FAMILY TRADITION IN THE FIELD OF GYNAECOLOGY
Dr Juan Carlos Castillo is a gynaecologist at Instituto Bernabeu and a renowned specialist in his field. He is married and has a young daughter. He has been part of the team at the Instituto Bernabeu Group since 2013 and is a key player in healthcare for international patients.
Dr Castillo was surrounded by medicine from a very young age. His father is a gynaecologist and he knew very early on that he also wanted to work in this field of medicine and to continue with the family tradition. He graduated with a degree in Medicine and Surgery in 1999 and, six years later, completed specialist training in gynaecology. In 2004, he did a rotation at Pennsylvania Hospital in the USA in the High Risk Obstetrics, Ultrasound and Gynaecologic Oncology departments. In 2010, he was awarded a Doctorate in Medicine with distinction from the University of Valencia. Has has been part of the medical team at the Instituto Bernabeu Group since 2013 and is one of the international patient specialists.
Dr Castillo was very drawn to reproductive medicine and received specialist training on numerous courses and Master’s courses on human reproduction. It was in 2005 that he decided once and for all upon the future of his professional career. He was a collaborating doctor in the assisted reproduction unit at the University Clinical Hospital in Valencia that year and it was there that he added practical training to the technical side and familiarised himself with ovarian stimulation and other assisted reproduction procedures. In the scientific community, he is considered one of the leading researchers on the prevention of ovarian hyperstimulation syndrome.
When Dr Castillo searched for related protocols and information, he found that there was hardly any written information or research so he decided to take a serious look into it. One of the heads of department asked him to review the hospital’s clinical histories using this groundbreaking protocol since 2002. The curious part of this story is that, until 2004, the information was not available in digital format and he was forced to go through them, one by one, on paper. Dr Castillo’s research work was so successful that it was presented in an oral presentation at the European Society of Human Reproduction and Embryology (ESHRE) infertility congress in Lyon. This really was quite an achievement for such a young doctor since ESHRE is considered one of the world’s most significant platforms for assisted reproduction. His knowledge opened up the door to publicising his unwavering research, forming part of a group of international experts in the prevention of ovarian hyperstimulation.
ESHRE named Dr Castillo associate editor in 2016 and he is the only Spaniard to form part of the editorial committee of the journal Human Reproduction, the most prestigious journal in the world in the field of reproductive medicine. His work consists of reviewing and validating the research work that is sent to the journal for publication. When the work is associated with his field, he determines its quality and worth. He also decides which experts are the most appropriate for evaluating other pieces of research work. Dr Castillo explains that “reviewing other pieces of research means I can keep up to date with the latest progress in reproductive medicine” and, as such, always be at the forefront.
His knowledge and degree of specialisation have meant he is responsible for over 50 publications in specialist journals and the number is increasing day by day.
FIVE QUESTIONS FOR THE MAN AND FOR THE DOCTOR
What fascinates you most about reproductive medicine?
From the early days of assisted reproduction techniques, it was clear that we needed to retrieve a greater number of eggs so that more embryos enabling improved selection and better chances of pregnancy could be generated. However, developing a greater number of follicles in order to obtain more eggs is linked to the so-called ovarian hyperstimulation syndrome (OHS), one of the most feared complications in our field of work. So, from my very first contact with assisted reproduction, I was driven by the attempt to work out a protocol that would facilitate optimising the number of eggs obtained whilst, at the same time, preventing any form of OHS. Thanks to a joint effort by many experts on an international scale, we can now say that we have developed a protocol that prevents this potentially serious complication. This achievement really has meant huge progress in the safety of the technique for our patients and I am personally very pleased to have made a contribution (and continue to make a contribution) towards its development.
What has been the greatest challenge you’ve faced during your career?
Funnily enough, its a constant challenge that I face pretty much every day in my line of work. It consists of showing my patients (or at least trying to show them) that the best way of achieving our common goal – a healthy child born to a full term pregnancy – is to transfer just one embryo per attempt. For many different reasons, patients tend to opt for the transfer of more than one embryo. Some of them tell me that they would ‘really like’ to have twins. My answer is always the same: you can have all the children you’ve ever wanted to have, but one by one. This is always the best scenario, particularly from an obstetrics point of view.
What led you to move from Valencia with your family in order to work at Instituto Bernabeu?
My career as a specialist in assisted human reproduction began in Valencia, a city I have very fond memories of. Once I’d finished training at the University Clinical Hospital, I began to work in a clinic there. I was already aware of how prestigious Instituto Bernabeu was and that it was a strong institution with a stimulating interest in innovation and research that was reflected in its continuous presence in major forums within our field of speciality. For example, the Spanish Fertility Society and ESHRE. When the time was right and the opportunity to broaden my horizons at IB came up, there was no doubt in my mind and the interview that followed at the clinic with the Medical Director, Mr. Rafael Bernabeu, simply confirmed that this would be a step forward for me both personally and professionally… I wasn’t wrong. Of course, I also had to get permission from my personal boss: my wife. Thankfully, she agreed!! Alicante is, furthermore, a great place to bring our daughter up in.
What advice would you give a patient wishing to begin assisted reproduction treatment?
In short, I’d recommend trying to deal with it eagerly, with perseverance and optimism, but also with an equally healthy dose of realism.
There are always a number of uncertainties in the decision to turn to a specialist in fertility. First of all, trying to understand why something supposedly so ‘easy’ for other couples (getting pregnant) is now proving so difficult for them. Most couples come to us with many doubts and uncertainties. My advice during the first visit is to try and cover the case as naturally as possible and to face the steps needed in order to get over the reproductive issues with enthusiasm, to do it in an agreeable manner and to be totally honest about providing all relevant information. Likewise, the medical team must provide all the available information in simple and understandable terms. In this case, a specialist and honest, but also humane, touch is essential.
What has changed in the time between the first positive beta pregnancy test a patient of yours had and the most recent one?
I’m glad you asked me that question. It’s taken me back many years and has reminded me of many exciting times. I’ve got very fond memories of the first positive pregnancy test (it was a urine test, by the way) because of how happy the patients were and because of the feeling of a job well done. Up until then, I’d seen the same success in my mentors and teachers, but that first positive beta pregnancy test in a case I’d dealt with entirely on my own was a really satisfying moment. Of course, I continue to enjoy them now, but a little more calmly. Perhaps I know that, although a positive pregnancy test is the result of a lot of effort by a lot of people – the couple, the family, the doctors, the nurses, the biologists – it’s only the first big achievement and that there are more challenges ahead: the pregnancy going well, the well-being of the mother and foetus and, last of all, the birth of a healthy child. The latter is, of course, our common aim.