With increasing numbers of couples in Indonesia turning to in-vitro fertilization (IVF), also known as test-tube babies, doctors and clinics across the country have been doing their best to respond to the demand.

According to a report from the Indonesia Association for In-Vitro Fertilization (Perfitri), there were a total of 3,581 IVF cycles last year, up from 3,000 in 2011 and only 1,500 in 2010.  

Ivan R. Sini, the CEO of the Morula IVF Indonesia clinic ' the biggest fertility clinic in Indonesia in terms of IVF patients ' said the high success rate for many couples in the past five years had convinced other couples to try the same.

'I think in the past 10 years the success rate has been quite high. If 15 years ago the success rate was only around 10 to 15 percent, today it can even reach 50 percent in some cases,' he said in a recent interview.

The age of the woman plays an important role in the success of IVF, as the older the woman is the fewer total eggs she has.

Moreover, IVF's success supported by the number of obstetricians and gynecologists that have started to refer patients to IVF programs, in line with the arrival of advanced technology.

Ivan said most patients today used Intracytoplasmic Sperm Injection (ICSI), including his clinic.

The technology that was developed in 1992 involves injecting a single sperm into an egg, rather than placing many sperm close to the egg in standard IVF.

And since last year, his clinic has also offered the latest technology in IVF, called Intracytoplasmic Morphologically-selected Sperm Injection (IMSI).

The technique, developed in 2004, allows greater magnifying of the sperm than ICSI by the embryologist in the laboratory.

'In ICSI, the sperm is magnified 200 times, while in IMSI, we can magnify the sperm up to 6,000 times. So we can pick the sperm much better with IMSI,' Ivan said.

He said with such magnification, a sperm's morphological defects could be easily detected, while ICSI could not identify such defects.

'That technique can lead to higher fertilization rates,' he said.

However, he said, not all patients could get IMSI, only patients with certain conditions.

At work: Lab technicians work at an IMSI lab in Jakarta. Increasing numbers of couples in Indonesia are turning to in-vitro fertilization. JP/R. Berto Wedhatama

He said IMSI would be much preferred for patients who failed with their previous IVF programs. In addition, the technique was also recommended for men whose sperm count was limited, or because of the presence of bad quality embryos.

'Those patients may not have had high success rates in other IVF treatments, so we suggest they try the IMSI technique because that can increase their opportunity to succeed,' Ivan said.

He added that for such patients, the success rate using IMSI was 20 percent higher than ICSI.

IMSI begins with standard IVF procedure. The woman will be stimulated to boost her egg production and the mature eggs will be retrieved from the woman's body and be prepared for fertilization.

The embryologist will then use a microscope that can magnify up to 6,000 times to examine the sperm. With a long, thin, hollow needle, the embryologist will pick up the desired sperm cell, holding the egg cell in a special pipette, and push the sperm through the outer shell of the egg and into its inner area where fertilization takes place.

The egg and sperm are left for about a day, and then are checked for fertilization and embryo culture ' a phase when the fertilized egg divides and becomes an embryo.

The embryo is then transferred to the woman's womb 3 to 5 days after egg retrieval and fertilization.

'If the embryo grows, then the woman is pregnant,' Ivan said.

Currently, only Morula offers the IMSI technique in Indonesia. The clinic has around 35 IMSI patients, and a quarter are now expecting babies.  

With the high success rate and sophisticated devices used in IMSI, the procedure comes at a high price.

Ivan said in his clinic couples usually pay around Rp 60 million (US$6,180) in total for conventional IVF techniques. For IMSI, couples pay an additional Rp 4 million.

But for some couples, the money is not the problem.

Lady Inola Novianty is one of them.

Last year, the 30-year-old housewife tried an ICSI program after getting married three years earlier.

But her attempt was ineffective.

'The doctor said the embryo could not grow well, so the program did not succeed. But that did not stop us from trying again,' the woman, who goes by Inola, said over the phone.

She consulted with Ivan again, and after they found the problem they decided to try IMSI.

'I thought it was just the sperm, but there was actually something wrong with the egg. I tried IMSI, and now I'm 10 weeks pregnant,' she said.

'Not just that, I'm going to be a mother of twin babies. I can't wait,' Inola said.

According to Perfitri, there are currently 22 fertility clinics in several major cities in Indonesia. All the clinics have professional doctors and have top facilities, and offer services ranging from medical to cost consultations.

The cost for IVF treatment in Indonesia averages between Rp 40 million and Rp 70 million, which is relatively competitive compared to Singapore, which offers the service at S$6,300 (US$5,061) to S$10,000.

Nevertheless, the cost is still considered high given its benefits.

'The challenge now is the high cost, mostly because of the expensive price of the medicines. In addition, there is no insurance that covers patients that have IVF treatment,' Perfitri chairman Soegiharto said.

He said the government needed to take a greater role by spreading information about IVF and its benefits to the public.