Someday, parents will tell their children the story of how they came into the world and there will be no minor stories. Perhaps, they were not more desired than the rest of the little ones whom his family began to love since they were just an embryo in the womb; but, in their cases, the road traveled before the happy birth will have overcome that of many because it is difficult and anguishing.

They could not speak ignoring the perseverance and dedication, first of those who made science and experimentation a spur to achieve a pregnancy, even if a reagent was missing or supplies were scarce and, later, of their personal battle not to give up when the first artificial insemination failed or when an abortion occurred, despite having adhered to any advice or recommendation to the extreme.

These certainties are what encourage and comfort, the same ones for which on any given day up to 20 couples can be treated at the Provincial Center for Assisted Reproduction, who arrive referred from the Health areas or of their own free will, driven by the "rumor" that "miracles" are achieved there.

Everyone could tell a different experience: Yadelbis Aliste Nápoles, who since 2015 has returned time and time again, adding six failed attempts without losing hope; Marta's nerves, who will undergo the painful hysterosalpingography for the first time to check the state of her tubes; and Anais, who tries to control, before everything else, a hormonal disorder.

Dr. Marvely Isaac Rodríguez, provincial coordinator of the Assisted Reproduction Program, and the multidisciplinary team that accompanies her prefer to focus on the yeses, on the indicators met, on the pathologies resolved, on carrying out complementary analyzes in a timely manner, and from there make decisions medical, and in the families that today savor their dream: a healthy baby in their arms.

“We indicate that after a year of unprotected sexual intercourse, if fertilization has not been achieved, specialized help is sought. We apply low technology techniques such as artificial insemination, the most used here, and high technology, when in vitro fertilization is used. Sometimes, it is about correcting only one condition, posture, or practicing programmed intercourse; if not, we try up to six inseminations and then in vitro fertilization at the reference center located in Cienfuegos”.

One of his headline reflections is that "no case is like another" and this good clinical eye for going from the general to the particular, in addition to the organization and cohesion achieved by the program from the base in the last year, have made possible, perhaps when it seemed least likely, a noticeable improvement in quality indicators, which are carried out there at the point of a pencil.

We are talking, for example, of 301 pregnancies achieved from the use of assisted reproduction techniques and an efficiency of 52 percent, which gives us a positive and increasing relationship between the new cases that entered the system and the pregnancies. In the long run, there were 132 births inventoried by this route in said period, since there are several causes that determine a happy term or not; however, the 108 registered in 2021 were exceeded.

Currently, only Baraguá remains to complete the team dedicated to these functions, but reality shows that, many times, couples skip Primary Health Care and get to the Provincial Center for Assisted Reproduction more easily and quickly than to their doctor's office in the municipality.

In the experience of Dalver Hernández Calzadilla, a specialist in Obstetrics and Gynecology, the most common causes of infertility are tubal, prostatic or testicular pathologies, hormonal disorders, varicocele and infections. Therefore, ruling out possibilities is the basis of the working algorithm.

For this, there is a long list of studies to be carried out: spermogram, post-coital test, serial ultrasounds from the third day of menstruation, vaginal exudates, hysterosalpingography and evaluation of cervical mucus from day 10 of the menstrual cycle to verify how the uterus prepares for ovulation.

It is added to this psychological support for couples, since stress, depression and anxiety are also factors that predispose and abound among those who want and cannot be parents. Depending on the results, it is decided whether or not interconsultation with other specialists such as urologists, endocrinologists or geneticists is necessary.

For hormonal tests, until very recently couples had to travel to Camagüey or Sancti Spíritus, but it is expected that, soon, they can be carried out in the laboratory of the Roberto Rodríguez General Teaching Provincial Hospital, another necessary impulse for a better functioning of the Program of Assisted Reproduction.

The practice of many of these methods of clinical analysis falls to Gelsy Díaz Álvarez, a specialist in Histology, who in a moment deconstructs at least two of the most deeply rooted stereotypes.

“Children achieved through assisted reproductive techniques are healthy, nothing indicates a predisposition to suffer from some type of disease or congenital malformation. The other thing is common in twin and triplet pregnancies due to the preparation with reagents that the semen receives in order to guarantee optimal conditions, although this is not a fixed rule either.

Ciego de Ávila reports a decrease of 1,185 births in the last 10 years, adolescent pregnancies are gaining ground, and low birth weight and prematurity keep the indicators of the Maternal and Child Program in the red, so inventorying preconceptional risks and the use of assisted reproductive techniques could clear some obstacles in this race for life.

Only in January of this year there are already eight pregnancies by this route; I hope this number is an omen of what is to come.