Mulyoto Pangestu
Education Program in Reproduction and Development, Dept. Obstetric and Gynaecology -Monash University Faculty of Animal Husbandry - Jenderal Soedirman University - Indonesia e-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
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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
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Klinik Permata Hati RSUP Dr. Sardjito, Yogjakarta Klinik Teratai, RS Gading Pluit, Jakarta RS Sam Marie Basra, Jakarta Goulbourn Valley Equine Hospital, Shepparton-Australia
Pekerjaan (sekarang)
Konsultan
Treatable
◦ Medication (drug) ◦ Surgery, reconstruction ◦ ART (IUI, IVF, surrogacy)
Not treatable
◦ Living without children ◦ Adoption ◦ Another marriage (??).
30%
30%
30%
10%
Male Female Both Unknown
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 (8090%), 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. Sudradji Sumapradja and team at Melati/Harapan Kita. 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.
◦ Number of infertile couples? One in every ????
◦ Social cost?
Cultural acceptance
Moral Mental Other issues? i.e. Genetics.
cost of social ? Parental readiness ◦ Financial disturbances
SP 1 SP 2 GP Patients-Clinician and Clinics
Possible pathways for infertility treatment in Indonesia
ART CLINIC
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
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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’s
Impact on
IVF 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?
Indonesia IVF’s trends
NO 1 2 3 4 5 6 7 8 9 11 10 12 11
KLINIK Halim Fertility Centre (Medan) Program Melati (HarKit) Makmal FK – UI Klinik IVF Family Morulla IVF Jakarta Klinik Fertilitas Teratai Klinik Fertilitas Aster Klinik Permata Hati Klinik Infertilitas Telogorejo Klinik Fertilitas Soetomo Klinik IVF Siloam Budi Mulya TOTAL
2006 25 100 27 35 105 0 41 67 9 25 267 726
2007 70 95 50 45 125 15 50 70 5 24 290 864
2008 70 132 124 50 205 58 43 79 12 42 337 1,152
Jun-09 40 57 93 50 150 53 30 65 No Data 21 240 799
Nov 2008, Inul hamil 1 bulan; Sanglah: Tidak ada data
1853
?
Number of ◦ ◦ ◦ ◦ ◦ ◦
Patients: Increase Doctors (FER): Increase IVF Clinics: May increase Embryologist: ???? IVF Nurse: ???? Psychologist: ????
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Competition in ASEAN (Thailand, Malaysia, Singapore) Cost Laboratory facilities and drugs similar Patient-Doctors-Clinic interaction Public awareness
Quality of service
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
