"Is the baby biologically mine?”
At the brand new Fertility Clinic Cambodia, the question isn’t a paternity pop quiz so much as a philosophical quandary facing couples hoping to get pregnant through artificial insemination. Married couples who have spent years struggling to conceive are rushing to the new facility – which declares itself Cambodia’s first full-range fertility treatment centre – in search of answers, medical advice and, most of all, a nudge in the right direction when Mother Nature stalls.
This past week, the clinic, which has been open less than a month, performed the first in vitro fertilisation (IVF) cycle in Cambodia. On Sunday, it is set to perform four more.
“I believe it is an auspicious date, the miracle of IVF in Cambodia [is starting],” said Samnang Hor, the practice’s director and co-founder.
Hor and his wife and business partner, Dr Sean Sokteang, are importing to Cambodia modern medicine’s high-tech response to an age-old problem. Using assisted reproductive technologies including intrauterine insemination, a technique that involves placing sperm inside the woman’s uterus, and in vitro fertilisation, the pair aims to deliver biological offspring to otherwise infertile couples.
As the pioneers in Cambodia of a treatment filled with space-age sounding jargon like “zygote”, “blastocyst” and “intracytoplasmic sperm injection”, the husband-and-wife team said the introduction has so far involved a lot of education.
“One of the frequent misconceptions we encounter is that . . . some people think we grow the baby. We do not grow the baby,” Hor said.
In conventional IVF, which began in 1978, eggs are collected from the mother and then fertilised in the lab before the best two or three embryos are transferred back into the womb with the hope that one will implant and lead to a successful pregnancy.
“I feel very excited and anxious about it. I have been waiting a long time for this,” said Channa*, 33, one of the women scheduled for the procedure on Sunday.
Channa and her husband got married more than four years ago, but despite their best efforts, she has not become pregnant. The pair consulted local doctors and tried fertility drugs and tracking Channa’s fertility cycle – all to no avail. Channa said she became increasingly convinced she would not be able to become a mother until, two years ago, her neighbour had success with fertility treatment abroad.
“It was very difficult to admit that we could not get pregnant naturally,” she said. “And I worried about whether a baby that was created outside [the womb] would be as healthy, but the doctors convinced me it was OK.”
Since the advent of “test-tube babies”, there have been concerns about the long-term development of offspring arising from the technology. But evidence from 36 years and more than one million IVF babies has found no differences in the physical or psychological health of the children.
Nonetheless, even after seeking fertility consultations in Singapore and Thailand, it wasn’t until Channa heard that treatment would be available in her home country that she decided to give it a try.
“To get the treatment abroad is very expensive; you have to pay for a flight, a hotel, food and translation. Here, I can talk with doctors in my language, I can be comfortable in my own home and my family can be with me,” she said.
Comparing the facilities and the procedures, Channa found the treatment identical among the neighboring countries, though offered at a markedly different price point.
In Thailand, the average IVF cycle runs about $9,000, whereas the starting cost in the US or Australia is closer to $12,500. The Fertility Clinic Cambodia, meanwhile, charges $4,700-$6,000 for the procedure. But in a country where the average annual per capita income is just $2,890, the treatment’s cost remains prohibitively expensive to the average couple.
However, IVF is one of the most extreme infertility treatments and is not the only, or even most frequently sought-after, solution to reproductive troubles. Hor said his patients, more than 90 per cent of whom are Cambodian and come from all walks of life and income levels, have a variety of needs and budgets.
“Not all fertility treatment is expensive,” he said. “There are different solutions to infertility for different couples. Some of them can even conceive naturally with the help of a regulated period.”
For decades, infertility issues in the region and especially in Cambodia have been eclipsed by public health priorities such as family planning and decreasing maternal and newborn mortality rates, including increasing the use of contraceptives to reduce unwanted or unintended pregnancies. But recently, fertility services have ballooned in Southeast Asia, and health experts said they weren’t surprised that a fertility clinic would be starting up in Cambodia.
“I imagine in the near future there will more [assisted reproductive health clinics] opening,” said Dr Ping Chutema, director of clinical services at the Reproductive Health Association of Cambodia. “People see the medical advances in Thailand or Vietnam, and then want to have the option as well.”
Though the full array of assisted reproductive technology may be beyond the confines of the average ASEAN wallet, the wealthy are not the only prospective parents willing to go to drastic lengths and expenses to have a baby. In Vietnam, which started offering IVF in public hospitals in 1998 and now boasts more than 10 centres in Ho Chi Minh alone, patients have reportedly sold land and homes to afford the cost of a procedure. It’s a large wager to gamble; fertility treatment generally averages a 70 per cent success rate among all patients, and the odds of a successful pregnancy from IVF are closer to one in three.
The desperation is at least partially driven by social stigma. For many, the personal suffering from infertility is compounded by public humiliation.
“In Cambodia, people who cannot conceive face a lot of discrimination,” said Ros Sopheap, director of Gender and Development for Cambodia. “For women, it can be especially painful. Women are supposed to get married and have a family. It is a woman’s obligation to have babies, and if she does not, it will likely affect her relationship with her husband and her in-laws, and could lead to divorce or domestic violence.”
According to a little observed Cambodian marriage law, impotent men are not even allowed to wed.
While there are no Cambodia-specific infertility statistics, worldwide it’s estimated that one in six couples struggle to get pregnant, and in the worst-affected countries, up to 25 per cent of couples are unable to conceive.
“We saw [infertility] as a social problem and a health issue in Cambodia that needs to be addressed,” said Hor, who has invested more than $1 million, mostly from loans, to build his new lab.
So far, he hasn’t been disappointed with the results. Less than a month after opening, and still waiting for hospital beds to arrive, the clinic is already seeing 35 new patients a day and has a waiting list for IVF over 50 couples long.
“I think most people don’t want to be the first one to try [a treatment], but then once it starts being recognised as successful, more and more people will be open to it,” said Billy*, whose wife just conceived their second child with the clinic’s assistance. “A lot of guys don’t want to admit, or even know they are incapable. The ego is one of the main barriers.”
Initially, with no options in Cambodia, Billy – who has Cambodian and Australian roots – and his wife went to Thailand. They learned that due to health issues “they never stood a chance” at getting pregnant the old-fashioned way. A round of intrauterine insemination (IUI) in Thailand also failed.
They decided to try again when Hor and Dr Sokteang opened their initial IUI-only clinic in Phnom Penh in early 2012, and were rewarded with a long-awaited pregnancy. Billy’s son is 1 year old now, and has a sibling on the way.
For Hor, the question of parentage is easy.
“My answer is very simple, it is an assisted reproductive technology with your egg and your husband’s sperm, so this is your biological child simply assisted with technology.”
Additional reporting by Vandy Muong
*Names have been altered at the request of the patients.