Statistics indicate that one in ten births that take place in Spain is the result of assisted reproduction and the demand for this type of treatment continues to increase. This has a lot to do with the delay in the age at which women decide to become mothers and the deterioration of semen quality, factors that reduce fertility and affect the chances of conceiving for many couples. But there are cultural factors that are also contributing to driving these treatments: from gender biases to the culture of immediacy in which we live immersed.
"Assisted reproduction techniques have taken over the market because they are more effective and profitable than any treatment to improve fertility or semen quality and because more and more couples want to control their reproduction; they want to choose the moment of pregnancy based on their professional or personal agendas", explains Lluís Bassas, andrologist and director of the Puigvert Foundation's semen bank.
"We are used to planning our whole lives and, in this agenda, we decide now I study, now I'm looking for a job, now I want to buy a house... and at a certain moment it is decided 'now reproduction fits', and how probably this decision to have children has been delayed, it is more difficult to achieve it and the pressure is increased to achieve quick results", agrees Julio Herrero, head of the assisted reproduction area of the Vall d'Hebron hospital.
He emphasizes that the culture of speed is added. "We are a society used to turning to medicine to find an immediate solution to everything that happens to us, and in the same way that you take a pill when you don't want to have children, you have the idea that you should stop this pill the person will become pregnant; but this is not the case because 22% of couples of reproductive age have difficulties (and the older the percentage, the higher), and since they know that medicine offers reproductive methods that are more effective than natural ones, they resort to them", he says blacksmith
This implies, says Bassas, that some people refuse treatments that might allow them to achieve pregnancy naturally in a year or two and prefer to undergo the physical (for the woman) and financial cost of an assisted reproduction treatment "because they say that they need the pregnancy already because now is when it fits them into a professional break to prepare for exams, for example".
The andrologist at the Puigvert Foundation believes that this behavior also obeys a certain gender bias. "The increase in late maternity cases means that doctors do not focus on the man, that male fertility is not looked at (many reproduction clinics do not even have andrologists on the team), and that the woman is directly subjected to more effective and faster treatments than waiting for slow sperm to succeed”.
Herrero assures that this pressure of immediacy reaches reproductive medicine specialists "because patients want quick results, for the embryo to be transferred already and to achieve pregnancy with the first embryo, and nature does not work like that".
The director of innovation at IVI RMA Global and the IVI Foundation, Nicolás Garrido, agrees that when an infertile person seeks treatment to have children "they want the cure for today, not six or ten months from now". As an example, he comments that they have a research project that requires the patient to undergo treatment for four months before undergoing assisted reproduction in order to improve the results "and there are patients who refuse to wait these four months and that with this they would improve their chances of success".
Josep Maria Pomerol, andrologist at the Institute of Andrology and Sexual Medicine in Barcelona, assures that this also happens with varicocele surgeries. “Varicocele can affect reproduction and sperm quality, and we used to operate on them, just like obstructions of the seminal tract; however today, always in a hurry, waiting six months for at least two generations of sperm to develop after surgery is considered a long time and many of the patients go directly to assisted reproduction", he explains.
Garrido assures that it is necessary to distinguish between couples who undergo assisted reproduction in order not to wait and avoid the uncertainty of whether they will conceive on their own in six months simply because they wish to have a child immediately and those who undergo it for reasons of cost- benefit, because they are already late in motherhood and the probabilities of pregnancy that they can gain by waiting a few months are lost because the woman's age continues to advance.
"We often see women at the limit of reproductive age with a partner with subfertile semen who, perhaps with more time, would achieve a pregnancy but with whom, since they have left motherhood until very late, we do not have this margin of waiting", matches Pomerol.
Piotr Sokol, specialist in assisted reproduction at Dexeus Mujer, explains that the need for immediate treatment in most cases "is modulated by the woman's age and gynecological circumstances in terms of ovarian reserve and quality", so that when there is a factor of male infertility that requires treatment or lifestyle change for several months (spermatogenesis takes three) "the dilemma arises and the need to offer couples an attractive proposal from the point from a reproductive point of view", and end up in assisted techniques.
Pomerol and Bassas admit that the recourse to assisted reproduction also has to do with the fact that andrology has not found valid and quick treatments to improve the number or quality of sperm while artificial fertilization techniques allow pregnancies to be achieved with a single sperm per egg.
