Laura García Sánchez never was sure she wanted to be a mother, but she did not rule it out. She simply postponed that decision. At 45, she knew she was on her last attempt and thanks to an egg donation process, Noa came into her life. Along the way, there are four frozen embryos that she will not carry, but she would like to make available to other women.
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A decision constrained by a rule designed 20 years ago: “I cannot dispose of my embryos. Either I wait until I turn 50, while continuing to pay for their storage at the clinic, or I request two medical reports that prove I will no longer be able to be a mother.” Laura demands that women be able to have authority over their eggs and embryos, “if we talk about sperm, it is easier. They are not examined to see if they can or cannot, they are simply given the green light to destroy what was donated.”
Joaquín Llácer, gynecologist specializing in reproductive medicine and member of the Spanish Fertility Society (SEF), makes it even clearer: “It sounds harsh, but in this country, it is easier for a woman to abort an embryo she does not want than to get rid of them before implantation.” This statement could cease to be true in the coming months if the reform advances in the Parliament, which has already taken the first step.
Last April, a broad majority of the Congress admitted this reform proposed by the PSOE, which seeks to equalize the cryopreservation of eggs and semen and strengthen women’s autonomy against the current regulation.
Vanessa Vergara, medical director of IVI Clinics Spain and Portugal, applauds this modification because it can have a positive impact “by facilitating freer, informed, and more personalized reproductive decision-making for each woman, improving the use of the technique and reducing unnecessary barriers.”
Currently, what Law 14/2006, of May 26, on assisted human reproduction techniques (LTRHA) allows is the destruction of male gametes, but not female ones, “at least not so easily. They just have to say ‘I don’t want them anymore’ and that’s it,” points out Laura. However, women have it more complicated.
What are the steps currently contemplated by the regulation?
First, cryopreservation in authorized banks of oocytes may be extended until the medical responsible, with the favorable opinion of two independent specialists unrelated to the center, determine that the recipient does not meet the clinically appropriate requirements to undergo an assisted reproduction technique.
Second, the law sets different possible destinations for cryopreserved oocytes: use by the woman herself or her spouse; donation for reproductive purposes; donation for research purposes; and cessation of their preservation without other use. In practice, the different options other than use by the woman herself are “infrequent,” although in Laura’s case it does occur, with the nuance that what she donates is already the fertilized egg.
In this scenario, “the preservation of fertility through oocyte vitrification is practically the only effective tool to mitigate the biological impact of this delay,” notes Vergara. However, “we know that not all women will end up using those oocytes, and the current regulation somewhat limits the efficient management of this reality,” adds the expert.
In the case of cessation of preservation without other purpose, it can only be carried out when the maximum preservation period established by law has been exceeded, that is, when the woman’s fertile period ends (in our country set at 50 years), without having opted for any of the other aforementioned destinations.
All this contributes to producing an accumulation of oocytes in authorized banks, “as a consequence of the limitations that the regulation establishes to cease their cryopreservation,” warns Llácer and adds that “the situation almost leads us to the fact that the oocytes have to remain frozen indefinitely.” Through her case, Laura emphasizes that “there is still much ignorance on this matter. And much stigma. It is neither told that one goes through this process, nor is it known what happens after you no longer need the reproductive material. There is also the economic issue; not everyone can continue paying once the process is finished, which is already expensive in itself.”
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Llácer emphasizes this: “Women abandon because they do not want to keep paying for preservation. And we enter a dynamic where there is no equality because they cannot decide about those samples.” There is no other country, he assures, that establishes these obstacles for the destruction of frozen genetic material from women.
For the medical director of IVI, all this is especially relevant in a very clear social context: “In Spain, women are delaying motherhood to some of the highest figures in Europe, with an average age of first child above 32 years and birth rates below 1.2 children per woman.”
What happens with the embryos?
The law reform admitted for processing that will be debated in the coming months is limited only to the regulation of oocytes, although the situation of embryos, which is what worries Laura, would remain pending.
Parliamentary groups, during the debate to consider its processing, also pointed out the need to reform what happens with fertilized eggs, since the requirements to be able to destroy them are the same: simple will is not enough, a favorable report from two specialists accrediting that the woman does not meet the conditions to undergo treatment or waiting until 50 years old is required.
Again, Llácer expresses his disagreement: “It is an aberration and I am not saying it is done, but it is legally easier for a woman to have the embryo implanted, get pregnant, and then abort,” as he emphasizes that “when it comes to interrupting pregnancy, no woman is required to do anything.”
However, Vergara is more cautious about the possible amendment of two- and three-day pre-embryos, which today also cannot be destroyed without bureaucracy. “Here additional ethical considerations come into play that are not exactly comparable to gametes,” says the medical director of IVI.
Laura has been undertaking information and training for women who are going through one of the multiple formation processes for some time. “I try to resolve doubts that arise for me through my Instagram channel,” she says.
From the clinical and patient point of view, “it would be reasonable to move towards a system that, maintaining all ethical and legal guarantees, allows more agile processes focused on the will of couples or patients,” defends Vergara.
The importance of these modifications, concludes the IVI director, “lies in finding the balance between scientific and technological advances, the needs of patients, and a flexible regulation that allows solving society’s problems efficiently with responsibility and ethics.”
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