Sometimes making babies is not as easy as it seems

WHILE many people consider it a choice whether to have children or not, there are those who really want children but find it hard to conceive.

Infertility is more common than most people would think: according to a 2012 World Health Organization study, “one in every four couples in developing countries had been found to be affected by infertility.”

These couples today have the choice to conceive via treatments such as in-vitro fertilization (IVF), a process an egg and sperm meet in a lab’s petri dish before the resulting zygote is implanted in the prospective mother’s uterus.

IVF and other fertility treatments are available in the Philippines, although this is not generally known or discussed - mostly because of the perceived social stigma connected to admitting to being infertile, said a fertility doctor.

“It’s taboo to discuss infertility because it puts you in a class or a special category which is less than what is normal,” Dr. Anthony Marc B. Ancheta, section chief of reproductive medicine, infertility and gynecologic endoscopy at The Medical City, told BusinessWorld at the sidelines of a forum on assisted reproductive technology (ART) on April 22.

“The good thing now is people are becoming more open to at least getting the basic investigations done [on what’s causing the difficulty to conceive],” he said.

He noted that five to 10 years ago, most people who would come in to get themselves tested for infertility were women because they thought their difficulty in conceiving was their fault. Now, both parties are coming in for testing.

When you look at it, it’s easy to get pregnant, you just need an egg and a sperm -- which means that a pregnancy is not just the sole responsibility of the wife but is a 50%-50% thing,” Dr. Ancheta said.

He attributed the new-found openness to the entertainment industry.

“They see it on TV. People in the entertainment industry are talking about it,” he said.

He used the example of Bill Rancic (the winner of the first season of The Apprentice) and his wife, Guiliana, who talked about infertility (they tried for four years to have a baby) and had their first child in 2012 via gestational carrier (a surrogate) after undergoing three courses of IVF.

There are two kinds of infertility: primary, which is when a couple is having trouble conceiving on the outset and haven’t had children yet; and, secondary, which is when a woman has been pregnant before and now has difficulties conceiving.

TREATMENTS 
After the root cause of infertility is found -- some of the common causes for women are ovulation problems, tubal blockage and uterine blockage, while males commonly have problems with low semen quality -- fertility doctors will then present the available treatments.

“As fertility doctors, we try to provide the least invasive and the most cost-effective option which is timed intercourse,” Dr. Ancheta said.

Timed intercourse involves the doctors and patients taking note of the woman’s ovulation cycles to know the optimal time to have intercourse. If that fails (after a few ovulation cycles), it is time to move on to intrauterine insemination or artificial insemination, and if that also fails (again, after a few ovulation cycles), they proceed to IVF which Dr. Ancheta calls the “last, best option after repeated failures.

” There are some cases where a couple immediately qualifies for IVF such as when the woman has problems with her fallopian tubes or when there is a defect in the man’s sperm quality.

For IVF, mandatory screening is done for both parties including ovarian reserve testing (the capacity of the ovary to provide eggs for fertilization), semenalysis (testing sperm quality), testing for hepatitis B antigen and hepatatis C antibody, HIV, blood group, and RH antibody among others.

Once that’s done, it is a matter of taking enough healthy sperm and eggs to fertilize and then culturing the resulting zygote for two to six days before insertion in the uterus.

After two weeks (the women are advised to avoid strenuous activities during this time), it is time for a pregnancy test -- IVF is not a fool-proof method of getting pregnant. Dr. Ancheta said that at best, the chance of IVF leading to pregnancy is around 40%-45% as there are a number of factors -- notably age -- that affect the success rate.

“You don’t know what will make them stick (the embryo to the uterus),” he said though medicines and hormones like progesterone are used to help nature take its course.

Dr. Ancheta said that a woman’s peak of fertility potential is at the age of 35 and after that, her chances of getting pregnant “dives down.

” IVF success among women below the age of 35 is 46%, but for those over at 42, the chance of success drops to 8.9%. Older women are also at higher risk of having a miscarriage.

He has seen couples who got married at a later age (around 37-40) who come in and ask to make clear their chances of conceiving naturally or if they need help at once.

“They know they shouldn’t be wasting their time,” he said.

There are also patients who decide to store their sperm or egg for future use, he said. These include overseas workers, frequent travelers, and those who are planning for the long term such as patients who are about to undergo chemotherapy as the treatment can render them sterile.

While the preserved sperm and egg do not have expiration dates, doctors suggest that they be used within five years to ensure that the parents are still capable of rearing a child.

“It’s not just about getting pregnant but also the social responsibility of bringing another life into this world,” said Dr. Ancheta.

It is also important to keep in mind that IVF is a highly stressful treatment option and entails high emotional, physical and financial costs -- Dr. Ancheta said the treatment can cost around P300,000. IVF can also have complications like ovarian hyperstimulation which results in the production of too many eggs, and multiple pregnancy (twins, triplets, etc.) which can be seen either as a blessing or a burden.

THE PHILIPPINES AND IVF 

Dr. Ancheta said that currently, only five center are capable of doing IVF in the Philippines: Victory ART Lab Philippines in Makati City; the Center for Reproductive Medicine in Ortigas; the Center for Advanced Reproductive Medicine and Infertility in St. Luke’s Medical Center, Bonifacio Global City; Repro Optima in Cebu; and IVF-Davao.

He also said that while surrogacy -- in which a woman other than the egg donor carries the baby to term -- can be considered an option and is actually possible to do, it is not allowed in the Philippines.

“We’re bound by ethical rules where they (the Philippine Society of Reproductive Endocrinology and Infertility) don’t allow us to do third-party IVF (sperm donor, egg donor or pregnancy via surrogacy). Not yet at least, here in the Philippines. But we can do it, it’s just that we’re not allowed to,” he explained. This is also why the country doesn’t have a commercial sperm bank.

“We can bank sperm here, though. For example, your husband is a seafarer and he’s only in the Philippines four weeks in a year -- those people can bank sperm so even if they’re not around, a procedure can be done. But it’s not allowed to sell [sperm],” he said. Other things they can do but are not allowed to do is third-party IVF (sperm donation, egg donation, surrogacy, embryo donation and same-sex IVF) and sex selection. “It’s a big headache to have [a sperm bank right now]. It’s what telenovelas are made of. Until we can have a way to legally regulate things, then that’s the only we’ll be ready,” Dr. Ancheta said. -- Zsarlene B. Chua
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