by Ha Nguyen
After suffering the agonies and angst of struggling to conceive, 28 year-old Le Huynh Anh Thu got far more than she bargained for last month when she gave birth to five children after undergoing intrauterine insemination (IUI).
The HCM City case, the first time in Viet Nam that IUI produced such extreme results, has left officials, researchers and doctors facing a number of awkward questions over the way this technology is applied, after health experts branded the birth a clinical success but a healthcare failure.
A milder form of the better-known in vitro fertilisation (IVF) treatment, IUI involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm.
The fast-moving sperm are then placed into the woman's womb close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle.
Although the process has helped many couples fulfil their reproductive ambitions, the risk of multiple births appears to increase with IUI and this can lead to premature births and a heightened risk of defects.
Furthermore, many clinics have been accused of offering sub-standard care and failing to apply due diligence.
The clinic address where Thu underwent IUI remains anonymous, but there are many private clinics in Ha Noi and HCM City carrying out IUI for between VND5-7 million a case.
Nguyen Thuy Hai, from the northern province of Cao Bang, came to a private clinic in Ha Noi to overcome infertility because State-owned hospitals were very crowded and patients from other provinces faced long waits for the complicated procedures.
"At the private clinic, medical workers gave me a medical check-up while doctors held a consultation before applying IUI on the spot," said Hai.
During the IUI procedure a catheter is used to place a number of streamlined sperm directly into the uterus. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilisation.
Doctors told Hai that if IUI failed, she would need to rely on public obstetrics clinics to undergo IVF.
Dr Hoang Thi Diem Tuyet of the Tu Du Hospital said the prevalence of IUI represents an alarming overuse of technology. It has led to vulnerable women giving birth to twins, triplets and more, posing increased dangers to both mothers and their children.
"Doctors treating women with fertility issues should carefully research each specific case and ensure they use the right dose to ensure a woman doesn't carry four or five foetus at the same time. This places the mother at risk of hypertension and diabetes, while her children are likely to be born prematurely," said Tuyet.
Dr Vo Duc Tri of the HCM City Hospital for new-borns agreed with Dr Tuyet, saying multiple foetuses can be very dangerous as the mother risks contracting Pre-eclampsia (which if left untreated can lead to the risk of seizures) while her children could face respiratory conditions and many other issues.
Dr Huynh Thi Thu Thuy, of the Tu Du Hospital said the hospital has applied methods to reducing the number of foetuses, so that the remaining foetuses have a better chance of survival and good health.
Multiple pregnancy can cause a high risk of complications: preterm labour and birth, low birth weights, pregnancy-induced hypertension, anemia, birth defects and miscarriage are just some of the risks, Thuy said.
Women carrying multiple babies need special care, especially in terms of nutrition, she said.
According to the city's Population and Family Planning Division, the Government has not yet produced a support policy for multiple pregnancies.
Dr Quan Hoang Lam of the Research Centre for Embryo Technology said that Viet Nam had no regulations for how many foetuses women who use fertilised-assistance technology should carry.
Meanwhile, Dr Vu Te Dang of the Tu Du Hospital who was in charge of watching Thu's case, said: "We are worried about Thu's children who face the prospect of learning difficulties and slow mental development."
To Thi Kim Hoa, deputy director of the city's Department of Population and Family Planning, said Viet Nam should have laws to clearly define that women using reproductive methods should be allowed to carry a maximum of two foetuses.
Viet Nam also has no policy to financially assist women carrying three or more foetuses, said Hoa, adding that their families should psychologically prepare for the burden of raising a large number of infants.
Dr Nguyen Dinh Cu, former rector of the Institute for Population and Social Issues, said many Chinese circumvent the Government's stringent one-child policy by using modern technologies such as IUI or IVF to give birth to two or three children at the same time.
Viet Nam has not yet implemented such a policy, but it should be bore in mind that the number of children produced through IUI depends largely on the doctor, Cu said, adding that infertility rates in Viet Nam are increasing, particularly for women who have given birth to one child but are unable to conceive a second.
Demand for reproductive methods has also been increasing but public hospitals lack the capacity to cope. Many couples are forced to visit private clinics which aren't currently regulated by a health agency, Cu said.
Duong Quoc Trong, director of the Department for Population and Family Planning, said: "Although Viet Nam has made achievements on preventing families from having more than two children, there are still many women in rural and remote areas trying to have three to five children."
These families have faced poverty and hunger for at least one to three months a year, Trong said.
He believed the most solid solution was promoting communications and improving the awareness of local people that being able to have one or two children and feed them well is a more sustainable policy. — VNS