MONEY AD­VICE FOR WOMEN OVER­COM­ING IN­FER­TIL­ITY KNOW YOUR OP­TIONS

Strug­gling with in­fer­til­ity? Wor­ried that time is run­ning out on your bi­o­log­i­cal clock? With modern medicine, the sit­u­a­tion is far from hope­less— and is preg­nant with pos­si­bil­i­ties for those who wish to con­ceive.

Good Housekeeping (Philippines) - - Front Page - In vitro fer­til­iza­tion (IVF)

In 2014, Vanessa Chan and her hus­band, Den­nis, de­cided to try for a sec­ond baby. At this point, the cou­ple al­ready had an eight-year-old daugh­ter, Lexi, who was con­ceived not long af­ter they got mar­ried. Vanessa’s first preg­nancy hap­pened so nat­u­rally and ef­fort­lessly that she hardly ex­pected to ex­pe­ri­ence any trou­ble the sec­ond time around. De­spite months of try­ing, how­ever, she failed to con­ceive. Af­ter a con­sul­ta­tion with her doc­tor, Vanessa found out she had en­dometrio­sis, a con­di­tion wherein the tis­sue that nor­mally lines the uterus grows out­side it, thus im­ped­ing her ovu­la­tion and mak­ing her in­fer­tile.

It was an emo­tional time, Vanessa re­calls: “You would see other women hav­ing ba­bies, parang ang dali-dali. I had my pan­ganay, bakit ang dali? Sa pan­galawa, ang hi­rap?”

Ac­cord­ing to the World Health Or­ga­ni­za­tion (WHO), there is an es­ti­mated 48.5 mil­lion cou­ples all over the world who, like Vanessa and Den­nis, strug­gle to con­ceive a child due to in­fer­til­ity. Lo­cally, a re­cent sur­vey of 100 house­holds com­mis­sioned by phar­ma­ceu­ti­cal com­pany Merck Serono found that 1 in 10 Filipino cou­ples share this prob­lem.

WHEN IN­FER­TIL­ITY STRIKES

In­fer­til­ity is de­fined by the WHO as “the in­abil­ity of a sex­u­ally ac­tive, non­con­tra­cept­ing cou­ple to achieve preg­nancy in one year” or “an in­abil­ity to be­come preg­nant with a live birth, within five years.”

The causes of this con­di­tion are var­ied and com­plex. For one, a woman’s fer­til­ity de­clines as she gets older. There­fore, women who de­cide to have chil­dren later in life nat­u­rally face lower chances of get­ting preg­nant. Many med­i­cal ex­perts say the ideal age to have a child is 35 and below.

Then there are the many health is­sues that can af­fect a per­son’s re­pro­duc­tive sys­tem. Women may de­velop hor­monal im­bal­ances and dis­or­ders such as, in Vanessa’s case, en­dometrio­sis, which dis­turbs the nor­mal process of ovu­la­tion;

any med­i­cal pro­ce­dure such as surgery in the ab­domen, or a con­di­tion like pelvic in­flam­ma­tory dis­ease, which can cause an ob­struc­tion in the fal­lop­ian tubes; and ovar­ian, cer­vi­cal, or uter­ine can­cer; among oth­ers.

Men also face in­fer­til­ity prob­lems such as poor sperm qual­ity, struc­tural ab­nor­mal­i­ties that can block the flow of se­men, and in­fec­tions or dis­eases like can­cer, which can se­verely af­fect sperm pro­duc­tion. Stud­ies show that male fer­til­ity prob­lems con­trib­ute to 30 per­cent of all in­fer­til­ity cases world­wide.

And still, in­fer­til­ity can some­times be un­ex­plained. In such cases, doc­tors are not able to de­tect any­thing wrong with ei­ther mem­ber of the cou­ple af­ter stan­dard assess­ment.

The trou­ble with in­fer­til­ity is that it catches you off guard, and it can hit any­one. “There is no sure­fire way to prove you are fer­tile in ad­vance, no blood test to screen new­borns or teenagers for the in­abil­ity to have chil­dren as one might for he­mo­philia or celiac dis­ease,” writes au­thor and women’s rights ad­vo­cate Les­lie Mor­gan Steiner in the book The Baby Chase: How Sur­ro­gacy Is Trans­form­ing the Amer­i­can Fam­ily. “Part of in­fer­til­ity’s cru­elty is the sur­prise of its as­sault. You rarely learn you are in­fer­tile un­til you try, and fail, to have a baby.”

The heart­break a cou­ple feels when they un­ex­pect­edly dis­cover that their bod­ies have de­nied them the abil­ity to re­pro­duce is in­com­pa­ra­ble. “Yung emo­tional roller coaster ang mahi­rap, I think, for any cou­ple try­ing to con­ceive,” says Vanessa. “I mean, ako meron na akong isa; what more yung mga cou­ples na wala? What more them, who are try­ing to con­ceive for the very first time?”

What is a cou­ple sup­posed to do? What hap­pens af­ter you find out you are in­ca­pable of hav­ing chil­dren? The good news: In­fer­til­ity isn’t al­ways a dead end. While many of its causes are be­yond hu­man con­trol, modern medicine has found ways to work around this road­block and give cou­ples a shot at par­ent­hood.

TO­DAY’S TREAT­MENTS

These days, many would-be par­ents who ex­pe­ri­ence dif­fi­cul­ties con­ceiv­ing turn to fer­til­ity spe­cial­ists—that is, doc­tors with a back­ground in ob­stet­rics and gy­ne­col­ogy (OB-GYN), specif­i­cally trained to ad­min­is­ter as­sisted re­pro­duc­tive tech­nol­ogy (ART).

ART com­prises med­i­cal tech­niques—like hor­monal med­i­ca­tion, and egg and sperm cell col­lec­tion—that aim to by­pass the fac­tors that hin­der con­cep­tion.

Rudie Fred­er­ick B. Men­di­ola M.D., an OB-GYN with sub-spe­cial­iza­tion in in­fer­til­ity treat­ment and med­i­cal direc­tor of the Kato Re­pro Biotech Cen­ter (KRBC) in Makati, which ad­min­is­ters ART, ex­plains that pa­tients who sus­pect they are in­fer­tile can still opt to get checked by their gen­eral ob­ste­tri­cians first. “But in cer­tain con­di­tions,” he says, “OB-GYNS may have to re­fer these pa­tients to spe­cial­ists.”

An OB-GYN can pre­scribe med­i­ca­tion or cer­tain sur­gi­cal pro­ce­dures to try to re­verse in­fer­til­ity at its on­set. But when those don’t work, ART can help.

Vanessa, for in­stance, upon con­sul­ta­tion with her OB-GYN, un­der­went two rounds of oral med­i­ca­tion, plus surgery to ad­dress her en­dometrio­sis. “I de­cided to have the surgery right away kasi nga gusto na namin magka-anak,” she says. But when three months had passed af­ter her last round of med­i­ca­tion and she still wasn’t get­ting preg­nant, she de­cided to seek other opin­ions.

“I went to an­other doc­tor, had an­other ul­tra­sound, and it turned out that my en­dometrio­sis was back. And my tubes were al­ready blocked with scars, prob­a­bly due to the op­er­a­tion,” she shares. “I went to sev­eral doc­tors, and one said, ‘You can’t have kids any­more.’ The other one said, ‘Let’s do adop­tion.’ Sabi namin ng hus­band ko, hindi ta­laga siya op­tion.” It was then that she and her hus­band de­cided to try ART, specif­i­cally, in vitro fer­til­iza­tion (IVF).

What it is: One of the most com­mon forms of ART to­day, IVF is a multi-step pro­ce­dure that gen­er­ally en­tails the col­lec­tion of a woman’s egg cells and a man’s sperm cells, and the act of fer­til­iz­ing them to form em­bryos in vitro (Latin for “in glass”). This means that fer­til­iza­tion takes place in a test tube or a petri dish be­fore the fer­til­ized egg is trans­ferred to the woman’s uterus. (See “IVF, Step by Step,” page 29.)

Most of the steps of the IVF pro­ce­dure, from the blood tests and base­line ul­tra­sound to fer­til­iza­tion, are com­pleted within the pa­tient’s men­strual cy­cle. Many IVF cen­ters also do the em­bryo trans­fer within the same time. This is called a “fresh trans­fer.” How­ever, some rec­om­mend an­other way: In a “frozen em­bryo trans­fer,” the em­bryos are im­planted dur­ing the woman’s next cy­cle—or even sev­eral months or years later, if the par­ents pre­fer. And un­til this hap­pens, the em­bryos are frozen and kept in a lab.

This method in­creases the chances for a suc­cess­ful preg­nancy. Dr. Men­di­ola ex­plains, “We do that be­cause the medicines we give to make the fol­li­cles grow can have a bad ef­fect on the lin­ing of the uterus. That’s one the­ory. Also, clin­i­cally, based on our data—we did a lot of fresh trans­fers and then we com­pared them to those who did frozen trans­fers—we saw higher preg­nancy rates when we did the lat­ter.”

Asked if she ex­pe­ri­enced any pain or dis­com­fort dur­ing her pro­ce­dure, Vanessa says she didn’t feel any­thing. But as med­i­cal pro­ce­dures go, re­ac­tions tend to vary per pa­tient.

Forty-seven-year-old Rachele Bonus-pes­tano, who un­der­went IVF in Toronto in 2003, de­vel­oped bruis­ing on the site of her in­jec­tions. “Kasi it’s a very thick for­mula, and then masakit siya ’pag ni­lala­gay. Parang you feel it’s in­side you. Eh my thresh­old for pain na­man is pretty okay. And hindi na­man ako maarte sa ganu’n.”

De­spite her high tol­er­ance for pain, Rachele says she also felt some dis­com­fort dur­ing the other parts of the pro­ce­dure. “Nu’ng in­im­plant, ang sakit-sakit. Parang la­bor,” she shares. “Kasi dur­ing the har­vest, the nurse was ask­ing me, ‘Is it painful?’ Sabi ko, ‘Yes, it’s so painful!’ There’s cramp­ing. And then the nurse goes, ‘Well, those are la­bor pains.’ It’s com­pa­ra­ble daw to la­bor pains, but it’s not the same in­ten­sity. Pero yung ta­la­gang it’ll make you cry, and you won’t be pro­duc­tive. It’s not some­thing you can en­joy.”

Rachele adds that the pro­ce­dure “zapped the en­ergy” out of her ev­ery time. Suc­cess sto­ries: In spite of the phys­i­cal chal­lenges, Rachele is glad she un­der­went IVF, es­pe­cially since it gave her a daugh­ter, Bea, now 12.

The suc­cess of Rachele’s IVF pro­ce­dure—on her first try, no less—was a wel­come re­sult af­ter she and her hus­band, Tom, tried, and failed to con­ceive, twice through in­trauter­ine in­sem­i­na­tion (IUI). In this pro­ce­dure, the sperm is placed di­rectly in­side a woman’s uterus where they are left to fer­til­ize. (While most fer­til­ity spe­cial­ists also ad­min­is­ter IUI, some would ar­gue that it is not a form of ART since it does not as­sist the ac­tual fer­til­iza­tion and im­plan­ta­tion process.)

Oth­ers, like Dada Ma­banag-bautista and her hus­band, Jay, had to un­dergo nu­mer­ous cy­cles of IVF. The cou­ple, who wed in 2004, did their first round in Sin­ga­pore af­ter four years of try­ing un­suc­cess­fully. Dada got preg­nant through the pro­ce­dure, but even­tu­ally mis­car­ried. By a happy turn of events, how­ever, she con­ceived her first child, a son, nat­u­rally the fol­low­ing year. When they de­cided to try for an­other baby a few years later, and it didn’t hap­pen the nat­u­ral way, they re­turned to IVF, this time at KRBC.

Their first round at KRBC was un­suc­cess­ful. “The test didn’t come out pos­i­tive, so we went for a sec­ond round,” re­calls Dada, who even­tu­ally learned that the rea­son for her strug­gle to con­ceive was a con­di­tion called an­tiphos­pho­lipid an­ti­body syn­drome (APAS), mean­ing her sys­tem was “re­ject­ing or at­tack­ing any­thing com­ing from my hus­band, hence the mis­car­riages.” She sought the help of an im­mu­nol­o­gist to ad­dress the APAS, and suc­cess­fully con­ceived her sec­ond child, a daugh­ter, on her sec­ond round of IVF at KRBC in 2015. By this time, Dada was 42.

Even Vanessa un­der­went sev­eral rounds of IVF. It was on her sec­ond try (and first at KRBC) in mid-2014 that she con­ceived her twin boys, Brady and Ri­ley. “To be given one was al­ready a bless­ing. But to have two? Sabi ko, God re­ally has a sense of hu­mor. He makes you wait and then he gives you two.”

Mul­ti­ple preg­nan­cies are not un­com­mon among IVF moth­ers. In the past, fer­til­ity ex­perts would rec­om­mend trans­fer­ring more than one em­bryo to in­crease the chances of a suc­cess­ful im­plan­ta­tion. These days, how­ever, some clin­ics have low­ered the max­i­mum num­ber of al­lowed em­bryos for trans­fer since mul­ti­ple preg­nan­cies are also viewed as a com­pli­ca­tion.

“In the past, know­ing that IVF is ex­pen­sive, and since you’re not sure if the em­bryo will im­plant, they would trans­fer about three to four em­bryos,” ex­plains Dr. Men­di­ola. “But when two of those im­plant and you have more than one baby, you in­crease the chance of a pre-term birth and other com­pli­ca­tions. So to avoid that, our cen­ter rec­om­mends a sin­gle em­bryo trans­fer. This is the safest for the mother and the baby.”

If par­ents wish to have twins, though, the clinic can re­con­sider. “When we started, we were very strict and said only one em­bryo will be trans­ferred. Then we had a lot of pa­tients who said, ‘Doc, we want twins.’ So we agreed we could trans­fer two at the most if the rea­son is you want to in­crease the chance of twins.”

For Vanessa, the de­ci­sion to trans­fer two em­bryos was not so much based on a de­sire to have twins but the fact that other fac­tors were not in her fa­vor. “Be­cause of my his­tory of a failed IVF, and then my age [37 at the time], nagha­habol na ako. That’s why they trans­ferred two.”

Ex­cess em­bryos that are not trans­ferred are frozen and kept in the clinic’s lab un­til the par­ents come back for them.

Ac­cord­ing to Dr. Men­di­ola, the suc­cess rate of IVF pro­ce­dures is now be­tween 40 to 45 per­cent. Among the 818 pa­tients who un­der­went the pro­ce­dure in KRBC in 2015, 371 (45 per­cent) suc­cess­fully con­ceived and 331 (40 per­cent) had live births.

How much it costs: Not so long ago, IVF would com­mand a whop­ping P500,000 to as much as a mil­lion pe­sos. Now, you can avail of a full IVF pack­age for about P280,000 to P300,000 for one cy­cle. KRBC, in par­tic­u­lar, al­lows stag­gered pay­ments—mean­ing you only pay for the pro­ce­dure that is done on the day you come in.

Oo­cyte cry­op­reser­va­tion (egg freez­ing)

What it is: Some­times, the prob­lem isn’t that a woman can’t con­ceive but that she wants to have chil­dren, but can’t see her­self hav­ing them soon—ei­ther be­cause of other pri­or­i­ties or not hav­ing found the right part­ner yet. When this is the case, she may con­sider get­ting her eggs frozen.

This pro­ce­dure is sim­i­lar to IVF: Fol­li­cles are stim­u­lated through hor­mone med­i­ca­tion and the egg cells are har­vested. But rather than fer­til­iz­ing the eggs, un­fer­til­ized eggs are frozen and kept in the lab un­til they are needed.

The num­ber of eggs har­vested de­pends on the pa­tient’s age, though spe­cial­ists of­ten rec­om­mend har­vest­ing as many as 20 to up the chances of preg­nancy. But be­cause the num­ber of fol­li­cles varies per woman, and Dr. Men­di­ola says the av­er­age num­ber of eggs they can har­vest is 10, women who un­dergo this pro­ce­dure are given the free­dom to de­cide if they want to do a sec­ond round so they can meet the rec­om­mended num­ber.

The best time to get this done, says Dr. Men­di­ola, is at age 36 or below.

Ra­dio DJ and host Sam Oh, who turned 36 in Jan­uary 2016, de­cided to get her eggs frozen that same year. “I’m sin­gle, which isn’t a bad place to be, but I’m aware of the very real bi­o­log­i­cal chal­lenges I could be fac­ing with re­pro­duc­tion,” she says. “I was pretty ter­ri­fied of the pro­ce­dure be­cause I had never had any kind of surgery prior to this one.”

Sam shares that she ex­pe­ri­enced some dis­com­fort dur­ing the pro­ce­dure, though it was tol­er­a­ble. “The pro­ce­dure was fairly quick but quite un­com­fort­able (some women of­ten re­port that it is down­right painful). I felt some­thing like acute dys­men­or­rhea af­ter the pro­ce­dure. The surgery site felt kind of raw in the next few days but that was the ex­tent of my dis­com­fort.”

At her age, she says, she was as­sured by her doc­tor that nine eggs would be enough to pro­duce three to four chil­dren in the fu­ture. “But I do won­der about the sce­nario where my eggs don’t make it through the thaw­ing process, or fer­til­iza­tion, or im­plan­ta­tion. I’m ac­tu­ally con­sid­er­ing a sec­ond round be­cause if the time comes that I would have to tap into my frozen eggs, I would feel so much bet­ter about get­ting eigh­teen tries than nine. I’m still think­ing about it,” she shares.

But over­all, Sam says the de­ci­sion to un­dergo the pro­ce­dure has given her a new

sense of se­cu­rity. “I can’t pos­si­bly put a price on hav­ing chil­dren and the peace of mind this pro­ce­dure has brought me. And frankly, I don’t feel it was phys­i­cally all that chal­leng­ing.”

Egg freez­ing is also a vi­able op­tion for can­cer pa­tients who may be re­quired to un­dergo cer­tain op­er­a­tions that could af­fect the re­pro­duc­tive sys­tem. If they wish to have chil­dren later on, they can tap into their egg cell re­serves.

Suc­cess rate: Most clin­ics now use a fast freez­ing process known as vit­ri­fi­ca­tion to keep the eggs in good con­di­tion.

Vit­ri­fi­ca­tion uses liq­uid ni­tro­gen to avoid dam­ag­ing the cells. “Be­fore, they did slow freez­ing, which is like plac­ing it in the re­frig­er­a­tor,” Dr. Men­di­ola of KRBC ex­plains. “If you have a soda bot­tle in the freezer, it can ex­plode, be­cause ice has a big­ger mass. The same thing can hap­pen to cells. Vit­ri­fi­ca­tion is an im­prove­ment be­cause the su­per fast freez­ing does not form ice crys­tals. So when you thaw the egg, you have a higher sur­vival rate.”

Ac­cord­ing to a 2013 study by the So­ci­ety for Re­pro­duc­tive Medicine and the So­ci­ety for As­sisted Re­pro­duc­tive Tech­nol­ogy in the U.S., “There is good ev­i­dence that fer­til­iza­tion and preg­nancy rates are sim­i­lar to IVF/ICSI [in­tra­cy­to­plas­mic sperm in­jec­tion] with fresh oocytes when vit­ri­fied/ warmed oocytes are used as part of IVF/ ICSI in young pa­tients,” though some data shows de­creased suc­cess in women of ad­vanced age, pos­si­bly due to the nat­u­ral de­cline of a woman’s fer­til­ity.

“Of course, when you’re in your for­ties and above, it will get harder to get preg­nant, be­cause like I said, egg qual­ity de­te­ri­o­rates. So bet­ter if you’re younger; do it sooner,” notes Dr. Men­di­ola.

How much it costs: The cost of egg freez­ing ser­vices to­day ranges be­tween P130,000 to P150,000. The to­tal price largely de­pends on the amount of med­i­ca­tion you’ll need to take, but al­ready in­cludes a one-year stor­age fee (P20,000). The an­nual stor­age fee for suc­ceed­ing years is P11,200.

Sur­ro­gacy

What it is: There are some in­stances when a woman does not have the phys­i­cal ca­pac­ity to bear chil­dren. Dis­eases such as can­cer may re­quire surgery that se­verely af­fects, or to­tally re­moves, a woman’s re­pro­duc­tive sys­tem. Other women may have a his­tory of re­cur­rent mis­car­riages due to uter­ine or ovar­ian ab­nor­mal­i­ties. For such pa­tients, sur­ro­gacy may be their best bet.

Gen­er­ally speak­ing, sur­ro­gacy is the prac­tice of tap­ping a third party to carry a cou­ple’s child. How­ever, this is still not prac­ticed nor of­fered by doc­tors in the Philip­pines. “We don’t have any laws per­tain­ing to that process. So you may do it, it’s not il­le­gal, but there are no laws that can pro­tect sur­ro­gates or cou­ples,” ex­plains Dr. Men­di­ola. He goes on to say that the Philip­pine So­ci­ety for Re­pro­duc­tive Medicine, of which he was Pres­i­dent, “came up with guide­lines, and it’s stip­u­lated there

that we do not per­form donor IVF, whether sperm or egg. Nor do we do sur­ro­gacy.”

He notes, how­ever, that there are on­go­ing dis­cus­sions among stake­hold­ers about the pos­si­bil­ity of al­low­ing sur­ro­gacy to be prac­ticed lo­cally. “I think that’s a good start be­cause there are re­ally med­i­cal in­di­ca­tions for sur­ro­gacy.”

What course of ac­tion, then, do fer­til­ity spe­cial­ists take when they meet pa­tients who are qual­i­fied for sur­ro­gacy? “What we can do is re­fer you abroad, to cen­ters that do that,” says Dr. Men­di­ola. Lo­cal fer­til­ity clin­ics usu­ally have part­ner clin­ics abroad for these cases.

There are two forms of sur­ro­gate con­cep­tion. 1 Tra­di­tional sur­ro­gacy. This is when the sperm taken from the in­tended fa­ther fer­til­izes the sur­ro­gate mother’s egg, usu­ally through IUI. As a re­sult, “The woman car­ry­ing the baby is the ge­netic and bi­o­log­i­cal mother, also known as the ‘bio mom,’” writes Steiner in The Baby Chase.

The po­ten­tial trou­ble with this setup is that some sur­ro­gates, who, in these cases, are the bi­o­log­i­cal moth­ers, can “suf­fer grief and doubt dur­ing the preg­nancy, and long af­ter re­lin­quish­ing the child—a deep re­gret and guilt akin to the sor­row felt by moth­ers who give up ba­bies for adop­tion.” Incited by such feel­ings, sur­ro­gates can run af­ter in­tended par­ents in an at­tempt to re­gain rights over their chil­dren. And if it turns into a le­gal case, the court will rule in fa­vor of the sur­ro­gate.

“Un­der the cur­rent law, the one who gives birth is the mother,” says Dr. Men­di­ola. “So even if you have a con­tract, if you go to court, the court will rec­og­nize the woman who bore the child as the mother.”

2 Ges­ta­tional sur­ro­gacy. This form of sur­ro­gacy works like Ivf—mean­ing the em­bryo is 100 per­cent ge­net­i­cally re­lated to both in­tended par­ents, but is im­planted in an­other woman’s uterus. A po­ten­tial down­side, notes Steiner, is the ad­di­tional cost of the IVF pro­ce­dure.

In some cases, cou­ples can opt to tap an egg donor sep­a­rately from the sur­ro­gate. This means the re­sult­ing em­bryo will not be bi­o­log­i­cally re­lated to ei­ther the in­tended mother or the sur­ro­gate.

Suc­cess rate: Ac­cord­ing to Sen­si­ble Sur­ro­gacy, an in­ter­na­tional sur­ro­gacy con­sul­tancy firm based in Ne­vada in the U.S., suc­cess rates vary de­pend­ing on sur­ro­gacy type.

When the sperm donor has been thor­oughly eval­u­ated med­i­cally, and both the egg donor and sur­ro­gate are young and have pos­i­tive fer­til­ity his­to­ries, there will be a 55 to 65 per­cent chance for preg­nancy.

On the other hand, in cases where the in­tended mother do­nates her own eggs for the pro­ce­dure, chances for a suc­cess­ful preg­nancy go down to around 15 to 20 per­cent. “These cases are typ­i­cally very high risk, since the cou­ple of­ten has a long his­tory of failed preg­nan­cies, and the egg donor is typ­i­cally much older than what is rec­om­mended,” notes the con­sul­tancy firm on its web­site.

How much it costs: Be­cause sur­ro­gacy in­volves a third party, in­tended par­ents have to pay more.

To give you an idea about the amount of money de­manded by sur­ro­gacy, here’s a break­down based on Steiner’s re­search: agency fee ($15,000; $2,000 ad­di­tional for in­ter­na­tional clients); sur­ro­gate fee ($20,000 to $30,000 de­pend­ing on the state she lives in, and how many times she has been a sur­ro­gate); sur­ro­gate ex­penses ($45,000 to $65,000), which in­cludes at­tor­ney’s fees, al­lowance for psy­cho­log­i­cal coun­sel­ing and sup­port groups, ma­ter­nity clothes, travel ex­penses to meet with the in­tended par­ents and for doc­tors’ vis­its, plus mis­cel­la­neous costs; among oth­ers.

Fac­tor­ing in ad­di­tional ex­penses, the to­tal cost of sur­ro­gacy (at least in the U.S.) can reach as much as $100,000 to $200,000 (P5 to P10 mil­lion). This amount can still go higher. Ac­cord­ing to Steiner, “There are cases where the to­tal ex­penses for a sur­ro­gate preg­nancy and neona­tal care have run north of $500,000.” That’s a whop­ping P25 mil­lion. And in­sur­ance does not cover these ser­vices yet.

SENSE OF HOPE

As­sisted re­pro­duc­tive tech­nol­ogy, in gen­eral, has been prac­ticed in the West since the 1970s. It was es­tab­lished in the Philip­pines in the early ’90s by the pi­o­neers of re­pro­duc­tive medicine in the coun­try, though it was only in re­cent years that it started gain­ing con­sid­er­able at­ten­tion lo­cally.

Dr. Men­di­ola es­ti­mates that the rise in the num­ber of pa­tients was most no­tice­able be­gin­ning 2013. He and his team at KRBC con­duct an av­er­age of 50 con­sul­ta­tions per day. “We usu­ally start at 8:30 a.m. and we end at around 3:00 to 3:30 p.m. Some­times we go be­yond that,” he says. “So I would say that’s a lot be­cause, be­fore KRBC, I did in­fer­til­ity con­sul­ta­tions in other med­i­cal fa­cil­i­ties as well, but I wouldn’t get the same num­ber.”

Why are more peo­ple drawn to ART? Dr. Men­di­ola posits that it is the sense of hope that these pro­ce­dures bring, re­al­ized through gen­er­ally pos­i­tive out­comes. “I guess be­cause of the num­ber of pa­tients who had good re­sults—they pass it on; they spread the word,” he says.

Many cou­ples dream of hav­ing chil­dren of their own, so it can be dif­fi­cult to deal with a con­cern as per­sonal and com­plex as in­fer­til­ity. But know­ing that these op­tions ex­ist can some­how ease any hope­ful par­ent’s anx­i­eties.

Many cou­ples are able to have chil­dren soon af­ter mar­riage. For some, though, in­fer­til­ity gets in the way. Thank­fully, modern medicine has found ways to over­come this road­block to par­ent­hood.

If your OB-GYN isn’t able to help, it might be time to con­sult a spe­cial­ist.

In­fer­til­ity can hit any­one, even women who have al­ready con­ceived and given birth nat­u­rally.

As­sisted re­pro­duc­tive tech­nol­ogy (ART) has given women the pos­si­bil­ity of hav­ing chil­dren later in life.

In vit­ri­fi­ca­tion, egg cells are frozen us­ing liq­uid ni­tro­gen to keep them in good con­di­tion.

“If you feel you need med­i­cal in­ter­ven­tion to help you have chil­dren, go for it,” says IVF mom Dada Ma­banag-bautista. “Do not de­lay be­cause our body clock also has a lot to do with the suc­cess of the pro­ce­dure.”

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