The popularity of assisted conception procedures (ACP), or fertility treatments continues to grow in Singapore.

One major reason for this rapid growth is the increasing number of women who leave motherhood too late to conceive naturally. But are these patients adequately informed on the specifics of these laws?

There are several types of ACPs, with the most well-known being in-vitro fertilisation or IVF, for which improvements to the process that would also make it cheaper and less invasive are being developed.

Government encourages the use of ART

According to preliminary figures from the Ministry of Health, 6,059 assisted reproductive therapy (ART) cycles were carried out in 2014, 549 more than in 2013 and 1,099 more than the year before. The increase is partly due to co-funding by the Singaporean government from 2008, as part of the policy to boost birth rates. State funding is available for a maximum of three fresh and three frozen ART cycles at public hospitals only, for an age cap of 40.

Each cycle costs at least $10,000, but "with co-funding coupled with Medisave, Singaporean couples can do IVF at almost no out-of-pocket cost," said Professor P.C. Wong, who heads reproductive endocrinology and infertility at the National University Hospital. Currently, there are eight private fertility centres and only three at public hospitals.

Prior to starting any fertility treatments, the couple is required to consult a fertility clinic so that the cause for difficulty in conceiving (a time frame of after one year of regular, unprotected sex for women under 35 and six months for those over 35) may be determined. The costs for this are not included in the co-funding.

No application process is required for the co-funding; couples simply fill in a declaration form at the clinic, to be used to check their eligibility for it. Once this is confirmed, it will be automatically incorporated into the couple’s bill.

However, ART is available only to married couples, even if they already have children. Moreover, although there are no explicit laws prohibiting the use of surrogate mothers, Ministry guidelines state that fertility clinics are not allowed to carry out surrogacy arrangements.

Women cannot freeze their eggs early and use them later whenever they choose

Although it is recognised that the quality of a woman’s eggs starts declining after she reaches the age of 24, ‘social egg freezing’ - for women to extract and freeze their eggs when they are in their prime and use them when they are ready later in life – is not allowed in Singapore.

According to a report published by the Lee Kuan Yew School of Public Policy, “freezing eggs for future use is only allowed for women who might lose their fertility through medical treatments such as chemotherapy.”

In 2014, Dr. Amy Khor, Minister of State for Health, cited medical concerns as well as social and ethical implications as reasons for the ban. Social concerns include the fear of more women delaying marriage and giving birth at a later age.

From a medical point of view, the procedure is still at an experimental stage with limited data on clinical outcomes. The MOH is inclined to be cautious about allowing social egg freezing due to “the lack of data on the long term effects that the procedure might have on the mother and child.”

In fact, embryos survive freezing and thawing much better than eggs (80% to 90% live births for embryos, compared to 30% to 50% using thawed eggs). Moreover, there are considerable medical risks in the necessary procedures, such as the possibility of pain, bleeding and infection.

Donor sperm is more accessible than donor eggs

The use of donor sperm or eggs is permissible if either partner has issues with their own. None of the donors have any claim to the children conceived. Nevertheless, the laws are slightly different.

Some hospitals and clinics have their own sperm banks, and the MOH does approve some overseas sperm banks for use. The sperm donor’s identity is kept confidential.

In contrast, there is very little access to donor eggs, with couples having to source their own donors. Under Singapore law, egg donors cannot be paid for their contribution. Still, reasonable expenses incurred during the donation process may be paid for by the couple. MIMS

Read more:
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