Globally, it is estimated that some 48 million couples have impaired fertility, which represents about 15% of those of childbearing age. 10 years after the enactment of the National Assisted Fertilization Law (26,862), the number of births due to treatments is growing in Argentina. The look of the doctor Rodolfo Agustn Pasqualini. 04 July 2023 2:30 p.m.
According to the World Health Organization (WHO), infertility is a condition that compromises both men and women and is characterized by the impossibility of achieving a pregnancy despite at least 12 months of regular sexual intercourse without contraceptive measures.
Globally, it is estimated that some 48 million couples have impaired fertility, which represents about 15% of those of childbearing age. Meanwhile, fertility treatments have a success rate of just between 10% and 40%, percentages that can decrease with age. Ten years after the approval of the National Assisted Fertilization Law (26,862), Forbes spoke with Rodolfo Agustn Pasqualini (MN 102,009), Halitus Medical Director and spokesperson for Laboratorio Ferring, specialists in reproductive medicine.
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-How many babies are born per year in Argentina by assisted fertilization?
In Argentina there is the Argentine Registry of Assisted Fertilization (RAFA), which is part of the Argentine Society of Reproductive Medicine (SAMER). The registry is in charge of keeping the data of the annual treatment cycles that are carried out in the country. The contribution of data is voluntary, that is, there is no obligation to report, although many do, since not all do, surely there is an underreporting of data.
Are there changes compared to previous years?
Undoubtedly, yes, and for two reasons. The first is that, over the years and due to improvements in results as a result of technological advances (improvements in culture media, etc.), treatments have become more effective, which is why there are surely more pregnancies. And the second thing is that as of 2013 we have a National Law on Assisted Fertilization, which gives access to treatments to a lot of people who perhaps without this law could not carry out a treatment in a particular way. Rodolfo Agustn Pasqualini.
-Within assisted fertilization treatments, what proportion is low complexity versus high complexity (and within these, IVF, IVF-ICSI)?
Low complexity is currently very little realized. Mainly because the average age of the first consultation is approximately 38 years and often for different reasons, not just age, it is convenient to perform an invitro. Obviously, this must be analyzed in each particular case and it is difficult to generalize, but the reality is that intrauterine insemination is rarely carried out.
This means that most of the treatments are highly complex, approximately 70% are performed with their own eggs, and 30% with donated eggs. It is important to note that this figure has also been increasing over the years as a result of increasing age, especially of women and the prevalence of low ovarian reserve even in young women.
-What advances and techniques are being incorporated into the field of reproductive medicine?
Genetics and all its applications for the diagnosis and prevention of diseases have been a great advance. Both the screening of recessive diseases with blood studies of the couple who is going to carry out a treatment, as well as the genetic study of preimplantation embryos or PGT. But, without a doubt, what is coming now is artificial intelligence and its application to help in sperm selection, in the classification of the ova and in the embryo selection to finally help us improve the results of our patients.
-How is Argentina, compared to other countries in the region in terms of progress, techniques and access to fertility treatments?
Our country in terms of access is a pioneer in Latin America, so access is very good. Obviously, certain issues need to be improved, but in terms of progress we are doing very well. We know the difficulties that this country has and, despite this, the centers make an enormous effort to stay up to date with technology. All our inputs and equipment are imported, which sometimes makes it more difficult. Likewise, a not minor issue is that of imports, which sometimes means that suppliers do not have the necessary inputs to supply the centers.
-How did the promulgation of the national law on Assisted Fertilization impact Argentina?
I think there are several points of analysis, since there are also several actors at this point. Patients benefited from having access to the necessary treatments for each one. The financiers had to incorporate high-cost treatments into their practices offered to affiliates, in a system in which we know that costs have a direct impact on its efficiency. Likewise, the fertility centers had to accommodate themselves to a modality of work under an agreement and adapt to the values and payment terms of each financier.
-What has changed mainly in reproductive medicine since the start of the pandemic?
The pandemic affected us all and reproductive medicine was no stranger. Fertility centers were closed and only handling emergencies, some for months. Later, managing very strictly and under the suggestions of SAMER, the activities were reactivated. The year 2021 could not be like before the pandemic, but already in the year 2022 more cycles were reached than even pre-pandemic, so treatments currently increased.
What is mainly seen on the increase is a freezing of eggs and a decrease in the age of women who wish to do so. It used to be an average of 38 years old and now it is around 35. Today the freezing of ovules for that woman who wants to postpone motherhood for different reasons is a reality. And post-pandemic, it is also seen that older women consult for maternity.
-What are the major issues related to reproductive medicine that need to be worked on?
Without a doubt, the information. Especially to young women regarding the effects of age on reproduction. Although women today are super active and dedicate themselves more to personal things, the biological clock remains the same and the best fertility is found up to 35 years of age. Then until 37 she remains stable and it is from 38 that she begins to decline. Obviously there is pregnancy, it is not to be scared, but the quality of the eggs decreases.
That is why it is good in consulting with the gynecologist or with a specialist in reproductive medicine to ask about the ovarian reserve and receive information to be able to make decisions. Today through a blood test and an ultrasound it is very easy to know.
When one talks about family planning, contraceptives come to mind. Perhaps we should call it reproductive planning which is more comprehensive and includes both contraception and egg freezing.
Luckily, nowadays there is more talk about treatments and it is not so much a taboo anymore. What you do have to respect is the moment of each individual and not be invasive if they don’t tell you where you are regarding the desire for motherhood. I believe that everyone’s time must be respected and that is why from Halitus we join the Ferring laboratory’s campaign to stop this question, that sometimes some even ask it as a joke about you for when?
-What happens with the embryos or gametes that remain in banks?
Although there is a coverage law with regulations, there is no regulation regarding embryos. Today there are many embryos frozen for years that the parents no longer have contact with the centers and the centers have no way of contacting them. A census is being carried out from the RAFA to find out how much we are talking about but, without a doubt, a regulation is needed both by the patients and by the centers.
