Hope for the infertile here - New Straits Times - Thursday June 20, 2002

In Malaysia infertility affects one out of seven couples. And over the decades infertility rates in the country have been increasing to between 10 and 15 per cent. Despite this figure, awareness of this and the treatments available are still lacking. Many are not aware that infertility is a disease of the reproductive system which in the majority of cases can be treated.

Infertility is classified into two types: 

· Primary infertility, if there was no previous pregnancy, which affects approximately 40 per cent of infertile couples.

· Secondary infertility, if there was a previous pregnancy, affecting approximately 60 per cent of infertile couples.

Approximately 30 per cent of infertility cases is due to the male factor such as low sperm count, absence of sperm count and sperms with low motility. A female factor is responsible for 50 per cent of infertility in couples. The causes are endometriosis, ovulation dysfunction, hormone imbalance, ovarian cysts and tubal blockage. The remaining 20 per cent can be caused by contributing factors in both partners.

According to Dr Colin Lee, a consultant obstetrician and gynaecologist with a private clinic, the majority of infertile couples can be treated with procedures as simple as hormone injection or laparoscopy (keyhole surgery) if causes of infertility are due to female factors. There are also several assisted reproductive treatments available such as intra-uterine insemination (IUI), in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), for more severe cases of infertility he added.

"With the advancement of assisted reproductive technologies, infertile couple now have more opportunities to explore wh ich of these methods will work for them." One of the options is IVF or ICSI. ICS1 car assisted fertilisation is for those with severe sperm or fertilisation problems.

However, Dr Lee said due to lack of information, many infertile couples are unaware of the treatments available in the country and they continue to seek treatment abroad. He said the percentage of infertile couples in Malaysia seeking treatment is still low as many do not realise that the fertility treatment centres in the country are on par with developed countries.

"It is important that they know the success of our local fertility centres so that the perception of other countries as better than Malaysia can be discounted," he said.

He added the success rate of IVF treatment in Malaysia is on par, if not higher, when compared to a leading centre in Britain. Last year, one of the fertility treatment centres in Malaysia handled 155 IVF cases and recorded live birth rate per embryo transfer of 39.5 per cent. In 2000, a leading IVF centre in Britain recorded live birth rate per embryo transfer of 38.8 per cent.

In Malaysia, there are 17 privately-owned and three Government-owned fertility treatment centres which offer assisted reproductive technologies that are of equal standards to other global facilities. Dr Lee said the high cost of fertility treatment is also another factor affecting an infertile couple's decision to seek treatment. The cost for IVF treatment could run up to RM1,000 per cycle.

He urged the Government and other relevant authorities to provide financial subsidy for those seeking fertility treatment. He said in many developed countries, the Government either pay or heavily subsidise the cost of treatment while insurance companies will include infertility for coverage.

"Unfortunately, in Malaysia, the Government has not given fertility treatment priority in terms of funding. Similarly, insurance companies do not consider it as a disease. "They have to realise that it is not a luxurious condition that people choose to have. I hope that treatment for infertility will be covered by insurance companies." He said people are now more open when discussing infertility compared to 15 years ago as it was then viewed as a taboo subject. "This is a good trend because it shows that people are accepting that not being able to have children is not something that they should hide and be ashamed of."