14 May 2008

Should IVF be finance entirely by the government?

Statistics has shown that 2 in 10 of newly married couples will have difficulty to conceive after a year of marriage. In-vitro fertilization or IVF, introduced exactly 30 years ago (this year) has helped thousands if not millions of couples to overcome this problem. IVF involves the use of many different types of drugs to stimulate the ovary to produce enough eggs (from the women) for harvesting. This stimulation requires a series of injections. Furthermore, a good and efficient lab with competent embryologists is essential to ensure the success of an IVF cycle. No doubt, setting up of an IVF lab needs money. In addition, the drugs used are not cheap. Some infertile couple may not be able to afford it, therefore, it has been suggested that government should fund IVF fully. But is it possible?

It is only fair to help couples who are infertile to get pregnant. They should receive proper medical advice and treatment for their problem. We have seen so many who have suffered from anxiety and depression from the pressure families and friends put on them. Unfortunately, not all can afford this treatment.

Conversely, the government's expenditure on health care will increase tremendously if free IVF treatment is given to all patients. This money can be channel for the treatment of patients with more severe diseases like cancer or chronic organ diseases. This group of patients can die if treatments are not started immediately. Those who are in favour of this option will certainly argue that no patient have died just because he/she can not conceive.

It is my opinion that the government should help those who have difficulty to conceive access to affordable assisted reproductive treatment. These patients do not choose to be infertile, so why should they suffer (both mentally and emotionally). However, I feel patients should share part of the treatment cost as this will instil a sense of responsibility on them to see the entire programme through. Probably treatment should be partly subsidized by the local health department and patients pay a nominal fee for the IVF programme. The government should also set up more IVF/ART centres across the country. HKL has actually started their first IVF cycle in 2006 (under the patronage and hard work of Dr. Anisah), but I have no figures on how many cycles they have done so far. I know Trengganu (with the effort put in by Dr. Zul and Dr. Nasir Tak Abd) shall start their lab soon, Ensha Allah. I am glad KKM has selected our centre Likas as the third centre of referral for IVF. The question is of course “Where to get the embryologist!!”

IVF treatment is expensive but it should be made affordable to all infertile couples. Free treatment may not be practical but the government should make an effort to subsidise it. May be the first cycle can be made free to the patient but subsequent cycle should be paid. Infertility should be seen as a ‘disease’ like any other diseases suffered by our people. Thus, cheap and appropriate fertility treatment should be made available to all citizens of Malaysia.

13 May 2008

IVF... how can I reduce ectopics???

We were fortunate to complete 8 cycles of IVF last month. Unfortunately only 4 got pregnant. One may say that the results are extremely good (50%) but 2 got ectopics. Both were young patients (below 35y).
After searching through the net, I fail to find the answer on how to prevent ectopic pregnancy in IVF. It is a known fact that IVF carries a high risk of ectopic pregnancy BuT how do one prevent it.???
There was an interesting article in the European Society for Human Reproduction and Embryology Journal back in July 2003 on "Risk of ectopic pregnancies after IVF declines with age in women with tubal disease"
I like to quote, if I may from the article"The question that remains unanswered is why the risk of ectopic pregnancies should decline with age in women with tubal disease.
ALSO "endometriosis appeared to be a risk factor for ectopic pregnancies after IVF-ET. Incidence rose to 2.3% in these women AND there was a small but significantly higher incidence of ectopic pregnancy when three embryos were transferred rather than two."

I post this question to anyone out there who may have the slightest idea- how do you prevent!!

P.S. By the way, we put back 3 embryos..

Welcome back... to me

It has been more than 6 months since I last wrote anything on this blog of mine. Well, let's see... what has happened so far...
For one, I am still eagerly waiting for AMC's reply on my EICS. You see, it is part of the requirement before registering with the Australian Medical Board.
Oh ya, another problem is that English exam again. Still can get the minimum requirement. I just hope the AMC is not too strict... Common man... after all only one component-lah!