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Mulyoto PangestuEducation Program in Reproduction and Development, Dept. Obstetric and Gynaecology -Monash University
Faculty of Animal Husbandry - Jenderal Soedirman University - Indonesiae-mail: [email protected]
Nama: MULYOTO PANGESTU Jabatan: ◦ Lektor/Penata Muda/Gol 3c, Fak. Peternakan Unsoed – Purwokerto◦ Laboratory Manager/Coordinator Education Program in Reproduction and
Development Monash University. Pendidikan:◦ 2003: Monash University, Australia, Ph.D. Medicine◦ 1997: Monash University, Australia, 1998, Master of Reproductive Science◦ 1994: The University of Melbourne, Australia, Post-Grad. Dip. Agric. Sc.◦ 1987: Universitas Jenderal Soedirman, Purwokerto, Indonesia, Ir. Peternakan
Pekerjaan (sekarang)◦ Lecturer Dept. Ob-Gyn, Monash University◦ Coordinator program Master in Clinical Embryology, Monash University.◦ Staf Pengajar Fakultas Peternakan Unsoed, Purwokerto◦ Staf Pengajar program Pendidikan Konsultan FER, Universitas Gadjah Mada◦ Staf Pengajar program Pendidikan Konsultan FER, Universitas Diponegoro
Konsultan◦ Klinik Permata Hati RSUP Dr. Sardjito, Yogjakarta ◦ Klinik Teratai, RS Gading Pluit, Jakarta◦ RS Sam Marie Basra, Jakarta◦ Goulbourn Valley Equine Hospital, Shepparton-Australia
Treatable◦ Medication (drug)◦ Surgery, reconstruction◦ ART (IUI, IVF, surrogacy)
Not treatable◦ Living without children◦ Adoption◦ Another marriage (??).
30%
30%
30%
10%
MaleFemaleBothUnknown
Often: Physically healthy No symptoms or pain Found after the couple get married /
(normal-routine unprotected sexual intercourse)
Chance for conception: 3mths (30%), 6 mths (50-60%), 9 mths (60-70%); 12 mths (80-90%), 24 mths (95%).
BOTH (husband and wife) should consult to infertility specialist
“One in 8 couples is infertile with the cause equally distributed between the female and male partners” (Findlay, 2003)
ART (Assisted Reproductive Technology) ◦ overcomes infertility ◦ but not cures◦ New technologies had been developed for the last
20 years to improve the result and overcome complex infertility problems.
◦ Recent progress, treats social infertility and child selection (?).
Started in 1987 pioneered by Prof. SudradjiSumapradja and team at Melati/HarapanKita.
22 May 1988, Nugroho Karyanto Until now more than 1000 babies born from
IVF in Indonesia compare to more than 2 million in the world.
Number of IVF clinic/centres and cycles per year
Number of staffs/skilled personels◦ Clinicians◦ Scientists/embryologists◦ Other allied staffs
Small number IVF cycles/year and number of IVF clinics compare to population.
Indonesian Infertily/IVF patients?◦ Treated in country?◦ Treated overseas?
IVF skills◦ Clinician (Ob-Gyn) and Embryologist, also other
staff.
Lack of embryologist?
Infertility in Indonesia, previously no accurate data but now start getting (PERFITRI)
Patient attitude (most of the case women/wife got the blame)
Family and community attitude/pressure Medical service providers (clinicians, scientist,
and allied health) Service availability Cost, no insurance nor government subsidy.
-Population? -Health? +Status social of
children in a family.
? Parental readiness
◦ Number of infertile couples? One in every ????◦ Social cost? Cultural acceptance Moral Mental Other issues? i.e. Genetics.
◦ Financial cost of social disturbances
ART CLINIC
GP SP 1 SP 2Patients-Clinician and ClinicsPossible pathways for infertility treatment in
Indonesia
Problems that your patient may deal with: Financial: Cost for IVF it self, or often other
“treatment” prior to IVF Social, public perspective on childless family.
Family and relative pressure. Physical issue, pain, sickness, morbidity Psychology, desperate to have their own
“biological children”
Psychological status on infertile patients/couples
Triggering factors◦ Family (parents, siblings) pressure◦ Community acceptance◦ Financial, pressure to get money to pay the cost◦ “Uncertain” results (30% success rate)◦ Time, getting old and less chance◦ Unsecure family future: divorce, husband seeking
another wife, or wife looking for a new husband◦ Choice: Clinic or “Klenik”, alternative medicine
Adanya saling percaya antara Pasien dan Dokter. Mengingat angka keberhasilan tidak 100%, maka
pasien dan dokter juga sudah siap apabila proses ini gagal.
Kesabaran dan ketenangan emosi pasien mengingat proses ini bisa lama dan mahal
Kondisi yang kondusif di lingkungan pasien, keluarga, teman, tetangga, tempat kerja.
Keyakinan pasien (suami dan istri). Kedua belah pihak (pasien dan dokter) siap
menerima kegagalan dan “puas” meskipun gagal
Inul’sImpact onIVF Treatment In Indonesia
Data sampai pertengahan 2009 menunjukkan terjadinya peningkatan jumlah pasien/siklus IVF ◦ Secara nasional◦ Di hampir semua klinik
Angka keberhasilan? Jumlah pasien per klinik?
2006 2007 2008 Jun-091 Halim Fertility Centre (Medan) 25 70 70 402 Program Melati (HarKit) 100 95 132 573 Makmal FK – UI 27 50 124 934 Klinik IVF Family 35 45 50 505 Morulla IVF Jakarta 105 125 205 1506 Klinik Fertilitas Teratai 0 15 58 537 Klinik Fertilitas Aster 41 50 43 308 Klinik Permata Hati 67 70 79 659 Klinik Infertilitas Telogorejo 9 5 12 No Data11 Klinik Fertilitas Soetomo 25 24 42 2112 Klinik IVF Siloam Budi Mulya 267 290 337 240
TOTAL 726 864 1,152 799
NO KLINIK
Nov 2008, Inul hamil 1 bulan;
Sanglah: Tidak ada data
1011
Indonesia IVF’s trends
?1853
Number of ◦ Patients: Increase◦ Doctors (FER): Increase◦ IVF Clinics: May increase◦ Embryologist: ????◦ IVF Nurse: ????◦ Psychologist: ????
Quality of service◦ Competition in ASEAN (Thailand, Malaysia, Singapore)◦ Cost◦ Laboratory facilities and drugs similar◦ Patient-Doctors-Clinic interaction◦ Public awareness
Who is our competitors◦ Another clinic within Indonesia or ASEAN
Service improvement◦ Proper diagnose; treatments and referral◦ Up skill the clinician and commitment◦ Other staffs and service provided
Public awareness◦ Public education and campaign◦ Moments opportunity
Patients mapping and investors
Prof. David Healy◦ Dept. Obstetrics and Gynaecology, Monash
University Prof. Peter Temple-Smith and team◦ EPRD-Monash University
Dr. M. Sodik◦ Dean Fac. Animal Husbandry UNSOED
