Prof. Paul Devroey: “Infertility problems are due more to a social issue than a physiological one”
On October 3 Eugin celebrated its 15th anniversary in Barcelona, an age at which it arrives in top form having established itself as a leader in assisted reproduction in Catalonia, with more than 8,000 treatments per year. To mark this anniversary, Eugin invited the Belgian researcher Prof. Paul Devroey, one of the world’s leading authorities on fertility and assisted reproduction.
In 1992, when in charge of the Centre for Reproductive Medicine of the Vrije Universiteit Brussel, he developed the technique of intracytoplasmic sperm injection (ICSI), through which it is possible to inseminate an egg with a single sperm. Since then, men all over the world with serious alterations in their semen have been able to fulfill the dream of parenthood. Prof. Devroey exudes enthusiasm for the coming challenges of assisted reproduction and declares himself to be fascinated by the medical and social progress that egg vitrification brings with it.
Assisted reproduction techniques are a commonly accepted option which more and more people turn to. What have they contributed to modern society?
In the past, people with fertility problems could not have children and had to accept the existence of a medical reason that could not be overcome. All that has changed.
How many people worldwide are estimated to have benefited from ICSI?
Millions of people. 10% of men have fertility problems, some even to the point of having no sperm in the ejaculate. The problem is that in many countries these techniques are not available because for many decision makers they are not a priority. So you have to work to improve outcomes and facilitate the acceptance of this technique worldwide.
Can science get any man to be the biological father?
Yes. I remember when we first extracted sperm directly from the testes to fertilise an egg. Many colleagues said it would not work because the end stage in sperm development, the capacitation phase, occurs after ejaculation [when they enter in contact with fluids in the woman’s genital tract]. “The sperm have to be capacitated,” they used to say, even in books. Along with the researcher, Gianpiero D. Palermo, we obtained sperm from the testes of a man who had been diagnosed with aspermia [total absence of sperm]. Thus we saw that the story about capacitation was not entirely correct. A man can be a biological father even in extreme cases such as aspermia.Totally!
What are the future challenges to male infertility?
Andrologists must understand the mechanisms of infertility: why one man produces sperm normally and another isn’t capable of it? In some cases, the changes are due to genetic factors, but in many other cases the cause is unknown and that creates difficulties about what treatment to follow. We want to know how to treat them. When we introduced the technique of ICSI we were convinced that it wasn’t a question of treating the man, you can only treat the gamete, the spermatozoon. That was the turning point: we went from the man to the gamete. One possibility for men to preserve their fertility is to freeze the sperm, because with the passage of time sperm production suffers in extreme cases.
Is there an increase in infertility problems in developed societies?
No, I don’t believe so. The number remains fairly stable; I don’t think the cases of infertility are increasing. What I do see is that more and more women study, develop a career, organize many aspects of their lives and end up putting off motherhood. And with each passing year, fertility decreases.
So, then, it’s more of a social issue than a physiological one?
Given this tendency to delay childbearing, what contribution does egg freezing make?
Vitrification is an incredible development, the next major challenge for assisted reproduction. It’s a fantastic technique! And do you know why? Because it equal men’s and women’s rights, and there are some societies that don’t accept it. In addition, freezing eggs is less symbolic than freezing embryos. It’s exciting!
What do you think about assisted reproduction techniques in Spain?
Consider ethics, which for me has a twofold dimension. There is an ethic that involves respect for science and another one that may be understood as a tendency to ban. In Spain, the respect for science is predominant, which they can be very happy about. This means that here the ethical implications of science are respected, unlike other European countries. They have leaders in research on assisted reproduction and they can put these technologies at the service of the people. For this reason so many people come to Spain for treatment.
Thanks to Pre-implantation Genetic Diagnosis (PGD) the DNA of each individual can be studied and thus prevent the transmission of hereditary diseases. At the same time, techniques like this fuel the ethical debate. As a former president of the Belgian National Bioethics Committee, what course of action do you believe should govern reproductive medicine?
Of course, if a mother or a couple has a child with a hereditary disease they should take care of it, of course! But if, for example, we have six embryos and three of them have genetic alterations and the other three are perfectly normal, I see no reason not to use the normal ones, thus avoiding suffering and hardships. It all depends on the basic philosophical and religious principles of each and every one of us: If you think you should not abort or that you should not resort to PGD to analyze the genetic load of your embryos, it’s your right. But if you want to, go ahead. Nobody should forbid others from doing it.
Does assisted reproduction still have to counter prejudices?
Yes, to some extent, we still have to tackle prejudices. In Belgium, Parliament respects the ethics of science and Spain is lucky regarding the assisted reproduction situation it is in. In other countries it’s catastrophic, where researchers have to contend with hostile public opinion.