Just walking down the street is enough to see the variety of families that exist. There are single-parent and two-parent families, two-parent same-sex and two-parent heterosexual families, and so on and so forth. On the occasion of the International Day of Families, we will take a closer look at the obligatory impact of fertility on families and how assisted reproduction helps.
The main objective of human assisted reproduction is to enable people with reproductive problems to achieve their dream of becoming parents. From the beginning of assisted reproduction to the present day, there has been a great evolution. At the beginning, only simple problems could be solved, in which patients were medicated in order to know when they ovulated and treated by means of programmed coitus.
Later, artificial inseminations could be performed. For this, the semen was treated and placed in the uterus at the moment when the patient ovulated. In this way, the distance that the sperm had to travel was shorter. Later, oocytes began to be extracted from patients in such a way that they were then placed in drops with a high concentration of sperm, and this is how conventional in vitro fertilisation began to be carried out.
Finally, ICSI began to introduce the sperm into the oocyte. The embryos that were generated were kept for two days, then three, then five, then six, and now up to seven days in incubators.
Developments in assisted reproduction techniques
On the other hand, in the past, about three embryos were transferred, then two, and now just one, since the probability of success is very high. In addition, leftover embryos were discarded because the vitrification was not ready; now, leftover embryos, or if the patient does not have the possibility of fresh transfer, can be frozen, knowing that the success rate of devitrification will be very high.
The evolution in assisted reproduction techniques has also made it possible to know the chromosomal endowment of the embryos, and even to know if they carry any type of genetic disease. This is possible with embryo biopsy. Initially it was performed with embryos on day 3 of development, but nowadays, the biopsy can be performed at the blastocyst stage, at which point it is compulsory to vitrify the embryos (which is not a risk due to the high rate of survival to devitrification) and all the disadvantages that can be faced with blastomere biopsy are solved. For example, not being able to identify mosaic embryos.
Today, many of the problems that prevented offspring years ago have been solved. However, there are still many more to be investigated.
Misinformation: an obstacle to assisted reproduction
One of the main problems that professionals face every day in assisted reproduction clinics is misinformation. Unfortunately, missing the right reproductive moment can make it impossible to have children, but in order for this not to happen, we must have a dissemination network. Let’s get down to practice:
Frequently asked questions in AR
How many of you know that women are born with a certain number of eggs and that as they get older they have fewer and fewer? Knowing this fact would probably lead many women to have their ovarian reserve measured at different times in their lives. And in the case of low ovarian reserve or early ovarian failure, they would not have to face an infertility consultation at the age of 32 when egg donation would be discussed, since this problem could have been identified in time.
Does this mean that it is compulsory to become a mother early or to go on to egg donation? Of course it does not. It only means that the fertility of each woman must be preserved. In other words, vitrify the eggs and keep them for as long as you want before becoming a mother. At that time, they would be thawed to generate embryos for transfer.
If you have an early ovarian failure and you have not vitrified your eggs, are there alternatives? Nowadays, this is one of the fields in which most research is being done. Currently, the option is to donate eggs.
Furthermore, we must not forget that the current pace of life means that motherhood is delayed, that is to say, that a large part of the population does not consider becoming parents before the age of 35. In the case of men, there is no problem because they continuously generate semen, so if they have pathological sperm, it will not depend on their age, but rather on environmental, personal or health conditions. There are even formulas that can improve sperm quality.
What about women then? From the age of 35, there is an increase in the probability of an error in the separation of chromosomes. It can therefore happen that one or more of the 23 chromosome pairs do not separate equally and that the genetic load contained in the oocytes is either too high or too low. Thus, the possibility of miscarriages, pregnancies of children not compatible with life or pregnancies of children with diseases compatible with life such as Down’s syndrome or Turner’s syndrome increases.
Is it therefore necessary to become a mother before the age of 35? No, but it is necessary to have carried out the vitrification of the eggs before the age of 35 so that when you want to become a mother, you can do it with oocytes of 28, 30 or 32 years of age, that is to say, with the age at which you were preserved.
But does this come at a cost? Yes, every year we would have to pay for the maintenance of these gametes, as they must be kept at the right temperature so that they can be preserved without the risk of losing the optimal conditions for their future survival.
And what if in the end it is not necessary to use them because you are a natural mother? In that case, you could donate them to other couples (provided you meet certain requirements), donate them to science, or stop preserving these cells at the age of 50.
And would I have to pay for maintenance until the age of 50 if I don’t want to do any of the above? Yes, they would. Egg freezing is an insurance against becoming a mother in the future in case something happens.
