5th FERTILITY AWARENESS 2017: What Causes Infertility and Treatment Options

5th Fertility Awareness 2017: Hear from the experts – Debunking the Myths on Infertility, What is Egg Freezing or Oocyte Cryopreservation, and 3 Types Treatment Options for Infertility

EDSA Shangri-La MANILA, Philippines, October 21 2017- Merck Philippines’ recently held a 4-hour symposium in observing the 5th Fertility Awareness 2017 with this year’s theme: “Bridging Baby Steps.” Learn about fertility issues, signs and symptoms, and treatment options available in the country today.

Guests were able to understand the comprehensive details about infertility and its treatment options for couples who have problems conceiving a baby. On the same note, the majority of the Filipinos haven’t heard of egg freezing preservation — how it’s being done and what is the primary purpose of egg freezing particularly for women’s socio concern.

The health activity started with a 3-minute video viewing dealing with infertility facts in the country, followed by responding to a digitized Fertility Quiz. The survey serves as the guest’s health evaluation of their body condition, as a result will provide an appropriate fertility approach design for them. Seen around the event area are displays of infertility facts and information for public dissemination.

5th Fertility Awareness 2017 Bridging Baby Steps by Merck Philippines — L-R – Mr. & Mrs. Dennis Basilio, Dr. Gia Pastorfide, Dr. Leonardo Almeda, and Dr. Anthony Marc Ancheta

Having trouble getting pregnant?

INFERTILITY is the ability to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse (or after 6 months if the woman is older than 35). The term describes men who can’t get a woman pregnant and women who can’t get pregnant or carry a pregnancy to term.

What causes infertility?
Health conditions, age, genetics, and other factors can all cause or contribute to infertility in men and women.

For men
• Medications such as testosterone gels or patches to treat “low T”
• Testicular injury or overheating

For women
• Gynecological disorders such as polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI), endometriosis, and uterine fibroids
• Problems with anatomy of the reproductive organs

For men and women alike
• Exposure to chemicals
• Cancer and/or exposure to radiation or chemotherapy
• Stress
• Conditions such as diabetes, heart disease, obesity, high blood pressure, and autoimmune disorders
• Smoking, alcohol and/or drug abuse
• Sexually transmitted infections (STIs)

AGE is a big factor, as age increase, so does the likelihood of infertility:
• Older men produce fewer sperm and lower-quality sperm
• Older women have fewer eggs and lower-quality eggs
• The risk of some health conditions associated with infertility increases with age
• Age-related declines in sperm and egg quality increase the risk of health conditions such as down syndrome, autism, and schizophrenia in future generations.
• After age 30, a woman’s fertility decreases rapidly every year until menopause, usually around age 50. In the decade before menopause, her fertility is also greatly reduced. Male fertility also declines with age, but more gradually.

Opening remarks was delivered by Dr. Raymond Tapang, MD of Merck Biopharma as they observe Merck’s years’ excellence in service as health care provider.

First on the deck was Anthony Marc Ancheta, MD, (Obstetrics and Gynecologist, Infertility Specialist) his talk is about the 3 Types Treatment Options for Infertility, these are:

1. Ovulation Induction + Follicle Monitoring + Timed Intercourse
This method made sure the woman produces an egg through an oral medication or injectable and does an ultrasound scan to monitor and be certain of the size of the egg and development. The uterine lining should be thick enough for the embryo to attach. The method is considered the least invasive.

Dr. Ancheta’s advice is to delete any health apps used to monitor the partner’s monthly cycle of period, ovulation and fertile days, he reiterates that the timing of ovulation differs from one woman to another.

Prerequisite for this method:
• there should be a good quality egg
• fallopian tubes have to be open and
• there should also be an adequate number of rapidly swimming and good-looking sperms.

This method has a 25% chance of success for 20-30 years old females and <10% for above 35 years old.

2. Ovulation Induction + Follicle Monitoring + Artificial Insemination or Intrauterine Insemination (IUI)
With this method, the husband abstains for at least 3-5 days. It allows the patient to produce an egg and around the time the egg will be released, a sample of sperm is induced.

Abstaining a bit too long to allow collection of good looking sperm during IUI. Pre-select good sperm will go through ovulation induction instead of intercourse. These sperm will find its way through the fallopian tube going to the egg. Once it has the embryo, it needs to get out of the fallopian tube and swim all the way to the uterus.

Pre-requisite for this method:
• there should be good quality egg
• at least one of the fallopian tube have to be open and
• a total of 5 million motile sperms inseminated
This method has 15-20% chances to occur per cycle.

3. IVF – In Vitro Fertilization
Assisted by medication (in the form injectable) to stimulate the ovaries to collect good quality eggs, given around 10-12 days, monitor the response, follicles should come out and start to grow in size. The follicle is the house of the egg. For egg retrieval – with an ultrasound scan it monitors the size of the follicle. Once it’s big enough, retrieval is done by a small needle. It punctures a hole of the follicle to collect the content (egg). Egg retrieval is an out-patient procedure, it takes about 15-20 minutes to get all the eggs out. The patients can go after 1 to 1.5 hours to recover from the anesthetics. The same day the eggs are taken out, the husband’s sample of sperm is also collected.

The eggs are retrieved, fertilized outside the womb and transferred to the womb.

For every single egg collected, a handful of sperm (usually in the thousand) mix it in a dish. Though manual procedure has been done in the past 10 years, it is called Intracytoplasmic Sperm Injection (ICSI). For every single oocyte or egg, they matched the best and most good looking sperm and injected the sperm directly into the egg, allowing nature to take its course, thus allowing the sperm to fertilize the egg. Once fertilization takes place, allow the embryo to grow more until ready.

Embryo transfer
Embryo is transferred around day 3 to day 5 via Intrauterine Insemination (IUI). A living embryo technically means pregnancy; it will just find a spot to implant itself. After the transfer the doctors will facilitate support like “pampakapit” for the next two weeks. It might be the longest 2 weeks in your life. The most crucial is the first 12 weeks of pregnancy regarding the age of the mother.

Pre-requisite for this method:
• there should be minimum number of developing follicles
• fallopian tubes are not required
• there should be a minimum number of good-looking sperms
This method has 41% chances of getting pregnant for women <35 years old and <12% for 41 -42 age and higher.
Match the expectation of the patients, “Start with the least invasive, most cost-effective way of getting pregnant.”

Available IVF Centers in the Philippines
• In Vitro Fertilization, Davao Inc.
• Center for Reproductive Medicine (CRM)
• Center for Advanced Reproductive Medicine and Infertility (CARMI)
• Kato Repro Biotech Center
• Victory Art Lab Philippines

Gia Pastorfide, MD (Reproductive Endocrinologist and Infertility Specialist) discussed Egg Freezing Preservation or “Oocyte Cryopreservation”

EGG FREEZING – What women needs to know

Egg freezing is a procedure done to preserve a woman’s egg or oocytes. The oocytes are extracted, frozen, and stored.

Beat your biological time clock
Usually women will face health risk as they age such as chromosomal abnormalities increases, risk of miscarriage, and even conceiving will become more difficult for an average woman as she gets older. Egg freezing is a method to preserve younger eggs, to lengthen women’s reproductive life, and is seen as a way to stop the biological clock. Cryopreserving the eggs and sperms can be made for patients who prefer to delay child bearing.

There are 2 types of women that undergo egg freezing

Medical patient – cancer patient before undergoing chemotherapy or radiotherapy, women requiring gonadotoxic drugs, patients who need to remove their ovaries, and patients who have a strong family history of early menopause or a history of premature ovarian insufficiency.
2
Social – majority or 80% of patients are not in a long-term relationship who wish to preserve future fertility options and other demanding concerns which include career or schooling.

There is a decline in fertility with aging, mechanisms of reproductive aging are:

Gradual decrease in quantity and quality of oocytes; distinct acceleration at age 3
Reduction in oocyte quantity – progressive from fetal life to menopause, genetic influences, and other factors: endometriosis, ovarian surgery, gonadotoxic, etc.
Reduction in oocyte quality – increasing aneuploidy due to chromosome misintegration, impaired mitochondrial function, and decrease uterine receptivity

How do you perform egg freezing?
A video clip as explained by Dr. Pastorfide from DeiVille Youtube is available to show the actual process of extracting the oocyte and when you’re ready to you use the preserved eggs – the video will also show the timeline of events in egg freezing; the procedure of egg retrieval – performed as a short outpatient procedure under ultrasound guidance. The oocytes are extracted, frozen, and stored. These eggs can be thawed at a later time; IVF with conventional insemination method when the egg and sperm meet outside a woman’s body; embryo development to monitor the signs of correct cell division; and embryo transfer.

When do you perform egg freezing?
During egg freezing there is no age limit but the best outcome will be for women younger than 35 years old.
Optimal fertility from 20 – 35 years old
Declining fertility from 35 years old and above
End of fertility starts at 40 to 50 years old

The reproductive potential per oocyte where it remains constant is between ages 23 – 37, success rate is dependent on the ovarian response. However, there is a rapid decline in reproductive potential per oocyte from age 38 onwards, not dependent on the ovarian response.

From day 1 to 10 – daily injection of ovarian stimulation drugs (with intervals scan day 1, day 5, day 5), simultaneously daily injection of antagonist from day 5 to day 10.

How many eggs should we freeze?
Technically 10 eggs are recommended to store for each pregnancy attempt. Thus, if 10 eggs are frozen:
7 oocytes are expected to survive the thaw
5-6 oocytes expected to fertilize and
3-4 embryos transferred

Chances of success pregnancy will depend on the woman’s age on retrieval and the sperm quality. In a study made, for 2-6 thawed eggs, the percentage that 1 egg will lead to a live birth is:
at 30’s, 9-24% chance
at 40’s, 5-13% chance

Leonardo Almeda, MD (Infertility Specialist) tackled Debunking the Myths on Infertility.

Know your specialist, Dr. Almeda pointed out responsibilities of an Infertility Specialist must include:

Sonographic monitoring of follicle growth in Controlled Ovarian Stimulation
Laparoscopic and Hysteroscopic surgery in indicated cases
Assisted conception
Collaboration with Embryologist, Genetic counsellor, and Urologist in special cases

Can IVF solve the problem for the older patient?

One of the most important causes of infertility is ovarian and testicular aging, even with advanced technology the adverse effect of aging cannot be reversed.

Effects of male age on semen quality and fertility

Decrease in semen volume 3% to 22%
Decrease in sperm motility 3% to 37%
Decrease in percent of normal sperms 4% to 18%
Decrease in pregnancy rates from 23% to 38%

One of the most important causes of infertility is ovarian and testicular aging, even with advanced technology the adverse effect of aging cannot be reversed.

Top 10 Myths About Fertility

Spicy Food will induce fertility – it’s a total blunder when you believe a raised blood pressure and pulse rate for increased sexual potency. Body sweat and sting on your young won’t get you fertile.
Having Sex in the Morning will not Increase Fertility – some may presume that sperm levels are often highest in the morning, having had a chance to “replenish”
overnight.
A man’s testicles should be cool if you want a daughter and warm for a son – choosing the baby’s gender is not predetermined through your husband’s body temperature.
You’re most fertile the day you ovulate – most advantageous chance of conceiving, couples should have sex before and during ovulation. Sperm can live within the reproductive tract for up to three days.
Eating yams while trying to conceive will help you get twins – there may be a discourse linking yam and fertility, however, this has not been proven yet.
Gulping cough syrup will help you conceive – this false notion has long been thought to help make sperm travel to the cervix easier. Please drink cough syrup only if you have a cough.
If you work at it and want it enough, you’ll get pregnant – infertility may be beyond your control. With the help of medical research and the success rates of newer treatments available, couples’ chance of having a baby has improved.
Special diets can boost your chances of getting pregnant – there is no evidence that a specific diet (be it eating pineapple every day or never eating gluten) will increase your chances of success. But eating a healthy diet is always good for the body.
Going to the headstand will help sperm find their way – sperm cells are chemically programmed to travel in the right direction no matter where your pelvis is pointing.
The size of a man’s penis will determine how fertile he is – as long as it is done right, bigger does not guarantee a higher chance of being impregnated. Your partner’s soldiers still swim upstream, regardless of how big or small it is.

Fertility awareness 2017 manifest that as estimated only 6 of 10 couples with infertility seek medical advice while 2 in 10 couples receive medical care. Infertility is a significant problem affecting about over 70 million couples worldwide.

For Filipino couples dealing with infertility issues, medical breakthroughs can now assist you with the 3 kinds of treatment options available. It is best to consider consulting with your health care specialist so you can weigh in the causes and risk factors of infertility and at the same time get suitable treatment advice that is cost effective for your family.

“A child’s cry may sometimes irritate you, but for others they long for it.”

Learn the options on how to address infertility problems as well as how to preserve your fertility.
www.facebook.com/fertilityawarenessphilippines.