Get to know Dr Juan Carlos Castillo

FAMILY TRADITION IN THE FIELD OF GYNAECOLOGY

Dr Juan Carlos Castillo is a gynaecologist at Instituto Bernabeu and a renowned specialist in his field. He is married and has a young daughter. He has been part of the team at the Instituto Bernabeu Group since 2013 and is a key player in healthcare for international patients. This May 2022 he has been appointed scientific director of IB as responsible for the continuing education of specialists.

Dr Castillo was surrounded by medicine from a very young age. His father is a gynaecologist and he knew very early on that he also wanted to work in this field of medicine and to continue with the family tradition. He graduated with a degree in Medicine and Surgery in 1999 and, six years later, completed specialist training in gynaecology. In 2004, he did a rotation at Pennsylvania Hospital in the USA in the High Risk Obstetrics, Ultrasound and Gynaecologic Oncology departments. In 2010, he was awarded a Doctorate in Medicine with distinction from the University of Valencia. Has has been part of the medical team at the Instituto Bernabeu Group since 2013 and is one of the international patient specialists.

Dr Castillo was very drawn to reproductive medicine and received specialist training on numerous courses and Master’s courses on human reproduction. It was in 2005 that he decided once and for all upon the future of his professional career. He was a collaborating doctor in the assisted reproduction unit at the University Clinical Hospital in Valencia that year and it was there that he added practical training to the technical side and familiarised himself with ovarian stimulation and other assisted reproduction procedures. In the scientific community, he is considered one of the leading researchers on the prevention of ovarian hyperstimulation syndrome.

When Dr Castillo searched for related protocols and information, he found that there was hardly any written information or research so he decided to take a serious look into it. One of the heads of department asked him to review the hospital’s clinical histories using this groundbreaking protocol since 2002. The curious part of this story is that, until 2004, the information was not available in digital format and he was forced to go through them, one by one, on paper. Dr Castillo’s research work was so successful that it was presented in an oral presentation at the European Society of Human Reproduction and Embryology (ESHRE) infertility congress in Lyon. This really was quite an achievement for such a young doctor since ESHRE is considered one of the world’s most significant platforms for assisted reproduction. His knowledge opened up the door to publicising his unwavering research, forming part of a group of international experts in the prevention of ovarian hyperstimulation.

ESHRE named Dr Castillo associate editor in 2016 and he is the only Spaniard to form part of the editorial committee of the journal Human Reproduction, the most prestigious journal in the world in the field of reproductive medicine. His work consists of reviewing and validating the research work that is sent to the journal for publication. When the work is associated with his field, he determines its quality and worth. He also decides which experts are the most appropriate for evaluating other pieces of research work. Dr Castillo explains that “reviewing other pieces of research means I can keep up to date with the latest progress in reproductive medicine” and, as such, always be at the forefront.

His knowledge and degree of specialisation have meant he is responsible for over 50 publications in specialist journals and the number is increasing day by day.

TEN QUESTIONS FOR THE MAN AND FOR THE DOCTOR

What fascinates you most about reproductive medicine?

From the early days of assisted reproduction techniques, it was clear that we needed to retrieve a greater number of eggs so that more embryos enabling improved selection and better chances of pregnancy could be generated. However, developing a greater number of follicles in order to obtain more eggs is linked to the so-called ovarian hyperstimulation syndrome (OHS), one of the most feared complications in our field of work. So, from my very first contact with assisted reproduction, I was driven by the attempt to work out a protocol that would facilitate optimising the number of eggs obtained whilst, at the same time, preventing any form of OHS. Thanks to a joint effort by many experts on an international scale, we can now say that we have developed a protocol that prevents this potentially serious complication. This achievement really has meant huge progress in the safety of the technique for our patients and I am personally very pleased to have made a contribution (and continue to make a contribution) towards its development.

What has been the greatest challenge you’ve faced during your career?

Funnily enough, its a constant challenge that I face pretty much every day in my line of work. It consists of showing my patients (or at least trying to show them) that the best way of achieving our common goal – a healthy child born to a full term pregnancy – is to transfer just one embryo per attempt. For many different reasons, patients tend to opt for the transfer of more than one embryo. Some of them tell me that they would ‘really like’ to have twins. My answer is always the same: you can have all the children you’ve ever wanted to have, but one by one. This is always the best scenario, particularly from an obstetrics point of view.

What led you to move from Valencia with your family in order to work at Instituto Bernabeu?

My career as a specialist in assisted human reproduction began in Valencia, a city I have very fond memories of. Once I’d finished training at the University Clinical Hospital, I began to work in a clinic there. I was already aware of how prestigious Instituto Bernabeu was and that it was a strong institution with a stimulating interest in innovation and research that was reflected in its continuous presence in major forums within our field of speciality. For example, the Spanish Fertility Society and ESHRE. When the time was right and the opportunity to broaden my horizons at IB came up, there was no doubt in my mind and the interview that followed at the clinic with the Medical Director, Mr. Rafael Bernabeu, simply confirmed that this would be a step forward for me both personally and professionally… I wasn’t wrong. Of course, I also had to get permission from my personal boss: my wife. Thankfully, she agreed!! Alicante is, furthermore, a great place to bring our daughter up in.

What advice would you give a patient wishing to begin assisted reproduction treatment?

In short, I’d recommend trying to deal with it eagerly, with perseverance and optimism, but also with an equally healthy dose of realism.

There are always a number of uncertainties in the decision to turn to a specialist in fertility. First of all, trying to understand why something supposedly so ‘easy’ for other couples (getting pregnant) is now proving so difficult for them. Most couples come to us with many doubts and uncertainties. My advice during the first visit is to try and cover the case as naturally as possible and to face the steps needed in order to get over the reproductive issues with enthusiasm, to do it in an agreeable manner and to be totally honest about providing all relevant information. Likewise, the medical team must provide all the available information in simple and understandable terms. In this case, a specialist and honest, but also humane, touch is essential.

What has changed in the time between the first positive beta pregnancy test a patient of yours had and the most recent one?

I’m glad you asked me that question. It’s taken me back many years and has reminded me of many exciting times. I’ve got very fond memories of the first positive pregnancy test (it was a urine test, by the way) because of how happy the patients were and because of the feeling of a job well done. Up until then, I’d seen the same success in my mentors and teachers, but that first positive beta pregnancy test in a case I’d dealt with entirely on my own was a really satisfying moment. Of course, I continue to enjoy them now, but a little more calmly. Perhaps I know that, although a positive pregnancy test is the result of a lot of effort by a lot of people – the couple, the family, the doctors, the nurses, the biologists – it’s only the first big achievement and that there are more challenges ahead: the pregnancy going well, the well-being of the mother and foetus and, last of all, the birth of a healthy child. The latter is, of course, our common aim.

You have just been appointed scientific director of Instituto Bernabeu, taking responsibility for the continuing education of doctors, what does taking on this new responsibility mean to you?

A colossal duty and, in equal measure, an honourable privilege and a source of great satisfaction. Instituto Bernabeu’s trajectory in the area of medical research is highly recognised in our speciality and to continue along this path, while adding a personal touch, is certainly a privilege. I must add that collaborating on a daily basis with the wonderful people behind the magnificent professionals who make up our institutional team will make the task, although inherently highly committed, also enjoyable. In my opinion, it is relatively easier to face this type of challenge if you have the right logistical and human resources and if it is carried out in an unbeatable working environment, and Instituto Bernabeu has and provides all these factors, which add up to success.

One of the pillars of the Institution is continuous training. How is the Instituto Bernabeu team trained?

Basically, the team at the institution has a great deal of experience in the area. In addition to this, continuous training comes from various sources. One of these is the weekly scientific session (lasting approximately two hours), in which complex clinical cases are discussed and presentations are made on specific topics, experimental techniques, new developments or review topics. These meetings involve all the Instituto Bernabeu sites (telematics is very useful in this task) and constitute one of the pillars of the constant “updating” at the centre. Another focus of continuous training is attendance at national and international forums and congresses; in this case, the attendee at such an event must present (in one of the aforementioned weekly sessions) the topics that have been the most relevant during the scientific event and thus act as a thread and disseminator of current issues. Finally, the IB team has free full-text access to scientific publications from high-impact journals in our speciality, an indispensable tool for optimal continuing education.

What will be your objectives in further promoting this aspect?

In general terms, one of our missions will be to strengthen the innate abilities of those who have an inclination for research and to “ignite the spark” and motivate those who do not have this tendency. To this end, we will collaborate with the R&D department in the design, assignment and monitoring of research projects that are of the greatest scientific interest, but also exciting for the team that will carry them out. Everyone is part of the team, and teamwork continues to be the key to success in the institution. As for the weekly scientific sessions, our mission will consist of “scanning” among the most relevant publications of the journals with the greatest impact in our speciality the topics of interest to be discussed and assigning the papers to the team, trying at all times to be balanced in the distribution of topics, we understand that it is an additional effort but which undoubtedly results in a common benefit. And the same goes for the attendance to events; of all the events that are scheduled throughout the year, the most outstanding ones will be chosen and the staff that will attend such an event will be selected based on the topic, experience, special interest in the subject and of course motivation. Last but not least, we will seek to incorporate the potential of new social communication tools such as Twitter or WhatsApp in the continuing education process, as they currently have agile, practical, fast, and simple (and at the same time very complete!) formats for sharing information, such as “tweetorials” or “virtual abstracts”; we are convinced that these tools are essential in these times dominated by immediacy in the flow and dissemination of knowledge.

Having highly trained doctors is reassuring for patients, what does this hyper-specialisation mean for the practice?

The speciality of reproductive medicine has seen dizzying progress in recent years and now draws on individual input from many fields of study: clinical, biological, genetic, endocrinological, immunological, haematological, surgical, psychological and even ethical. And each of these is constantly advancing, driven, among other things, by powerful technological developments. Continuing education at the Instituto Bernabeu aims to interconnect the best information about advances in the various areas of reproductive medicine, so that when we sit down with our patients, we can provide them with the most accurate diagnosis possible and the best strategies available for achieving the common goal. The goal is to achieve excellence in providing the best care to our patients under a firm commitment that this is based on the best medical evidence available.

How do you reconcile your daily work in consultation or the laboratory with continuous training? What is the reason for this desire for improvement and self-improvement?

Reconciling care work with research and updating projects is certainly an “extra” effort, and in my opinion, in this aspect of professional development, as in other aspects of life, the key word is: motivation. As I mentioned earlier, a hallmark of the institution is its commitment to research, it is in its “institutional DNA” and the IB team is inspired by these values from its first days at the centre. The medical management and the scientific and research managers aim to maintain this research motivation by distributing tasks in an organised and balanced way and, above all, by coordinating projects that are of interest to the team that will develop them and providing the logistical means required for this purpose. In this sense, we are driven by a healthy spirit of competitiveness, we are motivated by seeing our name on that work which will later be published in a scientific journal or presented at a congress and which will contribute to the progress of the speciality by contributing to knowledge, with the understanding that the final beneficiaries in this continuum will be our patients. The results of this motivation are there: this year 2022 the Spanish fertility congress (SEF) and the congress of the European Society of Human Fertility and Embryology (ESHRE) accepted 33 of the 34 scientific papers presented by the Instituto Bernabeu, a great achievement and a source of pride for the human and professional team of the institution and entirely convinced to continue on the right path.