In a 2020 marked by the pandemic of COVID-19, almost all processes of human life in society came to a halt. While the economic crisis tightens and the world is restless, Cuba moves forward in the path of life, fulfilling the dreams of couples who, for reasons beyond their control, have not being able to conceive naturally.
Despite the economic, financial and commercial blockade the government of the United States has imposed on Cuba, and has steadily tightened in the last few years, an aggressive virus and an ongoing reordering process of the national economy, the Program of Attention to Infertile Couple has continued unstoppable toward the universalization of its services to make them available to a higher number of families on the island.
About this topic, Dr. Roberto Álvarez Fumero, head of the Mother and Child Department at the Ministry of Public Health (MIinsap), spoke in an exclusive interview with Granma:
–How many centers of high technology for the attention of infertile couples are there in Cuba?
–Since the creation of the Program in 2016, there are four regional centers of high technology: one in the Vladimir I. Lenin Hospital, in Holguin, for couples living in the eastern region of the country, from the province of Las Tunas to the province of Guantánamo; another in in the Gustavo Aldereguía Lima Hospital, Cienfuegos, for couples referred from the health services in the provinces of the center, from Ciego de Ávila to Villa Clara; the third one is located in the Ramón González Coro Hospital, in Havana for couples referred from the Western provinces from Pinar del Río to Matanzas; and the fourth one is located in the Hermanos Ameijeiras Hospital, which provides specific techniques and therefore, receives couples from all the country.
In 2018, Minsap expanded the existing four high-technology centers of assisted reproduction to six, with the opening of one in Santiago de Cuba and another one in Camagüey, which will increase the number of couples who receive this attention, reduce the distances and the expenses on transportation, food and accommodation for the Cuban family.
Due to economic limitations, the conclusion of these centers was postponed to 2021, and even under the current pandemic conditions, we haven’t stopped working in their construction and assembly.
–What are the technological and structural characteristics of these hospitals?
–These units have specialized technologies and structures in the surgical unit, where the aspiration of ovarian follicles and the transfer of the obtained embryos to the uterine endometrium are performed.
They have gamete laboratories where in vitro fertilization and the follow-up of the embryo development is done. They are equipped with an air-conditioning system of frequent exchange and filters to avoid damage to the growing embryo, whether by particles and by other harmful environmental conditions.
They are also equipped with tri-gas incubators, specialized stereo microscopes, micromanipulator, anti-vibration table, among others, to carry out the processes. Moreover, they have high-resolution and high-technology hormone dose ultrasound for the preparation of the couples, the follow-up to the induction of the ovulation and the confirmation of the pregnancy.
–How many couples received care under the Program in 2020?
–At the end of the complicated and challenging 2020, the network of attention to the infertile couple tended 25,574 couples who turned to the program for the first time and 7,027 pregnancies were achieved (830 more than in 2019), the highest number recorded by the program since 2016.
There was a significant increase in the municipal consultations to new couples. At that level of attention, for the first time, were received 16,669 couples and 4,894 pregnancies were achieved (703 more than the ones obtained in 2019), which represents 69% of all the pregnancies achieved by the network. In addition, the efficiency rose from 5.2% to 29.4% pregnancies for every one hundred couples (24.2% over 2019).
There was an increase in the influx of couples to the provincial centers for assisted reproduction, where 8,203 couples (141 more than in 2019) were attended for the first time and 2,056 pregnancies were achieved, 267more than the 1,789 achieved in 2019, with an effectivity of 77.6% pregnancies for every 100 women inseminated and/or who have undergone other surgical procedures, 16.9% over 2019.
Due to the financial limitations to begin the cycles of in vitro fertilization, there has been a reduction of the activities in the four territorial centers for high-technology assisted reproduction, where 702 couples were attended for the first time and 77 pregnancies were achieved out of the 80 expected with the available resources.
–What is the impact of the economic, financial and commercial blockade imposed by the US government against Cuba on the treatment of infertile couples?
–Fertility treatments are very expensive worldwide. The medicines, the consumables, hormonal reagents, embryo culture media and spare pieces of the equipment and the component for the maintenance of the specialized engineering systems are manufactured by a small number of companies, to which we have been unable to pay and obtain the credits to do so in time, as an effect of the financial chokehold caused by the tightening of the blockade on our country.
The commercial and import obstacles have prevented to have all the products available at once, and they required to be chained throughout the process, from its import to its internal distribution, and these hurdles provoke delays and a reduction of the number of in vitro fertilization cycles planned for a period of time.
It has not been possible to modernize all the equipment, which becomes obsolete after a short period of time and hinders the purpose of improving efficiency and the introduction of new techniques for assisted reproduction.
–How has the Program continued amidst the pandemic of COVID-19?
–Since the beginning of the pandemic, we have been following all the scientific evidence on its effects on human health, its transmissibility and the ways the virus can spread, as well as the possible effects of the SARS-COV-2 virus on the embryogenesis resulting from an in vitro fertilization.
During the struggle against COVID-19, the assistance services for the preservation of life and the continuity of the Program of Attention to the Infertile Couple remained.
However, social distancing, restraint measures in communities with local transmission and the psychological effects of the complex epidemiological context on the couples, initially affected the attendance and influx of couples through the different levels.
The number of couples coming to consultation increased during the recovery phase and reduced the delay in the couples pending follow-up due to the COVID-19 restrictions.
In coordination with the local government, transportation arrangements were made for the couples coming to the provincial services, located in the administrative centers, from all the municipalities. A positive example of these arrangements is Santiago de Cuba, where they guarantee a bus to bring the couples from that province to the regional center in Holguin.
At the same time, other measures for the prevention of COVID-19 were implemented in the service network. Patients received information over the phone, telling them not to attend consultation if they had had fever, cough or respiratory symptoms in the last 4 days, if they have been in touch with someone who had been diagnosed or was suspected of having the disease, that if possible, they came without companion and to be on time for their appointment to avoid staying in the waiting room for a long time.
The centers established an access point at their entrance, where patients are triaged to this day, they are requested the use of the face mask, their temperature is measure and the social distancing of 1.5 meters is observed.”
“In couples where there have been symptoms or have been in contact with positive cases, it was necessary to postpone the treatment for at least four weeks after the symptoms have disappeared.
For the attention of the couples in the provincial services, we used detection tests whose results were received before the consultation and patients from areas on local transmission were allowed to attend these services only if the tests ruled out active transmission.
Nasopharyngeal samples were taken to carry out PCR tests 72 hours before the surgery for in vitro fertilization, cancelling or postponing them if there was a chance of them being positive.
The departments of epidemiology in the hospital assessed and defined the risk scenario and the protection means of the acting professionals, that is how challenging this year of encouraging numbers had been.
(Translated by ESTI)
