Ten years of in vitro fertilization in Indonesia: Access to infertility care in a developing country

OBJECTIVE

This research was conducted to assess access to assisted reproductive technologies (ART) and the current status of the in vitro fertilization (IVF) program that have been implemented in Indonesia over the last 10 years.

METHODS

We established a retrospective cohort study and descriptive analysis of the current state of access to infertility care in Indonesia. The data were collected from all IVF centers, clinics, and hospitals in Indonesia from 2011 to 2020, including the number of IVF clinics, total ART cycles, retrieved fresh and frozen embryos, average age of IVF patients, IVF pregnancy rate, and causes of infertility.

RESULTS

The number of reported fertility clinics in Indonesia has increased from 14 clinics in 2011 to 41 clinics by 2020. As many as 69 569 ART cycles were conducted over the past 10 years, of which 51 892 cycles used fresh embryos and 17 677 cycles used frozen embryos. The leading cause of consecutive infertility diagnosis was male infertility. Nearly half of the women who underwent IVF procedures (48.9%) were under 35 years old. The pregnancy rate outcome of women who underwent IVF ranged from 24.6% to 37.3%.

CONCLUSION

Developments in ART in Indonesia have led to improvements in the ART cycles performed throughout the 10 year period. The identification of key areas that require improvement can provide an opportunity to enhance access to infertility care.

Outcome findings of COVID-19 vaccine among 31 977 pregnant women in Indonesia

OBJECTIVE

We provide an overview of the safety of messenger RNA and inactivated coronavirus disease 2019 (COVID-19) vaccine and monitoring of pregnant women after COVID-19 vaccination. The vaccine safety outcome profile is beneficial for further recommendations of COVID-19 vaccination in pregnancy.

METHODS

This research was conducted as descriptive research. Sampling was performed using an online questionnaire to be filled out voluntarily and distributed to all pregnant women in Indonesia who received the COVID-19 vaccination. Data collection was performed and descriptive statistics were obtained.

RESULTS

Among 31 977 pregnant women, 24 212 (75.7%) received the first dose, 7619 (23.8%) received the second dose, and 146 (4.5%) received the third dose of the COVID-19 vaccine. Sinovac vaccine is the most administered vaccine to pregnant women (27 122 [84%]). Most pregnant women (78.7%) who were vaccinated had no adverse effects after immunization, while the most reported adverse effects were mild symptoms.

CONCLUSION

The current study contributed evidence that COVID-19 vaccination during pregnancy has minimal adverse effects. These findings may help pregnant women and healthcare providers to make informed decisions regarding vaccination.

Comorbidities and COVID-19 severity in pediatric patients: systematic review and meta-analysis

Background COVID-19 has spread around the world. Although symptoms in children are often mild, children remain at risk of developing severe or critical forms of COVID-19, especially those with underlying or comorbid medical conditions. Objective To evaluate the association between comorbidities and severity of COVID-19 in pediatric patients. Methods A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We used PubMed and Google Scholar to locate observational studies that involved children with RT-PCR-confirmed COVID-19 with comorbidities and compared them with controls without comorbidities. Studies must also involve children with severe COVID-19 and provide the risk of severe COVID-19 in children with and without comorbidities as outcome. We performed a meta-analysis to estimate the pooled odds ratio (OR) of severe COVID-19 in children with vs. without comorbidities. Results We included 41 observational studies with a total of 285,828 pediatric COVID-19 patients, comprising 9,754 patients with comorbidities and 276,074 controls. The comorbidities indentified included obesity, congenital malformations, neurological disease, and genetic syndromes. Children with comorbidities had a significantly higher risk of developing severe COVID-19 compared to those without (pooled OR 4.07; 95%CI 2.31 to 7.19; P<0.00001). Conclusion The presence of comorbidities increases the risk of severe COVID-19 in children.