know your gene card.

Bear in mind that these tests allow the birth of children not affected by mutations that you and your partner are carriers of, but do not guarantee the birth of a healthy baby because many of the diseases are caused by de novo spontaneous mutations.

Usually we do not think that it is going to happen to us, but when we see in the media a very sick little boy, him and his family surrounded by suffering, continuous treatments, uncertainty about the future, etc., our hearts get broken.

As for the moral implication, I have heard all kinds of opinions: people who refuse it because they think we are going to make designer babies, eugenics, fear of abuse or genetic manipulation, people who say that it is fine but who would not do it and people who consider it a breakthrough and, if they can, they will perform the genetic analysis to find out whether they are carriers.

According to my experience, patients who have the same mutations end up with recurrent miscarriages, with a history of dead children or with a child with severe disabilities. They do not look for designer babies. They just want to have a healthy baby!

In our team, the gynaecologists who practice obstetrics and gynaecology inform about these tests to women who would like to get pregnant, but that becomes harder to explain for the gynaecologist who does assisted reproduction. Let me explain you why: as a referral centre, most of the patients we look after have a long history of years of infertility or of unsuccessful treatments. I will tell you about a case of a German couple I saw yesterday, a 40 years old couple: she has undergone an endometriosis operation and her ovaries respond poorly and he has a very low sperm concentration. They have already done four IVF cycles in their country. Well… You must imagine that I was not able to tell them: “Have you thought that you might also be carriers of hereditary diseases?” I think they already have enough problems.

We often say that genetics are the future, but now it starts to become the present.

 

IVF to the Beat of the Music. We Have Made our Embryos Dance

I couldn’t imagine the enormous impact of the publication of the results of the In vitro Fertilization with music, both among colleagues from other centers, our patients and the media.

Once the scientific study was presented at the European Society of Human Reproduction’s congress (ESHRE) in July 2013, the doctors were dying of desire to talk about this with the parents of the first-born children. It’s funny because, even though the embryos have no sense of hearing, they all tell us stories that closely relate their children with music: they cease to weep when they hear music, it helps them to sleep… What it really is a striking coincidence is an Italian twin that, ever since he was very small, seems to be singing.

After discovering that musical vibrations improve the fertilization rate, we have implemented them to all of our incubators.

The songs are selected based on the choices of the biologists because they constantly hear them when they open the incubators and they play at a very high volume.

The music style is changed every month although we have seen no differences between them. This month is very lively as we have heavy metal playing.

Patients can see from their computer or mobile phone how their embryos develop in the Embryoscope and also listen to the music playing. It’s exciting!

Now we are continuing with this line of research to find out if music also improves embryo development and its implantation in the uterus. I will keep you updated…

First baby born in UK with musical IVF

The story of an IVF

Almost every day, I receive visits from patients who come to our clinic to introduce me to their children. I am really glad they do so because we all have done our best so that those children can be born.

Today I want to explain what the process of In Vitro Fertilization consists of, making use of the fact that I am also explaining it to Sofia, an Italian girl who has come to meet me today.

In the video that you will find bellow, you will be able to see the whole process, from the moment we receive the first email until the day we receive the results of the pregnancy test, including the laboratory procedures and the doctor’s consultation.

Surrogate Motherhood

Surrogate motherhood or surrogacy has been in the news these days in Spain because of two cases: a couple from Asturias who was not allowed to bring back to Spain their twins born in India via surrogacy and a Balearic gay couple who also used surrogacy in Thailand, and expect quintuplets! (one of the surrogate mothers is expecting twins and the other one, triplets).

I would like to tell you more about this topic and know your opinion about it. I think it’s something very important and controversial that can be seen in many ways.

When there is some news about reproduction, the media usually call me to discuss about them. Today, before speaking to a radio station, I was reading material that I had written ten years ago and I was surprised at how my opinion has changed. I’ve gone from believing that surrogacy was horrible, even a way to use the body of a woman in a situation of need, to help doing it to whom asks me to. This evolution comes after learning about different situations (like the one about a girl whose son died in childbirth and whose uterus had to be removed due to an hemorrhage), and also after seeing the dedication and love attitude of women pregnant thanks to surrogacy.

Where is it allowed?

Legally, in Europe the parenthood of the child is determined by birth; the law forbids to rent a womb.

As an exception, England allows it only if there is a family connection between the two women, if there is no financial arrangement and if both of them are English. Following the same law, in South Africa, a 48 years old woman could give birth to her daughter’s triplets.

It is also allowed in some states of the USA, Canada, Russia, Ukraine, and also in India and Thailand, but the problem in those last two countries is to bring the child back to Europe, as the documentation required is often difficult to obtain.

In the last few years and until January 2013, many surrogacy treatments have been performed in India because of their low cost and easiness during the process, since the fertility clinics themselves are also responsible for the surrogate mothers, from their selection up to the birth. Should the legal requirements change, I guess this will become again the main destination country.

Who may need to rent a womb?

We constantly take care of people who would like to have some information about how and where to do it.

On the one hand, it is requested by couples or single women presenting a medical inability to carry a pregnancy (because their uterus has been removed, because they were born with uterine malformations, because they are taking medications that are incompatible with a pregnancy or because they suffer from conditions where a pregnancy is contraindicated). Some people think that there are also women who would like to use it it in order to avoid risks and damaging their own body. I believe that is the answer to ignorance and a certain frivolity, and the truth is that I’ve never had this request at my clinic.

On the other hand, it is requested by gay men, singles or couples, as well as by heterosexual single males. Increasingly, men claim their rights to single parenthood; you all know celebrity cases which have used it.

Why is a woman willing to be a surrogate mother?

What kind of women are capable to go through a fertility treatment, a pregnancy and a birth and then deliver the newborn to other people?

A study presented in an international congress stated that surrogate mothers have no psychological consequences and that the reasons why they do it are in 91% of the cases to help, although it is actually to help their children. An 8% does it for the pleasure of being pregnant (our experience as gynaecologists says that being pregnant is not a pleasure, indeed, in most cases it’s just the opposite: the pleasure lies in having a child) and only 1% says that they do it exclusively for the money.

From what I’ve seen over the years, most surrogate mothers do it to get resources to support their children. They are proud of it and live it as “I’ll help you raise your child and you help me raise mine.”

A child conceived this way can have three mothers, the biological mother, (who provided the eggs), the gestational mother (who carried the pregnancy), and the legal mother, who will look after the child forever. It may also be that there is a legal father.

The woman who carries the pregnancy is the gestational mother but usually not the biological mother. The oocytes are either from the legal mother or from an egg donor; moreover they always have their own children, among other things to avoid the risk of becoming sterile because of a complication during birth.

What kind of relationship is created between the woman and the child’s parents?

The relationship between the legal parents and the surrogate mother is very different depending on the countries and cultures.

In the USA and Canada, they can meet and have the relationship that they have decided to establish. Online communication is very frequent, even visits and occasional gifts, but they can also remain anonymous. In these countries, the woman who is going to act as the surrogate mother sets the rules. She can even be the one who selects the legal parents.

After the birth, a fast trial is done in which the three parts are present and where the end of the contract they had made as a ‘temporary adoptive mother” is signed, that is, as someone who cares about the child during a period in which the legal parents are unable to do it: pregnancy. I know patients that, after this trial, a week after birth, went all together to a barbecue at the gestational mother’s house.

Emotional support is necessary in these cases and, in these countries, both the surrogacy agencies and the legal parents provide it.

In India and Thailand, the centre itself takes care of everything, they have homes in which they live until after the birth and there is no communication at all with the legal parents. Three possible candidate profiles (containing photos, medical and family history, etc.) are sent to the legal parents from Thailand or India for them to choose one of them. When patients ask me for advice about which candidate to choose, I feel very bad and I tell them that it should be the centre and not them to choose her. After the childbirth, there is paperwork to do in court and with the police. In many cases, they leave the country with the baby appearing as a child of the surrogate mother and the male partner, and then in Europe, the wife adopts him or her.

Economic aspects

A surrogacy process is payable in stages; there are fees for each part of the process to be paid according to the evolution of it, with a price list for extras such as amniocentesis, twin pregnancy, etc.

The amount paid to the surrogate mother is much less than you think. Most of the money goes to lawyers, agencies, medical expenses for the fertility treatment and pregnancy, childbirth and the incubator if needed, insurance and trips. A process of surrogacy, if everything goes well on the first try, can cost around 50,000 Euros in India or Thailand, nearly the double in the USA and intermediate prices in other countries.

Obviously, there are many people who, despite a whole-hearted desire to have a child, can not afford it economically.

What must be taken into account?

It’s necessary to have an attorney specialized in this area in the parents’ country of residence. It’s also very desirable to have a specialist in reproductive medicine who has handled many cases and is up to date with the clinics’ medical aspects. I know of many patients who have privately organized the whole process through the Internet and have suffered a fraud.

I’ve been able to see and share all kind of experiences with the patients that I have accompanied through this adventure: negative experiences because of repeated failures or, for example, after arriving to India to start the process and noticing a rejection’s attitude of the centre’s staff because the husband is in a wheelchair (in their culture, it’s still widespread to conceive illness as a divine punishment), as well as fantastic experiences because of finally having that child in their arms.

Questions for the debate

Without a doubt, the scientific and medical progresses such as surrogacy create a social, cultural and legal debate. It’s quite clear that not everything that is technically possible is morally acceptable.

What do you think, on an ethical level, about surrogacy?

Do you think that the trouble and risks of pregnancy can be paid with money? Or instead, should it be seen as a help exchange?

How would you write the law in your country? Would you allow surrogacy in all cases, in just a few or never? Would you be a surrogate mother for your sister?

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