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From tube to cradle

Publication Date : 10-04-2012

 

Hope for infertile Indonesian couples is now just around the corner.

Decades ago, the term in-vitro fertilisation (IVF), the joining of a woman’s eggs and a man’s sperm in a lab to assist with conception, was not familiar in Indonesia.

Since the introduction of IVF technology, perceived as a last resort for infertile couples, in the country in 1987, nine years after the first successful birth of a so-called test tube baby in 1978, the number of couples participating in the programme is still relatively small compared to other Asian countries.

Data from the Indonesia Association for In-Vitro Fertilisation (Perfitri) in 2010 showed the country had only 2,000 cases, much lower than Vietnam’s 6,000 or Thailand’s 4,000. Most of Indonesia’s infertile couples had been looking for treatment in Singapore, with 2,500 IVF patients the same year.

The technology’s high cost and the lack of information about it, as well as the absence of a reliable medical support system and human resources, have been cited as factors behind the slow development of IVF in Indonesia, with the country’s fertility rate standing at a worrying 10 to 15 per cent, according to recent statistics.

However, things are about to change and infertile couples may be able to get help without having to flee to other countries.

A group of Indonesian obstetricians and gynecologists established Perfitri in 2009 to assist infertile couples, medically defined as men and women who after one year of marriage have not produced a pregnancy despite having frequent and normal sexual relations.

The association manages 20 fertility clinics in eight of the major cities in Indonesia, with two more opening soon in Palembang, South Sumatra, and Makassar, South Sulawesi.

"Those clinics are supported by professional doctors and have top facilities. The services range from medical to cost consultations,” Perfitri chairman Soegiharto said.

Currently, 120 medical experts, including doctors, embryologists and nurses, are members of the organisation. Perfitri also runs a website, MauPunyaAnak.com, that contains A to Z information on IVF in the country.

The existence of Perfitri, which held its first national congress last month, and its supporting elements has seemed to propel the number of test tube babies in Indonesia to 3,000 in 2011, a 50 per cent increase from a year earlier.

Perfirtri secretary-general Budi Wiweko expects the figure to continue to soar this year as progress in IVF treatments at local clinics and hospitals has encouraged infertile couples to seek treatment.

Living in the fourth most populous country in the world has not discouraged Indonesians from wanting to have children, as social and cultural norms mandate married couples reproduce.

These reasonings, coupled with the government’s unclear policy on its population, have been the major driving force for partners to strive to have children through whatever means necessary, including using modern technology.

Among those is Shanty S. Marthondy, who doctors declared sterile after one-and-a-half years of marriage.

The 40-year-old said doctors found a problem in her fallopian tubes that prevented her from having children.

Wanting very much to have children, Shanty asked her husband to take her to Singapore to have IVF treatments.

Yet, the quest ended empty-handed, as she had a miscarriage when her fetus was two weeks old.

After that failure, the woman decided to look for fertility centers in Indonesia, realising family support was important to her during the process.

"I preferred to be here because I felt at home,” Shanty told The Jakarta Post in a recent interview.

After two failed attempts, one in Singapore and one in Indonesia, Shanty finally had her dream come true at the Yasmin fertility clinic at Cipto Mangunkusumo General Hospital in Jakarta in 2009.

That success encouraged her to try and conceive again at the same clinic two years later.

"At first, there was not a big difference in the cost with the one in Singapore, but with the spending on accommodation and food, it becomes cheaper here,” Shanty said.

The cost for IVF treatment in Indonesia now averages between 40 million rupiah (US$4,400) and 70 million rupiah ($7,600), which is relatively competitive compared to Singapore, which offers the service at S$6,300 ($5,034) to S$10,000 ($7,900).

Yet, not all consider the cost cheap.

Civil servant Ni Made Diah, 36, who was childless after 10 years of marriage, said she spent all her family’s savings to conceive her first child through IVF last year.

With Indonesia’s IVF success rate at only 30 per cent on average, Diah put her family’s future at risk when she made the decision to undergo the treatments.

"What do you need money for, if not for children?” she asked.

Luckily, she was successful on her first attempt. After all the blood, sweat and tears, Diah is now the proud mother of one-month-old Putu Keiavanya Wirentana, who was born at Sammarie Hospital in Jakarta.

Commenting on the relatively low success rate of IVF treatment, Budi of the Yasmin fertility clinic said a woman’s age played a major role.

"The younger the women, the better chance the IVF will work,” said the gynecologist, referring to a woman’s limited ability to produce good eggs after a certain age.

Each woman is born with an average of 700,000 eggs. However, the number will decrease as women reach puberty until they have only approximately 25,000 eggs at the age of 37, with the total decreasing until menopause.

But there are other options, including egg donation or surrogacy, a practice that is quite common for menopausal-age women abroad.

Another determining factor in IVF besides age is stress level.

"Think positive, relax and, sure, you will get pregnant,” Budi, who has been in the field since 2006, said.

Psychologist Ratih Ibrahim offered the same suggestion, believing that apart from financial and physical preparations, couples interested in having IVF must also be ready mentally.

"It will help when failure occurs,” Ratih said of the importance of mental preparedness.

Shanty agreed with the experts, confessing that the hardest part of the process was containing the stress and pressure from all the people around her that keep asking and nagging with endless questions about when she would have children.

"I usually shut myself off from the outside world during the treatment, just enjoying me-time in my bedroom,” she said.

But now, Shanty’s struggle and sacrifice financially and spiritually seem to have paid off with the birth of her adorable children Ameerazelia and Adrian, who are now almost three years old and five months old, respectively.
 
Five basic steps in IVF:

Step one: Stimulation, also called super ovulation, involves fertility drugs given to the woman to boost her egg production.

Step two: Egg retrieval, involves minor surgery to remove the eggs from the woman’s body.

Step three: Insemination and fertilisation, is when sperm is placed together with the best eggs and stored in an environmentally controlled chamber.

Step four: Embryo culture — When the fertilised egg divides it becomes an embryo. Within about five days, a normal embryo has several cells that are actively dividing.

Step five: Embryo transfer — Embryos are placed into the woman’s womb 3 to 5 days after egg retrieval and fertilisation.

If an embryo sticks to the lining of the womb and grows, pregnancy results. More than one embryo may be placed in the womb at the same time, which can lead to twins, triplets or more. Unused embryos may be frozen and implanted or donated at a later date.

 

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