Director of the IVF laboratory, IVI Zaragoza, Spain
Born in Teruel (Spain), she began her career in the world of human reproduction after finishing her studies in Valencia. She has developed her entire career in IVI, first working in IVI Valencia, then moving to one of their centres in Madrid, to end up in IVI Zaragoza, where she is currently working.
“It still seems miraculous to me that small group of cells eventually developing and becoming a baby”
E.M. First, we would like to get to know you a bit more. Could you tell us about your previous background and your experience working in the field of human reproduction? What did you study?
R.H. I studied a BSc in Pharmacy in Valencia. I wanted to pursue a career in nutrition, so when I finished my studies I joined the Department of Bromatology to start my PhD, where I worked with a liquid chromatograph. A friend of mine, Pedro Caballero, was doing his PhD at IVI Valencia with Dr Carlos Simón. He told me they needed someone to run a chromatograph, so I was proposed to go to IVI Valencia for research.
E.M. How did all start? In other words, what reasons made you decide to study and work on human reproduction? What was your first contact with reproductive medicine?
R.H. My first contact with reproduction was through the amazing stories of clinical cases, embryo development, etc. that clinicians told me during coffee breaks. They worked hard every day, but always with a smile on their faces. They represented all I had imagined for a perfect job: teamwork and an exciting job that allows you to see immediate results. Within 15 days you could know whether the patient had gotten pregnant or not, and that feels very rewarding.
One day, I went down to the IVF lab and I saw how ICSI was performed. It was at that moment that I decided what I really liked was reproduction and working in the laboratory. First of all, I got into the andrology laboratory; later, I took care of the co-culture system of blastocysts, and finally I got my training in IVF. After some time, there was a vacancy in one of our clinics in Madrid, so I decided to move there. I stayed in IVI Madrid for 10 wonderful years. Eventually, we had the chance to open here in Zaragoza, and here I am!
E.M. Was it easy to step into this field?
R.H. Of course, I have already been working in reproduction for many years. Back in that time there were not so many people who wanted to dedicate themselves to IVF. People like Amparo Ruiz, Imma Pérez, Carmen Rubio, Yolanda Mínguez, Pep Romero, Reme, Menchín… (people from the IVF lab in IVI Valencia) opened the field of reproduction here in Spain. They were actually the pioneers in reproduction and I learned firsthand from them.
It is true that, in those years, the job market was not as complicated as it is now. And given that I switched from having studied pharmacy and considering a career in nutrition to a career on reproduction, I guess it was just being in the right place at the right time. I was lucky to start working for IVI Valencia. Fortunately, they liked me and my way of working.
E.M. How long have you been working in IVI?
R.H. Oh, please, do not ask me that… [she laughs]. I entered IVI to do research in 1996, so between 1996 and 2000 I got my training in Valencia. In fact, I defended my PhD last year (I had put it aside for years). But I have been working in IVI ever since, I have never moved to another company in all these years.
E.M. Do you collaborate with any institution (university, association, …)?
R.H. I do. IVI has an agreement with the University of Valencia, where we offer our own MSc degree. We also have agreements with universities in other cities, such as Oviedo and Madrid, for people studying their own diplomas and who are willing to attend their training in our laboratories. The truth is that IVI has always been totally committed to training.
E.M. Are you certified by ESHRE (European Society of Human Reproduction and Embryology) as a senior embryologist?
R.H. Yes, I am certified by ESHRE. I have also been part of the Embryonic Health interest group of the SEF (Spanish Society of Fertility) and the Embryonic Quality interest group of ASEBIR (Association for the Study of the Biology of Reproduction). Nowadays, from time to time, we collaborate with the people who make up these interesting groups, although we are not part of the permanent committee. Sometimes we organize some scientific courses.
“You can take this job in two different ways: as a technical embryologist (…) or as an opportunity of living a different experience everyday”.
E.M. In this field one finds valuable living experiences every day, some better than others. Tell us about your personal trajectory. What does this work mean for you in your daily life?
R.H. For me, this is a job with both routine technical aspects and dynamic clinical development. Technical aspects change as soon as improvements on IVF are developed. There is also another very important technological factor, which forces you to learn and motivate yourself, so you can never get bored. You can take this job in two different ways: as a technical embryologist, and then you come to work, perform your cycles and go home. Or you can also think of it as an opportunity of living a different experience every day. It is a great job for those eager to continue developing to improve their training.
For example, new incubators are being designed with a built-in time-lapse system that makes you reformulate and question the entire classical embryonic classification again. We are currently beginning to measure new factors such as contraction of the blastocyst, which seems to be an important morphological feature of the embryo, possibly indicative of low quality or some type of failure. So, if you think of it that way, this is a very satisfying job. But you need to be involved because it is also very demanding. You have weekend shifts and no regular schedule. It is not a perfect job, but if you like it, it makes up for it.
Finally, it still seems miraculous to me that small group of cells eventually developing and becoming a baby.
E.M: If you were to start all over again, would you choose to be an embryologist again?
R.H. Yes, I would [she affirms decisively]. To be honest, I sometimes miss a little bit more prominence. I think of the IVF laboratory as the kitchen in a restaurant. You may go to a restaurant thinking it is very nice, but if the kitchen is bad, you will not go back. We should make efforts to let patients know both us and our laboratories. In fact, there are some clinics that offer clinical appointments depending on IVF procedures and embryo development. Obviously, this is about teamwork, from patient care to gynaecologists, nurses, patient attention and laboratory, and everyone should be regarded as an essential part of the clinical team.
“The word improvisation does not fit in with the IVF laboratory”.
E.M. How do you feel about helping couples who have problems to have children?
R.H. I feel very lucky helping people to have babies. Infertility is a medical problem, but it involves emotional and psychological aspects that other types of diseases do not. And we have to take care of these aspects too.
Being the best in your field and trying to grow embryos properly is not enough. You must also provide fundamental emotional support. The goal of the professionals of assisted reproduction (AR) is to bring a healthy baby home as fast as possible, and to know how to give emotional support to the patients within the process.
E.M. In your opinion, the work of an embryologist is quite hard. What characteristics should a good embryologist have?
R.H. My main concern is that a good embryologist must like working in a team. In order to function properly, protocols need to be established, and everyone must follow them in the same exact way. The word “improvisation” does not fit in with the IVF laboratory. This minimizes risks and ensures that your protocols work, because we do not have patients assigned to ourselves personally. So if I leave a patient in a certain condition, I need to know what to do with them next. This is where teamwork comes in. Work as a whole belongs to everyone.
Obviously, a good embryologist also needs to have technical skills, and he/she should not have problems with the schedule. In other words, availability is a must [she laughs]. If you want to be a good embryologist, of course you need to love your work. And being a good person, too, but that is important for every job.
“Sometimes the road is long, but it eventually has it rewards”.
E.M. We know that nowadays it is not easy to get a position in clinical reproduction. Could you give some advice or encouraging words to young people who wish to enter this passionate world?
R.H. Well… if they really like this, I would tell them: “Do not get discouraged”. Sometimes the road is long, but it eventually has its rewards. The world is currently quite small and there are always other places where you can go to and work, learn, and then come back having improved your CV. That would open you many doors to other different opportunities.
E.M. We would like to know your personal opinion on embryology in the 21st century and how we live today. After so many years working on AR, do you think demand has increased within recent years? If so, what is the reason?
R.H. I think the demand has increased after the peak of the economic crisis. There was a noticeable decrease in demand because people could not afford to go for cycles, which are an expensive treatment in the private health system. Nowadays demand has especially increased for single women and lesbian couples. There is also a higher amount of people who come into the clinic and talk about the subject more naturally (as I said, AR is becoming more normalized over time). Not long ago, many people used to keep their problems a secret, without even family knowing they were being treated. Now, people talk normally about AR. And this is also good for both clinics and patients, who do not have so much social pressure on them.
E.M. On a related note, do you think there are still social prejudices towards AR treatments?
R.H. I think it is changing and nowadays it is more normal. Of course, everyone can have their own opinion, and there will always be people with prejudices. But it is definitely becoming more accepted.
E.M. What do you think about delayed motherhood and women currently deciding to have children at an advanced age?
R.H. I think women have won many things in terms of professional growth, building up a career and developing ourselves at the workplace. However, we are paying a high price if we want to become mothers. The problem is postponing motherhood; my mother had me at 26 and I had my first child when I was ten years older. There is a logical delay in having our children because we want to study, we want a career and we want economic stability. And at the same time, this must coincide with having a partner, wanting to be parents… in actuality, being a mother between 20 and 30 is practically impossible.
I believe we should think a little about where we are heading ourselves to. If women decide not to have children, eventually we will have a problem. So, I think it would be a very good thing to make social politics to take care of this situation in favour of motherhood. This type of measure would greatly help not to have so many fertility problems.
E.M. What would you recommend to a person who wants to go to an AR centre?
R.H. Let them come to IVI, we are the best [she laughs]! On a serious note, I would recommend them going to a reproduction centre for a diagnosis, so the specialist will decide whether you really need treatment and which is the best choice for you. If you are over 35, do not wait too long before visiting a centre. I encourage people to go to the specialist, who can provide the best guidelines for each particular case.
E.M. Numerous advances are being made in this field, such as genetic modification of human embryos, embryos with DNA from three parents, open debates about the regulation of surrogate motherhood in different countries… How do you imagine the future of AR?
R.H. Let me tell you something: when I talk to my friends about my work, they sometimes ask me science fiction questions. The reality is that everything is controlled by legislation, which determines what we can and cannot do. Even so, the future is unimaginable. As Dr Carlos Simón said in a conference: “The future of humanity enters into Assisted Reproduction because, in the end, it will be safer to have a child through assisted reproduction than in a natural way”. This is a very futuristic image, but it is true that all the advances have been made to improve the possibility of having a healthy baby at home. This is a field in which many changes are achieved in a short time. But everything is strictly controlled by law and ethical committees. Thanks to science we can make so much progress, but always using it in the right direction.
E.M. In Spain 34,000 children are born by AR techniques every year, which puts the country at the head of AR treatments in Europe and third in the world, behind Japan and the US. In addition, 15,000 couples travel to Spain annually in search of reproductive medicine treatments. Despite the undoubtedly sanitary work done by embryologists today, there is no specialisation in clinical embryology that gives this subject the rank it really needs. What is your opinion about the incorporation of the specialisation in Clinical Embryology for biologists in the public health system?
R.H. I think it is necessary, specially in Spain. There are many people working as embryologists, not just biologists, but there is currently no specialisation. Certification by ESHRE does give you prestige, but legally that is not enough to apply for a public vacancy in reproduction. Both ASEBIR and SEF are always making efforts to recognize embryology as a specialisation, and we hope one day the Ministry will listen to us and accept the proposal.
E.M. That would be it from us, Raquel. Would you like to add anything else to what has already been said?
R.H. Indeed, I would like to talk about eggs vitrification, and tell women it is a way to preserve their fertility if they do not really find the right time to have children when they are young. It is a possibility among many others, obviously, but it is actually a step forward for those young girls who are not able to become mothers but would like to be in the future. It would be desirable to be able to have children at the age of 25 if you wish to, but as long as society does not change, we should try to promote this option more and more.
And as for new techniques, preimplantation genetic diagnosis of aneuploidies (PGD-a) is being implanted as a routine in laboratories. Studies on endometrial receptivity are being performed because reception at the uterus is as important as embryo quality.
E.M. Thank you very much for your time, Raquel.
R.H. Thank you, too. It has been my pleasure.