By Lisa Ante Pangan
Infertility has become less and less of a taboo in recent years. Nevertheless, for the affected couples, talking about the situation can be very difficult as it is a very intimate topic no one wants to discuss openly about. Although sexual education is part of the curriculum in schools, in practice there is hardly any "fertility awareness" among many young people. Knowledge about women's menstrual cycle and the daily hormone cycle of men is little.
Fertility disorders are very common as infertility affects about one of six couples. Affected women suffer from diseases like polycystic ovary syndrome (PCOS), endometriosis, tubal disorders, or other medical problems. In recent years, a decrease in sperm quality has also been observed, which is often attributed to the unhealthy lifestyle of men.
According to the definition of the World Health Organization, after twelve months of regular unprotected sexual intercourse without the occurrence of a pregnancy, there is an involuntary childlessness. At this stage it is already recommended to look for medical support. The peak of the reproductive years of a woman is between her late teens and late 20s. By the age of 30, the ability to get pregnant starts to decline and by the age of 35, the chances of achieving a pregnancy become much lower. Many couples frequently underestimate this in their family planning and overestimate the success rate in fertility treatment like in in-vitro fertilization (IVF). Sometimes they have to go through many attempts to conceive, eventually resulting in a live birth because the pregnancy rate is 20-25% per attempt and is closely age related.
Undergoing fertility treatment is time-consuming, emotional and financially costly for the affected couples. Despite the various offered options, in-vitro fertilization (IVF) is the most complex treatment in reproductive medicine.
Working as a Filipino IVF nurse and being an artist at the same time
My career started in nursing in one of the leading IVF centers in Austria. In some countries, in addition to the qualification as a nurse, an IVF-nurse is expected to have in-depth training. In Austria, this is not yet necessary. Nevertheless, I received an international certification from The European Society of Human Reproduction and Embryology , became an academically certified nursing counselor after I studied a special program at the University for Continuing Education in Krems. After a few years, I got certified as a Medically Assisted Reproduction nurse, have been working as a lead nurse in the field for almost 10 years. I've now been working at an IVF institute in Vienna  for almost 15 years.
Lisa Ante Pangan
I'm not sure how much my being Filipino influences my work at the IVF institute. I followed my mother's footsteps. She came to Vienna as one of the first Filipino nurses in the 1970s. My parents are both Filipino; they built a life with their small family in this foreign country. The big family was the Filipino community that grew larger in the following years. There were so many cultural misunderstandings and confusions for me while growing up between two cultures. In the past, I've been through many difficulties. I have learned to become more empathetic. This skill is very helpful at work as an IVF nurse, where the subject is very sensitive - not only for the patients, but also for my co-workers. IVF is associated with a roller coaster of emotions, and that affects the individual staff members as well. As a leader and a nurse, I am there to guide through the emotions in a mindful and appreciative way.
Many of these emotions influence my paintings. One part of my artworks includes EmbryoArt. Some show the classic representation of embryos and others a different interpretation of them hidden in a water bowl full of flowers. The purpose of my EmbryoArt is to give affected couples something back. I want to pay tribute to their IVF journey as many were also not successful in IVF and lost their child. This is a very painful experience. An implanted embryo represents life and energy. Thus, even a deceased child was alive for a short time and had its place in this world. With my artwork I would like to show that this embryo lived. Perhaps this supports some parents to cope with their experienced loss as affected couples are not recognizable. They don't show themselves and discuss their infertility in public because the topic is related with shame.
Life is a gift
"I'm sending my daughter to you at the institute. I want to be a grandma soon."
In the Austrian-Filipino community, I experience that there is still a lot of pressure on some couples (especially after marriage) regarding family planning. It feels like everyone is asking about it, as if the only thing to do after getting married is to immediately bring children into the world. [Having children] is a naturally chosen topic of conversation in every family celebration, community gatherings and even after church mass — without considering that this causes a lot of stress for the affected couple. Awareness has not yet arrived in Filipino communities. Sometimes I even find myself in the most bizarre situations, where people shout across the room: "My daughter is not having children. I'm sending her to you at the Institute. I want to become a grandmother so much."
If the topic of sexuality is seen as a taboo, I'm surprised that people don't seem to have a problem directly addressing someone's infertility. It's considered as small talk, only meant nicely to show interest in someone. However, it isn't. It is an intimate topic and only the couple decides when to talk about it and with whom, whether they want to get help or not - and above all, in what form.
Questions about one's family planning could be perceived as very painful and seen as insensitive. I want to create awareness for these couples, who probably came from a long and intense fertility journey until they have decided to remain childless.