I WANT TO BE A MOTHER: GUIDE Bernabeu Institute

To become a mum is a wonderful and unique experience; an adventure starting with a longing, a desire: to be a mother, which might be one of the most powerful desires a woman can feel.

At the same time, this feeling will come along many doubts and uncertainties. This is why, below, we will talk about how to start this path by solving some of them.

I want to be a mum, when would it be the right time?

Becoming a mother is one of the most important decisions in a woman or couple’s life.

It often seems that the right time to fall pregnant never comes. Sometimes, it is because of our lifestyle: work, traveling or even stress. Sometimes because we can’t find a partner with whom to share this path. Or sometimes any other reason can influence this decision. That is why, in the first place, the right time to have children will depend on you (and in any case, if in couple, both of you). Once you feel ready, that will be the right time.

It is true that, once we have decided to fulfil this dream, we must ensure we are in good health and, if there is any underlying illness, make sure it is under control. This is why, a good gynaecological check-up and, if necessary, a consultation with the specialist will help us.

One-parent families

Nowadays there are different family models. Late social changes have made possible for single women, without a partner, to start the adventure of becoming mothers. This is what we, in reproductive medicine, call “single motherhood” or “be a single mother”. Medicine can help them achieve pregnancy in a safe and accompanied manner thanks to reproductive techniques.

What kind of infertility situations can we find?

Many women looking for single motherhood probably don’t have any health or fertility problems and all they need is to use donor sperm. However, sometimes we may find some alterations; this is why it is advisable to carry out an individualised assessment on each patient in order to offer the best treatment for each case.

This initial assessment consists of a basic health and fertility evaluation. To do this, we will complete a medical history, considering the woman’s age, family, personal and gynaecological history of interest, general and hormonal blood tests, cytology and a transvaginal ultrasound.

Once we have done these tests, we will be able to detect or suspect if there is a fertility problem, such as polycystic ovary, alterations in menstrual cycle, low ovarian reserve or an advanced maternal age which may lead to an altered oocyte quality. Situations, each one of them, that require a specific treatment.

What treatments are available?

There are different fertility treatments available to help women who chose to become single mothers. Each one of them has its indications. Once assessment and initial evaluation is done, we will be able to recommend which would be the best option in a personalised way.

Artificial Insemination

Consists of making the patient ovulate (following her menstrual cycle or gently stimulating the ovary with hormonal medication) and, at the right time, introducing the sperm (in this case from a donor) into the uterus.

It is a simple technique, useful to young patients with no added fertility problems or menstrual cycle alterations such as anovulation, without irregular cycles and fallopian tubes in good shape.

In vitro fertilisation (IVF)

This treatment takes a step further. It consists of stimulating the ovary with hormones to achieve multiple follicular growth. When most of the follicles are ready, using a technique called ovarian puncture, and with the patient sedated so she doesn’t feel any pain, we retrieve the eggs. The eggs are then fertilized in the laboratory with donor sperm and, once fertilized, they are left in culture until blastocyst stage. Once the embryo has reached this stage, it is ready to be transferred to the woman’s uterus. If there are any remaining embryos, they can be vitrified for future transfers.

This treatment, a bit more complex, is advised for women with bilateral tube obstruction, advanced age patients, patients who wish to analyse her embryos to confirm they are chromosomally healthy, when there is a low reserve or when insemination has failed.

Egg donation

Consists of using donor eggs, after the donors have fulfilled all the requirements and studies stablished by the Law on Reproduction and advised by the Spanish Fertility Society. In this case we would be talking about a double donation, since the oocytes are going to be fertilized in the laboratory with donor sperm.

A woman who opts for such a treatment must prepare her endometrium by taking oestrogen or by taking advantage of her natural cycle and, at the right time, transfer the embryo to her uterus.

It is indicated for even older patients with oocyte quality problems where previous techniques have failed. Also, in the case of being carrier of a monogenic disease or having alterations in the chromosomes and not wanting to transmit them to the offspring and the pre-implantation genetic diagnosis has failed.

Testimonies

Laura came to consultation when she was 35 years old and a desire of being a single mother. She explained this desire was the result of a long-meditated decision and now she felt ready.

Her personal history included diabetes diagnosed in childhood. Laura, aware of her illness’ importance, had been under control for some time and provided us with a report from her endocrinologist stating she was at this moment in good shape to become pregnant.

Her fertility assessment was normal and with a hysterosalpingography we confirm her tubes were permeable.

Given her age and the normal tests results obtained we decided to perform an artificial insemination with donor sperm and, keeping her diabetes in mind, we decided to do it in a very natural way: following her natural cycle.

After triggering ovulation, the insemination took place at the exactly right time and 15 days later we were able to congratulate Laura. The first step had been taken.

Laura’s pregnancy was completely normal. She followed all her gynaecologist and endocrinologist’s recommendations and a few days ago she came to our office, very happy, to introduce us to Rodrigo, her son.

Dr. Judith Morraja, gynaecologist at Instituto Bernabeu