Meet the "mother" of Spain's first test-tube baby
Anna Veiga, the soon-to-be president of the European Society of Human Reproduction, celebrates a three-decade career with EL PAÍS
Anna Veiga's good-luck charm is a tiny hedgehog made of Swarovski crystal that sits on the right side of her cluttered desk. It shines as if it was brand new, yet it has been bringing her good fortune for all of 27 years. Or at least that's what she thinks. It turns out that this determined 54-year-old who holds a PhD in biology, who pioneered assisted reproduction in Spain and who is in charge of an ultramodern stem cell bank at the Barcelona Regenerative Medicine Center, is also a superstitious woman. In truth, she says, she is a pureblooded scientist - rational, Cartesian and agnostic. She is highly accustomed to seeing life emerge right under her microscope, and understands the origins of every creature on Earth. But nobody better touch this particular creature - the hedgehog, you see, is sacred.
"The knowledge we gained through IVF opened up a huge range of options"
Until 1998 it was not known that embryonic stem cells are pluripotent
It was a gift from Dolors Perea and Ricard Sánchez, who gave it to her in the summer of 1984. Nine months earlier, Veiga and her colleagues at the Dexeus Institute in Barcelona had managed to fertilize one of Dolors' eggs with Ricard's sperm inside a test tube, and then transferred the embryo into Dolors' womb. Thirty-seven weeks later, following a textbook pregnancy, doctors performed a C-section on Dolors and brought out Victoria Anna Sánchez Perea, Spain's first test-tube baby. It was July 12, 1984, which Anna Veiga remembers as her own personal V-Day. It was, she says, the most exciting moment in her life, together with the birth of her only biological son, Ian, now 23.
That is how she describes it in her memoirs, El milagro de la vida (or, The miracle of life), a review of her 30-year career published just before taking over as president of the European Society of Human Reproduction and Embryology (ESHRE). This is the highest position specialists in this field can hope for, she says without any hint of false modesty. "I am filled with pride," she admits.
The position has traditionally been held by scientists from northern European countries, but Veiga prepared conscientiously and, after a strenuous series of interviews, finally prevailed over the other final contender, a Danish biologist who, she suspects, has not forgiven her yet. "He thought it was a given that he would get the job, and has yet to digest the bad news," Veiga jokes. "Seriously, I have the feeling that I am reaping the fruit of long years of labor, and that I am coming full circle." And with that, she returns the hedgehog to its rightful place on her desk on the fourth floor of the Biomedical Research Park in Barcelona, where she has been working since 2006.
Veiga has spent her entire life working to promote life. She began by "producing" embryos so that couples could become parents. Now she studies embryos in order to improve the quality of life of people in the future. Her journey from assisted reproduction to stem cell research was "a natural evolution," she says. One thing led to another and finally to the cutting edge of world biomedical research. She did not want to miss the boat. She always liked being at the forefront of things.
"The knowledge we gained through in vitro fertilization opened up an enormous range of possibilities," she explains. "Before that, nobody had been able to study or manipulate a human embryo in the early stages. We hadn't even seen one. But that know-how, and the fact of having access to 'leftover' embryos from fertilization treatments, is what now allows us to explore the possibilities of stem cells."
Here, inside this U-shaped building covered with cedar boards and facing Barceloneta beach, is where the Stem Cell Bank of Barcelona (BLCB) is maintained under Veiga's stewardship. It is one of three public centers in Spain, along with Granada and Valencia, that obtain and preserve embryonic stem cells. When couples who undergo fertility treatment in Catalonia donate the remaining embryos to science, this is where they end up.
Veiga's team obtains stem cells from these donors and offers them to researchers who request them. The Swarovski hedgehog, by the way, also played a role in the early days of this particular type of research.
"I went to the Karolinska Institute in Stockholm to learn cell line derivation techniques," she recalls. "But when I got back, we tried it and kept failing. One day, tired of seeing the stem cells grow poorly, I took the hedgehog down to the lab and there it sat until things began working better. I only believe in what I see."
Veiga knew better than anybody else, because she saw it on a daily basis, that the union of a human egg and a spermatozoid generates all the cells for all the organs in a baby. That is over 200 types of cells. But until 1998 it was not known that embryonic stem cells are pluripotent; in other words, that they have the ability to transform into any type of specialized cell. What scientists have been trying to find out since then is how they do this, in order to reproduce the process and transfer them into patients to regenerate damaged organs or tissues. Cell therapy is the name of this procedure. The field has yet to produce concrete clinical applications, but findings are constantly trickling in and the promise of a medical revolution remains a powerful incentive to keep trying. One of the most exciting discoveries, in 2006, was the possibility of creating induced pluripotent stem cells (iPS cells) in the lab using adult cells, rather than embryonic cells.
Juan Carlos Izpisúa, the star researcher at the Salk Institute in California and director of the Regenerative Medicine Center in Barcelona (CMRB), is a world authority on this matter. He is also Veiga's boss. Before that, and even before the creation of the CMRB, Veiga had traveled to California to familiarize herself with Izpisúa's work. The Spanish "mother" of assisted reproduction and the Spanish "father" of stem cell research immediately hit it off. After 25 years at the Dexeus Institute, Veiga was rethinking her professional future. Izpisúa, a leading example of Spain's brain drain, was being considered by Spain's political managers for a job back home. It is unclear who hired who.
English is the lingua franca at the Biomedical Research Park of Barcelona. The halls are filled with an international contingent of young men and women sporting piercings and tattoos under their white lab coats. Veiga admits that although she is quite the senior compared with so many juniors, when she hears a "Ma'am" behind her, she does not even turn around, thinking they must be addressing someone else. These straight-A students are here on grants to conduct state-of-the-art research, and Veiga notes that with her own college grades, she would have never made the cut herself. But "I am not easily scared," she remarks.
It was her curiosity and restless nature that led her, at age 50, to abandon a field of knowledge that she fully mastered and embark on another one where many of these youngsters - who could be her children - run rings around her.
"It wasn't easy going from being the lion's head to the mouse's tail," she admits. "I have many scientific gaps, especially in molecular biology, which did not even exist when I was in college. I have to study every day, and even then there are things I do not understand, but then I ask these kids, who were born with these tools. What I can add to the team is an overall vision and the capacity to bring together research groups and clinical groups. These are worlds that have much in common, yet can be very separated," says Veiga, looking stylish in a black knitted suit and half a dozen jiggling bracelets on her arms.
She was a 23-year-old biology graduate when she read an interview in the parenting magazine Ser Padres. In it, Pere Barri, a gynecologist at Dexeus Institute, discussed in vitro fertilization (IVF). The technique had recently been developed by the British physiologist Robert Edwards - who won the Nobel Prize in Medicine last year - and culminated in the 1978 birth of Louise Brown, trumpeted as the world's first "test-tube baby." Veiga knew what she had to do. She asked her mother, a client of Dexeus' gynecology department like herself, to use her contacts to get her an interview with Barri. The rest is history.
It was Barri, Veiga and her colleague, the biologist Gloria Calderón, who set up the assisted reproduction department at Dexeus. Veiga would get into her Seat 124 and drive 300 kilometers to the French city of Montpellier (and back again) to buy the culture tubes they needed to join eggs and sperm in the lab. Back then, this equipment could not be found in Spain. They treated 20 cases unsuccessfully until Dolors and Ricard's embryo eventually became Victoria Anna. Veiga and her colleagues followed that pregnancy "as if it was the first one in the world, and for us in a way it was."
There were many other "firsts" after that: the first baby born from a frozen embryo; the first pre-implantation diagnosis; the first embryonic sex selection to prevent the transmission of genetic disease; and the first pregnancy using donated eggs and sperm. Her team was almost always the first to achieve these milestones in Spain, usually just one small step behind international pioneers. Veiga regularly went to see these pioneers to learn, import their technique and teach it to other teams getting started elsewhere in Spain. The excitement of exploring new territory was stronger than her fears and insecurities.
"I never had the feeling of walking on the edge, in the sense that I could fall on the wrong side. But I did feel that I was walking along a road that was empty," she recalls. "It was the solitude you feel when things don't work out and you say: 'so now what do I do? Who do I ask?' These days, information is conveyed and shared instantly, which facilitates knowledge and allows for much faster progress in science. But back then we were quite alone; we didn't even own a fax machine."
What began as nearly a miracle ("it still deserves that description: even if it is not a miracle, it appears to be because of how extraordinary, marvelous and exceptional it is to help create human life") is now one more option for couples who have trouble conceiving. But it is also helpful for women who decide to become mothers beyond the optimal age for reproduction. And for same-sex couples who want to become mothers using a donor's sperm. Not to mention men and women who wish to freeze their eggs and sperm and use them to conceive a child later in life. Two percent of children born in Spain every year came to this world with help from assisted reproduction techniques at one of 150 public and private fertility clinics.
Some of the kids who were conceived in recent years at Dexeus joined Veiga for the EL PAÍS magazine photo op. It has been a long time since she last personally fertilized or implanted an embryo, at least on a daily basis, but she still gets calls from former patients. "Not a day goes by without someone locating me, and I try to help them," she says. That is how close she is to the parents of these test-tube babies. "They can't remember, but I've known them since they were very, very small."
The 10,000 or so children born at Dexeus since 1984 would not be here without assisted reproduction. Veiga, an active member of the Catalonia Bioethics Committee, still remembers "the tiny group of protesters that used to march with placards in front of the clinic in the early days, calling us abortionists." Since then, scientific progress has gone hand in hand with social change in what constitutes one of the most spectacular cases of supply-and-demand adaptation in the history of medicine.
"One thing caused the other and vice-versa," says Veiga, who is very aware that her job questions everything which, until recently, was considered 'natural.' "The limits of nature are being constantly breached, even from the moment you take an antibiotic to stop an infection that, left to its own devices, could kill you. It is equally impossible for a woman with obstructed Fallopian tubes, or a man with no sperm, or two women, or two men to conceive. Is one case worse than another? Why so? They are different types of families, and I won't be the one to decide who may or may not have children. Our way of thinking has changed very quickly, and the child's wellbeing is what needs to prevail. We need a legal framework for our work. It is up to society to decide what it does and does not want."
Yet Veiga admits that, although cases should be analyzed on an individual basis, she is not convinced by methods like surrogacy, which is allowed in the United States and India but prohibited in Spain. "I don't like it. It makes me uneasy, especially because of the element of female commercialization," she says. And that's not even mentioning the cases of Hollywood celebrities who allegedly used surrogate mothers because they did not want to 'ruin their own bodies' with a pregnancy. "That's downright idiotic," she splutters. Veiga also does not think that "freezing eggs at age 25 in order to use them at age 40, as some young women are doing in Spain, is the solution to women's difficulties balancing family and professional life. Have we gone mad?"
The 2006 Assisted Reproduction Law formally enabled scientists to conduct research on embryos donated by Veiga's former clients. She admits that it was tough changing from a line of work in which she had direct contact with patients and could see the results of her efforts just nine months later, to another one in which the time frame for curing diseases with stem cells is 10 years and beyond.
"Sometimes you ask yourself 'where is the child?' In basic research it is much harder to see the concrete results of what you are doing. But if we don't do it, and do it well, we will never see results."
Veiga seems at ease before the cameras. In fact, she is almost a national celebrity, and not just in her field. Unlike other colleagues, she never shunned the media. On the contrary, she considers outreach "an obligation and a responsibility." "To refuse to do it seems to me to be disrespectful to citizens. Many of our research programs are funded with public money, and people have a right to know what we are doing." It is very likely, then, that in her new role as president of the European medical association, Veiga will become the visible head of assisted reproduction across the continent.
She still sees her "daughter" Victoria Anna in private from time to time. Her 25th birthday was the last they celebrated together under the flash of the cameras. Vicky did not come to the photo op for this story. She will be 28 in July and she is fully independent.
"In vitro kids are absolutely normal; no developmental differences have been observed compared with in vivo conception," explains Veiga. "Just look at Louise Brown. She is already a mother. Haven't you seen the pictures? She looks enormous, poor thing, these English folk have such eating habits... She was the first, OK; ours was born six years later, all right... but our Vicky is much cuter, don't you think?"