Sun, 25 May 2003

IVF program enables couples to have babies

Heru H. Rahadi, Contributor, Jakarta

Babies are symbols of love unification, an evidence of love and are a legacy of commitment.

Despite the numbers of street children and orphans, or unwanted babies being dumped in the gutters, many couples still yearn for their own flesh and blood.

Like "Lia" for example. Even though she is still single, she is longing for a baby from her own womb.

"I yearn for the feeling of having a human being growing inside me and pushing it out into the world. I figure, that must be a sensational feeling," she said.

Maybe it is because her biological clock is buzzing as she is in her late 20s, that she is so eager to experience the magical feeling of being pregnant, and giving birth to a baby. So much so that she is even willing to be a single mother.

While for Jack, not his real name, getting a baby from his wife is a symbol, to him, of manhood. Because infertility was an obstacle to their complete happiness, Jack and his wife went to Singapore to have and entered an in-vitro fertilization (IVF) program to get their own most valuable wedding gift.

Does it have to be so difficult?

Statistically, human beings are the least productive creatures in the world.

"It's the way natural selection works. Compared to other creatures, human beings have the most difficult time getting pregnant because women only have a 20 percent chance of having their egg fertilized each month," said Dr. Indra N.C. Anwar from the Bunda Maternity Hospital's Morula Fertility Clinic in Menteng, Central Jakarta.

A couple is considered infertile when they regularly have sexual intercourse for more than a year but the woman doesn't get pregnant.

Dr. Soegiharto Soebijanto from the Obstetrics and Gynecology Clinic at the Cipto Mangunkusumo General Hospital, Central Jakarta, said this was the case for 15 percent of couples worldwide.

There are several causes for infertility. It could be due to poor quality of sperm in men, or for women it could be blockage of fallopian tubes, infection, obstruction to releasing the egg or that the women's womb does not support pregnancy.

Rita Armani, a mother who had entered the IVF program, was upset by her infertility, and after nine years of marriage, she was still childless.

"I didn't know what was wrong. My husband and I went to a doctor and he found nothing. We both were declared healthy," she said, so they decided to do the insemination program as soon as they heard about it.

Insemination is only one method of assisted pregnancy, said Dr. Augustine Tandang from Bunda Maternity Hospital.

"Sperm is placed in the uterine cavity to make it easier to reach the egg. This is a conventional method of assisted pregnancy and the first to be suggested to healthy couples," she said.

But after trying the insemination eight times, Rita found that no embryo successfully conceived in her womb. Her doctor then suggested she try the IVF program.

The IVF program itself involves taking eggs from a woman, fertilizing them in the laboratory with her husband's sperm and transferring the resulting embryos back to her uterus a few days later.

After trying twice at different hospitals, Rita finally succeeded in becoming pregnant and they now have twin daughters, who turned two-years-old this month.

It was a different story for Ida Rahmawati. She had waited for seven years and tried many different techniques in several hospitals in Surabaya, Jakarta and Yogyakarta.

She finally conceived triplets in her womb which were born healthy on Feb. 10, 2001, at the Dr. Sardjito General Hospital in Yogyakarta. Dr. A.R. Amino Rahardjo, who helped in the delivery, said it was the first time that triplets were successully born in Indonesia with the IVF program.

The possibility of having twins or triplets is greater when a couple decides to go with the IVF procedure. It is because the three morulae (the first form of fertilized egg cell) are placed into the mother. The doctor will only undertake the procedure when they have three or more good quality morulae.

"It's too risky placing only one morula into the mother's womb, considering the rate of successful conception is only between 30 and 40 percent. While the rate of miscarriage is up to 25 percent," said Dr. Muchsin Jaffar from the Harapan Kita Maternity Hospital in West Jakarta.

To get more than one morula, a mother must be treated with ovarian stimulation. This procedure forces the ovaries to release more than one egg at time using hormonal medication.

Such treatment discouraged "Lina" from doing the IVF as it required her to take the medicine every two hours during stimulation.

"It's hard for me to take the medicine in the middle of my tight schedule since I often travel out of town for meetings. I also would have had to do a blood check every two weeks. It's too hard," she said.

Getting the sperm to fertilize the egg is another thing that requires more than one morula. Healthy, mobile and adequate sperm are needed to fertilize the eggs.

When there's not enough healthy, mobile sperm, the doctor must extract it and take the quality sperm. If the doctor can obtain only one good quality sperm cell, they must use another technique called ICSI (Intra Cystoplasmic Sperm Injection) where they "shoot" the egg with that sperm cell in a laboratory. Certainly, it will cost more for a procedure such as that.

Doing the IVF procedure can be quite expensive. The IVF program itself, without medicine, costs Rp 16 million (US$1,885) at the Siloam Graha Medika Hospital, West Jakarta.

While the ICSI costs Rp 20 million while extracting sperm from sterile males costs Rp 24 million. Prices may vary from one hospital to another, but generally, it costs between Rp 30 million and Rp 40 million, for the complete procedure, including medicine.

When it fails, a couple may try again in another cycle with further costs, or use the cryogenically preserved morulae obtained as a "bonus" from the first IVF program cycle attempt. Of course, preserving morulae cryogenically will cost less compared to having a complete IVF program all over again.

Since there are many hospitals in Jakarta that already have the IVF program, people like Jack and his wife no longer have to go to Singapore to have a baby. But single parents like "Lia" would still be unable to fulfill such a wish due to medical ethics that forbids single women in the IVF program.