In Vitro Fertilization: IVF

In Vitro Fertilization (IVF): Side Effects and

Risks
In Vitro Fertilization is a one assisted reproductive technology (ART) commonly referred to as IVF. IVF is the
process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the
embryo to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote
intrafallopian transfer (ZIFT).

Why is IVF used?

IVF can be used to treat infertility with the following patients:

 Blocked or damaged fallopian tubes

 Male factor infertility including decreased sperm count or sperm motility
 Women with ovulation disorders, premature ovarian failure, uterine fibroids
 Women who have had their fallopian tubes removed
 Individuals with a genetic disorder
 Unexplained infertility

What is involved with in vitro fertilization?

There are five basic steps in the IVF and embryo transfer process:

1. Monitor and stimulate the development of healthy egg(s) in the ovaries.

2. Collect the eggs.
3. Secure the sperm.
4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for
fertilization and early embryo growth.
5. Transfer embryos into the uterus.

Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because
some eggs will not develop or fertilize after retrieval. Transvaginal ultrasound is used to examine the ovaries,
and blood test samples are taken to check hormone levels.
Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow
needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential
discomfort.
Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.
Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to
encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic
sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in
an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are
taking place. Once this occurs, the fertilized eggs are considered embryos.
Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval
and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is
painless for most women, although some may experience mild cramping. If the procedure is successful,
implantation typically occurs around six to ten days following egg retrieval.

Side effects of in vitro fertilization

Although you may need to take it easy after the procedure, most women can resume normal activities the
following day.
Some side effects after IVF may include:

 Passing a small amount of fluid (may be clear or blood-tinged) after the procedure
 Mild cramping
 Mild bloating
 Constipation
 Breast tenderness

If you experience any of the following symptoms, call your doctor immediately:

 Heavy vaginal bleeding

 Pelvic pain
 Blood in the urine
 A fever over 100.5 °F (38 °C)

What are the risks associated with in vitro fertilization?

As with most medical procedures, there are potential risks. Fertility medications can have various side effects
including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects.
Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS). Symptoms of
OHSS may include abdominal pain or a feeling of being bloated. More severe symptoms include the
following:

 Nausea or vomiting
 Decreased urinary frequency
 Shortness of breath
 Faintness
 Severe stomach pains and bloating
 Ten pound weight gain within three to five days

If you experience any of these symptoms above, contact your doctor right away.
Additional risks of IVF include the following:

 Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
 The chance of a multiples pregnancy is increased with the use of fertility treatment. There are
additional risks and concerns related to multiples during pregnancy including the increased risk of
premature delivery and low birth weight.
 Assisted reproductive technology (ART) involves a significant physical, financial, and emotional
commitment on the part of a couple. Psychological stress and emotional problems are common,
especially if in vitro fertilization (IVF) is unsuccessful.
 IVF is expensive, and many insurance plans do not provide coverage for fertility treatment. The cost
for a single IVF cycle can range from at least $12,000-$17,000.
How successful is in vitro fertilization?
The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age,
cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same
as live birth rates.
In the United States, the live birth rate for each IVF cycle started is approximately:

 41-43% for women under age 35

 33-36% for women ages 35 to 37
 23-27% for women ages 38 to 40
 13-18% for women ages over 40

What if I don’t produce healthy eggs or my husband is sterile?

You may choose to use donor eggs, sperm, or embryos. However, make sure to talk with a counselor
experienced with donor issues. You will want to be informed about various legal issues related to gamete
donation including the legal rights of the donor.

How many embryos should be created or transferred?

The number of embryos transferred typically depends on the number of eggs collected and maternal age. As
the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase
the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having
a multiples pregnancy. Make sure to talk with your doctor before the procedure so you both agree on how
many embryos to implant.

How do I choose an infertility clinic?

There are a number of questions to ask regarding the cost and details of specific centers and fertility programs.
Some suggested questions are available online in Selecting Your ART Program.
Last Updated: 09/2015

American Society for Reproductive Medicine. (2014). Gamete and embryo donation: Deciding whether to tell.
Retrieved from https://www.asrm.org/FACTSHEET_Gamete_Donation_Deciding_Whether_To_Tell/ Human
Fertilisation & Embryology Authority. (2014). IVF- What is in vitro fertilisation (IVF) and how does it work?
Retrieved from http://www.hfea.gov.uk/IVF.html Human Fertilisation & Embryology Authority. (2014). Risks
of fertility treatment. Retrieved from http://www.hfea.gov.uk/fertility-treatment-risks.html MedlinePlus.
(2014). In vitro fertilization (IVF). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm Mayo Clinic. (2013, June 27). In vitro
fertilization (IVF). Retrieved from http://www.mayoclinic.org/tests-procedures/in-vitro-
fertilization/basics/definition/prc-20018905 RESOLVE: The National Infertility Association. (n.d.) IVF/ART.
Retrieved from http://www.resolve.org/family-building-options/ivf-art/

http://americanpregnancy.org/infertility/in-vitro-fertilization/
What is IVF?

In vitro fertilization (IVF) is a method of assisted reproduction in which a man's sperm and a woman's
eggs are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) may
be transferred to the woman's uterus, where they may implant in the uterine lining and develop. Excess
embryos may be cryopreserved (frozen) for future use. Initially, IVF was used to treat women with
blocked, damaged, or absent fallopian tubes. Today, IVF is used to treat many causes of infertility, such
as endometriosis and male factor, or when a couple's infertility is unexplained. More information >>

When is IVF indicated for an infertile couple?

IVF was initially used to treat women with blocked, damaged, or absent fallopian tubes. Today, IVF is
used to treat many causes of infertility, such as endometriosis and male factor, when a couple's
infertility is unexplained or in women with advanced maternal age where her chances for pregnancy are
rapidly declining and IVF remains as the best possible option. More information >>

What are the steps in the IVF process?

The basic steps in an IVF treatment cycle are ovarian stimulation, egg retrieval, fertilization and embryo
culture, and embryo transfer. During ovarian stimulation, medications or "fertility drugs," are used to
stimulate multiple eggs to grow in the ovaries rather than the single egg that normally develops each
month. Using ultrasound examinations and blood testing, the physician can determine when the follicles
are appropriate for egg retrieval (Figure 1). Generally, eight to 14 days is required. When the follicles are
ready, hCG or other medications are given.
Egg retrieval is done before ovulation occurs, usually 34 to 36 hours after the hCG injection. It is usually
accomplished by transvaginal ultrasound aspiration, a minor surgical outpatient procedure (Figure 2)
that is done with some form of analgesia administered. The eggs are aspirated from the follicles through
the needle connected to a suction device with the guidance of ultrasound probe inserted through the
vagina. Removal of multiple eggs can usually be completed in less than 30 minutes. In some
circumstances, one or both ovaries may not be accessible by transvaginal ultrasound and
laparoscopymay then be used to retrieve the eggs using a small telescope placed in the umbilicus. In the
phase of fertilization and embryo culture,the retrieved eggs are examined in the laboratory for maturity
and quality (Figure 3). Mature eggs are fertilized by micro-insemination or intracytoplasmic sperm
injection (ICSI). The next day, the eggs are evaluated for signs of fertilization and are kept under special
conditions to allow further growth and development. Depending on the program, developing embryos
may be cultured in the IVF lab for two to six days after the egg retrieval and become.embryos from 2-
cells to blastocysts (Figure 4).

During embryo transfer, the physician and the embryologist inform the couple about the quality and
number of available embryos and discuss the options before the couple decides on the number of
embryos for transfer. Once a decision is made, the embryologist loads the embryo/s into a transfer
catheter while the physician prepares the patient. No anesthesia is necessary, although some women
may wish to have a mild sedative. Once the catheter is prepared, it is quickly handed over to the
physician who gently guides the tip of the transfer catheter through the cervix and places the fluid
containing the embryos into the uterine cavity (Figure 5). The patient is then given additional
medications for 2 weeks after which a serum pregnancy test is done. More information >>

How long is the IVF process?

The average time that is required to complete one IVF cycle (from start of ovarian stimulation to testing
for pregnancy) is about four to six weeks, depending on the chosen ovarian stimulation protocol
appropriate for your case. More information >>
What is ICSI?

Intracytoplasmic sperm injection (ICSI) is the step in the IVF process which aims to achieve fertilization
for the collected eggs. In ICSI, a single sperm is directly injected into each mature egg (Figure 6). ICSI is
usually performed when there is a likelihood of reduced fertilization, i.e., poor semen quality, history of
failed fertilization in a prior IVF cycle, etc. More information >>

What are my chances to achieve success in an IVF cycle?

Your chances will depend on a few factors, most crucial of which are women's age, presence of co-
morbidities (endometriosis, previous ovarian surgery), and quality of husband's sperm). In addition,
success rates vary from center to center and between practicing clinicians. Generally, pregnancy rates
from a single IVF cycle may range from 20% to 80% depending on the clinical picture per case. Do ask
your doctor regarding your chances after full evaluation. More information >>

How do I increase my chances in IVF?

Patients themselves may help increase their chances by approaching their ideal body weight and by
avoiding avoiding certain lifestyle habits (smoking, alcohol-drinking, caffeine-drinking). Studies have
shown that women who are within normal body mass index (BMI) 20-24 kg/m2 tend to have a higher
chance of success during IVF than women who have higher or lower BMI values. Similarly, some reports
have shown that cigarette-smoking and alcohol-drinking, by either the wife or the husband especially
during the time of IVF treatment significantly decreases their chances of a successful outcome. A similar
recommendation regarding coffee-drinking has also been reported. For these reasons, these lifestyle
habits must be avoided during an IVF try. More information >>

How much will I prepare for one IVF attempt in CARMI?

The average cost of one IVF cycle in CARMI should be around P250,000 to P300,000 unless certain other
services were added to the specific programs. These rates are the lowest in the country and are
comparable to the rates in Taiwan, Vietnam, and Thailand. All this for top-of-the-line services and
excellent success rates. More information >>

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is a fertility procedure in which sperm are washed, concentrated and
injected directly into a woman's uterus. In natural intercourse, only a fraction of the sperm make it up
the woman's genital tract. IUI increases the number of sperm in the fallopian tubes, where fertilization
takes place. IUI may be done in a natural cycle, but is commonly performed with fertility medications to
enhance ovulation. Thus, for the infertility couple, IUI is commonly performed as a low-tech, cost-
effective approach to enhancing their fertility. More information >>

When is IUI recommended?

IUI is typically the first procedure utilized if a woman cannot conceive either naturally or with the use of
fertility medications alone. It may be recommended for several diagnoses of infertility, some of which
include:

•Issues with cervical mucus

•Unexplained Infertility

•Ovulation problems, such as those that occur with polycystic ovarian syndrome (PCOS)

•Mild male factor infertility

•Mild endometriosis

Intrauterine insemination is not considered to be an effective treatment for:

•Blocked fallopian tubes or tubal damage

•Ovarian failure or lack of ovulation

•Significantly reduced ovarian reserve

•Advanced endometriosis

•Severe male factor infertility

More information >>

What are the prerequisites for IUI to be successful?

Because sperm are inseminated into the uterus, it is important that the woman has no serious fertility
problems. Prior to initiating IUI treatment, the woman must have at least one documented open
fallopian tube as demonstrated by a hysterosalpingogram (tubal dye study), and has a normal uterine
cavity.
Because IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, it is
important that tests for male infertility indicate reasonable sperm function (count, motility and
morphology). An average total motile sperm count of 10 million is the standard threshold utilized when
deciding if IUI should be considered, or, if the couple should look at other options such as in-vitro
fertilization (IVF) with Intracytoplasmic sperm injection (ICSI). More information >>

How is IUI done?

IUI is usually done with concomitant controlled ovarian stimulation using fertility medications, such as
clomiphene citrate or injected gonadotropins. IUI can be timed via ovulation induction protocols, as
when the patient’s ovulation is being monitored by her physician or, through the use of ovulation
predictor kits that the woman can do herself. Response to ovulation medication via ovarian follicle
growth (size and number of follicles) will be assessed through serial transvaginal ultrasound monitoring
(Figure 1). This will determine the proper timing for the IUI procedure.

Prior to IUI, a semen sample will be collected from the male partner through ejaculation into a sterile
container and then washed. Sperm washing refers to the laboratory technique that separates sperm
from semen, and non-motile sperm from motile sperm. Approximately 2 hours are required to process
the sperm. The IUI procedure usually takes place quickly after sperm washing has been completed.

To prepare for the IUI procedure itself, a speculum will be inserted into the woman’s vagina and then
a thin, flexible catheter, or tube, will be placed into the cervix. Washed sperm (Figure 2a) are then
injected directly into the uterus with a syringe (Figure 2b). The procedure is not uncomfortable for most
women and takes 5-10 minutes from start to finish. More information >>
What are the possible complications of IUI?

While complications of the IUI procedure itself are uncommon, they can include brief uterine cramping
and infection. Risks of controlled ovarian hyperstimulation with IUI are increased when fertility
medications are used. These include multiple pregnancy and Ovarian Hyperstimulation Syndrome
(OHSS). OHSS is a serious complication, which may result in fluid imbalance, blood clotting problems,
cardiopulmonary compromise, and rarely, even death. Thus, it is advised that IUI using controlled
ovarian stimulation protocols be handled by a competent Reproductive Endocrinology and Infertility
specialist. More information >>

How many IUIs can a couple have?

It is suggested in most clinical guidelines that 3-6 repeat cycles of IUI may be done, granting that there
are no serious causes of infertility identified. If unsuccessful, then in vitro fertilization or IVF is the next
appropriate treatment option. More information >>

What is the success rate of IUI?

With clomiphene citrate and IUI, pregnancy rates average 7% per cycle. FSH ovarian stimulation
(injectable gonadotropins) and IUI treatment have a reported pregnancy rate of 12% per cycle.
However, there may be other factors that need to be considered in predicting possible success in IUI.
These include age of the wife, quality of semen of the husband, and cause of the infertility. More
information >>
http://www.ivfphilippines.com/

IVF - In Vitro Fertilization

he core principle of IVF (Invitro Fertilization) is to accomplish in the laboratory certain physiologic
processes that normally occur in the woman's fallopian tube which are prevented by pathologic
conditions causing infertility. Many of these involve various steps resulting in fertilization and embryonic
development. Therefore, IVF in a way bypasses the pathology that results in infertility.

The basic steps in an IVF treatment cycle are (1) ovarian stimulation, (2) egg retrieval, (3) fertilization
and embryo culture, and (4) embryo transfer. During ovarian stimulation, medications or "fertility
drugs," are used to stimulate multiple eggs to grow in the ovaries rather than the single egg that
normally develops each month. Using ultrasound examinations and blood testing, the physician can
determine when the follicles are appropriate for egg retrieval. Generally, eight to 14 days are required.
When the follicles are ready, hCG or other medications are given.

Egg retrieval is done before ovulation occurs, usually 34 to 36 hours after the hCG injection. It is usually
accomplished by transvaginal ultrasound aspiration, a minor surgical outpatient procedure that is done
with some form of analgesia or anesthesia administered. The eggs are aspirated from the follicles
through the needle connected to a suction device with the guidance of an ultrasound probe inserted
through the vagina. Removal of multiple eggs can usually be completed in less than 30 minutes. In some
circumstances, one or both ovaries may not be accessible by transvaginal ultrasound and laparoscopy
may then be used to retrieve the eggs using a small telescope placed in the umbilicus.
In the phase of fertilization and embryo culture, the retrieved eggs are examined in the laboratory for
maturity and quality. Mature eggs are fertilized by micro-insemination or intracytoplasmic sperm
injection (ICSI). The next day, the eggs are evaluated for signs of fertilization and are kept under special
conditions to allow further growth and development. Depending on the program, developing embryos
may be cultured in the IVF lab for two to six days after the egg retrieval and become.embryos from 2-
cells to blastocysts.

During embryo transfer, the physician and the embryologist inform the couple about the quality and
number of available embryos and discuss the options before the couple decides on the number of
embryos for transfer. Once a decision is made, the embryologist loads the embryo/s into a transfer
catheter while the physician prepares the patient. No anesthesia is necessary, although some women
may wish to have a mild sedative. Once the catheter is prepared, it is quickly handed over to the
physician who gently guides the tip of the transfer catheter through the cervix and places the fluid
containing the embryos into the uterine cavity. The patient is then given additional medications for 2
weeks after which a serum pregnancy test is done.

In certain cases, ‘assisted hatching’ is performed among embryos just prior to their intrauterine transfer
to improve the chances for implantation. ‘Assisted hatching’ is done to help the embryo break through
the shell (zonapellucida) and is performed by a few methods, the most accepted method of which is
with the use of laser. CARMI uses this method of assisted hatching, which is generally indicated for
women over 38 years, women with repeated implantation failure, and for those with elevated FSH.

Some couples are fortunate enough to collect a fairly large number of embryos from one egg collection.
Excess viable embryos that are not transferred into the woman's uterus during the fresh treatment cycle
may be frozen in small tubes and kept in storage in the embryo laboratory for future use.
Cryopreservation allows the patient to limit the number of embryos transferred "fresh" without
discarding the unused embryos that could lead to a future pregnancy. The frozen embryos may be
‘cryopreserved’ for several years. By transferring frozen-thawed embryos into the uterus, it is possible to
achieve several pregnancies in different years from just one fresh IVF cycle.

IVF - In Vitro Fertilization ::

What is IVF?

In vitro fertilization (IVF) is a method of assisted reproduction in which a man's sperm and a woman's
eggs are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) may
be transferred to the woman's uterus, where they may implant in the uterine lining and develop. Excess
embryos may be cryopreserved (frozen) for future use. Initially, IVF was used to treat women with
blocked, damaged, or absent fallopian tubes. Today, IVF is used to treat many causes of infertility, such
as endometriosis and male factor, or when a couple's infertility is unexplained.

When is IVF indicated for an infertile couple?

IVF was initially used to treat women with blocked, damaged, or absent fallopian tubes. Today, IVF is
used to treat many causes of infertility, such as endometriosis and male factor, when a couple's
infertility is unexplained or in women with advanced maternal age where her chances for pregnancy are
rapidly declining and IVF remains as the best possible option.

What are the steps in the IVF process?

The basic steps in an IVF treatment cycle are ovarian stimulation, egg retrieval, fertilization &embryo
culture, and embryo transfer. During ovarian stimulation, medications or "fertility drugs," are used to
stimulate multiple eggs to grow in the ovaries rather than the single egg that normally develops each
month. Using ultrasound examinations and blood testing, the physician can determine when the follicles
are appropriate for egg retrieval (Figure 1). Generally, eight to 14 days is required. When the follicles are
ready, hCG or other medications are given.

Egg retrieval is done before ovulation occurs, usually 34 to 36 hours after the hCG injection. It is usually
accomplished by transvaginal ultrasound aspiration, a minor surgical outpatient procedure (Figure 2)
that is done with some form of analgesia administered. The eggs are aspirated from the follicles through
the needle connected to a suction device with the guidance of ultrasound probe inserted through the
vagina. Removal of multiple eggs can usually be completed in less than 30 minutes. In some
circumstances, one or both ovaries may not be accessible by transvaginal ultrasound and
laparoscopymay then be used to retrieve the eggs using a small telescope placed in the umbilicus. In the
phase of fertilization and embryo culture,the retrieved eggs are examined in the laboratory for maturity
and quality (Figure 3). Mature eggs are fertilized by micro-insemination or intracytoplasmic sperm
injection (ICSI). The next day, the eggs are evaluated for signs of fertilization and are kept under special
conditions to allow further growth and development. Depending on the program, developing embryos
may be cultured in the IVF lab for two to six days after the egg retrieval and become.embryos from 2-
cells to blastocysts (Figure 4).

During embryo transfer, the physician and the embryologist inform the couple about the quality and
number of available embryos and discuss the options before the couple decides on the number of
embryos for transfer. Once a decision is made, the embryologist loads the embryo/s into a transfer
catheter while the physician prepares the patient. No anesthesia is necessary, although some women
may wish to have a mild sedative. Once the catheter is prepared, it is quickly handed over to the
physician who gently guides the tip of the transfer catheter through the cervix and places the fluid
containing the embryos into the uterine cavity (Figure 5). The patient is then given additional
medications for 2 weeks after which a serum pregnancy test is done.

How long is the IVF process?

The average time that is required to complete one IVF cycle (from start of ovarian stimulation to testing
for pregnancy) is about four to six weeks, depending on the chosen ovarian stimulation protocol
appropriate for your case.

What is ICSI?
Intracytoplasmic sperm injection (ICSI) is the step in the IVF process which aims to achieve fertilization
for the collected eggs. In ICSI, a single sperm is directly injected into each mature egg (Figure 6). ICSI is
usually performed when there is a likelihood of reduced fertilization, i.e., poor semen quality, history of
failed fertilization in a prior IVF cycle, etc.

What are my chances to achieve success in an IVF cycle?

Your chances will depend on a few factors, most crucial of which are women’s age, presence of co-
morbidities (endometriosis, previous ovarian surgery), and quality of husband’s sperm). In addition,
success rates vary from center to center and between practicing clinicians. Generally, pregnancy rates
from a single IVF cycle may range from 20% to 80% depending on the clinical picture per case. Do ask
your doctor regarding your chances after full evaluation.

How do I increase my chances in IVF?

Patients themselves may help increase their chances by approaching their ideal body weight and by
avoiding avoiding certain lifestyle habits (smoking, alcohol-drinking, caffeine-drinking). Studies have
shown that women who are within normal body mass index (BMI) 20-24 kg/m2 tend to have a higher
chance of success during IVF than women who have higher or lower BMI values. Similarly, some reports
have shown that cigarette-smoking and alcohol-drinking, by either the wife or the husband especially
during the time of IVF treatment significantly decreases their chances of a successful outcome. A similar
recommendation regarding coffee-drinking has also been reported. For these reasons, these lifestyle
habits must be avoided during an IVF try.

How much will I prepare for one IVF attempt in CARMI?

The average cost of one IVF cycle in CARMI should be around P250,000 to P300,000 unless certain other
services were added to the specific programs. These rates are the lowest in the country and are
comparable to the rates in Taiwan, Vietnam, and Thailand. All this for top-of-the-line services and
excellent success rates.

http://www.stlukescarmi.com/services/ivf-invitro-fertilization

Pregnancy : IVF Revolution Thanks to the advancement of technology, many couples are given
hope for a baby. Nothing carries more stigma to a married person than being labeled as sterile
especially in a country that puts so much emphasis on family. Now, with In Vitro Fertilization,
even ‘sterile’ couples may be given the chance to become parents. Introducing IVF In Vitro
Fertilization (IVF) involves a sequence of highly coordinated steps beginning when a woman is
given hormones to stimulate her ovaries to produce large amounts of mature eggs. These eggs
are then retrieved under transvaginal ultrasound guidance. Unlike in spontaneous conception,
where the eggs are fertilized within the female’s fallopian tubes, in IVF, fertilization happens in a
container hence the term “in-vitro”. After 3 to 5 days of incubation in a special solution, the
developing embryos are then “returned” by way of the cervix into the uterus where they are
expected to grow into full-term infants in 9 months time. IVF was developed by Drs. Patrick
Steptoe and Robert Edwards with the birth of the 1st test tube baby Louise Brown in 1978.
Since then the technology has improved vastly and made so readily available that in the US
alone, as of 2005, there are 422 fertility clinics that perform IVF with 52,041 “test-tube” babies
born for that single year. In the Philippines, it was only in 1996 that the 1st IVF center, RM lab,
was established with the subsequent birth of their 1st IVF baby that same year. But even before
1996, Filipino couples with infertility problems had been going to the United States and other
nearby Asian countries like Singapore for the procedure. Presently, there are 2 centers in the
country, RM lab and Victory ART, both located in Metro Manila that offer IVF and other forms of
assisted reproductive technology. In Singapore, the In Vitro Fertilization program began in 1982
with the commitment to improve fertility and management through Assisted Reproductive
Techniques (ART). The IVF technology in Singapore has the latest emphasis on extended
embryo culture, thus it has maintained a clinical pregnancy rate of 38% per embryo transfer.
The cost for this procedure could reach as much as Singapore $8,000 or Php 240,000.00.
Indications Initially, IVF was only performed on women with severe tubal disease, where both
fallopian tubes are blocked resulting from a previous infection, advanced stages of
endometriosis or bilateral tubal ligation or those whose tubes have been surgically removed for
ectopic pregnancies. Presently the use of IVF has expanded so broadly that it is offered as
management for almost all causes of infertility including severe male factor infertility (low or no
sperms, poor sperm motility and poor sperm morphology) and unexplained infertility (all
laboratory test show normal results and yet the couple has difficulty conceiving). With IVF,
women who a few years back were written off as incapable of bearing children of their own have
now been given that possibility, these include those with premature ovarian failure or women
aged over 40 with poor ovarian reserve. We have heard about grandmothers becoming mothers
again. Women diagnosed with cancer or other medical disorder facing imminent treatment
(chemotherapy or radiotherapy) that pose a serious threat to their future fertility may have their
eggs harvested, fertilized and frozen before treatment may begin and subsequently reimplanted
after treatment is completed. Women with no functional uterus as a result of congenital
anomalies or surgery (hysterectomy) may still be afforded the opportunity to have their own
genetic offspring of embryos to the uterus of gestational surrogate. IVF has revolutionized the
way couples may become parents. Success rates Success rates of the different IVF programs
are usually given as pregnancy and delivery rates. There is a difference between the two.
Delivery rates are also commonly termed “take-home-baby” rates. High numbers of the latter is
what centers try to attain and what couples want. The overall live birth rate in the U.S. is about
27% per cycle (33% pregnancy rate). Live birth rates among the different centers may vary
widely depending on a lot of factors but range between 30 to 40% per cycle. Not all women who
undergo IVF will become pregnant and of those who do become pregnant not all will end up
with full-term babies. Approximately 18% will result in miscarriages, stillbirths or ectopic
pregnancies. The chances of a successful pregnancy vary widely based on the age of the
woman or, more precisely, on the age of the eggs involved, for women under 35, the pregnancy
rate is approximately 43% per cycle (and a 37% live birth rate), while for women over 42, the
rate falls drastically to only 4%. Other factors that determine success rates include the quality of
the eggs and sperm, the duration of the infertility, the health of the uterus and the medical
expertise. IVF is a laboratory-dependent process so success rates will also depend a lot on the
technical skill of the center and the people involved. Complications Like all other medical
procedures, IVF has its risks and complications. The major complication of IVF is the risk of
multiple births (twins, triplets etc.). This is directly related to the practice of transferring multiple
embryos to improve the chances for a successful pregnancy especially among older patients.
With multiple pregnancies, the mother is at risk for developing hypertension, diabetes mellitus,
anemia and heart failure.. It also increases the chances for surgical intervention such as
cesarean delivery. Infants of multiple pregnancies are more likely to be born premature and with
lower birth weight which increases the risk for neonatal morbidity and mortality and possible
long term damage. Coupled with the increased risk for complications is the increased financial
burden and psychological stress on both partners. Because of the risks of multiple pregnancy to
the mother, the American Society for Reproductive Medicine recommends that women under
age 35 have no more than two embryos transferred, women age 35 to 37 have no more than
three, women 38 to 40 have no more than four transferred, and women who have had repeated
failed cycles or are over age 40 have no more than five embryos transferred. While the National
Collaborating Centre for Women’s and Children’s Health in the United Kingdom recommends
the transfer of no more than two embryos per cycle. Other complications include, ectopic
pregnancy, which is the abnormal location of the developing embryo and ovarian
hyperstimulation syndrome, where fluid and proteins accumulate within the abdomen of the
patient. Both situations may be life-threatening to the mother. Costs IVF maybe widely used as
a treatment option for most cases of infertility but unfortunately the financial cost makes it
beyond the reach of most couples particularly those in developing countries like the Philippines.
The average cost of an IVF cycle in the U.S. is $12,400, according to the American Society of
Reproductive Medicine. Here, couples should expect to spend roughly between Php 200,000 to
400,000 for every try. The cost covers the medications, laboratory and doctor’s fees. This price
will vary depending on the age of the woman, the amount of medications required, and the
number of IVF cycles. What the amount does not cover are the other incidental expenses that
may be incurred especially if the couple resides outside of Metro Manila or intends to have the
procedure done outside of the country, like airfares, hotel accommodations and living
allowances. Controversies Since the birth of Louise Brown almost 30 years ago, IVF has been
mired in controversy, even when huge strides in the improvement of the technology have been
made. The procedure has both its champions and its critics. In the process of In Vitro
Fertilization, egg cells, sperms and later the embryos are incubated in solutions that closely
resemble those produced by the human body, yet the question as to whether exposure of
embryos to these ‘unnatural’ substances increases the potential for birth defects among infants
conceived by IVF remains a valid concern to potential parents. A systematic review of the
different studies published reveal that the number of birth defects among babies conceived by
IVF is no higher than those found in the general population. Studies also show that physical and
psychomotor development of ‘IVF’ babies is comparable to their naturally conceived
counterparts. As to the long-term risk for the development of cancer is still something to be
studied and determined for the oldest of these ‘test-tube’ children are still in their 3rd decade of
life. So far, the available data paints a reassuring picture about the health and welfare of
children born by assisted reproductive technology. To assure a successful pregnancy only the
best embryos are chosen from a legion of many and if multiple embryos remain after
transferring 2 or 3, the rest are frozen. Those embryos are placed in liquid nitrogen and can be
preserved for a long time, the process is called cryopreservation. Currently, there are 500,000
frozen embryos in the United States. The advantage of storing unused embryo is that patients
who fail to conceive may become pregnant using such embryos. Or, if pregnancy occurred, they
could come back later for another pregnancy without having to go through a full IVF cycle.
Subsequent pregnancy attempts turn out to be cheaper. Unfortunately much controversy
surrounds how embryos are handled from the initial quality control to the final fate of frozen
embryos, when the couple finds no need for them. Although, there have been suggestions to
use these discarded or frozen embryos for medical research, particularly stem cell research,
their use for such purposes still remains a debatable issue. It is hoped that as the technology
evolves and experts continue to refine the procedure there will be less and less need to fertilize
large number of eggs and consequently fewer embryos to store.With moral and legal
implications, another issue confounding the technology is the practice of using donor eggs,
sperms and surrogacy. The use of eggs and sperms from third party donors is employed when
either one of the couple is unfit or unable to contribute his or her germ cell and surrogacy—
when the fertilized embryos are implanted in the uterus of a third party. This arises on occasions
when a woman has no uterus or has a uterus but is unfit for the fetus to implant or her health
prevents her from supporting a pregnancy. The sale of eggs and sperms and the use of “uterus-
for-hire” are discouraged but unfortunately due to the enormous demand from couples in
developed countries and the lack of implementing laws in most countries, the illegal trade has
become a multi-million business with most sellers and surrogates coming from third world
countries. IVF like any other medical breakthrough, when done correctly and for the right
reasons, can and should improve the lives of many. SOURCES: Clinical Gynecologic
Endocrinology and infertility; 7th edition; Speroff, L and Fritz, M. Fertility: assessment and
treatment for people with fertility problems; National Collaborating Centre for Women’s and
Children’s Health, 2004. Novak’s Gynecology, 14th edition; Berek, J. Centers for Disease
Control, official website (www.nuh.com.sg) - See more at: http://www.asianhospital.com/health-
digest/pregnancy-ivf-revolution/#sthash.famqQj8M.dpuf

Law

Conceived on a Sunday

AS EASY AS ABC By Alex B. Cabrera (The Philippine Star) | Updated April 5, 2015 - 12:00am

4 22 googleplus1 6

While enjoying their vacation in the US, the last thing she expected from her 10-year-old son was a
question she hoped would never be asked: “‘Nay, is it true what Ate said? That I am not your real son,
that I am just ampon?”

Her eyes were suddenly tearful, as she stood frozen by the bathroom door. She was speechless for 15
seconds, which felt like an eternity before she finally uttered: “You are not my son by birth, but you are
so much more... you are my son...by choice!”
What I shared is a conversation that has really transpired, and many more poignant and challenging
conversations like this will happen at homes. But they will not break the bonds between parent and
child. Adoption completes a family, and saves and grants new lives.

The question we pose this Sunday touches on surrogacy. If adoption is an international human norm,
should the process of hiring surrogate mothers be looked upon with disdain, even criminalized, as one
locally proposed legislation suggests?

Surrogate mothers conceive, and carry babies who they will have to give up at birth in favor of the
genetic parents, for a fee. So the stark difference with adoption as we know it is that there is a contract
to deliver the child even before the child is born. Stated otherwise, the child would not have been
conceived had it not been for the wishes of parents who wanted a child from their genetic line and are
not able to have one naturally.

There are countries that recognize surrogacy arrangements as legal. Some don’t. Invariably, the issue
that comes to court even on these pre-contracted conceptions is this: Who has greater parental
authority between the birth mother and the genetic parent? For instance, in the US, the surrogate
mother who developed much attachment to the baby she bore refused to give up the baby and was
granted joint custody with the genetic mother. In another case in the UK, the surrogate mother refused
to give up the baby upon learning that the genetic parent has violent tendencies. The surrogate mother
feared for the safety of her baby and won the court case to retain her daughter.

Business ( Article MRec ), pagematch: 1, sectionmatch: 1

Surrogacy is largely practiced, and nowadays, there are even websites (legal or not) that advertise
surrogate mothers, describe their state of health and hobbies, age and experience with bearing a child.
It should be noted that even in some countries where surrogacy is allowed, soliciting or brokering for
surrogacy is criminalized. This only shows how this complex phenomenon has turned into an industry.

In the Philippines, the contract of surrogacy is not expressly stated as illegal. Some are of the legal
opinion that a female’s reproductive system or parts thereof are beyond the commerce of men. I view
surrogacy, however, in the genre of a service contract, the validity of which may lie in whether the
service is right or wrong. Although not listed in the law, I would classify surrogacy as an unenforceable
contract. This means that if you have paid for it and go to court to enforce it, you will lose because our
laws will only consider the birth mother as the parent unless parental rights and authority are
transferred by process of adoption. But if no one complains, it is ratified. Still, the right process should
be to legally adopt the child you have contracted to be conceived by a surrogate. We are not unaware,
however, of the shortcut process that after delivery—the names of the genetic parents are immediately
placed on the birth certificate of the child.

It may surprise you that the Philippine law is not completely zero in recognizing reproductive
technologies, when used by spouses without involving a surrogate mother. In Article 164 of the Family
Code, the child is considered legitimate even if the wife was artificially inseminated with the sperm of a
donor. The spouses should simply put this arrangement in writing before the child is born. Article 164
refers to artificial insemination (AI). It was obviously written before in vitro fertilization (IVF) technology.
With IVF it is possible for the wife, if needed, to receive sperm as well as egg donations. The egg and
sperm of third-party donors are fertilized in a laboratory and the developed embryo is then placed in the
womb of the wife. So technically, in an IVF where the wife received egg donation, the child of the legally
married couple will be considered illegitimate under Article 164. Our Constitution protects the child
from conception, but it is a promise that cannot be fulfilled without fresh legislation.

A surrogate mother can be impregnated through AI or IVF. A recent spat between two international
celebrities brought to light just recently the very human issues in surrogacy. The fashion icon who
referred to IVF technology as producing “synthetic” babies said certain things should not be changed
such as a baby being born out of a husband-and-wife relationship. The pop icon replied that IVF is a
miracle that fulfilled dreams of legions to have children of their own. And a reply was made
electronically, apparently from the “synthetic children”, in so many words: “Where is our mother?”

This Easter and in this article, I struggle between legal technicalities and my faith that would not look
kindly on these new reproductive methods. Although I am unworthy, I cannot help but think that all that
has life comes from God; that in the final judgment, our Creator will count less the steps how life was
brought about, but will look more on how much that life has been nurtured, respected, and protected
by the persons the child call as parents. A very happy and meaningful Easter Sunday to all my readers.

* * *

Alexander B. Cabrera is the chairman and senior partner of Isla Lipana & Co./PwC Philippines. He also
chairs the tax committee of the Management Association of the Philippines (MAP). Email your
comments and questions to aseasyasABC@ph.pwc.com. This content is for general information
purposes only, and should not be used as a substitute for consultation with professional advisors.

http://www.philstar.com/business/2015/04/05/1440375/conceived-sunday

The "RH Act" (2012) in brief

The Responsible Parenthood and

Reproductive Health Act of 2012
 This is an outline of The Responsible Parenthood and Reproductive Health Act of 2012.
 It sets out the sections that are of particular interest to freedom of conscience issues.
o Text of the law is on the left, Project comment on the right.
o Researchers should consult the full text of the law.
 Red Text identifies parts of the Act struck down by the Supreme Court of the Philippines in April,
2014. Mouseover the red text to see annotation in the right column.
o Supreme Court Decision, April, 2014

SEC. 1. Title

SEC. 2. Declaration of Policy

Text Project Comment

The State recognizes and guarantees the
1. A universal basic human right must
human rights of all persons, including their
pertain to "all persons." This includes single
right to equality and nondiscrimination of
people. It must aslo include everyone without
these rights, the right to sustainable human
consideration of preferences in sexual
development, the right to health which
includes reproductive health, the right to
education and information, and the right to
choose and make decisions for themselves in
accordance with their religious convictions,
ethics, cultural beliefs and the demands of
responsible parenthood. . .
. . .it is the duty of the State to protect and
strengthen the family as a basic autonomous
social institution and equally protect the life
of the mother and the life of the unborn from
conception. The State shall protect and
promote the right to health of women
especially mothers in particular and of the
people in general and instil health
consciousness among them. The family is the
natural and fundamental unit of society. The
State shall likewise protect and advance the
right of families in particular and the people
in general to a balanced and healthful
environment in accord with the rhythm and
harmony of nature.
The State also recognizes and guarantees the
promotion and equal protection of the welfare
and rights of children, the youth and the
unborn.
Moreover, the State recognizes and
guarantees the promotion of gender equality,
gender equity, women empowerment and
dignity as a health and human rights concern
and as a social responsibility. The
advancement and protection of women's
human rights shall be central to the efforts of
the State to address reproductive health care.
partners.
2. No one can be said to have a right to
health or to reproductive health, since this
would mean that someone suffering from
influenza or congenital sterility is the victim
of a violation of human rights violation.
3. Presumably, the legislators did not mean
to absolutize the notion of a "right to choose
and make decsions", since many choices and
decisions are legitimately prohibited by law.
4. The section implies that the legislators
recognize freedom of conscience, but this is
not evident in the sections that follow.
5. No person and no family is, in fact,
autonomous.
6. "Family" is undefined. It is later said that
marriage is the foundation of the family. The
context and typical usage elsewhere in the
Act suggests that "family" is understood to
refer to a husband, wife and
children. However, the Act does not
associate reproductive health, sexual health
and childbearing with marriage, so the notion
of "family" as it relates to these subjects
appears to be elastic. See Comment 13.
7. Political/ideological concepts and
terminology are transformed into "health
concerns."
8. Provisions related to "gender" have been
revised to preclude the suggestion of
additional "genders" invented by activists
who identify themselves or others as
something thing than male or female. This
 has reduced the likelihood of conflicts of
conscience arising from contested gender
claims.
The State recognizes marriage as an
inviolable social institution and the
foundation of the family which in turn is the
foundation of the nation. Pursant thereto, the
State shall defend:

a) The right of spouses to found a

family in accordance with their
9. Defend, but not guarantee.
religious convictions and the demands
of responsible parenthhhod;
b) The right of children to assistance,
including proper care and nutrition, and
special protection from all forms of
10. Defend, but not guarantee.
neglect, abuse, cruelty, exploitation and
other conitions prejudicial to their
development;
c) The right of the family to a family
11. Defend, but not guarantee.
living wage and income; and
d) The right of families or family
associations to participate in the
12. Defend, but not guarantee.
planning and implementation of
policies and programs that affect them.
The State likewise guarantees universal
access to medically-safe, non-abortifacient,
effective, legal affordable and quality 13. The state is to be the guarantor of
reproductive health care services, methods, "universal access" to reproductive health care
devices, supplies which do not prevent the services, as further defined in Section
implantation of a fertilized ovum as 4(q). "Universal access" and subsequent
determined by the Food and Drug references to individuals, couples and persons
Administration (FDA) and relevant indicates that the guarantee extends to single
information and education thereon according people, unmarried couples and those who
to the priority needs of women, children and identify themselves as homosexual. See
other underprivileged sectors, giving Comment 6.
preferential access to those idientified through
the National Househlold Targeting System for 14. No similar State guarantee is offered with
Poverty Reduction (NHTS-PR) and other respect to other forms of health care, such as
government measures of identifying palliative care, even in the National Health
marginalization, who shall be volunatry Insurance Act.
beneficiaries of reproductive health care,
services and supplies for free.
 15. "Infringement" need not imply actual
violation. This has implications for the
The State shall eradicate discriminatory
public expression of religious beliefs in
practices, laws and policies that infringe on a
words or in actions. The adverse effect of
person's exercise of reproductive health
this section on freedom of conscience and
rights.
religion may be amplified by Section
27. See Comment 51.

16. What constitutes "a truly humane" way

The State shall also promote openness to life:
to raise children is not defined in the
Provided, That parents bring forth to the
law. Parents who are found to have
world only those children whom they can
violated this obligation can be fined or
raise in a truly humane way.
imprisoned. See Section 24.

SEC. 3. Guiding Principles for Implementation

This Act declares the following as guiding principles:

a) The right to make free and informed

decisions, which is central to the exercise of
any right, shall not be subjected to any form
of coercion and must be fully guaranteed by
the State like the right itself;

b) Respect for protection and fulfillment of

reproductive health and rights which seek to
promote the rights and welfare of every
person, particularly couples, adult
individuals, women and adolsecents;

d) The provision of ethical and medically

safe, legal, accessible, affordable, non-
abortifacient, effective and quality
reproductive health care services and supplies
is essential in the promotion of people's right
to health, especially those of women, the poor
and the marginalized, and shall be
incorporated as a component of basic health
care;
17. "Non-abortifacient" must be understood
to include services, drugs and devices that do
not cause abortions, cause the death of an
implanted embryo or fetus, and that do not
cause the death of an embryo before
implantation. See the definition of
"abortifacient" in Section 4(a).

g) The provision of reproductive health care,

information and and supplies. . must be the
primary responsibilty of the national government
consistent with its obligation to respect, protect
and promote the right to health and the right to
life;

h) The State shall respect individuals'

preferences and choice of family planning
18. The significance of the qualification is
methods that are in accordance with their
unclear, since it seems to imply that the State
religious convictions and cultural beliefs, taking may have contrary obligations under
into consideration the State's obligations under unspecified "human rights instruments."
various human rights instruments;

i) Active participation by nongovernment

organizations (NGOs) women's and people's
organizations, civil society, faith-based
organizations, the religious sector and
communities is crucial to ensure that
reproductive health and population and
development policies, plans and programs will
address the priority needs of women, the poor
and the marginalized;

k) Each family shall have the right to determine

its idela family size; Provided, however, That the
State shall equip each parent with the necessary
information on all aspects of family life, including
reproductive health and responsible parenthood
in order to make that determination;

l) There shall be no demographic or populaiton

targets and the mitigation and/or stabilization of
the population growth rate is incidental to the
advancement of reproductive health;

m) Gender equality and women empowerment

are central elements of reproductive health and
population and developmenet;

SEC. 4. Definition of Terms

For the purposes of this Act, the following terms shall be defined as follows:

a) Abortifacient refers to any drug or device that
induces abortion or the destruction of a fetus
inside the mother's womb or the prevention of
19. "Abortifacient" is defined to include
surgical abortion, abortions induced by
drugs or devices, and embryocides (drugs or
devices that kill an embryo before
the fertilized ovum to reach and be implanted in
the mother's womb upon determination of the
FDA;
e) Family planning refers to a program which
enables couples and individuals to decide freely
and responsibly the number and spacing of their
children and to have the information and means
to do do so, and to have access to a full range of
safe, affordable, effective, non-abortifacient
modern natural and artificial methods of planning
pregnancy;
g) Gender equality refers to the principle of
equality between men and women and equal
rights to enjoy conditions in realizing their full
human potential. . .
h) Gender equity refers to the policies,
instruments, programs and actions that address
the disadvantaged position of women in socity
by providing preferential treatment . . .
i) Modern methods of family planning refers
to safe, effective, non-abortifacient and legal
methods, whether natural or artificial, that are
registered with the FDA to plan pregnancy.
n) Public health care service provider refers
to (1) public health care institution, which is
duly licensed and accredited and devoted
primarily to the maintenance and operation fo
facilities for health promotiion, disease
prevention, diagnosis, treatment and care of
individuals suffering from illness, disease,
injury, disability or deformity, or in need of
obstetrical or other medical and nursing care;
(2) public health care professional, who is a
doctor of medicine, a nurse or a midwife; (3)
implantation).
However, it is up to the Philippines Food
and Drug Agency to determine the
mechanism of action of a drug or
device. Classifications and descriptions
provided by the American Food and Drug
Administration have been on ongoing cause
of controversy in the United States.
20. Notwithstanding the emphasis placed on
the family and marriage, this implies that
individuals and unmarried couples have a
"right" to have children, which, under Section
2, is guaranteed by the State.
21. The terms "gender equality" and
"gender equity" are defined in a way that
precludes the suggestion of additional
"genders" invented by activists who identify
themselves or others as something thing
than male or female. This is one of the
significant revisions made to earlier drafts
of the legislation.
22. Presumably, professionals in private
practice or employed by private or
denominational institutions would not be
considered "public health care service
providers."
public health worker engaged in the delivery
of healthcare services; or (4) barangay health
worker who has undergone training programs
under any accredited govenrment and NGO
and who voluntarily renders primarily health
care services in the community after haivng
been accredited to function as such by the
local health board . .

p) Reproductive Health (RH) refers to the

state of complete physical, mental and social
well-being and not merely the absence of
disease or infirmity, in all matters relating to
the reproductive system and to its functions
and processes. . .

q) Reproductive health care refers to the

access to a full range of methods, facilities,
services and supplies that contribute to
reproductive health and well being by 23. The definition includes various forms of
addressing reproductive health related artificial reproduction, such as in vitro
problems. It also includes sexual health, the fertilization.
purpose of which is the enhancement of life
and personal relations. . . .

r) Reproductive health care program refers to

the systematic and integrated provision of 24. A program would presumably include
reproductive health care all citizens, various forms of artificial reproduction, such
prioritizing women, the poor, marginalized as in vitro fertilization, as noted above.
and those in vulnerable or crisis situations.

25. This implies that individuals and

s) Reproductive health rights refers to the
rights of individuals and couples to decided
freely and responsibly whether or not to have
children; the number, spacing and timing of
their children, to make other decisions
concerning reproduction, free of
discrimination, coercion and violence; to have
the information and means to do so, and to
attain the highest standard of sexual health and
reproductive health; Provided, however That
reproductive health rights do not include
abortion, and access to abortifacients;
unmarried couples have a "right" to have
children, which, under Section 2, is
guaranteed by the State. It follows from the
text of the statute that this "right" includes a
right to artificial reproduction as per Section
4(q), also guaranteed by the State.
26. Moreover, since neither "individuals" nor
"couples" is further qualified, the Act implies
that homosexual individuals or couples have a
right to have children by means of artificial
reproduction, and that this right is guaranteed
by the State under Section 2.

27. The right does not inlcude a right to


w) Sexual health refers to a state of physical,
mental and social well being in relation to
sexuality. It requires a positive and respectful
approach to sexuality and sexual relationships,
as well as the possibility of havng pleasurable
and safe sexual experiences, free from
coercion, discrimination and violence.
SEC. 5. Hiring of Skilled Health Professionals for Maternal Health Care and Skilled Birth Attendance
SEC. 6. Health Care Facilities
SEC. 7. Access to Family Planning
All accredited public health facilities shall
provide a full range of modern family
planning methods, which shall also include
medical consultations, supplies and necessary
and reasonable procedures for poor and
marginalized couples having infertililty issues
who desire to have children:
Provided That family planning services shall
likewise be extended by private health
facilities to paying patients with the option to
grant free health care and services to
indigents,
except in the case of non-maternity speciality
hospitals and hospitals owned and operated by a
religious group, but they have the option to
provide such full range of modern family
planning methods.
Provided further, That these hospitals shall
immediately refer the person seeking such care
and services to another health facility which is
conveniently accessible: Provided finally, That the
abortion or to what the Philippines Food and
Drug Agency declares to be abortifacient or
embryocidal drugs and devices. [See Section
4(a)]
28. No reference here to sexuality within the
context of marriage and family life.
29. The requirement to provide assistance to
"couples . . . who desire to have children"
appears to contradict Sections x and y, which
guarantee that individuals also have a right to
determine the number and spacing of their
children.
30. Legislators may have intended that
private health care facilities be required to
offer "a full range of modern family planning
services" to paying clients, but that is not
what the Act says. Similarly, legislators may
have intended that private facilities could
offer free reproductive health care to
"indigents," but, once more, that is not what
the Act says.
31. This passage indicates that the whole of
Section 7 is intended to refer to a "full range
of modern family planning methods" and
"reproductive health care.' Non-maternity
specialty and denominational hospitals may
provide such services, but are not required to
do so.
32. However, a hospital that refuses to
provide a "full range" of family planning or
reproductive health services must
"immediately refer" patients to another
person is not in an emergency condition or
serious case as defined in Republic Act No. 8344.
No person shall be denied information and access
to famly planning services, whether natural or
artificial: Provided, That minors will not be
allowed access to modern methods of family
planning without written consent from their
parents or guardians, except when the minor is
already a parent or has had a miscarriage.
SEC. 8. Maternal Death Review and Fetal and Infant Death Review
SEC. 9. The Philippine National Drug Formulary System and Family Planning supplies
The National Drug Formulary shall include
hormonal contraceptives, intrauterine devices,
injectables and other safe, legal, non-
abortifacient and effective family planning
products and supplies. . .
. . . These products and supplies shall also be
included in the regular purchase of essential
medicines and supplies of all national
facility that will do so. This suppresses
freedom of conscience on the part of those
who object to referral because it makes them
complicit in the act that follows.In April,
2014, the Philippines Supreme Court ruled
that this provision was an unconstitutional
violation of freedom of conscience.
33. Further: that facility must be
"conveniently accessible." The law does not
explicitly state what is required if another
facility is not conveniently accessible.
34. However, the statement that "no person
shall be denied. . . access to family planning
services," read in conjunction with Section
27, invites the conclusion that if another
facility is not conveniently accessible, the
objecting institution must provide the morally
contested service.In April, 2014, the
Philippines Supreme Court ruled that this
provision was an unconstitutional violation of
freedom of conscience.
35. Refusing to refer a patient leaves the
persons responsible and officers of the
institution liable to imprisonment for one to
six months, a fine of up to 100,000 pesos, or
both.In April, 2014, the Philippines Supreme
Court ruled that this provision was an
unconstitutional violation of freedom of
conscience. [Section 24]
36. Section 9 of the Act is
incoherent. Intrauterine devices and
injectables are known to act by preventing the
implantation of an embryo, and are thus
forbidden by Section 4(a) of the Act, but this
section requires that they be kept in stock.
37. This is the first and only time that
"emergency contraceptive pills" and
"postcoital pills" are mentioned in the
hospitals. Provided further, That the foregoing
offices shall not purchase or acquire by any
means emergency contraceptive pills, postcoital
pills, abortifacients that will be used for such
purpose and their other forms or equivalent.
Act. This section appears to equate them to
abortifacients or embryocides, a classification
that is hotly disputed. This section also
appears to preclude their approval by the
Philippines FDA under Section 4(a), since
the products are not described in the Act by
mechanism of action. Finally, "other forms
or equivalent" can include regular hormonal
contraceptives, since some of these can be
prescribed in ways that cause them to act like
postcoital interceptives.

SEC. 10. Procurement and Distribution of Family Planning Supplies

SEC. 11. Integration of Responsible Parenthood and Family Planning Component in Anti-Poverty
Programs

SEC. 12. PhilHealth Benefits for Serious and Life-|Threatening Reproductive Health Conditions

SEC. 13. Mobile Health Care Service

SEC. 14. Age and Development Appropriate Reproductive Health and Sexuality Education

SEC. 15. Certificate of Compliance

No marriage license shall be issued by the Local
Civil Registrar unless the applicants present a
Certificate of Compliance issued for free by the
local Family Planning Office certifying that they
had duly received adequate instructions and
information on responsible parenthood, family
planning, breastfeeding and infant nutrition.
38. Only those who plan to marry are
required to obtain certificates. Those who
plan to have children out of wedlock or who
have extramarital sex are exempt from the
requirement to attend State classes on
responsible parenthood, family planning,
breastfeeding and infant nutrition.

SEC. 16. Capability Building of Barangay Health Workers

SEC. 17. Pro Bono Services for Indigent WomenIn April, 2014, the Philippines Supreme Court ruled that
"conscientious objectors are exempt from this provision as long as their religious beliefs and
convictions do not allow them to render reproductive health service, pro bona or otherwise."

SEC. 18. Sexual And Reproductive Health Programs For Persons With Disabilities (PWDs)

SEC. 19. Duties and Responsibilities

a) Pursuant to the herein declared policy, the
DOH shall serve as the lead agency for the
implementation of this Act and shall integrate in
their regular operations the following funcitons.

1) Fully and efficiently implement the

reproductive health care program;
2) Ensure people's access to medically
safe, non-abortifacient, legal, quality
and affordable reproductive health
goods and services; and
3) Perform such other functions
necessary to attain the purposes of this
Act.
b) The DOH, in coordination with the PHIC,
as may be applicable, shall:
1) Strengthen the capacities of health
regulatory agencies to ensure safe, high
quality, accessible and affordable
reproductive health services and
commodities with the concurrent
strengthening and enforcement of
regulatory mandates and mechanisms;
39. The requirement to "ensure people's
access" may be used as an excuse to suppress
freedom of conscience among those who
object aspects of the programme.
40. This is the first reference to "reproductive
health goods and services," a term that is
presumably related to but broader than the
defined terms "reproductive health" and
"reproductive health care."
41. A blanket warrant to act.
42. DOH: Department of Health
PHIC: Philippines Health Insurance
Corporation
43. This section appears to require
professional regulators to develop policies,
regulations and codes of ethics that can be
used to force objecting health care workers
and institutions to comply with the Act.

SEC. 20. Public Awareness

SEC. 21. Reporting Requirement

SEC. 22. Congressional Oversight Committee on Reproductive Health Act

SEC. 23. Prohibited Acts

The following acts are prohibited:

(a) Any healthcare service provider, whether

public or private, who shall:In April, 2014,
the Philippines Supreme Court ruled that this
provision was an unconstitutional violation of
freedom of conscience "insofar as [it]
punish[es] any healthcare service provider
who fails and or refuses to disseminate
information regarding programs and services
on reproductive health regardless of his or her
religious beliefs."

(1) Knowingly withhold information or 44. Objectors who have drawn attention to
restrict the dissemination thereof, or potentially abortifacient or embryocidal
intentionally provide incorrect information effects of drugs and devices have sometimes
regarding programs and services on been accused of providing
reproductive health, including the right to "misinformation." Those who have refused to
informed choice and access to a full range of facilitate procedures to which they object by
legal, medically-safe non-abortificent and offering contact information for a service
effective family planning methods; provider have been accused of withholding
information.
(2) Refuse to perform legal and medically-
safe reproductive health procedures on any
person of legal age on the ground of lack of
consent or authorization of the following
persons in the following instances:
(i) Spousal consent in case of married
persons: Provided, That in case of
disagreement, the decision of the one
undergoing the procedure shall prevail; and
(ii) Parental consent or that of the person
exercising parental authority in the case of
abused minors, where the parent or the person
exercising parental authority is the
respondent, accused or convicted perpetrator
as certified by the proper prosecutorial office
of the court. In the case of minors, the written
consent of parents or legal guardian or, in
their absence, persons exercising parental
authority or next-of-kin shall be required only
in elective surgical procedures and in no case
shall consent be required in emergency or
serious cases as defined in Republic Act No.
8344; and
(3) Refuse to extend health care services and
information on account of the person's marital
status, gender, sexual orientation, age,
religious convictions, personal circumstances,
or nature of work; Provided, That, the
conscientious objection of a healthcare
service provider based on his/her ethical or
religious beliefs shall be respected; however,
the conscientious objector shall immediately
refer the person seeking such care and
services to another healthcare service
provider within the same facility or one which
is conveniently accessible who is willing to
provide the requisite information and
services; Provided, further, That the person is
not in an emergency condition or serious case
as defined in Republic Act 8344 which
penalizes the refusal of hospitals and medical
clinics to administer appropriate initial
medical treatment and support in emergency
and serious cases.In April, 2014, the
Philippines Supreme Court ruled that this
provision was an unconstitutional violation of
freedom of conscience "insofar as [it]
punish[es] any healthcare service provider
who fails and/or refuses to refer a patient not
in an emergency or life-threatening case, as
defined under Republic Act No. 8344, to
another health care service provider within
the same facility or one which is conveniently
accessible regardless of his or her religious
beliefs."
45. The Act asserts that unmarried persons,
and those identifying themselves as
homosexual have a right to artificial
reproduction as well as various forms of birth
control. However, some health care workers
decline, for reasons of conscience, to provide
such services. They are motivated by a wish
to avoid complicity in perceived wrongdoing,
not by personal characteristics of the
patient. This section does not protect them,
because it erroneously presumes that
conscientious objection is motivated only by
discriminatory attitudes.
46. The exemption is limited to a refusal for
reasons set out in Section 23(3). No
exemption is permitted for moral objections
to contentious procedures or services.
Further: some health care workers consider
referral to be unacceptable because it makes
them morally complicit in an act they believe
to be wrong.
47. Refusing to refer a patient leaves the
persons responsible and officers of the
institution liable to imprisonment for one to
six months, a fine of up to 100,000 pesos, or
both. [Section 24]

(b) Any public officer, elected or appointed,

specifically charged with the duty to
implement the provisions hereof, who,
personally or through a subordinate, prohibits
or restricts the delivery of legal and
medically-safe reproductive health care
services, including family planning; In April,
2014, the Philippines Supreme Court ruled
that this provision was an unconstitutional
violation of freedom of conscience "insofar as
[it] punish[es] any public officer who refuses
to support reproductive health programs or
shall do any act that hinders the full
implementation of a reproductive health
program, regardless of his or her religious
beliefs." or forces, coerces or induces any
person to use such services; or refuses to
allocate, approve or release any budget for
reproductive health care services, or to
support reproductive health programs; or shall
do any act that hinders the full
implementation of a reproductive health
program as mandated by this Act;In April,
2014, the Philippines Supreme Court ruled
that this provision was an unconstitutional
violation of freedom of conscience "insofar as
[it] punish[es] any public officer who refuses
to support reproductive health programs or
shall do any act that hinders the full
implementation of a reproductive health
program, regardless of his or her religious
beliefs."

SEC. 24. Penalties

Any violation of this Act or commission of
the foregoing prohibited acts shall be
penalized by imprisonment ranging from one
(1) month to six (6) months or a fine of Ten
thousand pesos(P 10,000.00) to One hundred
thousand pesos (P 100,000.00) or both such
fine and imprisonment at the discretion of the
competent court; Provided That, if the
offender is a public official or employee, he
/she shall suffer the accessory penalty of
suspension not exceeding one (1)year or
removal and forfeiture of retirement benefits
depending upon the gravity of the offense
after due notice and hearing by the
appropriate body or agency.
48. Health care providers who refuse to
provide or refer for a full range of
reproductive health services, including
artificial reproduction and contraceptives, are
liable to one six months imprisonment, or a
fine of up to 100,000 pesos, or both.In April,
2014, the Philippines Supreme Court ruled
that this provision was an unconstitutional
violation of freedom of conscience.
49. The same penalties are applicable to
parents who give birth to children despite
being unable to raise them in a "truly
humane" way.

If the offender is a juridical person, the

penalty shall be imposed upon the president
or any responsible officer. An offender who is
50. In the case of objecting denominational
an alien shall, after service of sentence, be
institutions, it appears that religious leaders
deported immediately without further
could be imprisoned and/or fined, depending
proceedings by the Bureau of Immigration. If
upon their relationship to the institution.
the offender is a pharmaceutical company, its
agent and/or distributor, their license or
permit to operate or conduct business in the
Philippines shall be perpetually revoked, and
a fine triple the amount involved in the
violation shall be imposed.

SEC. 25. Appropriations

SEC. 26. Implementing Rules and Regulations

SEC. 27. Interpretation Clause

This Act shall be liberally construed to ensure
the provision, delivery and access to
reproductive health care services, and to
promote, protect and fulfill women's
reproductive health and rights.
51. This section is likely to be used to justify
suppression of freedom of conscience among
health care workers. See Comment 15.

SEC. 28. Separability Clause

SEC. 29. Repealing Clause

SEC. 30. Effectivity

http://www.consciencelaws.org/law/commentary/legal055-005.aspx#SEC._2.