When Sara López (Barcelona, 44 years old) specialized in assisted reproduction at the Hospital del Mar in Barcelona, she did not yet know the challenges she would have to face in her professional career. Over time, this specialist in Gynecology and Obstetrics who works at the Center for Infertility and Human Reproduction (CIRH) in Barcelona understood that for many of her patients not achieving a pregnancy meant physical and emotional exhaustion and that many of them went through something called “genetic grief”, which occurs when a couple or a single mother is told that they will have to resort to foreign gametes: “Most patients do not contemplate this scenario.” With this perspective in mind and aware that 17% of the Spanish population is sterile, she has written I want to get pregnant. Keys to understanding assisted reproduction (Alba), a manual in which he explains basic concepts to understand before embarking on the long path of assisted reproduction.
Ask. The genetic duel, in addition to an emotional issue, is it a moral issue related to the values of each one?
Answer. I wouldn’t say it’s necessarily moral. For many people it is a shock to think: this baby is not going to carry my genes, he is not going to look like me at all. There I show them the chances of success with a change of gametes and I explain that the genome from one person to another varies very, very little. That the idea of having a child is not to have a replica of oneself, but to take care of it, educate it, give it a life. It is about making them reflect on what is important to them.
Q. Is it more difficult for men to accept sperm donation than for women?
R. Historically there is that idea of masculinity linked to the alpha male, which is a social construction. I believe that the woman is experiencing everything more physically, in the first person and, since she has been experiencing all the phases in her own body, she accepts an egg donation more rationally. The man costs more.
Q. In his book, he explains that the causes of sterility are equally distributed: 30% of the time they are female, another 30% male. However, it is mostly women who undergo fertility treatments…
R. In the early 1980s, the age for a woman to have her first child was 25 years. Now we are almost at 33 years. This evolution, due to social, economic and labor factors penalizes us negatively because a 50-year-old man is still producing sperm but at that age she no longer has eggs or, if he does, they are of poor quality. In a 37 or 38 year old woman, the search for a natural pregnancy is more complicated.
Q. But the data indicates that, under equal conditions, with the same age, the causes of infertility are distributed equally between the sexes.
R. It is true that I have had couples of 30-year-old patients in which they are not the ones with the problem, but they have had to be fertilized in vitro because the seminogram was altered. When there are alterations in the seminogram, yes or yes it is the woman who has to do the treatment. That is, the person who is not sick, in quotes, that is, the one who is not affected, is the one who has to do the treatment.
Q. Do we live in a society that forces women to be obsessed with fertility and pregnancies?
R. Here is a bit of everything. There are women who want to be mothers but because they have not achieved economic stability or have not found the right partner, they reach an age where it becomes difficult. But then there is the one who does not want to be a mother and I think that she must be made more visible. Social pressure falls on them, the famous “you miss the rice” on which society would have to work, empathize and change.
Q. The book is aimed at heterosexual couples, female couples, and single women. For which of the three models does assisted reproduction pose the greatest psychological challenge?
R. For heterosexual couples, without a doubt. Many come with the emotional backpack and physical exhaustion of not conceiving at home, in the “romantic” way. The couple of girls or the woman without a partner a priori do not have the diagnosis of sterility, they have not been looking for it. I see more affected members of the heterosexual couple to whom everyone says: “And you, for when?”
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