Magic words: “Assisted reproductive assistance”
Between 15% and 17% of couples fail to achieve their desired pregnancy naturally and go to assisted reproduction centers. 40% of the difficulties are attributed to the man, another 40% to the woman and the remaining 20% to mixed causes.
The age of each member of the couple is usually one of the determining factors in the infertility of both sexes, although there are other causes of sterility of unknown origin (EOD).
Female sterility is defined by SEGO as “the inability to conceive after one year of having sexual intercourse without contraceptive protection”: 11% of cases in women aged 35 and up to 87% when they turn 45 years.
“In the case of men – emphasizes the gynecologist – despite the fact that they produce spermatozoa practically throughout his life, time also plays against him, since his gametes lose reproductive capacity over the years”.
What is assisted reproduction?
For Dr. Room and Dr. Amselem, a duo of experts in the quality of female life, this scientific aid to fertilization is made up of a series of avant-garde medical techniques and treatments always focused on the most precious good of humanity, our daughters and sons.
Artificial insemination and in vitro fertilization (IVF) are the two fundamental techniques in assisted reproduction, to which are added the oocyte donation and spermatozoa (female and male gametes), embryo donation and preimplantation genetic diagnosis.
Gynecologists and embryologists will be the professionals directly involved, along with different clinical and laboratory specialists, in trying to achieve the goal of pregnancy.
Its level of contribution will be intimately related to the difficulties of the female or male reproductive system at any part of the process: development of ovulation, quality of sperm, displacement and union of gametes, fertilization.
Assisted reproduction bluntly helps heterosexual couples, homosexual couples, transsexual couples and anyone, usually women, who wishes to have offspring without the direct intervention of someone more or less known.
Dr. Amselem, since when has it been dedicated to helping assisted reproduction?, asks our gynejournalist.
“I started practicing gynecology in 1980, and assisted reproduction has been a specialty to which I have devoted a great deal of time to study, practice and innovation, even though this area of work was in its infancy at the time,” answers the expert in sterility, endoscopic surgery and breast cancer.
It should be remembered that the first test-tube baby, Louise Brown, was born in 1978.
“From these hopeful beginnings, we came to understand the different sides – he continues -. We learned that human reproduction was flawed, that it wasn’t as perfect as a rule of three. Therefore, we had to improve it when these types of organic failures were encountered.”
“We had to learn… and we learned… and we continued to learn, studying in depth, buying and reading multiple specialized books, even training abroad… and developing all the techniques at our disposal”, he points out.
In fact, Dr. Room and Dr. Amselem, mind to mind, step by step, without hurry, but without pause and holding hands, they managed to assemble a “wonderful team” and make their dream come true, a vital project called Clinic Gine-3 in Barcelonawhich shows more than forty years of experience.
Dr. Amselem, Employs its own assisted reproduction laboratory?
“Since 2002 we have had a comprehensive clinical structure, with an ambulatory operating theater for major surgery for gynecological interventions, which has an area for anesthetic induction and post-surgical recovery”, he declares.
We talk about IVF injections, perineoplasties, breast tumors, vulvovaginal cysts, plastic surgery, blepharoplasty, breast prostheses, liposuction, otoplasty, vasectomies, epididymal cysts or angiovascular surgery.
At the same time, we have a study department for the complete image of the woman, with mammography, breast ultrasound and densitometry. Also a laboratory for clinical analyzes and another for the treatment of fertility, highly qualified.
In addition, we offer personalized care consultations, with rooms for prenatal fetal monitoring, urodynamics tests and microcolpohysteroscopy (detection of cervical neoplasms).
“And most importantly, a ‘poolprofessionals who are focused on our patients, whether young or veteran. We try to work like a Swiss watch without anyone noticing the mechanism of the inner gear”, shines in the words.
So much so that Assisted Reproduction (ART) technology and techniques have surpassed all expectations and predictions of the past.
“Now, the medical world in this area of health is at a very high level and an amazing future awaits us. We are already a magnificent example”, he says.
Are the treatments identical at all assisted reproduction centers?
“Not exactly. All clinical and hospital centers are governed by laws, rules and protocols that must be complied with by obligation and professional deontological conviction. But at Gine-3 we go further and personalize medical assistance”, emphasizes Dr. Amselem
A qualitative difference that is meat a la Dr. Carmen Salamaster soul of women who need help to get pregnant… or not.
Both her and him are above averages: success rates in assisted reproduction depend on each case, and not on published statistics.
When a woman, a man or any member of a couple asks me about success rates in assisted reproduction I always answer the same thing: Do you want me to deceive you or do you want to know the truth?
Accordingly, they emphasize two possible answers: “Repeat the statistical data that the specialized books subscribe to, a list of generalities, or explain that your case is not one more“, asserts the doctor and shares the doctor.
“The prognosis of an assisted reproduction must be as approximate as possible depending on the physical and biological female and male factors involved; binomial which, at the same time, always implies a mixed trigger”, he argues.
“General statistics – abundant – only serve to lie, that is to say, they are indicative, since each person will obtain a level of success, up to 100%, depending on a series of variables. These types of statistics are not useful for individualization”.
In a clinic with an IVF laboratory, is the occasional help of qualified external staff necessary?
“It is essential to have external professionals of absolute trust to carry out certain studies or techniques related to assisted reproduction. They complement us”, affirms Dr. Amselem
And both gynecologists present the same case: a male patient who comes to consultation, wishing to have offspring, and reports that a vasectomy had been performed in the past.
“Spermatozoa had to be extracted from the testicle. We were helped by an andrologist, a specialist in sexual and reproductive health, who performed a testicular biopsy. It is an infrequent situation”, he explains.
Another popular example offers us a specific genetic study of the embryo, a gestational stage of less than eight weeks.
“It is financially implausible that any assisted reproduction center, practically none, can count on the precise technology and the right professional to fulfill the objective of this diagnostic test,” he reiterates.
Changing third party, Dr. Amselem, Gynecologists, among whom I am included, do we offend women who are around 35 years old when we propose oocyte cryopreservation?
“We were pioneers in these matters, almost a decade ago. It’s a very common thing now. Women, in their vast majority, accept that fertility begins to drop dramatically after a certain age,” he says.
“Hence we have the necessary technology to preserve the oocytes (germ cells of a woman), which she can use when she deems it appropriate during her fertile stage or throughout her life in any legal situation, such as oocyte donation,” he reports.
And how often do we help couples of women who want to have children with the ROPA method?
“The couple’s oocyte retrieval technique (ROPA) accounts for around 15% of our workload,” explains Dr. Amselem
One of the women will contribute the egg and the other the pregnancy. The two biological mothers will be protagonists at conception, at the fetal stage, during childbirth and during breastfeeding, the beginning of the future baby’s development.
“Women have no problem requesting this intervention and the Gine-3 Clinic has always been, is and will be by their side to help them with everything they need”, he and she reaffirm in unison.
A donor’s sperm is used for in vitro fertilization (IVF), and that’s where the male collaboration ends. The selected embryo is then implanted into the endometrium using a cannula.
Finally, Dr. Amselem, are assisted reproduction treatments expensive or cheap?
“This help is neither expensive nor cheap. The prices are appropriate to the procedure and personnel required for this type of intervention. In our case, and I feel proud, we stay in the lower range of the price range compared to the market”, he emphasizes.
“And I can tell you that it is common for women to say… Is all this for me?… When they observe the amount of professionals, operating room and technology that is used only at the time of the oocyte extraction”, he concludes.
Dr. Carmen Sala Salmerón has done it again: she has put EFESalut’s microphone at the disposal of information and the dissemination of topics in the specialty of gynecology, even if it always turns out to be insufficient.
“We fell short in the interview; we would need to ask more questions and get many more answers for you and for you”, he declares with this impetus that comes straight from his heart.
