The biological clock weighs heavily on women. More than social pressure, which still exists, although it has evolved in the same way as society, reflects Sara López, a gynecologist specializing in assisted reproduction. The 44-year-old doctor from Barcelona works at the Human Fertility and Reproduction Center (CIRH) clinic and is the author of the book I want to get pregnant. Keys to understanding assisted reproduction’ (Alba Editorial) in which she answers the questions posed by heterosexual and homosexual couples or women who want to undertake motherhood alone. “Women aged 40-50 are great, but the quality of our eggs is not the same,” she warns in an interview for La Vanguardia.

In your book you explain that infertility and sterility are not the same.

In English it is called Infertility and that concept groups everything, but here we differentiate between sterile and infertile. In other words, we are talking about sterility when pregnancy has never been achieved, when a couple has been trying to have children for a reasonable time and has not been able to, which is generally twelve months on average and depends above all on the age of the woman. On the other hand, in infertility, a pregnancy is achieved and normally easily, but it never comes to an end, that is, it is not evolutionary and what we call repeated abortions occurs.

And there is primary and secondary infertility and sterility.

Yes, but in both cases the primary is the most frequent. When we talk about the difference between primary and secondary sterility, pregnancy has never been achieved in the first and usually occurs in 15-20% of heterosexual couples because a homosexual couple or a woman who does not have a partner a priori does not have a diagnosis of sterility. While in high school they do have children, but when they look for a second or third, they don’t come. In the case of infertility, in the primary there are abortions and there are no children, and in the secondary there are already one or two children, but later abortions occur and the second or third child does not arrive.

Can sterility and infertility be reversed or is it better to resort to some assisted reproductive technique?

It is not that it can be reversed. When a couple has sterility or infertility you have to study why that happens. There are a multitude of causes and depending on them it is decided what type of treatment to follow. Sometimes the cause cannot be treated but a treatment can be carried out, for example, in the case of a couple in which the man has an altered seminogram with few sperm: many times the origin of this shortage is not known why it is , then what we can do is a treatment for this alteration, which can be in vitro fertilization so that we can use these few sperm to fertilize them with the eggs. Another example: in an infertility where there are repeated miscarriages, what can happen? Perhaps the woman has coagulation problems, and what is done is that she has to inject an anticoagulant such as heparin, and then that pregnancy can be evolutionary.

Is it true that almost all fertility treatments are faced by women?

Yes. It is true that there are treatments for men, but they are very specific cases. For example, we can find a seminogram with a hormonal alteration and then the man can be given a hormonal treatment to improve that amount of sperm. But, generally, if it is the man who has the alteration, it is also the woman who has to undergo the treatment so that the pregnancy can occur. There are very few cases in which the man, doing the treatment, improves sperm quality and can get pregnant.

What profile of patients is the one that comes to your consultation? Has it changed a lot?

Yes, years ago they were mostly heterosexual couples, that is, man-woman who have been trying to get pregnant for some time and have not succeeded. In recent years there are more and more couples of women who come for treatment and especially women who come in what we call solitary maternity, they come without a partner because they want to have a child. But it is also true that more and more women want to freeze their eggs because they want to postpone motherhood. Women are increasingly aware of the impact of age on the quality of the eggs.

Is there an indicated age for egg freezing?

Yes, the ideal would be less than 35 years because from this age the oocyte quality and the quantity of ovules plummet. But many times circumstances make them consider it later and in consultation we often find women who are older than that age.

And do those who decide to freeze their eggs use them?

In my experience, rarely. They also do not have a diagnosis of sterility and many do not use them because they have become pregnant naturally, but it is like having a Modern Bed Designs, because at that moment they either do not have a partner or if they do, they have decided for various reasons not to stay pregnant, and have their frozen eggs. However, many times they lack the necessary information to do so.

Is social pressure still strong to want to have children?

Although as a society we are increasingly re-educated to let ourselves decide when we want to have children, social pressure still exists but I think that above all there is biological pressure, the biology of the human body, the physiology of the ovaries that we have today is the the same as a hundred years ago, what happens is that women used to get pregnant at 25 years old and it is true that this penalizes us, because if you delay your maternity for whatever reason, a completely legal reason, you are being penalized because this quality oocyte is getting worse. What’s happening? That women today with 40-45 years are great but the quality of our eggs is not the same. Theoretically, the ideal age to be a mother is between 20 and 30 years old. The good thing is that we are increasingly aware of this biological pressure.

Before, when you couldn’t have children, society looked at women. Has that changed? Is it assumed that when there is a problem of infertility it can be on the part of both the man and the woman?

Sterility continues to be a taboo subject, although less and less, and it is true that this weight continues to fall on women, but as I explain in my book, in reality there is 30% of total sterility for women and another 30% of total sterility for men. man, which means that in reality it is the same, but there is also a 20% that is a mixed cause and another 20% that we do not know why. On the other hand, the fact that women come for consultation at an age above 35 years – the average of my patients is 37-38 years – means that the weight falls on oocyte quality or the negative impact is worse on the woman than the man. It is also true that sperm quality affects men at slightly more advanced ages, between 45-50 years.

When is it advisable to consider assisted reproduction?

First, the medical history should be assessed, if there is a history of endometriosis in the woman, if there is no history of chemotherapy, some type of cancer in the couple or something that may be affecting the seminogram in the man. If in a year the couple has not achieved pregnancy, it is recommended to go to the specialist. Although a 35-year-old woman is already recommended to consult if she has been looking for a pregnancy for six months. In other words, the age of the woman with no medical history of interest is the one that will mark us or advise us to wait a little longer or not.

In what sense is the assisted reproduction process different in heterosexual couples, couples of women or in cases of solitary maternity? Is it a question of methods?

In terms of method, the difference is that a homosexual couple or a woman who goes to the maternity hospital alone will have to use a semen donor, while a heterosexual couple, a priori, if the seminogram is correct, does not have to use it. sperm donor. In the first two cases, if inseminations are performed, they can be asked to perform a cycle more than in a heterosexual couple. Because? Because in a heterosexual couple there is a diagnosis of sterility and in the others there is not. But the techniques themselves are the same.

Is it also different psychologically?

It has nothing to do with it, a heterosexual couple comes to see you after twelve months, in which each month the woman’s period has dropped and she can’t get pregnant, so they already come with that emotional and physical backpack, or the overwhelmed that every month an ovulation test is being done and the pregnancy does not arrive or abortions occur. While the homosexual couple and the woman who does not have a partner a priori does not come to you with these months ago looking for pregnancy because in principle she does not have this diagnosis of sterility. In other words, for the heterosexual couple what is something natural will become something that is not very natural, unlike the homosexual couple and women without a partner who are very clear that when they decide to expand the family is when they have to go to the clinic.

To what extent does the psychological issue influence when a couple cannot have children?

Having stress or anxiety in itself is not a diagnosis of sterility, that is, it is not the reason why you do not get pregnant. The famous phrase “go on vacation and you’ll get pregnant!” is not valid. However, being stressed or anxious does not help. The better tools you have to carry out the process and you are emotionally well, the better. Logically, when you have a negative pregnancy test result, it is very disappointing, but you have to have the tools to not stay in the hole and know how to get out and start over, that’s why the book only talks about how in vitro fertilization works, There is also talk of this psychological accompaniment around the process that is important to have.

What are the main fears of those who opt for assisted reproduction?

What happens is that patients come to the consultation with very high expectations, thinking that the pregnancy will be achieved quickly and this has to be worked on. On the one hand we have to lower expectations by always being positive but logically also realistic depending on the context of the case that each person has.

Is egg donation one of the most difficult techniques to accept?

Yes, normally it is difficult because they come with the expectation of using their ovules or the partner’s sperm or they already come imagining what their child will be like. Logically, one always tries with one’s own gametes, but what happens is that sometimes the evolution of the case requires the use of donor eggs or sperm. When the time comes to consider an egg donation, I always tell them we are going to take a break, because many have to go through a genetic duel, sometimes it takes months and it is difficult for them to take the step, but there are also patients who accept it super quickly because the process already leads to this. And although we are looking for a donor who is physically similar to the future parents, it is true that the genetics are not theirs, and therefore it is a serious enough step to meditate on, discuss with a partner and, if necessary, with psychological support. that will provide the key tools to make the chip change, because you have to be convinced to do it. I was just commenting on it to a patient. I have not met a couple who have received donor eggs or sperm who regret doing so.

Pregnancy is not always achieved the first time: when do you have to stop?

I always talk about it with the patients, every time there is a treatment that has not worked for me, we sit down and from here we decide: what we come from, what we have and where we can go, it is true that it does not make much sense in a woman 43-year-old woman who has undergone a treatment with her ovules and insisting has not worked because the chances of her getting pregnant are very low and, on the other hand, if she uses donor ovules they are very high. But we cannot put everyone equally, for example, maybe in a 43-year-old woman we can get pregnant with one cycle, while in a 30-year-old woman with low ovarian reserve we have a better chance if we try more times .