Overseas egg donors — what Singaporean women should be wary of

Recent news media reports suggest that most Singaporean women requiring egg donation travel abroad for the procedure. 

Strict regulations against payment of egg donors have resulted in a persistent shortage of donated eggs in Singapore. At the same time, women in Singapore do not have the option of freezing their own eggs when they are younger, due to the current ban on social egg freezing. This would leave many of them with no choice but to resort to overseas egg donation to conceive a child.

Foreign egg donors often receive generous payment abroad. Hence, there is a large pool of anonymous egg donors of suitable ethnicity to choose from abroad. Moreover, the medical fees of foreign fertility clinics may be much cheaper compared to Singapore. 

In fact, some local fertility clinics have collaborative ties with foreign clinics that perform egg donation. Hence, they would be able to advise patients on egg donation overseas, as well as coordinate with foreign clinics in the timing of hormonal injections to prepare the patient’s womb to be receptive for the egg-donation procedure abroad.

However, due to the less stringent regulation of fertility treatment in other countries, Singaporean patients may face a variety of marketing gimmicks and misleading information on the egg-donation procedure. Hence, it is imperative to highlight what Singaporean patients should be wary of, when travelling abroad for egg donation.

Although some claims put forward by foreign fertility clinics appear to have a sound scientific basis, it is important for patients to understand the limitations of such claims. For example, consider the claim that the egg-donation procedure has a much higher success rate compared to standard in-vitro fertilisation (IVF) treatment.

This is generally true to a large extent, simply because the selected egg donors are young and healthy. However, if the recipient patient had previous health problems with her womb that lead to recurrent miscarriages (e.g. endometriosis, uterine fibroids), then her chances of conceiving through egg donation might be much lower than advertised by the fertility clinic.

Other claims may have less scientific basis. For example, many foreign fertility clinics strongly encourage their patients undergoing egg donation to utilise preimplantation genetic screening (PGS) to detect genetic defects in the conceived embryos, due to the unknown genetic heritage of the anonymous foreign egg donor. 

Yet they often neglect to tell patients that similar genetic screening of the donor’s blood sample is much cheaper than PGS. Patients must also be aware that PGS is not a fool-proof method to detect genetic abnormalities in embryos, despite its high costs. 

There is a only a limited panel of common genetic diseases that PGS will detect, so it is impossible to screen and verify the entire genome of each individual embryo to be free of genetic defects. 

One notable example that cannot be detected by PGS is Autism Spectrum Disorders that are caused by multiple genes interacting with multiple factors within the birth environment. 

Additionally, if the egg donor is very young, it is unnecessary to utilise PGS to screen for Down syndrome that usually arises from genetic abnormalities in the eggs of older women. 

Although many fertility clinics claim that PGS can improve the IVF success rates of older women, this only refers to older women using their own eggs, which have a high incidence of genetic abnormalities. PGS will not improve the success rates of older women using a young egg donor. 

It must also be noted that PGS is not completely risk-free. There is a small chance of damaging the embryo as this delicate procedure involves drilling a hole through its protective shell (zona), to extract cells for genetic testing.

An important fact that is often downplayed by foreign fertility clinics is that the recipient patient’s age does really matter in egg donation. Recent much-hyped news reports about elderly women successfully giving birth in their 60s and 70s have led to many misconceptions. 

It is well-established in the medical literature that the risks of medical complications during pregnancy increase with maternal age. 

Another factor to consider is whether the expected remaining lifespans of the recipient couple are sufficient for raising a child to adulthood. 

Older patients travelling abroad for egg donation should ask themselves whether as elderly parents, they would be able to cope with the physical rigours of child-rearing.

Yet another critical piece of information that is often downplayed by foreign fertility clinics is the risk of accidental incest between half-siblings conceived by the same egg donor. 

Although such risks may be minimised in Singapore through safeguards that limit the number of children conceived per donor to three, it must be noted that there is no limit to the number of Singaporean recipients that a single foreign egg donor can donate to abroad. 

The risks of accidental incest may be further compounded by the much reported phenomenon of ‘Genetic Sexual Attraction’, which is sexual attraction between close-relatives that first meet as adults, for example siblings that are separated at birth and adopted by different families. 

This is particularly significant for Singaporean patients, given the small size and high population density of their country.

Patients should also take note of a deceptive marketing gimmick that claims a woman receiving egg donation passes some of her genetic material to the conceived child. 

This misconception came about because of misleading news reports a few years ago, about the gene expression behaviour of embryos being influenced by the nurturing fluid produced by the womb lining. This is due to the embryo taking up a molecule known as microRNA, which is a chemical relative of DNA. 

Being closely-related to DNA, microRNA can very broadly and loosely be considered a form of genetic material. However it is extremely short-lived and fragile, and does not transmit genetic inheritance from parent to child.

Some foreign fertility clinics may offer frozen egg donation as a cheaper alternative to fresh egg donation. The lower expenses are due to simpler logistics, as there is no need to synchronise the hormonal stimulation cycles of the donor and recipient patient, as well as cost savings from negating the travel and hotel stay required for fresh egg donation. 

However, the significantly lower success rates of frozen versus fresh egg donation, are often downplayed.

Last, but not least, Singaporean patients should also be aware of the lack of appropriate counselling for egg donation overseas. Rigorous counselling will ensure that both husband and wife are agreeable to egg donation, without any misgivings or emotional blackmail from either spouse, and without undue pressure from parents and in-laws.

Additionally, they would also miss valuable advice on whether or not to tell their child the truth about his/her conception in the future.

Perhaps, to avoid the perils and hassles of overseas egg donation, the Ministry of Health in Singapore should look at various ways to boost the local supply of donated eggs.

One solution may be to permit adequate monetary compensation for egg donation, which is a tedious and painful procedure. Another solution may be to permit social egg freezing with certain conditions, such as age limits of 35, which would negate the need for egg donation.

At the same time, permitting social egg freezing will also likely lead to an accumulated surplus of unused frozen eggs that can potentially be donated to infertile women.

ABOUT THE AUTHOR:

Alexis Heng Boon Chin is an associate professor of biomedical science at Peking University's School of Stomatology. He holds a Master in Clinical Embryology degree (distinction grade) from the National University of Singapore and has published over 40 academic journal articles in the field of clinical assisted reproduction ethics.