Maria Arqué: "Our lifestyle, our diet, and environmental pollutants all impact our fertility."

BarcelonaNo, having taken the contraceptive pill does not affect fertility. And yes, even if you've had a child, you may have complications getting pregnant again. Dr. Maria Arqué, a gynecologist specializing in fertility at CIRH and WoMer, debunks myths on social media. Her approach is integrative, which consists of "looking at the body as a whole" and reviewing each case to see what can be done to improve overall and reproductive health and increase the chances of a natural pregnancy and, if that's not possible, improve the results of assisted reproduction treatments. "We don't treat a uterus or ovaries, but a person," she states.

One in six people worldwide suffers from infertility. What are the main reasons?

— The most common cause is related to the woman's age. There is a lag between the moment when we are biologically in the best position to have children and the moment when we are socially able or begin to consider it. Then there are other problems such as ovulation disorders, endometriosis, or polycystic ovary syndrome. In 40% of cases, the cause is female, in 40%, it is male, and in 20%, it is a mixed cause. In men, we see that semen quality has worsened over time. In fact, the WHO parameters are now less stringent.

Are there other factors such as pollution or stress?

— Our lifestyle, our diet, and all the environmental pollutants we're exposed to have a significant impact on our overall health, including our fertility. There seems to be a synergistic effect between this and age, as if we're more affected as we get older, just as we recover more quickly from an accident if we're younger.

How to improve our reproductive health?

— The first thing we should try to do is have children sooner. Fortunately, we now have techniques like fertility preservation that extend the fertile window. Maintaining fertility is aligned with maintaining overall health. It involves eating a diet that's as anti-inflammatory as possible without going to extremes or restricting it; avoiding exposure to toxins as much as possible, including tobacco, alcohol, and drugs, as well as endocrine disruptors, which we often find in products we use every day, such as kitchen capers and pans, cosmetics, and cleaning products; and engaging in regular, moderate physical exercise. Then there are two major challenges: respecting circadian rhythms to give the body time to regenerate and trying to improve stress management. Supplementation is also available. I'm in favor of it, but only if it's supervised by a specialist. Just because supplements are natural doesn't mean they're harmless. We often have a lot of fear of medications and little of supplements, and we shouldn't be afraid of anything; instead, we should use it properly and in a planned manner. It's a medical field that moves a lot of money and interest.

There's no recommended supplement or food. The pineapple and broccoli thing is a fabrication, isn't it?

— I wish I had a magic diet. There's no magic food. It's a combination of things, and often it's not enough to alleviate infertility.

What impact can treatments have on patients and partners?

— Ovarian stimulation has a physical impact, but most of the time the symptoms are similar to premenstrual symptoms, and the process is safe and well-tolerated. We increasingly have more tools to perform stimulation with more personalized treatments and fewer risks. Beyond this, treatments have a significant impact on the bond with one's partner, as well as on relationships with friends and family. Sometimes, some patients don't know whether to share their experiences. There are times when life revolves around the treatment, and this is difficult to manage. And then there's the financial impact. Most of the time, treatments are performed privately, and the cost is high. This adds stress, and we can't guarantee the success of the treatment. It's not uncommon for couples to separate during these processes. Others emerge stronger and more resilient.

There are no cycle limitsin vitro in private healthcare?

— No, but it depends on the likelihood of success and the psychological aspect. I've told some patients: "That's enough, don't do any more treatments, you have to stop." It's not harmless, even if they are safe treatments.

What happens when it doesn't work?

— It's always complicated. It's still a grieving process that requires good support. I'm in favor of patients receiving good emotional support from a specialist.

Is it harder than we think?

— Pregnancy rates are 30-40%. Negative results are more common than we'd like. Depending on the situation, the steps to take should be assessed and support provided. For example, if it hasn't worked and other techniques such as egg donation should be considered, a genetic duel should be conducted.

A genetic duel?

— It is accepting or assuming that you will have a child with a gamete from a sperm or egg donor that will not be yours.

Egg donation has generated some ethical conflicts. For example, journalist Julia Bertran wonders Dear Stranger (The Bell) what consequences your desire has on another woman's body.

— Egg donation to Spain and Catalonia is anonymous and altruistic, and the compensation is for everything they have to go through. It's not a lucrative act. Why don't we think it's wrong for someone to donate a kidney or blood, and why don't we think it's wrong for someone to donate eggs? I don't feel in a position to judge whether it's right or wrong. The important thing is that donors here are well cared for and well informed throughout the entire process.

The cost of private healthcare is around 8,000 euros including medication, while public healthcare has a waiting list of approximately six months to a year.

— In an ideal world, we should have more direct and easier access without having to pay so much money, because infertility and sterility are already recognized as pathologies by the WHO.

Are assisted reproduction processes and the concerns surrounding them once again falling on women?

— Perhaps there is more of a tendency for women to bear the brunt of the process. Until now, fertility clinics have focused on women, who are the ones who go through most of the processes, and men are left in the background. They may feel a bit displaced, and perhaps it's not that they don't suffer from it, but that they don't have the space to express it or don't even feel they have the right to do so compared to what women go through. I think there's work to be done to change this role of having to remain silent and having to play the strong role. They often feel their masculinity is questioned when there are fertility problems, and we need to change this idea because fertility problems can affect both men and women.

What is the role of assisted reproduction in the diversity of family models?

— Increasingly, efforts are being made to ensure that care is inclusive of all possible models, so that there is no discrimination and we can treat all patients. The Spanish Fertility Society has worked hard to provide quality care to trans patients. Assisted reproduction also gives single mothers the opportunity to become mothers. Having a partner is becoming less linked to having children.

If we're going to get into science fiction, how do you imagine the future of assisted reproduction?

— Research is currently underway in laboratories to try to create gametes with stem cells. If we are able to create eggs and sperm with stem cells, gamete donation will end.

What else can we improve in a utopian future for its reproduction?

— It's necessary to raise awareness among businesses and governments about the impact of environmental pollution, disruptors, and toxins. We've even found microplastics in follicular fluid, the liquid that nourishes the egg. All of this can disrupt the endocrine system, affecting all the signals the egg must receive to mature properly.