By Henrylito D. Tacio
“The best age for women to get pregnant is between 20-29 years old, during which age, there is a highest chance of fertility. After 30, it may be harder for females to conceive; or if they do, the miscarriage rate increases.” — Dr. Rafael R. Castillo, quoting Dr. Rudie Frederick B. Mendiola, president of the Philippine Society of Reproductive Endocrinology and Infertility
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Robert and Chanda had been married for five years already. Both are successful in their chosen careers: Robert as bank manager and Chanda as business entrepreneur consultant. But there’s one thing lacking: a child of their own.
Hearing stories about how some couples were blessed with a child when they did the annual dance ritual in Obando, Bulacan, the couple wanted to try their luck there. “We had been trying to have a baby through these years,” Robert said.
Robert, 32, has a low sperm count while Chanda, 29, has polycystic ovary syndrome. “By asking help from Saint Pasqual,” Chanda said, “a baby – whether a boy or a girl — will be granted to us.”
In an interview with Health and Lifestyle, a monthly publication for health professionals, Dr. Anthony Marc B. Ancheta, a respected obstetrician and gynecologist and fertility expert in the country, thinks everything happens at the most unexpected time, especially for couples who are trying to get pregnant.
“If we think about it, in order to get pregnant, you just need an egg and a sperm and the two just have to meet at the opportune time, however, it’s not as easy as it seems,” Dr. Ancheta was quoted as saying.
A survey commissioned by Merck Serono and conducted by Synovate in 2011 found that one in 10 Filipino couples is suffering from infertility. By definition, infertility is the inability of a couple to achieve a pregnancy after repeated intercourse without contraception for one year.
“The cause of infertility may be due to problems in the man, the woman, or both,” says The Merck Manual of Medical Information. “Problems with sperm, ovulation, or the fallopian tubes each account for almost one third of infertility cases.”
In the Health and Lifestyle article, author Mylene C. Orillo identifies two types of infertility: primary and secondary. “Primary infertility is when the woman has never had a chance to get pregnant, whether it ended up as miscarriage or abortion; while secondary infertility is when the woman was able to get pregnant once, but developed a miscarriage, or was able to produce a pre-term conception but has difficulty getting pregnant again,” she explains.
Dr. Ancheta points out this fact: “Getting pregnant is a shared responsibility between husband and wife; 30 percent of the time there’s something wrong with how the eggs are being produced and the other 30 percent has something to do with the quality of the sperm.”
In a small percentage of cases, infertility is caused by problems with mucus in the cervix or by unidentified factors. As such, “the diagnosis of infertility problems requires a thorough assessment of both parents,” the Merck manual contends.
Among women, age is a factor. “As women age, becoming pregnant becomes more difficult and the risk of complications during pregnancy increases,” the Merck manual notes. “Also, women, particularly after 35, have a limited time to resolve infertility problems before menopause.”
Fortunately, “there are many safe and effective therapies for overcoming infertility,” the Minnesota-based Mayo Clinic claims. “These treatments significantly improve the chances of becoming pregnant.”
The Health and Lifestyle feature discusses some fertility myths. It is believed that if men ejaculate, they are fertile. The truth is: “Men may have a very low sperm count, low sperm motility or poor quality sperm and still ejaculate. In some cases, the ejaculate may contain no sperm at all. The only way of knowing what ejaculate contains is through analysis in a laboratory. Not everything that comes is sperm. Part of it is lubricant, food of the sperm, medium where the sperm will swim.”
Another myth: Fertility issues are more likely to affect women than men. “Conception difficulties are just as likely to affect men as they are women,” it clarifies. “Male fertility problems are the diagnosis in approximately 25 percent of cases.”
There are those who think that fertility treatment go against nature. “Being able to conceive a child is the most natural thing for humans,” it says. “Fertility treatments attempt to remove or bypass barriers causing conception difficulties hoping that nature will do the rest.”
The Merck manual, however, pinpoints that “up to 60 percent of the couples who have not conceived after a year of trying do conceive eventually, with or without treatment.” It adds: “The goal of treatment is to reduce the time needed to conceive or to provide couples who might not otherwise conceive the opportunity to do so.”
“Treatment of infertility depends on the cause, how long you’ve been infertile, your age and your partner’s age, and many personal preferences,” the Mayo Clinic says. “Some causes of infertility can’t be corrected. However, a woman may still become pregnant with assisted reproductive technology. Infertility treatment involves significant financial, physical, psychological and time commitment.”
Treatment for men
Approaches that involve the male include treatment for general sexual problems or lack of healthy sperm. According to the Mayo Clinic, treatment may include the following:
Treating infections. Antibiotic treatment may cure an infection of the reproductive tract, but doesn’t always restore fertility.
Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications. Your doctor may recommend hormone replacement or medication in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. In cases where no sperm are present in the ejaculate, sperm may often be retrieved directly from the testicles.
Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.
Treatment for women
While men’s treatment, women’s treatment is different and complicated: “Although a woman may need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before she’s able to conceive,” the Mayo Clinic says.
Among the treatments available for women, the Mayo Clinic says, are the following:
Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.
Intrauterine insemination (IUI). During IUI, healthy sperm that have been collected and concentrated are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.
Assisted reproductive technology (ART). ART is any fertility treatment in which the egg and sperm are handled. An ART health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.
Most of these treatments are now available in the country but which of these should a couple undergoes?
“That’s where the doctors come in to guide you in deciding what would be the best fertility program for you,” Dr. Ancheta was quoted as saying. “Treatment options and investigations need to be individualized. There are some things we need to consider before offering treatment options.”
