Dr. Esther Marbán

Since I was a little girl, it was always clear to me that I wanted to help people. Already in high school and in the year before university I knew I wanted to do something related to health sciences. I still wasn’t sure if it was going to be medicine, but I knew I was going to go for that branch. A little later I knew 100% that I would study medicine and I was lucky enough to get into medical school. When I finished my degree I liked gynaecology as a medical-surgical specialty, and I was also attracted to other more technical specialties such as oncology. I chose gynaecology because it is a very broad specialty and I always thought it could fit my character.

I was trained at the Gregorio Marañón Hospital where I did my rotation and in the last year of my residency I completed my Master’s Degree in Assisted Reproduction from the Spanish Fertility Society (SEF) and from there I got to know fertility first hand. And by a twist of fate, in 2010, and with several options on the table, I decided to dedicate myself to assisted reproduction.

Apart from objective things such as technology, staff experience and facilities, which are also important aspects, in my opinion, what stands out the most in Tambre is how involved we all are in each case. We are all dedicated to our work and we like to do it. And of course, personalisation.

We are very careful about that part and take care of our patients as much as we can. It is a centre where everything is done for them, to achieve the desired positive result.

I have very clear memories of my first patients and my first reproductive successes. And the truth is that it is a nice memory. Patients send you photos of their children, who are growing up so fast. It is emotional for me. I have accompanied many of them in their first pregnancy and then in subsequent pregnancies. I have been fortunate to keep in touch with some patients because they have come back for their gynaecological check-ups.

You don’t get used to it, because each case is different. Giving good news is always nice, but what you never get used to is negative betas, because they are very hard moments. It is very hard to have to give bad news because we have not achieved what we have longed for. I will never get used to that.

Totally. I have noticed a lot of changes in the patient profile we receive now. They are very different patients. It is true that we deal with more complex cases, we have many patients coming from all over the world. Many have already received complex treatment in their home countries.

The main challenge is that we are finding patients with multiple failures, with uterine problems, or endometrial issues. Currently, with the improvement of laboratory techniques and embryo genetic studies, we have more control over embryo studies, which gives us the best information to transfer them; but the problems we are currently dealing with are the cases of implantation failure and complications from endometrium.

We always want to get the best results in each case, but these endometrial complications are real challenges, and are hard to manage.

With the Matris clinical study we try to anticipate the prognosis of certain patients, to determine the moments of endometrial measurement. There are patients, especially many from abroad, with endometrium that is quite resistant to medication. In many cases we apply endometrial PRP. We do an endometrial study with 3D ultrasound with endometrial biopsy to learn more about your endometrium and to try to maximise the chances of pregnancy in the next attempt.

There are many who have given me a lot of joy because it has cost us a lot to achieve the goal of their pregnancy. But there is a case from a while back of a woman without a partner who started treatment with her own eggs and during the treatment we were able to diagnose her with something that had nothing to do with reproduction. She had angiodema, a rare immunological pathology, and thanks to our follow-up, we put her in contact with an expert, and she had a follow-up with the main angiodema specialist who consults at La Paz Hospital. 

An unusual thing also happened with this patient, on two occasions we transferred only one embryo and it divided. In the first treatment she unfortunately lost them both, but in the second pregnancy she had two children. The babies shared the placenta and the sac. It is one of the cases I remember most because of its complexity and the difficulty we had in reaching a positive result, and I also remember many other long term patients.

One thing that characterises us is sincerity and transparency.  There are times when you have to set limits. It has happened to me on a few occasions. Patients to whom we say that we have already done everything we could do and we have offered them everything we could offer, and they also, fortunately, when I have told them that the time has come to stop, they have understood the situation perfectly well.

These are very specific cases and are fortunately the exception, but there are times, even with long-standing patients, when we have had to say, with the utmost sincerity and affection, that it’s time to stop. And so they have. We must be aware that this is medicine. We must know how to say we have come this far and can’t go on, even if it is hard.

Apart from the experience we all have, the experience of years of treating patients. On many occasions we also need professional psychological support because these processes are very closely linked to emotions as is a reproduction process.

I love to travel, to see new places, and to spend free time with my family, with my friends, with my partner, to just spend time with them. Mostly that. And I also love the gym, I’m a real fan of keeping physically active. I try to make time, because personal well-being is important if you want to maintain your professional well-being.