The most haunting thing for Thai Tien Dung, 43 years old, for 17 years, every time his wife got pregnant, was the doctor's words "terminate the pregnancy".
Married since 2006, within three years, Mr. Dung's wife (living in Ho Chi Minh City) had two miscarriages, for unknown reasons. Five years later, the family welcomed their first son, but the joy quickly faded.
The day he lost his child, he hid it from his wife and quietly went home to clean out the baby stuff he had bought earlier. His wife, whose stitches had just been removed from her cesarean section wound, had to say goodbye to her newborn baby just 14 days after birth.
"The baby could not live," said Mr. Dung. His son died of a brain hemorrhage caused by a rare congenital disorder, identified as a lack of clotting factor number 7.
He and his wife both carry a recessive gene mutation - a very rare case, occurring in only one in 300,000-500,000 people. The child born has a 25% chance of lacking a blood clotting factor. Mild cases result in gastrointestinal bleeding, severe cases result in brain hemorrhage, and survival is difficult in the first months after birth. Mr. Dung's child falls into this 25%.
Since then, they have embarked on a decade of journeying to realise their dream of becoming parents. The couple would have had seven children, had they all been born alive.
Two years after losing their first child, his wife became pregnant for the fourth time, but the old illness still haunted her. Feeling sorry for his wife, he followed the doctor's advice and agreed to terminate the pregnancy.
Not giving up hope, in 2015, his wife became pregnant for the fifth time. When the fetus was 16 weeks old, the doctor discovered the same condition and once again advised termination of the pregnancy. But this time, the couple was determined to keep the baby.
"We accept the trade-off to have the feeling of holding our child in our arms, even if he is not healthy or does not live long," he said. Having lost children four times, they yearned to have a child.
At the age of two, the child lived "like a tree", only lying still to receive blood transfusions, unable to speak. The couple sold their house and moved to live near the hospital to treat their child. But everything went down the drain. The child gradually became exhausted and left his parents when he was only four years old. Once again, the couple had to say goodbye to their own flesh and blood.
The infertility rate among couples of childbearing age in Vietnam is 7.7% - about one million couples, according to the Ministry of Health. Of these, more than 50% are secondary infertility, meaning they have been pregnant or given birth at least once but cannot have another child, increasing by 15-20% each year. Mr. Dung and his wife are among them. Unlike primary infertile couples (not getting pregnant after a year of living together), his family faces a more difficult situation: they are pregnant, but do not dare to have children.
The desire to have children of couples like Mr. Dung is the driving force that has nurtured the infertility treatment industry, which has grown over the past three decades into a million-dollar industry in Vietnam.
"Every time I counseled the couple to terminate the pregnancy, it was really difficult, because I knew Dung's wife really wanted to be a mother. After losing the child, both of them were depressed, I told them to go for treatment, then come back for in vitro fertilization (IVF). At least there was still hope," said Dr. Quach Thi Hoang Oanh (Deputy Head of the Department of Medical Genetic Testing, Tu Du Hospital) - who has treated Dung and his wife since 2011.
IVF is a reproductive support method that combines the husband's sperm and the wife's egg in the laboratory, then inserts the embryo into the uterus to start a pregnancy. This is the central technique to solve most causes of infertility in Vietnam.
Mr. Dung learned how to handle similar cases around the world, and learned about the advanced technique of IVF that helps "read" abnormalities in genes and chromosomes, called pre-implantation genetic diagnosis (PGT) . Thanks to that, doctors can screen and select healthy embryos, without genetic disease genes, to transfer into the mother's uterus. He planned to take his wife to Malaysia for treatment.
But luck smiled on them. At the end of 2019, Tu Du Hospital made a new step forward in IVF technology when it successfully performed PGT for the first time, opening the door of hope for the couple. The first time, the doctor only selected one embryo, but failed. Undaunted, a year later, when Mr. Dung was over 40 and his wife was 39, they were determined to try again.
"My wife and I are not giving up," he said.
Having chosen two embryos to place in the mother’s womb, both the doctor and the patient were nervous. At 16 weeks, amniotic fluid tests showed that although the embryos were not completely normal, they both carried recessive genes like their parents, meaning the babies could be born and grow up healthy. Two years after losing their fifth child, they had hope again.
In May 2022, the baby was born, and the couple became parents again. The day they held the baby in their arms, they could not believe it."This is the only time I can bring my healthy child home," Mr. Dung could not hide his emotions, talking about the moment he was relieved of a decade-long burden. In total, his family spent more than 2 billion VND on their dream of becoming parents.
Mr. Dung's child is among more than 16,300 "test tube babies" born in the past 30 years thanks to IVF technology at Tu Du Hospital - the place that laid the foundation for infertility treatment in Vietnam.
"At that time, IVF was a strange concept and was strongly opposed because the government was focusing on family planning, contraception, and sterilization," said Professor, Doctor Nguyen Thi Ngoc Phuong (former director of Tu Du Hospital).
Having worked with thousands of infertile couples since the 1980s, Dr. Phuong has found that infertility is like a curse that haunts women, severely affecting family happiness. She decided to go against the tide of public opinion and find a way to bring infertility treatment technology to Vietnam.
In 1994, she was able to access IVF in France, bought the machines herself, and invited a team of experts to come back to the country to support her. Four years later, the first three "test tube babies" were born, marking a historic turning point for the field of infertility treatment.
From a field of opposition, IVF has developed explosively from the South to the North, becoming the leading reproductive support method in the country. More than 10 years ago, Vietnam had 18 facilities performing IVF and surrogacy techniques for humanitarian purposes. Since 2010, this number has increased continuously every year and currently there are 51 units.
According to the Ministry of Health, the birth rate with assisted reproductive technology increased from 2.11 in 2010 to 2.29 in 2020 - meaning that on average, for every woman who receives assisted reproductive technology, 2.29 babies are born.
The formation process and map of 51 medical facilities performing IVF in Vietnam
Dr. Ho Manh Tuong, General Secretary of the Ho Chi Minh City Society of Reproductive Endocrinology and Infertility (HOSREM), said that each year Vietnam performs more than 50,000 new IVF cases, much higher than many other countries. Mr. Nguyen Viet Tien (Chairman of the Vietnam Obstetrics and Gynecology Association, former Deputy Minister of Health) based on sociological statistics, estimated that each year Vietnam has 1-1.4 million children born, of which about 3% (30,000-42,000 babies) by IVF.
This strong growth, according to Dr. Nguyen Viet Quang (Director of the National Center for Reproductive Support, Central Obstetrics Hospital), stems from three reasons. First, the number of IVF centers "blossoming" from the South to the North, helping couples have easier access to assisted reproductive methods. Second, the increasing rate of infertility due to medical conditions in both men and women, along with the working environment that requires exposure to toxic chemicals, has increased the risk of infertility.
Finally, there is the development of medical tourism. Vietnam is emerging as a promising destination for tourists who want to receive medical treatment, including infertility treatment, beauty treatments, etc., due to reasonable costs and good services. Travel agencies also cooperate with hospitals and clinics to design tours to promote the quality of these facilities.
Each embryo transfer currently costs 70-100 million VND. The costs between public and private hospitals are similar because this is a fairly competitive industry. On average, a couple will be successful after 1-2 embryo transfers, but many cases have to do more. In addition to IVF, each assisted reproductive technique also has different costs and success rates such as genetics, combined screening, IUI (intrauterine insemination), ICSI (intracytoplasmic sperm injection), IVM (in vitro fertilization), cryopreservation of embryos, sperm, etc. However, most of Vietnam's IVF techniques have costs among the lowest in the world.
Cost of IVF treatment techniques in Vietnam and some other countries
After three decades, the national revenue of the IVF industry in 2022 reached more than 132 million USD, expected to reach an average annual growth rate of 7.47%, according to a report by Research and Market (an international market research company in the US). This rate is higher than the expected annual growth of 5.72% of the global IVF market from now until 2030. The report also forecasts that the market value of Vietnam in 2028 could reach nearly 203 million USD.
"Infertility treatment in Vietnam is becoming a million-dollar industry, which is expected to grow strongly in the period 2023-2027," said Dr. Nguyen Viet Quang. Vietnam's infertility treatment center system is currently among the top in Southeast Asia (ASEAN) in terms of the number of cases, and the success rate per IVF cycle is up to 40-50%, three times higher than in the early stages (10-13%). The current rate in the world is 40-43%.
Number of IVF cases between Vietnam and some countries in the world
According to former Deputy Minister of Health Nguyen Viet Tien, many foreign infertility patients have chosen Vietnam as their destination because of its low cost. Recently, he successfully treated a South African couple in their 40s. The wife suffered from ovulation dysfunction and blocked fallopian tubes, and had to resort to IVF technology. They have just welcomed their first child. Previously, a Laotian couple who had unsuccessful IVF in Thailand came to Vietnam for treatment and also had good news on the first embryo transfer.
From a professional perspective, Associate Professor, Dr. Vuong Thi Ngoc Lan (Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City) said that many overseas Vietnamese have returned to do IVF because Vietnam has specialized techniques, even leading the world in IVM. Vietnam is also the country with the highest number of international scientific publications in the region, and many doctors and experts from other countries have come to learn.
"If evaluated from an economic perspective, infertility treatment is a very potential industry," said Dr. Lan.
However, despite good techniques and the total cost of each embryo transfer for IVF is only 20-50% of that of other countries in the region, Vietnam is still not an attractive destination on the international infertility treatment map. The reason is that the medical tourism industry has not been invested in and planned for synchronous development, mainly spontaneously according to demand and potential.
Citing statistics, Dr. Ho Manh Tuong said that every year, Vietnam has about 400 foreigners coming to examine and treat infertility at hospitals and medical centers (accounting for 1-2%).
This figure is much lower than in Thailand, where 60-70% of IVF patients are foreigners. The Tourism Authority of Thailand has announced that IVF services helped the country earn at least 20 billion baht (about 611 million USD) in 2018 thanks to the development of tourism, resorts combined with IVF treatment. Similarly, in Malaysia, an estimated 30-40% of IVF cases are foreigners.
Meanwhile, China - which provides more than a million IVF cycles with about 300,000 babies conceived each year - announced that it would build facilities to provide IVF for 2.3 to 3 million people by 2025. The decision was made in the context of the country of a billion people facing a series of challenges due to its extremely low birth rate.
In the future, Vietnam is at risk of facing the same challenge as China, when over the past 30 years, the birth rate has nearly halved, from 3.8 children per woman in 1989 to 2.01 children in 2022. Meanwhile, Vietnam is one of the countries with the highest infertility rates globally and is getting younger, according to the World Health Organization (WHO). It is predicted that by 2050, the number of people over 60 years old will account for 1/4 of the population, posing the problem of population increase to balance the labor force.
The trend of declining birth rates in Vietnam and China over the past 70 years
Although the cost of IVF in Vietnam is cheaper than the rest of the world, experts say it is still too much for many low-income couples. One treatment costs about the same as the average annual income per capita (nearly 100 million VND in 2022). Meanwhile, a successful case may require multiple embryo transfers, costing several hundred million to billions of VND.
The 30-square-meter office of Nguyen Thai Manh (37 years old, Hanoi) is filled with thick stacks of medical records, neatly arranged. They remind him and his wife of their 6-year journey of infertility treatment.
Three years after getting married, the couple discovered they could not conceive naturally. They took many supplements but to no avail, so they went to the National Center for Reproductive Support, Central Maternity Hospital for examination. His wife was diagnosed with blocked fallopian tubes and had to undergo surgery. Joy smiled when a year later, they welcomed their first child.
The journey to find a second child was fraught with difficulties. In 2016, they wanted to have a child naturally but failed many times. The doctor diagnosed unexplained infertility. The couple turned to IVF. Since then, they have gone to the hospital once a year for artificial insemination, sometimes twice a year.
In 6 years, Mr. Manh's wife had a total of 7 embryo transfers (VND 70-100 million/transfer), but all failed. "It's not something that can be done right away if you want it and have the money. It's extremely hard work," said Mr. Manh.
In 2022, he decided that this would be his last IVF attempt, as his wife was nearly 40 - an age that was no longer ideal for reproduction. The couple only had enough frozen embryos left for one transfer into the uterus. Luckily, on the 8th attempt, his wife became pregnant and gave birth to a beautiful baby girl.
Mr. Manh's family spent a total of nearly one billion VND to "find" a child, while Mr. Dung and his wife spent more than two billion VND in 10 years of infertility treatment. The dream of becoming parents is not cheap for infertile couples, both materially and spiritually.
"The cost of treating this disease in Vietnam is lower than in many other countries, but it is still a huge barrier for patients," former Deputy Minister Nguyen Viet Tien acknowledged.
Paradoxically, patients who undergo treatment for diseases such as fibroid removal surgery without the need to have children are covered by health insurance, but if accompanied by infertility treatment, they must pay the entire cost themselves. Health insurance currently does not support any techniques in the infertility treatment process, while many causes come from diseases such as ovarian tumors, uterine fibroids, ovarian polyps, etc.
In many countries around the world, infertility is considered a medical condition and is covered by health insurance. For example, France allows up to four rounds of IVF, with patients only having to pay for the fifth round. China has also included 16 reproductive support services in the category covered by health insurance from 2022.
According to Mr. Tien, in foreign countries, the premium is high, so these services are covered by health insurance. Vietnam's insurance capacity cannot cover some services, including IVF, with the current premium. "In the short term, health insurance should cover infertile patients who have the same medical conditions as others. If the insurance is capable, it should pay attention to this group in the future," he said.
In addition, Vietnam's infertility treatment network has not yet covered all patients in need. Vietnam has one million infertile couples, but the average treatment capacity of 50 facilities per year is only 50,000 cases, accounting for 5%. Not to mention the geographical barrier when infertility treatment centers are mainly located in big cities, absent in mountainous and remote areas. In the long term, this will become a big problem when the population enters the aging stage.
"Vietnam does not need to increase the number of reproductive support centers. The important thing is to upgrade the qualifications and treatment capacity of doctors, master all techniques so that patients do not have to be transferred to higher levels," said Mr. Tien.
Meanwhile, Professor Nguyen Thi Ngoc Phuong hopes that each province will have a treatment center and more sponsorship programs for poor infertile couples.
"Having children makes one happy, so don't the poor deserve happiness?", she asked.
For more than a decade searching for their child, Thai Tien Dung and his wife lost many things, including the house they lived in since their wedding day. However, they have never regretted it. People who dream of becoming parents like them are willing to pay any price to enjoy that happiness.
Six months after the birth of the "IVF baby", Mr. Dung's wife naturally became pregnant with another baby girl, who was born safely. He believes that the "test tube" baby is the greatest blessing for the couple in their 16-year journey of wanting a child.
Content: Thuy Quynh - My Y - Le Nga
Graphics: Hoang Khanh - Manh Cuong
About the data: The data in this article is provided by the Ministry of Health; Dr. Nguyen Viet Quang (Director of the National Center for Reproductive Support, Central Obstetrics Hospital); Tu Du Hospital; Ho Chi Minh City Association of Reproductive Endocrinology and Infertility (HOSREM).
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