This article is the second of a three-part special on fertility treatments.
Assisted Reproductive Technology (ART) has been a viable option for Filipino married couples who have trouble conceiving. ART is the umbrella term for fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF), which has been available in the country for quite some time. Couples usually hesitate because of the cost, but, as you will read below, ART procedures are not as prohibitive in cost as it was, say, 10 years ago.
In the first part of this series, we discussed how preliminary consultations go up to the point when the couple may be advised to undergo IUI. If an IUI doesn't result in pregnancy, IVF is usually the next step.
SmartParenting.com.ph reached out to Dr. Gayla Perillo of Kato Repro Biotech Center, in Makati City, one of the leading IVF centers in Manila, to give us a walkthrough of what happens when a couple decides to undergo IVF at their center.
Natural cycle IVF vs. minimal "mini" stimulation IVF Natural IVF is drug-free -- a patient won't be given medication to stimulate the ovary to produce eggs. Instead, it follows her natural cycle; once an egg matures or it's the appropriate size (as determined by blood work and ultrasounds), an egg retrieval is performed.
Mini IVF involves medication, but according to Dr. Perillo, Kato uses fewer meds than the typical IVF procedure. The injections, five at the most for one cycle, can be done by the patient or her husband at home; it can be injected subcutaneously (in the fatty tissue of the stomach). Aside from the injections, the patient is also given medication to ovulate.
The patient, however, needs to go to the clinic for ultrasound and hormone level tests that can help determine when is the best day for egg retrieval. There's also a nasal spray, which is a maturation trigger, involved. "It stimulates the brain to increase a hormone and tell the eggs to mature and be ready for ovulation," Dr. Perillo explained.
The process of collecting sperm from the husband is similar to IUI. But unlike IUI, wherein doctors retrieve all alive and active sperm and inject it into the woman's uterus, the doctors choose the healthiest sperm and inject it directly into the egg -- fertilization occurs in the laboratory. Once the sperm fertilizes the egg, "we transfer it immediately [into the woman's uterus] after two days," Dr. Perillo said.
Does egg retrieval hurt? Dr. Perillo likens it to the pinch you feel when you get a blood extraction. "We inject a probe inside the vagina and check the ovary. If you already have large follicles, we inject a very, very long needle with a tiny tip that sucks out the fluid with the egg. The egg will then be examined by our embryologist to see if it’s a good egg or not," Dr. Perillo explained.
"Since we only give tablets and some injections, we only get around four to six eggs per cycle. One follicle takes about 40 seconds to retrieve, so the whole process is done after about two minutes. We can use local anesthesia and sometimes, wala pa nga," Dr. Perillo added.
What happens in the laboratory? After fertilizing the eggs, Kato conducts a "culture" technique. "When I say culture, aalagaan muna doon sa laboratory until it reaches the correct age of the embryo, either day 2 or day 5, depending on the indication. Then, we freeze the embryo and wait until the patient is ready to have it implanted in her uterus," explained Dr. Perillo.
Typically, the doctors wait for the woman's next cycle to implant the embryo "because we want the uterus to rest," said Dr. Perillo.
How does the implantation process go? The procedure should not hurt. Dr. Perillo described the mechanism that transports the egg into the woman's uterus as "a catheter within a catheter." When that contraption is in place, the embryologist gets the embryo, then the doctor transfers it into the catheter and leaves the embryo in an ideal spot inside the woman's uterus. The patient is considered a "graduate" of the IVF process when the embryo takes hold in the uterus for three months.
What are the chances of a successful pregnancy via IVF? It's much higher than IUI's five- to 18-percent success rate. Kato's IVF pregnancy success rate is high, around 44 to 56 percent. If the woman is in her 40s, the success rate is lower, but still high at above 30 percent.
How much is it going to cost? Kato's natural IVF costs around P200,000, but it's also a cost-guaranteed plan. Dr. Perillo explains that a couple only shells out P50,000 to P60,000 up front, which covers egg retrieval. If the patient does not get pregnant, there are no additional charges. But if the patient tests positive for pregnancy, that's the only time the couple pays the remaining P150,000.
According to Kato's website, the mini IVF costs around P280,000 to P300,000, which covers the medicine for the work-up, egg retrieval, and transfer and implantation. Dr. Perillo says that half of the cost is for the work-up and egg retrieval, while the other half covers the transfer of the embryo.
"If during the first try, nakabuo tayo ng embryos and you got pregnant, that's the P280,000 to P300,000. You'll have the remaining frozen embryos, so if you want to get pregnant again, you'd only have to pay for the transfer or implantation of the embryo, which is around P60,000 to P80,000 only." The price difference accounts for other laboratory procedures such as assisted egg hatching and freezing.
"If on the first try, wala tayong nabuong embryos, then you will need to shell out another P280,000 to P300,000 to repeat the whole procedure," Dr. Perillo said. To put it in perspective, IVF used to cost P600,000 or more when it was just starting in the country
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What if you still don't get pregnant after two IVF attempts? Stay tuned for the third part of this series.
Kato Repro Biotech Center is located at 8/F Tower 1, The Enterprise Center, 6766 Ayala Ave., Makati City. For inquiries, call (02) 822.1209, 801.1324, 801.8642, 919.6802, or (0917) 723.9211; email them at email@example.com; or visit their website.