Is the Philippines a new go-to destination for In Vitro Fertilisation in Southeast Asia?

Tatler takes a deep dive into this once-controversial medical procedure to know where we are now and what lies ahead

Once a taboo, the topic of infertility—especially assisted reproductive technologies such as in vitro fertilisation or IVF—has now become a common subject, especially among couples trying to conceive. Far from what it was like discussing such a hushed issue three decades ago, the world has become more open and more aware of this science-mediated procedure of cultivating embryos outside the human womb. Perhaps it also helped that more people, including notable personalities, have made their IVF journeys public.

Former US First Lady Michelle Obama, for instance, wrote in her book Becoming how she and former President Barack Obama turned to IVF when they realised that at her age, her “biological clock is real” and that “egg production is limited”. They now have two lovely daughters, Malia and Sasha, conceived through IVF.

The Obamas aren’t the only big names who underwent this fertility treatment. Friends stars Courteney Cox and Jennifer Aniston also revealed their respective experiences; and while Cox had a successful delivery after a second try, Aniston’s journey was challenging. Kourtney Kardashian also documented her going in vitro with her husband, Travis Barker, in the Hulu family reality series, The Kardashians. Eventually, the American socialite revealed her frozen embryos “did not survive the thaw” and that they were “done with IVF”. Finally, in November last year, they welcomed their son, Rocky Thirteen, just when they “stopped trying”.

These stories show that IVF, or any infertility treatment, may not be the solution for all, as everyone has different circumstances and concerns as far as their reproductive system and bodies are concerned. Still, as the old adage goes, there’s no harm in trying. The good news is that IVF and other assisted reproductive technologies are now more accessible—both location-wise and price-wise—almost anywhere in the world.

While the US and Russia remain some of the top places for IVF procedures because of the legal measures already in place there, many Asian countries, including the Philippines, are keeping up. “We’re at par with the rest [of Asia]. All the technologies they have are also here. We see a lot of locals and foreigners coming to the Philippines to undergo IVF and other related procedures,” says Dr Debbie Guani Dy-Meguizo, head of the Center for Advanced Reproductive Medicine and Infertility (CARMI) in St Luke’s Medical Center-Bonifacio Global City. Dy-Meguizo adds that another draw is the reputation of Filipinos for being compassionate; couples from other countries are happy with the patient care they get here.

“We’re at par with the rest [of Asia]. All the technologies they have are also here”

- Dr Debbie Guani Dy-Meguizo -

As the Philippines’ first and only hospital-based IVF centre, CARMI uses facilities that are among the most advanced in Asia. This means that patients do not need to travel abroad to avail themselves of services such as IVF, gamete intrafallopian transfer, in-vitro maturation, surgical sperm retrieval, intracytoplasmic sperm injection and embryo/gamete conservation. Even the diagnostic tests that were once unavailable in the country, such as the Anti-Mullerian Hormone (AMH) testing for ovarian reserve and sperm DNA Fragmentation Test, more popularly known as the Halo Test, are now offered in CARMI. The list of terminologies is quite overwhelming, but for those who have been trying for many years and would do anything to conceive, this list sparks a sliver of hope.

“In terms of results, of pregnancy rates, I would say we’re at par. The chance of getting pregnant has its limitations, whether in Singapore, the Philippines, or the US. We’re at par with the global success rate,” says Dr Rudie Frederick Mendiola, medical director at Kato Repro Biotech Center (KRBC), the fifth IVF centre to open nationwide. As proof, the success rates in KRBC and CARMI range from 53 per cent to 55-60 per cent, respectively. These numbers are not far from those of its Asian counterparts, such as Taiwan, Malaysia, Thailand, Vietnam and Singapore.

From one IVF centre established in 1996 by Dr Angela Ho in Greenhills, the Philippines now has eight centres in key cities outside Manila, such as Davao, Cebu, Angeles City in Pampanga. “There are more IVF centres that will open in the next year or two, and this will also [help] lower the cost of IVF [in the country], so it would be beneficial for everyone,” Dy-Meguizo says.

Another factor that draws patients to (or for locals to stay in) the Philippines for IVF is its affordability. Decades ago, one needed to shell out millions of pesos for a cycle of IVF, making this procedure prohibitive, especially for the middle and working class. Today, the centres have tried to reduce costs without sacrificing the quality of service and facilities. For instance, in CARMI, an IVF cycle starts at PhP 210,000, exclusive of the cost of medications, which vary depending on the stimulation protocol to be used and the bloodwork and laboratory tests needed before, during and after the procedure. In KRBC, the price ranges from PhP 350,000 to PhP 450,000, all-inclusive. “Not all countries pay [or subsidise the cost of ] infertility treatments. Like in the Philippines, it’s all out of pocket,” says Mendiola.

Above Photo: Emilija Manevska / Getty Images

The centre offers flexible terms to address this so more patients can afford IVF. “We don’t charge the full amount [up front]. It’s prorated. What we do, we charge. Sometimes, the procedure is not successful in one go. For example, we do a retrieval, we get several eggs, but no embryos are formed. Then, we have to stop there and start another cycle. So sometimes, the price can be a little less or a little more,” he explains. Dy-Meguizo adds, “Taiwan used to be one of our toughest competitors in Asia because their prices are low. But now that we are lowering our costs, only a few are going to Taiwan. That’s an excellent sign. Once we have many centres here, patients won’t need to go abroad anymore.”

The IVF approaches available in the Philippines are also world-class and competitive. For example, those who want to take a more conservative path can explore the treatments KRBC offers. This IVF centre advocates minimal stimulation IVF and natural cycle IVF developed by the renowned Japanese reproductive doctor Dr Osamu Kato. “We use Japanese technology and follow 100 per cent the techniques Dr Kato taught us. Usually, when you speak of IVF, the goal is to get as many eggs as possible. The more eggs, the more chances that it would be successful. The strategy there is to give you a lot of hormones to stimulate your follicles to grow. At Kato Ladies Clinic in Japan, they discovered that you don’t need to give that many hormones to get a good result. So in KRBC, we give less hormones,” shares Mendiola.

Other options available in the Philippines are intracytoplasmic sperm injection or ICSI, as well as the more common embryo transfer. “When we talk about IVF, we fertilise the egg outside the womb, outside the uterus. We get the eggs first and place them in a petri dish. We get the sperm and fertilise the egg within the petri dish, either allowing it to undergo in vitro fertilisation there, or we do ICSI or injecting the sperm directly into the egg,” Dy-Meguizo explains the process. Once the eggs are fertilised, they are cultured further and monitored for embryo growth until the fifth day. “On the fifth day, we have the option of freezing them [also known as cryopreservation], or we do a biopsy to check for the chromosomal condition of the embryo before transfer,” Dy-Meguizo elaborates.

Above Photo: Ted Horowitz / Getty Images

At pre-genetic testing, chromosomal abnormalities can already be detected early. “It’s also good because, in a sense, it would also minimise the risk for miscarriage, or avoid the emotional trauma of the patient losing their baby or of their baby having abnormalities when they do get pregnant,” she adds.

Other than IVF, there is also a growing number of centres offering and patients availing themselves of cryopreservation of eggs and sperm in the Philippines. “Right now, we get more than a 50 per cent increase of patients, mostly single women, freezing their eggs. This way, while they’re young, we can preserve their healthier and better-quality eggs to be used when they are ready to bear a child,” Dy-Meguizo says, adding that freezing can also be done to preserve the eggs before cancer patients undergo chemotherapy or radiotherapy. Cryopreserved sperm, on the other hand, can be used in intrauterine insemination (IUI), where they are injected directly into the mother’s uterus to increase the chances of conception.

However, bringing IVF to the Philippines was not without a challenge, principally with the country being predominantly Catholic. In a 2006 interview for The Philippine Star, Dr Greg Pastorfide, one of the pioneers of IVF in the country, said, “We promised Cardinal Sin that our practice would be only according to our religion. First, we will ensure the patients will be husband and wife. Secondly, we will recommend the procedure only to patients who have exerted all other measures but did not become pregnant. And thirdly, we tell them that in case of multiple pregnancies [twins or triplets or more], we won’t go into the process of foetal reduction.”

Above A 15-day-old baby holding the hands of their parents (Photo: fitopardo / Getty Images)

Though the IVF centres in the Philippines still adhere to this promise, the fact that there are no laws to protect all parties involved in the process is a glaring limitation. There are also no clear laws on surrogacy, so those who would like or need to go this route have to go abroad. “The more lenient system is in the US. They do allow donor sperm, donor egg... They have surrogates. They have laws about how many times a surrogate can carry a baby. These surrogates are taken care of in surrogate houses. Once the baby’s born, the birth certificate is under the biological parent’s name, which is clearer. Laws protect all parties. In the Philippines, whoever delivers the baby is considered the biological mother,” Dy-Meguizo expounds. “We don’t have laws to protect the real biological parents who own the egg and sperm as well as to protect the surrogate. That’s the problem. So we refer them outside the country.”

While there are still some limitations and variables in the IVF scene in the Philippines, we cannot discount the fact that it has come a long way. And, for couples who have been trying to conceive, this development means not only hope but a risk worth taking.

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Topics

In Vitro Fertilisation IVF

Tatler Asia

Having a baby: Is the Philippines a new go-to destination for In Vitro Fertilisation in Southeast Asia?