More women today are focusing on career and putting off getting married and having children. And while most are aware of their ‘biological clock ticking’, they do not realize that the chances of having infertility problems become higher as a woman ages.

Says Dr Gia Pastorfide, reproductive endocrinology and infertility specialist, “In the obstetric world, 35 is already a high-risk case.” 

Speaking to MIMS, she said that while modern women generally know they need to get pregnant sooner than later, what they don’t realize is how early sooner is, with many thinking that mid-30s is still young.

The infertility specialist expounds saying as women age, other medical problems set in such as hypertension and diabetes. And these are comorbidities that increase the risk of pregnancy in older women.

Not natural

Based on experience, she noted that women are rarely concerned if they are unable to conceive even after a few years. There are some who consult with her after 5 years - or in some extreme cases, 10 years - of not conceiving, yet they don’t think this unusual. “It is not natural for a woman having regular, unprotected sex to not get pregnant,” Dr Pastorfide stressed.

This is the first thing they impress upon patients who still have no baby after a year of constant sex without protection, and they are told their case is already defined as infertile. Most react with, “If I had known this earlier…”

Most of the time, couples who don’t get pregnant within a specified time just think they are not trying hard enough or attribute it to other external factors.

The reality is a woman older than 35 who does not get pregnant within 6 months of regular, unprotected sex is already defined infertile and will require more aggressive treatment the older they are.

Infertility issues

Even with the advent of the internet, where information is more readily available, there are still cases who consult a little too late, she shares. “They’re already in their late 30s when they seek consultation and they’ve had infertility problems for years.”

Infertility issues may be ovulation or tubal disorders, endometriosis, and polycystic ovary syndrome among women, while male fertility issues are low sperm count, poor sperm health and antisperm antibodies.

And Dr Pastorfide noted, “a huge chunk of it is (still) unknown.” There are cases where a husband and wife are normal in their workups but still can’t conceive. Thus, there is no simple infertility problem.

Her father, Dr Greg Pastorfide, in vitro fertilization (IVF) pioneer in the Philippines, added his insight when it comes to complexities in infertility issues. He said when they are faced with a couple, where both man and woman have infertility problems, the degree of difficulty in treatment increases. Most of the time, however, the problem is concentrated in just one partner, which is commonly the female.

But it is not necessarily uncommon that both man and woman are having problems. Knowing the problem, and to whom it is ascribed to, lessens the degree of complexity, Dr Greg admitted.

In other cases, there are other medical concerns that need to be seen by another medical specialist, say by a urologist or diabetes expert. But given that reproductive specialists are endocrinologists themselves, they can take on the limited endocrinology problems.

Assisted reproductive technology

The father-and-daughter infertility specialists are behind Victory A.R.T. Laboratory, which specializes in assisted reproductive technology. It is why Filipino couples need not go overseas to undergo IVF treatment because when everything is summed up, it is more economical to do it locally.

Dr Gia explained the procedure takes more than two weeks, so that means spending for accommodations for the duration of the stay, aside from airfare, and foregoing work instead of earning and being productive if it is done in the Philippines.

Most of the patients that see the Pastorfides are referrals who have already undergone some fertility treatment, like oral drugs, but without success. Depending on the case, they will be made to go through other advanced or aggressive treatment (including artificial insemination) before resorting to IVF, an option most are open to.

Still, this reproductive technology is not a guarantee that couples will finally conceive. “IVF is not 100 percent. There are still unknown causes why they don’t get pregnant,” Dr Greg pointed out. The last alternative that they do suggest is adoption.

Two embryos

Dr Greg added that they spend time to thoroughly explain that undergoing treatment does not mean 100 percent success. “It's by repeated procedure that will be performed on the patient, when it becomes successful. It's not unusual for some patients to have IVF six times. And we do find cases where they only get pregnant after these many attempts.“

On having multiple births with IVF, Dr Gia elucidates that at Victory, they transfer two embryos to increase the pregnancy rate. When two are transferred, and both implant, this will result in twins.

“But it does not mean that if you transfer two, it will automatically be multifoetal. Sometimes, you transfer two, but only one is conceived. It's just that the chances of pregnancy increase with two embryos.

However, if the patient is younger (below 35) and the quality of embryos is good, only one needs to be transferred to result in conception.

They always look back on the experience at the Victory lab to determine how to go about IVF, where it will result in pregnancy without it being multifoetal.