Interview with dr. Victoria Walker from Institut Marquès

Today we pay a virtual visit to Institut Marquès in Barcelona to interview dr. Victoria Walker. Institut Marquès was founded as a Gynaecology and Obstetrics clinic in 1941. The first IVF laboratory opened in 1989. The clinic has offices in Italy (a fully licensed clinic in Rome and a satellite centre in Milan).

Dr. Victoria Walker is a gynecologist and a fertility specialist. She entered medicine in 1995 and qualified as a GP in the United Kingdom in 2005. She moved to Spain that same year and joined the Institut Marquès in Barcelona, where she is now part of their international team of fertility doctors. Victoria speaks English, French, and Spanish. We have asked dr. Walker a few questions about the clinic itself, fertility treatments available, egg donors, patient service, etc.

Can you tell us why patients from abroad should consider Spain as their destination for fertility treatment abroad?

Spain has one of the most advanced and flexible assisted reproduction legislation in Europe. The law approved by the Spanish Parliament in May 2006 allows any woman over 18 years old and in full capacity to act to receive or use assisted reproduction techniques regulated by law, independently of her marital status and her sexual orientation. Therefore, single women, married heterosexual and homosexual couples, and legally registered heterosexual partners qualify for undergoing fertility treatment. Our law provides for reproduction techniques to be used not only to treat fertility issues but also for reproductive life planning (for example choosing single parenting or postponing motherhood by means of oocyte cryopreservation techniques). Also, unlike other countries in Europe, egg and sperm donation in Spain is anonymous and, therefore, the identity of the donor can never be revealed.

Institut Marquès was established in 1922. What is your medical director, doctors and embryologists’ experience in the fertility field?

Institut Marquès is internationally known in gynaecology and assisted reproduction with a century of experience. It has become an international reference in its sector, with headquarters in Barcelona (Spain), Rome, and Milan (Italy). The centre owes its name to the family whose members have represented the unity and continuity of the centre over time. Its founder, Dr Vicens Marquès i Bertrán, began practicing as a gynaecologist in 1922. Since then, the vocation for gynaecology has been passed down from generation to generation: to Dr Leonardo Marquès Giraut, son of Dr Vicens Marquès; to his grandson, Dr Leonardo Marquès Amorós and to his great-grandson, Dr Borja Marquès López-Teijón. Institut Marquès will always be a personal and family project. It represents 100 years of history and four generations of gynaecologists.

Unlike many other fertility clinics, Institut Marquès is managed by its doctors and it is exclusively dedicated to assisted reproduction and gynaecology. Led by Dr. Marisa López-Teijón, Institut Marquès treats patients from over 50 countries. Many of these patients have previously undergone fertility treatment, without success. The company’s CEO, Dr Marisa López-Teijón appears among the top 10% of the most influential researchers in the world, according to the platform Research Gate. Her book “I want to get pregnant now!” has become an essential fertility guide. She is also the author of Fertility-experiences.com, with more than 850,000 readers. She was awarded at Harvard University (USA) for her studies on fetal hearing and was recently awarded as “Best Physician of the Year in Assisted Reproduction” in Spain.

The embryology team at Institut Marquès is made up of expert embryologists who are active members of the most important national and international scientific societies in the sector, such as the ASEBIR (Association for the Study of Reproductive Biology) and the ESHRE (European Society of Human Reproduction and Embryology). Institut Marquès’ team also includes the president of the Spanish Association of Andrology, Sexual and Reproductive Medicine (ASESA), Dr. Ferran García, who manages its Andrology Unit.

Does Institut Marquès specialize in a certain area, e.g. male factor or multiple IVF failures? Do you get many patients with these issues?

Institut Marquès offers a wide range of first-class fertility services and personalised care, with its own Premium Sperm Bank and a broad programme of gamete and embryo donation, and specializes in especially difficult cases of patients with fertility issues (those who have previously undergone several cycles without success). We offer several alternatives for those patients that need a donor Artificial Insemination or an In Vitro Fertilisation (IVF). We have several specialised treatment units: Genetic Advice and Hereditary Diseases Unit, Recurrent Miscarriage Unit, Oncology and Reproductive Medicine Unit. In addition to the basic fertility treatment, we recommend some special add-on techniques, proposing only those that have shown to be effective such as the Preimplantation Genetic Test (PGT), male factor techniques (Fertile, IMSI, etc.) or the Embryoscope incubator (Time-lapse technology).

Institut Marquès has also carried out several studies on sperm quality and has its own Andrology Unit specialized in male infertility. Thanks to its research, the relationship between environmental toxins and low male fertility has been demonstrated. The “Male Fertility Unit” is one of the services that differentiate this clinic from its competitors. This is something noteworthy to point out, since currently it is estimated that the male factor (male infertility) is associated with more than 50% of cases of conjugal infertility, in 30% of cases, the male factor is the only responsible party and in the remaining 20%, it appears combined with a female factor.

We know from our experience that one of the reasons many couples avoid going abroad for IVF is the language barrier. Does your staff speak English and/or other languages?

In accordance with our holistic concept of patient care, where each person is unique and their treatment, too, so Institut Marquès has a specialised assistance team, fluent in different languages (Spanish, Catalan, English, Italian, French, German, Dutch, Portuguese, and Arabic), which guides the patients step by step during the treatment.

Is Institut Marquès obliged to report the results and success rates to national IVF monitoring organisations? Where and how can a patient check if your clinic is fully accredited and regulated before deciding on treatment?

Institut Marquès reports annually its results to the SEF (Spanish Fertility Society). At a local level, patients can check all our accreditations at the Catalan Health Department of the Catalan Government (Generalitat de Catalunya). At a national level, they can do it here at the National Register of activity and results of Assisted Human Reproduction centres and services. At a European level, they can obtain this information at the European Coding System for Tissues and Cells (EU coding Platform).

What is the maximum patient age for IVF treatment at your clinic?

In Spain, the maximum age for undergoing IVF treatment with own or donor eggs is not set by law. However, according to our experience, we propose undergoing IVF with own eggs until the age of 42-43, as in later ages the results when using own eggs are very low. Additionally, we advise women from 38-40 years onwards to use PGT (Preimplantation Genetic Testing) in all IVF cycles, as the percentage of embryos with anomalies significantly increases at these ages. In the case of donor egg IVF, we offer the possibility of undergoing treatment to women up to 50 years of age, knowing that the last day that we can do an embryo transfer is aged 51.

Can you please tell us about the donor egg recipient qualification process and which patients cannot be accepted for egg donation treatment? Are there any limitations apart from the patient’s age?

The great majority of patients would be eligible for egg donation, up to the age of 50. However, we request that patients with significant physical or psychiatric morbidity provide us with confirmation in writing from their main doctor in their own country that they are healthy and could carry a pregnancy to term. We do this to ensure the patients will be well looked after if pregnancy is created. We also request that women with a BMI ≥ 35 lose weight before starting their fertility treatments.

What egg donors do you have (race/ethnicity)?

Institut Marquès has donors of all phenotypes. They are young and healthy women who wish to help other women become mothers. They undergo medical and gynaecological check-ups, take a complete blood test including psychological tests, the study of the karyotype, tests to discard infectious diseases, and specific tests to discard the most frequent mutations within the European population causing cystic fibrosis. At Institut Marquès we carry out the matching between patients and donors in a rigorous and totally personalised way: the doctor is in charge of choosing the right donor taking into account the blood group, Rhesus as well as the physical and now also the psychological traits of both patients and donors thanks to our personality matching. By law, female donors must be over age 18 and under 35.

What is your protocol for patients with multiple IVF failures? Do they receive different treatment?

Patients who have undergone multiple IVF failures will discuss with their doctor at Institut Marquès all the investigative tests they have completed up to that point. In these cases, we always review the age and genetics of the couple (karyotypes), uterine tests (eg. ultrasound, hysterosalpingogram, hysteroscopy), sperm tests (eg. seminograms, DNA fragmentation tests and FISH tests, meiosis tests), the patient’s response to previous fertility treatments, and when the problem occurred (during the creation of the embryo, after embryo transfer or after implantation eg. a miscarriage). Based on that assessment we would then complete tests that we feel will help make a diagnosis as to the cause of the multiple failures, and then see if there is a way of correcting any abnormality detected. We really try to assess the whole picture of a patient’s infertility, and believe that ‘infertility of unknown cause’ hardly exists at all.

Do you consider egg donation the best alternative for patients aged 38-40? There are many patients of this age who are looking for treatment with their own oocytes.

A woman’s fertility starts to go down from the age of 35, but the rate at which it goes down is extremely variable. Some women aged 38-40 are still very fertile, and others are not. Tests of ovarian reserve can be useful in trying to work out what the situation is for an individual woman, but even these can be unreliable at this age because the genetic quality of the eggs produced by women aged 38-40 can be wildly different. So we find that the most useful adjunct to treatment at this age would be PGTa. If a woman does IVF with her own eggs and PGTa and finds that all the embryos created are genetically abnormal, then in her case maybe an egg donor would give her a better chance of having a successful pregnancy.

Can you tell us, in short, about the most difficult IVF case you have had that ended in successful birth? What made a difference in that case?

As a centre for quaternary referral, most of our cases are complicated! And given that patients come from all over the world for treatment at Institut Marquès, travelling long distances can add to the stress of the process. Probably the most difficult case I have had was for a patient from New Zealand who had completed multiple cycles of egg donation treatments using her husband’s sperm without success. We tested her uterus and implantation, we checked the embryos to make sure only genetically normal embryos were transferred, we tested for all manner of small print causes of infertility, but nothing happened – not a hint of pregnancy. Eventually, the couple decided to renounce on the use of the partner’s sperm and take a donor embryo from our bank – and it worked! So we are still not quite sure what in the husband’s sperm would have stopped the embryos from implanting, but a complete change of gametes did the trick, which was absolutely wonderful!

During the treatment process who is in touch with the patient? Can patients communicate with the doctor? Are they assigned an individual patient coordinator?

From the very first time they contact the clinic, patients are assigned a Patient Assistant, who provides them with all necessary information about our treatments and services (logistics, prices, forms to fill up, travel information) and helps them solving doubts about the process before fixing the first consultation with one of our doctors. After that first visit, they are assigned a Medical Assistant, who is in charge of coordinating and making sure that the information between the doctor and the patient flows adequately during the process. Patients can communicate with their doctor whenever they need to, either by mail, phone or video call, as they prefer. They just need to ask their Medical Assistant to schedule a visit.

What new/innovative IVF techniques are available at your clinic? Are there any innovative treatment solutions that you have implemented recently?

We are constantly carrying out innovative scientific studies to improve assisted reproduction treatments. Music, mobile technology, telemedicine and the use of virtual reality are some of the innovations that Institut Marquès is already using in its clinics.

We have developed a world pioneer innovation project with aiming to improve IVF by implementing music in all our embryo incubators in our assisted reproduction laboratories. Our scientific studies have demonstrated that musical microvibrations produce movements similar to those that fertilised eggs experience in their journey through the fallopian tubes and the uterus; they stir the culture medium, achieving a more homogeneous distribution of nutrients and scattering the waste metabolites. The use of music represents a significant advance in order to reproduce in our laboratories the natural conditions that embryos would have if they were in the maternal uterus. It is also a key factor of the increase in our success rates.

On the other hand, mobile phones have turned into another technological ally in order to improve the results of fertility treatments. The Embryomobile app, developed by Institut Marquès, allows parents a real-time follow-up of their embryos while they are in the incubator from any location. It is a commitment to transparency that, furthermore, considerably reduces the stress of the mother before the embryo transfer, favouring the implantation in order to achieve pregnancy. Institut Marquès is the only centre where patients can really see what their embryos look like.

Telemedicine is the medicine of the future. In this area, Institut Marquès is using videoconferences to communicate with patients all over the world.

In addition, the centre has developed and patented the Sperm Freezekit. This new technique allows patients to cryopreserve their sperm anywhere in the world and send it to the clinic, without having to travel. This is a practical and convenient solution for males who are away from home and who have difficulties for travelling to the clinic to undergo fertility treatment with their partner or, simply, for privacy reasons.

And, still thinking about the male, the sample collection rooms at Institut Marquès have an evocative design and include erotic devices to improve sexual arousal, such as virtual reality glasses. This is the Erotic Personal System, a special protocol for obtaining the best sperm because Institut Marquès’ studies have established a link between improved semen quality and erotic visual stimulation through virtual reality.

In the future, Institut Marquès will continue to innovate and adapt to its latest findings to ensure it remains successful in all of its endeavours.

If you wish to contact this clinic and book a consultation, go to their profile and contact Institut Marquès.