MADRID — One in six couples in Spain has fertility problems. In 2022, out of every 100 babies born, 12 were born thanks to assisted reproductive technology, according to data from the Spanish Fertility Society (SEF). This makes the country a leader in the European Union regarding the use of these techniques.
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Moreover, the average age at which
women in Spain decide (or are able) to have their first baby has been continuously increasing these past years. A mix of social and medical trends that translate into business opportunities for many private clinics.
“Ads on my
social media have changed from Clearblue to freezing your eggs,” said then-30-year-old journalist Noemí López in her book El vientre vacio (The Empty Belly). She points out how some clinics “compete to be the first to capitalize” on “doubts and uncertainties” by using what she describes as marketing slogans: “A newborn or your money back”, “free tests,” “limited space,” “interest-free financing,” or “discounts of up to 1,000 euros.”
Because of Spanish Social Security limits access to
fertility treatments to women up to 40 years old as well as the number of attempts at becoming pregnant, the vast majority of fertility centers are private. That is where we can find that account for the volume of business we are talking about: artificial insemination costs around €1,000; in vitro fertilization €5,000; IVF through egg donation, more than €7,000; and egg freezing for possible future insemination, close to €3,000.
But of course, those are the
costs if everything goes well on the first attempt. The final cost is usually much higher.
Hidden figures
Treatment prices are often clear, although some aspects, such as hormonal treatments or the maintenance of egg freezing, are sometimes not included in the first level of information.
Data about the success of the different reproductive techniques is more controversial. For example, clinics can showcase percentages of successful conceptions, ignoring the fact that some of these end in miscarriage. Or they do not mention that the success rate increases if the eggs come from another woman.
In this sense, sociologist and journalist Esther Vivas accuses this sector of “taking advantage of a suffering” caused by the increase in couples experiencing fertility problems. “Often what they sell is a guarantee of fertility, but they hide the real difficulties of achieving what they promise,” she says.
Some centers can “play with the percentages” of success by showing the most favorable data.
A lack of information is confirmed by Alba, a 42-year-old family doctor, mother of a girl and a boy both born thanks to fertility treatments. For her daughter, the treatment was covered by Social Security. For the second, however, she was already over the age limit and underwent the treatment in a private center.
On the one hand, Alba criticizes the coldness with which the public service communicates, particularly when a pregnancy doesn’t succeed. “On the other hand, in the private sector, everything is nice, everyone is smiling. Everything is described to you as being very easy, but they do not warn you of the inconveniences; you have to ask about them,” she says.
SEF President Dr. Juan José Espinós does not agree with criticism about advertising in the sector. Regarding the information on gamete donation, “there is a specific regulation that sets the limits on what can be said.” As for the rest of the treatments, he points out that they obey “the same rules” that apply to the rest of the medical specialties in the private sector.
Yet he recognizes that some centers can “play with the percentages” of success by showing the most favorable data, and encourages those who approach them to dig thoroughly about what the different treatments and success rates consist of.
Emotional manipulation
“I know when these patients get their period, because it is a new grief every month,” says therapist Ruth Imedio to illustrate the suffering and guilt of women who want to be mothers and cannot. According to this family specialist, not only do they have to go through the traditional pressure at family reunions, but they also are inundated with messages present on leaflets in the waiting room of their gynecologist or from advertising on social media and websites.
The algorithms are put to work: “If you search for early menopause, you get a notification about finding out your ovarian reserve,” Imedio says, adding that sometimes you don’t even have to do a specific search, you just have to be a woman of a certain age for these messages to come to you.
“Clinics are companies focused on reproduction, and therefore fall into the logic of the market. They use advertising that is very emotional and quite manipulative, like every other sector, except here, they are playing with a vital desire,” says Silvia Nanclares, author of the autobiographical novel ¿Quién quiere ser madre? (Who wants to be a mother?), in which she narrates the process of a woman who resorts to various fertility treatments.
As an example of this emotional manipulation she points out how “the messages about vitrification (the freezing of a woman’s eggs for future use) are the same old “the clock is ticking,” only reformulated in the million ways that an advertiser can think of.”
Destroying the eggs
Social dynamics mean that women in Spain can decide to become mothers at an increasingly older age. To avoid the aging of the eggs, freezing them allows the clock to be stopped for a few years while waiting for “the right time” to take the plunge. In Spain, more than 5,000 women froze their eggs in 2020, according to SEF data — 10 times more than seven years earlier.
New struggles arise when women decide to get rid of these embryos since, as with the previous abortion law, the current regulations establish that they can only do so certain ways: donating them to science (a residual possibility due to the few research projects); donating them to other couples (for free, although private clinics will then profit from them); or getting two medical professionals to certify they are clinically unable to have children.
They forced me to continue paying for 10 more years because I am 40.
Through her community, Mamás desobedientes (Disobeying mothers), journalist Esther Vivas received numerous complaints from women who decided to end the maintenance of their eggs: not only were they unable to do so due to these requirements, but they were forced to keep paying for it.
“They forced me to continue paying for 10 more years because I am 40,” one of them said, adding: “If I do not make the payments, they unilaterally decide to donate them and continue charging another woman for them.”
When donating is the only option
For her part, Nanclares still has two frozen embryos and has faced these same obstacles now that she has decided not to use them. She tried to donate them to science but has not been able to do so because “there are too few agreements.” The clinic does allow her to donate them to another woman, but she does not want the clinic to negotiate with them. So she finds herself in the position of continuing to pay, or looking for two medical reports to certify something that is not real because if she wanted to use those embryos she knows there would be no problem.
“It is quite crazy,” she says, while calling for a fight against that she says is legislation influenced by conservative “pro-life” discourse.
The system encourages women who want to give up their eggs to end up donating them, if only to avoid having to continue paying for their maintenance. But rather than be given to another woman, they are be given to the clinic, which will thus have a greater profit margin on the treatment.
There are already more than 700,000 frozen embryos in Spanish centers.
According to the law, a woman cannot be paid in exchange for her eggs, it is a “free contract”, and the maximum number of babies born from the same donor is six. But a common practice is to pay a “compensation” of around 1,000 euros. And the absence of a national donor registry allows many women to resort to this practice very frequently as a way of alleviating an adverse economic situation.
Regarding these regulations, Dr. Espinós also regrets “the contradiction” of “a very permissive legal framework for the interruption of pregnancy but not for egg thawing” and argues that the centers only comply with this legislation. The SEF president thus calls for the law on thawing to no longer be linked to these requirements and for women, or couples, to be able to decide on the future of their gametes.
Finally, he points to one of the unexpected consequences of this regulation: There are already more than 700,000 frozen embryos in Spanish centers. A good number of these come from mothers who hope that the law will change.
