It is increasingly common for a baby to be born through assisted reproduction in Spain.
While births fall to historic lows, these treatments continue to boom and have surpassed the barrier of 40,000 babies for the first time, which represents 12% of the total births in Spain, according to cross-data from the National Registry of Activity of 2021 of the Spanish Fertility Society (SEF) and those of the National Institute of Statistics.
The baby of Nieves Sánchez from Malaga belongs to the group of those born through assisted reproduction.
After several unsuccessful attempts and an emotional journey of endless ups and downs, she managed to get pregnant in February of last year and had her daughter when she turned 43. “Every time they tell you that it hasn't been achieved, you consider giving up.
It represents an enormous economic and emotional effort,” she Sánchez recalls.
Age plays a key role in women's fertility: as it increases, the chances of getting pregnant decrease, especially after 35. And Spain is the country of older mothers, since one in 10 births in 2021 were to a woman who had already turned 40, the highest proportion in the European Union.
On average, women in 2022 had children at 32.61 years old.
The job insecurity of young people, the difficulties in finding housing or the gender gap are for Clara Cortina, PhD in Demography from the Autonomous University of Barcelona, three of the main reasons that trigger late motherhood.
“When they become pregnant, many women lose opportunities at work or see their salary reduced.
Therefore, they wait until they have a more consolidated position,” argues Cortina.
Demographer Teresa Castro, from the Higher Council for Scientific Research, adds that “all the transitions of adult life have been delayed, such as emancipation or having a stable job,” which causes the first child to also be delayed.
The president of the Spanish Fertility Society, Juanjo Espídos also adds another factor to the equation.
“A few decades ago, having a child was a social obligation;
Now it is a choice,” he points out.
There is a lot of thought about whether to have it and when to do it.
Sometimes, when the decision is made, biologically it is already too late.
In vitro fertilization, which consists of joining eggs and sperm in a laboratory to transfer the resulting embryos to the uterus, is the most common technique and represents 88% of total births through assisted reproduction, according to the 2021 registry of the SEF, last year for which data is available.
The rest is produced through artificial insemination, in which this union takes place in the woman's body.
Although it is not an exact science, it is estimated that from the age of 35 and without ovarian donation, the probability of achieving a natural pregnancy is only 14% for each menstrual cycle and, from the age of 40, it drops to 4%. %, according to the American Society for Reproductive Medicine.
At 25, however, the probability is 25%.
In men, it is estimated that semen quality declines after the age of 45, according to doctor in Biology and expert in assisted reproduction Rocío Núñez.
Although she clarifies that this “is not enough so that pregnancy cannot be achieved in assisted reproduction, since a single valid sperm is enough.”
Núñez considers it a trap that efforts are only focused on improving reproduction techniques.
“We must encourage women to get pregnant at their fertile age, before 35,” she says.
Sánchez had no choice but to use another woman's eggs, a decision that was not easy.
“You have it in your head that, by not carrying your genes, it is not yours,” she says, and remembers that she had to request psychological assistance to overcome the “genetic grief.”
Although the average age at which couples come for any of the treatments is around 39 years, more and more women are choosing to freeze their eggs so they can be used later.
This is the case of Marisol, a 43-year-old Valencian who prefers not to give her last name.
She decided to have ovarian freezing at 37 because her work life as a nurse was incompatible with being a mother at that time and now she is pregnant.
“When my daughter turns 25, I'm going to insist that she make a reservation,” she says.
Clinic business
Spanish legislation allows access to assisted reproduction treatments through public health, although with a series of conditions.
The age limit at which they can undergo these techniques is 40 years in most autonomous communities - in the Community of Madrid it was extended to 45 and in others it is up to 38 - and the maximum transfer of three embryos is allowed. .
Long waiting lists, which in some cases last more than a year, represent an added barrier.
Once public avenues have been exhausted, many women choose to continue trying in the private sector, where financial expenditure skyrockets.
The final price depends on variables such as the clinics, the treatment applied or the number of attempts, but it is estimated that artificial insemination costs between 700 and 1,700 euros and in vitro fertilization costs around 5,000 when it is with one's own eggs and about 8,000. when it is with other people.
The woman from Malaga at the beginning of the report, for example, was forced to take out a loan and had to resort to the help of her parents to be able to pay for all the treatment.
The business of private assisted reproduction clinics has not stopped growing in the last decade.
From the 360 million euros in turnover obtained in 2014, it rose to 570 in 2022, with a single year of decrease due to the pandemic, according to the DBK Sector Observatory.
The KKR investment fund has seen a business niche in these companies and at the beginning of 2023 decided to buy the Spanish company Instituto Valenciano de Infertility for 3,000 million euros.
Infertility
But going to an assisted reproduction clinic does not guarantee pregnancy.
There are women for whom this process drags on for years and ends up exhausting them mentally.
This is what Cristina Malta, 41 years old and originally from Seseña (Toledo), tells it, who has made multiple attempts since, five years ago, she decided to become a mother with her partner.
Cristina Malta, who has been trying to become a mother through assisted reproduction treatments for more than five years and has invested 15,000 in the entire process, at her home in Seseña, Toledo, at the beginning of March.
Claudio Alvarez
First he tried the public health route, but the result was negative.
Once this route was extinguished, it became private, where he made three transfers.
In the first one she became pregnant, but at six weeks she had an abortion;
In the second she did not manage to fertilize and in the third she also became pregnant, but after nine weeks she had no longer heartbeat.
“It was a quite traumatic moment in my life, emotionally I broke down,” Malta recalls, who after each negative result she has considered abandoning the process permanently.
“I have felt stress, frustration, anxiety and envy,” she says.
Both Esther Segura, a 37-year-old from Barcelona, and Haridian Pérez, a 31-year-old from Tenerife, report psychological consequences similar to those in Malta and highlight the lack of tact of some of the professionals they have encountered.
“Medically they are super prepared, but for the emotional issue there is a lack of training,” summarizes Segura.
The three women also mention the harshness of the comments that people around them make without malice, but which can be “hurtful.”
“They ask you if you are going to give your mother a grandchild,” Malta quotes.
“Seeing a pregnant woman hurts me,” laments Segura.
Despite the accumulated emotional and economic wear and tear, Malta has still found the strength to make one more attempt.
“I have to get something out of this.
I don't know if I'm going to be a mother, but if my testimony helps just one woman, it will have been worth it,” she says.
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