Helping women get pregnant
Pinoy couples now more open to assisted reproduction
By Grace Roxas, Contributing Writer
With the birth of the first Pinoy test-tube baby in 1996, local clinics for assisted reproductive treatment (ART) have been operating quite successfully, albeit with deliberate lack of fanfare.
Obstetrician-gynecologist and local ART pioneer Leonardo Almeda of the Cardinal Santos Medical Center says that more than a decade since Jaime Cardinal Sin articulated the Catholic Church's position about ART in the country ("Your clinic is tolerated, but not encouraged") they have been careful not to cross the line by sticking to guidelines mutually agreed with the Church.
These guidelines include offering the ART option only within the natural context of marriage-no sperm or egg donation, surrogate parenting, or embryo donation-and making it the last resort when more conventional methods have failed. Other restrictions are on more upstream procedures such as implantation, genetic diagnosis, and prenatal gender selection.
Addressing infertility
Nevertheless, ART practices such as IVF or in vitro fertilization (the original "test-tube baby method") are here to stay, with a batting average of 30 percent live births per 100 cycles or periods of conception over the last few years. This percentage is even higher than the 25-percent chance a normal, fertile couple has to conceive within a given cycle.
In IVF, eggs retrieved from a woman's ovaries are fertilized in the laboratory by mixing them with a sample of a man's sperm. This is usually reserved for women with damaged tubes and some hormonal problems.
That younger Filipino couples are resorting to ART is a gauge of its growing palatability. "In the initial years when we did IVF, we were getting the older patients. We are now getting younger patients and maybe this is the real reason our success rates in the last few quarters have been better than in the last few years," said Almeda, speaking during the observance of World Infertility Awareness Month, organized in cooperation with Organon Phils.
In the first few months of 2007, he disclosed that if female women patients above 40 were not counted, local ART success rate hovers between 35 and 47 percent. It is said that the older a woman, the lower the chance of success with IVF, both in pregnancy rate and live birth, and the procedure can become more expensive as more drugs are needed.
The younger patient profile and growing popularity may also have something to do with more affordable local costs for IVF. The Philippines offers one of the lowest IVF costs in Southeast Asia, as much as half the US$12,000 to US$15,000 range for similar services offered in countries like the United States and Singapore.
"We are at par with the rest of the world as far as managing infertile couples are concerned," said Dr. Delfin Tan, obstetrician-gynecologist from the United Doctors' Medical Center and St. Luke's Medical Center.
Even patients from abroad come here to have the procedure, thus making IVF a possible draw for medical tourism. Some hospitals are already considering this, with accommodation and transportation arrangements to be included in the package.
"We try to make the cost of IVF as low as we can with the help of some pharmaceutical partners, since one of the major costs relate to the price of medication," Almeda said. "The other advance is in relation to making the administration more patient-friendly, making IVF simpler for both the doctor and patients."
The practice evolves
Aside from IVF, there are other ART techniques available locally. 1997 marked the birth of the first Filipino baby with the help of intracytoplasmic sperm injection (ICSI), a procedure that involves the injection of a single sperm cell directly into the oocyte. It is an option for men with extremely poor sperm quality, a second-line option to IVF, and a treatment of choice for unknown causes of infertility.
Another locally available technology is cryopreservation of the embryo. In 1998, the first frozen-embryo baby was born in the Philippines. Delfin said: "There is no known limit for the duration of storage for cryopreserved embryos. Patients often view their cryopre-served embryos as an assurance against maladies that may occur in the lives of their children."
Other ART techniques are intrauterine insemination and ovulation induction, which are both aided by fertility drugs. Intrauterine insemination, useful for women with a normal reproductive system and men with near-normal sperm counts, involves introducing a quantity of semen high into the female uterus and thereby encouraging natural fertilization once ovulation has occurred.
Ovulation induction is for treating women whose hormonal disorders are preventing conception. Conception occurs naturally once fertility hormones are given to stimulate the ovaries to do their job.
ART practices here are evolving in a context of an apparent higher incidence of infertility-defined as the inability to conceive after a year of unprotected and unrestricted intercourse-even in the Philippines' "population explosion" scenario. Delfin noted that among the causes of inability to conceive, male infertility is the most common in the Philippines.
He said: "Infertility in males accounts for about 45 to 50 percent of problems among infertile couples, while ovulatory disorders and tubal infertility account for 25 to 50 percent and 15 to 20 percent respectively."
Almeda cited the statement of the European Society of Human Reproduction on why ART might become even more useful in the future, in the Philippines and elsewhere. The confluence of older mothers and poorer sperm spells more trouble for human fertility.
"Women nowadays are delaying child bearing to prioritize their careers," went the statement. "The increasing number of pollutants in the environment may also be affecting male fertility. Male infertility is definitely increasing. If you do sperm analysis every 10 years, it's apparent that sperm quality is getting poorer."
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