ART application in Indonesia

Sini, et al. Blastocyst elective single embryo transfer improves perinatal outcomes among women undergoing assisted reproductive technology in Indonesia. Asian Pacific Journal of Reproduction 2020; 9(3): 118-123.

 

Summary of keypoints of ART application in Indonesia from the paper

IVF is not a new practice in Indonesia. Morula IVF Clinic is the largest fertility clinic in Indonesia.

Elective single embryo transfer (eSET) and double embryo transfer (DET) have become the two most implemented IVF practices worldwide, including in Indonesia. DET remains the most popular method used in IVF programs in Indonesia due to financial limitations, lack of understanding of the complications of multiple pregnancy, and patients’ preferences in conceiving twins.

The Indonesian infertile couples’ decision-making procedures in deciding the number of embryos to be transferred remained unknown. However, due to the lack of subsidies, ART’s overall cost to achieve a live birth may significantly impact the patients’ decision to prefer DET over eSET.

Comments

Indonesian people also see infertility as a serious health problem. It seems to have support from the government so that there is some clinic focused on fertility. The religious organization also sees this problem as a personal issue, so that I personally never heard or read about any religious organization go on strike to protest the fertility clinic. Some papers are available to lay the discourse of ethical or religious debate over the issue but not explicitly condemn the practices.

Financially, the Indonesian government is not subsidizing fertility procedures. Infertility is not the priority of the relevant ministry or public agency, mainly because Indonesia faces the more critical issue: high fertility rate, so the government focuses on family planning to reduce the national fertility rate.

Given that condition, it makes sense when the infertile couples prefer the procedure to put two embryos instead of only one. They want to improve the success rate, and perhaps they had calculated that the cost of getting twins (if both of the embryos transferred is successful) is much cheaper than redoing the whole procedure to get a total of two children.

Proposed research questions

1.     What is the impact of ART in the patients’ economy when the procedure was successful? (comparing the financial condition on the starting date of the program with the condition on the delivery, and following up in 1, 5, and 10 years after the delivery)

What is the impact of ART in the patients’ economy when the procedure was unsuccessful? (comparing the financial condition on the starting date of the program with the condition on the day when the program was declared unsuccessful, and following up in 1, 5, and 10 years after the that date)