Dr. José Enrique Islas Varela
Director General
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Accesible Fertility Treatment in Demand

Sat, 09/05/2015 - 20:11

Q: How do you define infertility, and how many couples in Mexico are facing this problem?

A: Infertility is categorized when a couple is unsuccessful after a year spent trying to conceive through unprotected sexual relations. Some of our patients had failed to conceive for up to 15 years before coming to us. Several have even visited other clinics and doctors without success. Therefore, one of our main goals is raising awareness about infertility and reducing the number of couples who are under the impression that this problem can never be solved. About 15% of couples between 25 to 45 years old have fertility problems. We receive approximately 5,000 patients per year and we perform In Vitro Fertilization (IVF) for about 1,000 of them. Most patients only require preliminary treatments to get pregnant instead of an entire round of IVF. The main factors that contribute to infertility are smoking, living a sedentary lifestyle, endometriosis, and age. The latter is the most significant factor as women above 38 years old will find it difficult to successfully get pregnant due to the decreasing quality of the ovum. This same issue leads to increased risk of misscarriage and developmental problems.

Q: What is Insemer’s success rate?

A: Insemer aims to become an institute that can solve up to 90% of infertility problems. Our IVF treatments have a success rate of 50% after the first procedure, 75% after the second procedure, and above 90% once we reach the fourth treatment. This places us in the top five reproduction clinics in Mexico, and we are proud to say that these numbers are consistent with the success rates of clinics in Spain, the US, and the UK. A major problem for couples seeking IVF is that they often do not have access to such treatments or switch doctors if the initial procedure fails, which can be detrimental as it is better to undergo the entire process with the same doctor. This enables a doctor to better understand the specific characteristics of each couple and implement necessary changes to improve the success rate of future procedures. The whole process, including laboratory tests and drugs for ovulation stimulation, costs approximately US$7,000. This compares to an average cost of US$21,000 in the US for a treatment with the same success rate.

Q: How do chronic diseases, such as obesity and diabetes, impact fertility?

A: These factors negatively affect the possibility of getting pregnant. In the few cases where patients have diabetes or hypertension, we ask them to control their blood sugar or blood pressure before starting treatment. Our patients are mainly young and healthy people who do not present these diseases. However, obesity has been proven to reduce the viability of implantation, so we require that obese women reduce their weight to increase the chances of a successful pregnancy. Our treatment often includes various alterations to patients’ lifestyle. They have to visit a psychologist to determine whether they are suffering from stress, depression, or anxiety, or to help determine whether any problems within the relationship might reduce their success rate. Our patients must also visit a nutritionist if they have weight problems. We prefer not to start treatment until these situations have been resolved so as to maximize the success rate of the procedure. Nevertheless, we will still treat a couple even if they refuse to change their lifestyle to improve the success rate. Our ethical committee helps us decide the proper course of action for specific cases. For example, we cannot accept patients who suffer from AIDS or terminal diseases, while women can also be rejected due to their age.

Q: Which role do certifications and partnerships with other hospitals play in your services?

A: We are certified by the Advance Fertility Center of Texas. This hospital helps Insemer to improve its techniques while we send physicians there for training. We also collaborate with Hospital Español, Hospital Ángeles, and Hospital ABC to perform cesarean sections. We do not have other certifications yet, but we are working to obtain ISO 9000. This is a complex process for a hospital since there are different regulations for every single profession within the hospital, from nurses to administrative assistants, as well as for every specific room in the hospital, such as waiting rooms and operating rooms. We are working to obtain this certification by the end of 2015.

Q: Given that fertility treatments are not covered by insurance companies, do you offer financial support schemes for low-income patients?

A: We provide several discounts as we often receive middle- to low-income patients. High-income patients usually travel to the US for fertility treatment. For some reason, many of them tend not to trust Mexican doctors, which is unfounded as Mexico has many highly experienced doctors. Our success rates are on par with those in the US while our services are far cheaper. However, it is difficult to persuade many high-income patients of the value of seeking treatment in Mexico.

Q: Which role could subsidized fertility treatments and cooperation between public and private clinics play in increasing access to such services?

A: Only two hospitals in Mexico provide subsidized fertility treatments, the National Institute of Perinatology and Centro Medico Nacional 20 de Noviembre, but they do not collaborate with private clinics. This differentiates Mexico from other countries. In the UK the NHS pays for the first round of IVF, while Argentina has passed a law allowing the government to fund fertility treatments in private clinics. We currently have the capacity to perform 2,000 treatments per year but we only perform half that number. If the public sector were willing to collaborate with us, we would be able to acconditionate an additional 1,000 treatments at a reduced cost. The waiting list for one round of IVF in a public hospital is eight months. Sadly, our government perceives IVF as an unnecessary luxury and private insurers are unwilling to cover it for the same reason.

Q: How far away are we from being able to choose the characteristics of our children?

A: It is impossible to modify features such as hair or eye color but not to change the basic genetic profile of the parents. Parents can work with donors that have the desired physical qualities, and we can carry out preimplantation genetic diagnostic tests to screen for genetic abnormalities. This is far more important than picking superficial features such as eye color. Efforts are currently being made to determine the future health of a baby before birth. It is impossible to repair an embryo, but it is possible to distinguish the healthiest embryo from those available. By mapping the chromosomes in an embryo, we are able to detect its predisposition toward several types of cancer, hypertension, and diabetes, for example. Our studies offer a 99.9% certainty of a healthy embryo but, after implantation, further studies are performed to confirm the fetus health. So far, we have never made a mistake.