In a 2020 marked by the COVID-19 pandemic, the world has seen almost all the processes of human life in society stop. While the economic crisis worsens and the planet convulses, Cuba advances on the path of the miracle of life, to fulfill the dreams of couples who, for reasons of force majeure, have not been able to achieve a pregnancy spontaneously.
Despite the economic blockade that the United States Government lets fall with all its forces on the Island, due to an aggressive virus, and in the midst of a process of economic reorganization, the Program of Attention to Infertile Couple continues unstoppable towards the universalization of its services, to benefit a greater number of families.
On this subject, Dr. Roberto Álvarez Fumero, head of the Maternal and Child Department of the Ministry of Public Health (Minsap), offered exclusive details to Granma.
– How many high-tech centers for the care of infertile couples exist in Cuba?
–Since the creation of the Program, in 2016, there have been four territorial high-tech assisted reproduction centers in the country: one in Holguín, at the Vladimir I. Lenin Hospital, where couples who require it in the eastern provinces attend, from Las Tunas to Guantánamo; another in Cienfuegos, at the Gustavo Aldereguía Lima Hospital, attended by couples referred from the provincial services from Ciego de Ávila to Villa Clara; the third is at the Ramón González Coro Hospital in Havana, which cares for couples referred from Pinar del Río to Matanzas; and the fourth is at the Hermanos Ameijeiras Clinical Surgical Hospital, where, due to the specific techniques that are only offered there, couples from all over the country attend.
«Minsap decided, in 2018, to expand the network from four to six high-tech assisted reproduction centers, with the creation of one in Santiago de Cuba and another in Camagüey, which will increase the number of benefited couples, reduce distances and minimize expenses for the Cuban family for transportation, food and lodging.
“Due to economic limitations, its completion was postponed to 2021, but even under current epidemiological conditions, progress has not been stopped in its construction and assembly.”
–What are the structural and technological characteristics of these hospitals?
–These units have specialized structural and technological conditions in the surgical unit, where aspiration of the ovarian follicles and transfers of the embryos obtained to the uterine endometrium are carried out.
«They have gamete laboratories, where under conditions in vitro Fertilization and monitoring of embryonic development are carried out, where there is an air conditioning system of frequent exchange and filters to avoid damage to the developing embryo due to variations in temperature, humidity, particles and other harmful environmental conditions.
“They also have trigase incubators, specialized stereo microscopes, micromanipulators, an antivibration table and other equipment to carry out the processes. They also have high-resolution ultrasound and advanced technology hormonal dosing for preparing couples, monitoring ovulation induction and corroborating the pregnancy diagnosis.
–How many couples were benefited by the Program in 2020?
–At the end of a complex and challenging year 2020, in the care network for infertile couples, 25,574 couples received care for the first time and 7,027 pregnancies were obtained (830 more than in 2019), the highest number in the history of the program since 2016.
“In the municipal consultations, significant progress was made in caring for new couples. At this level, 16,669 couples received care for the first time and 4,894 pregnancies were achieved (703 more than the 4,191 obtained in 2019), which means 69% of all those achieved in the service network. In addition, the efficacy rose from 5.2% to 29.4% of pregnancies per 100 couples (24.2% higher than 2019).
«The flow of couples to the provincial assisted reproduction services increased, where 8,203 couples received care for the first time (141 more compared to 2019) and 2,056 pregnancies were obtained, 267 more than the 1,789 achieved in 2019, with an effectiveness of 77.6% of pregnancies for every hundred women inseminated and / or subjected to other surgical procedures, 16.9% higher than in 2019.
«Due to financial constraints to start fertilization cycles in vitro Activity levels were reduced in the four territorial high-tech assisted reproduction centers, where 702 couples were seen for the first time and 77 pregnancies out of the 80 planned were achieved, with the resources available ”.
– What impact has the economic, commercial and financial blockade imposed by the US Government on Cuba had on the treatment of infertile couples?
– Infertility treatments are very expensive worldwide. Medicines, expendable material, hormonal reagents, embryonic culture media and spare parts for equipment and components for the maintenance of specialized engineering systems are produced by a small number of companies, for which it has not been possible to carry out the tests. payments and obtain credits in a timely manner, as a result of the financial asphyxia that the intensification of the blockade has caused the country.
«Due to trade and import obstacles, it has not been possible to have all the products at the same time, which require a chain in the process, from import to internal distribution, causing delays and a reduction in the number of fertilization cycles in vitro planned to be carried out in a period.
“It has not been possible to modernize all the equipment, which becomes obsolete in a short period of time, undermining the objective of improving efficiency and the introduction of new assisted reproduction techniques.”
–How has the Program developed in the midst of the pandemic caused by COVID-19?
–Since the beginning of the pandemic, we have been aware of the scientific evidence, not only on the negative effects on human health, transmissibility and the routes of viral transmission, but also on the possible effects of the SARS-COV-2 virus on embryogenesis resulting from fertilization in vitro.
«During the confrontation with COVID-19, the assistance services related to the preservation of life and the continuity of the Program of Attention to the Infertile Couple were maintained.
“However, the necessary social distancing, the quarantine in communities with local autochthonous transmission and the psychological effects on couples due to the complex epidemiological context, initially threatened their assistance and flow through the different levels.
«In the recovery phase, the frequency of consultations was increased to reduce delays in the care of couples pending follow-up for these causes.
«In coordination with the local governments, facilities were created for the transportation of couples from the municipalities to the provincial services, located in the provincial capitals. A positive example was in Santiago de Cuba, where every week a bus was guaranteed to transport couples to the territorial center of Holguín.
“At the same time, measures for the prevention of COVID-19 were implemented in the network of care services for the infertile couple. The patients received information via telephone, alerting them not to attend their appointment if they had had a fever, cough or respiratory symptoms in the last 14 days, if they had been in contact with someone with a diagnosis or suspicion of the disease, which to the extent of As much as possible, they came unaccompanied and kept their appointment time on time to avoid spending a long time in the waiting room.
«The centers established a transition zone at their entrance, where patients are still being investigated, they are required to wear a mask, their temperature is measured, their hands are disinfected and the safety distance of 1.5 meters is maintained.
«In couples with symptoms or a history of contact with positive cases, it was necessary to postpone treatment for at least four weeks after the symptoms disappeared.
“For the care of couples in provincial services, validated screening tests were used before the consultation and the attendance of patients from areas of autochthonous transmission was allowed only if the tests rule out active infection.
«Pcr were performed in nasopharyngeal samples 72 hours before the surgical intervention for fertilization in vitro, canceling and postponing the procedure if there was positivity.
“The hospital epidemiology departments evaluated and defined the risk scenarios and the means of protection for the professionals involved.” That’s how challenging this year of hopeful numbers was.
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