The delay in reproductive age redefines the medical approach to fertility

Assisted reproduction is now part of the medical approach to fertility problems, a health condition that affects a growing number of people and which, in many cases, occurs at more advanced ages and is associated with other pathologies. Clinical and technological advances in recent decades have improved outcomes, reduced risks and adapted treatments to increasingly complex patient profiles.
Currently, the goal of assisted reproduction is not limited to achieving pregnancy, but to doing so with the maximum guarantees of clinical safety, taking into account both physical health and the emotional impact of the process. Therefore, addressing fertility requires a comprehensive medical assessment and follow-up that extends beyond reproductive treatment to include pregnancy and birth.
The Assisted Reproduction Unit at Ruber Internacional Hospital operates within a highly complex hospital, which facilitates a coordinated multidisciplinary approach between the specialities involved in reproductive health. ‘The basis of the treatment is a complete diagnostic evaluation, which includes the study of the embryo, the uterus and the general condition of the patient, as well as medical follow-up that continues throughout pregnancy and birth,’ explains Dr Elena Carrillo de Albornoz, medical director of the unit.
Personalised treatment for more complex clinical profiles
The delay in the age of motherhood has significantly changed the profile of patients seeking assisted reproduction. Many have associated pathologies, a history of previous failures or a lower ovarian reserve, which requires a joint analysis of different clinical factors.
‘In these cases, it is essential to comprehensively evaluate embryonic, endometrial, hormonal, immunological and haematological factors in order to tailor the treatment to each clinical situation,’ says Dr Santiago Bau. Along the same lines, Dr Alfonso Bermejo emphasises that ‘true personalisation of treatment, based on clinical criteria and the team's experience, reduces unnecessary interventions and optimises the chances of a live birth, especially in older women.’
Coordination between the different professionals within the same centre is key to this process. ‘The proximity between specialities promotes continuous communication and more agile decision-making,’ explain Dr Silvia Iniesta and Dr Beatriz Bueno, something that is particularly relevant in treatments that often generate uncertainty and a high emotional burden on patients.
The laboratory, a pillar of the clinical approach
The assisted reproduction laboratory plays an essential role in clinical outcomes. ‘Coordinated work with the medical team, standardisation of protocols and the incorporation of technology based on scientific evidence are fundamental to maintaining optimal conditions for embryonic development,’ explains Dr Yosu Franco, scientific director.
Among the most significant advances are prolonged embryo culture to the blastocyst stage and the use of continuous monitoring or time-lapse systems. ‘These tools allow constant observation of embryonic development and facilitate more accurate decisions about the timing and the most suitable embryo for transfer,’ say embryologists Gonzalo Bescós, Amelia Villa, Florencia Soto, and Laura Barroso. They also highlight that ‘electronic traceability and biometric security systems help to reinforce the safety of the process.’
Reproductive genetics and less invasive techniques
Preimplantation genetic diagnosis has established itself as an important clinical tool for certain patient profiles. ‘It allows us to identify embryos with a higher probability of implantation and reduce the risk of miscarriage, especially in women over the age of 37,’ explain doctors Elena Melia, Vega Cabezuelo and Esther Suárez.
Reproductive genetics continues to advance towards less invasive techniques. ‘Research is currently being conducted into methods that allow genetic information to be obtained without the need for embryo biopsy,’ say doctors Daniel Ordoñez and Álvaro Martínez. In this regard, Dr Alejandra Rexach and Dr Ana Vegas point out that ‘non-invasive genetic diagnosis, combined with artificial intelligence tools, can help prioritise the order of embryo transfer and support clinical decision-making.’

The average age of patients who seek assisted reproduction is around 39-40 years old, and many do so after several failed attempts. This necessitates close medical monitoring and an appropriate emotional approach. ‘The psychological impact of treatment can be significant, so emotional support is part of a comprehensive approach to fertility and can influence adherence to and continuity of treatment,’ explains Dr Fátima Martínez.

In the coming years, assisted reproduction will continue to move towards less invasive procedures, greater use of artificial intelligence and strategies aimed at preserving or improving egg quality. ‘The trend is towards treatments that are increasingly tailored to each patient's clinical profile, without losing sight of clinical safety and quality of care,’ concludes Dr Yosu Franco.