Helping couples realize their dream of parenthood
For pregnancy to occur, conception begins when sperm and egg cells meet in an opportune time. But for some couples, it’s not as simple as that.
According to obstetrician and gynecologist Dr. Anthony Marc Ancheta, around 15 percent in the reproductive age group have difficulty in conceiving a child, usually because of infertility. Infertility, or the inability to conceive after a year of regular, unprotected intercourse, may be brought about by many factors.
In his talk on April 22 at the Marco Polo Hotel, Ortigas, Ancheta said infertility may be caused by the male parent, the female parent, combined, or an unexplained influence.
Shared responsibility
“Pregnancy is not a sole responsibility, but a shared responsibility of both husband and wife,” Ancheta said.
Ancheta also noted that there is a rise in the number of couples trying to delay marriage and child-bearing, which may also affect conception.
In this case, Ancheta said infertility doctors first suggest the least invasive and most cost-effective way of getting pregnant, like timed intercourse and artificial insemination.
Test tube baby
If it doesn’t work, in vitro fertilization (IVF), or the ‘test tube baby’ is recommended, according to him.
The IVF program, Ancheta explained, is divided into certain stages. First, the ovaries are stimulated to produce egg cells. When it’s big enough, it will be harvested and taken out—a process called oocyte retrieval stage.
“When the oocytes are harvested, we get a sample of the sperm and fertilize the eggs with it,” Ancheta said. “When the embryos are formed, we do the embryo transfer. In two weeks, we would know if the patient is pregnant or not.”
Ancheta said IVF is different from the normal pregnancy cycle because the female body only allows a production of one or two eggs in every cycle.
“With IVF, we stimulate the ovaries to produce more than two eggs,” he said.
Ancheta also said there is a technology that could store spare embryos in case the couple produced more than what is needed.
“We keep and freeze them in case they want to be pregnant in two or three years. You don’t repeat the process anymore; you just get the embryos and put them back again,” he said.
A similar technique is given to a male partner who is diagnosed with obstructive azoospermia, or blockage in sperm production. Ancheta said if the male partner cannot produce sperm in the seminal analysis, a testicular biopsy may be given for sperm cryopreservation, or preservation of the sperm samples.
Sperm cryopreservation may also be given to the male partners who will undergo chemotherapy, or are overseas Filipino workers and frequent travelers.
Oocyte cryopreservation or egg freezing, on the other hand, may be given to female partners who will also undergo chemotherapy or want to delay childbearing.
As for the selected embryo for IVF, Ancheta said it would undergo a preimplantation genetic diagnosis to identify if it is prone to genetic diseases such as chromosomal translocations, Down’s syndrome and Turner’s syndrome.
When the embryo is formed and cultured for three to five days, it is then transferred to the uterus. He said the whole IVF process will last around four weeks.
Prerequisites
However, Ancheta said that for the whole IVF process to proceed, there are prerequisites that should be considered: There should be a minimum number of developing follicles in the female patient, but fallopian tubes are not required. There should also be a minimum number of “good-looking” sperms.
“The whole procedure may be canceled when the wife is not producing too many eggs or if she is hyperstimulating or producing too much,” Ancheta added. “We try to avert this complication by giving out the proper dose of medicines and making sure that the patients are monitored.”
Ancheta said the IVF may entail complications such as ovarian hyperstimulation syndrome and multiple pregnancy. Some couples may see multiple pregnancies as a good idea, but it may carry additional risks both to the patient and the babies.
“If the mother’s tummy becomes too big, then there’s a higher risk of the patient to go into premature labor… the babies will end up at the ICU later on,” Ancheta said.
Ethical guidelines
Ancheta reminds couples that they should follow the ethical guidelines from the Philippine Society of Reproductive Endocrinology and Infertility, the governing body of all the infertility doctors.
A third party IVF, which includes using an egg or sperm from a donor, having a surrogate to carry out the pregnancy, embryo donation and same sex IVF, are not allowed in the Philippines, Ancheta said.
“Sex selection is also not allowed. Even if we can do all these, we can’t because of the ethical guidelines set,” he said.
There are four existing IVF centers in the Philippines: the Center for Reproductive Medicine in Ortigas and Makati City, Center for Advanced Reproductive Medicine and Infertility at the St. Luke’s Medical Center Global City in Taguig, and Repro Optima in Cebu City. Another center will open soon in Mindanao.
These IVF centers, Ancheta said, offers basic investigations, stimulation protocols and laboratory procedures in line with the IVF process.
According to him, couples who decide to undergo the IVF procedure should keep in mind that it would not only be a big economic investment, but also psychological and emotional.
Ancheta said: “IVF is a highly stressful and often times, the last resort. You need to discuss to the patients that it is not 100 percent successful. It entails high financial, emotional and psychological costs that you have to explain to patients undergoing IVF.”
