In 1984 the first baby gestated in Spain with fertilization techniques was born in vitro. Four years later, the first Spanish law was promulgated to regulate assisted reproductive techniques, a pioneer in Europe. Rocío Núñez Calonge (Madrid, 62 years old), author of Diary of a biologist: a journey through the soul of a reproductive professional (libros.com), finished his Biology studies in the eighties to “try to know the origin of life”. Later, during his training at the Ramón y Cajal Hospital in Madrid, he became familiar with male infertility and spermatozoa: “In the andrology laboratory I learned not only about the semen alterations that led men to infertility, but also about the problems of these and their partners. Núñez then discovered how important it was for all of them not to get pregnant, many times after trying for years.
In her recently published book, the biologist details the assisted reproduction techniques that some couples undergo to achieve the longed-for pregnancy, the joy after getting pregnant or the disappointment if it is not achieved. He recounts the hardness of the process for both professionals and patients, but above all he talks about emotions, since he considers that the treatment is as important as the care of the gametes and embryos, because “patients prefer humanity to wisdom: knowing what They take it for granted, but empathy does not.
ASK. The birth of the first girl by fertilization in vitro (IVF) in Spain somehow directed his steps towards embryology.
ANSWER. When I was studying Biology my goal was to work in a laboratory, I had never considered dedicating myself to assisted reproduction, but the end of my studies coincided with the birth of Victoria Anna, the first baby born in Spain thanks to IVF, and I felt attracted to this discipline. Circumstances and coincidences did the rest. In 1985 I started working at the Ramón y Cajal Hospital, where I worked for four years as a volunteer assistant, without any type of remuneration. Subsequently, I was hired and worked there until 1998. Then I went private. At that time, I really began to see the importance of infertility in our world, the suffering it causes couples and patients when they fail to get pregnant.
Q. What are the main reasons why a woman does not get pregnant naturally?
R. Right now the main reason is age. As maternity is delayed, there are more problems to conceive: the ovarian reserve decreases and the eggs are not of good quality. Then there are other causes that are distributed more or less equally, such as endometriosis, polycystic ovaries and low ovarian reserve in young women.
Q. How would you rate the journey that couples take in achieving pregnancy?
R. Arduous, difficult and stressful, although fortunately that has changed in recent years. Before, a couple, if they did not get pregnant, would wait and wait because there were not so many fertility centers and not so much information. Now, instead of going to the family doctor, although they also do, they refer them directly to a specialized center. The problem arises when the center either does not provide adequate information or is not interested in solving the problem or gives them false hope. Sometimes, women undergo treatment in one center and if they do not get pregnant they go to another, until they really find the one in which they feel more comfortable and whose professionals offer them more confidence.
Q. There are some ethical principles that must be considered in all areas of medicine, although perhaps even more so in those that also have an added responsibility towards the unborn. How to face them?
R. Our ethical principles imply truthfulness; that is, the patient must always be told the truth about the process and that it can be dealt with in many ways. If a patient has little chance of achieving a pregnancy you have to explain it to her, you cannot give her false hope. This would be an ethical principle. We would also have to respect her autonomy. If a couple makes a decision about any treatment, it must be discussed, agreed, studied with the medical team, but it is necessary to respect that autonomy. But there are not only principles, but also ethical values that we have to consider. We must be 100% honest in our work and with patients.
Q. What role does the couple play throughout the journey that is made until the pregnancy is achieved?
R. In the case of heterosexual couples, the role of the man is paramount. In the past, the man was alien; if the pregnancy was not achieved, “it was the woman’s fault” and he did not want to know anything. Now, in most couples, the man wants to be an active participant and in many cases he feels bad because it is the woman who suffers the most painful process as soon as she undergoes a puncture or needs to take hormones, for example, and he limits himself to putting the semen sample. However, from a psychological point of view, accompaniment is vital. Now, men participate more in the process and also suffer because sometimes they don’t know how to help. For example, when a woman’s period comes down and she is terribly upset, her partner wants to know how she should act to comfort her. In the case of couples of women, in those models in which one of them assumes the masculine role, there is no difference with heterosexual couples. On the other hand, in the case of those couples where these roles do not exist, they participate equally. In fact, now that the ROPA method (Reception of Oocytes from the Couple) is being used more and more, in which one provides the eggs and the other becomes pregnant, participation is joint.
Having to tell a patient to stop, that after a series of treatments —sometimes we don’t know why the pregnancy is not achieved— it’s time to quit, is a very painful moment
Rocio Nunez
Q. If the pregnancy is not achieved, how do you deal with this news?
R. It’s the worst time of all, especially if you have to tell a patient to stop, that after a series of treatments—sometimes we don’t know why she doesn’t get pregnant—it’s time to quit. It is a very painful moment. In these cases, what I tell them is that what is truly important is that they preserve their relationship as a couple and that they put it before everything else, because these procedures often culminate in a separation. If they get the child it’s wonderful, but if they don’t, they shouldn’t see it as a tragedy; it is necessary that they look for other avenues of fulfillment in their lives.
Q. In the field of assisted reproduction, what advances are you working on?
R. From the point of view of reproduction, there are two factors that will mark the coming years, linked to the field of genetics, and which are under development. One of them, which will soon become routine, is the replacement of preimplantation genetic diagnosis to select healthy embryos that are genetically fit for transfer by analyzing the DNA of the liquid, the culture medium, in which the embryos are. . In this way, without the need to harm the embryo, it is verified how it is genetically and the best one can be selected for transfer. This is a spectacular advance. The second would be the application of artificial intelligence, which will make it possible to select the best embryos for transfer, making them genetically perfect.
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