SINGAPORE — A pilot scheme launched seven years ago to boost the success rate of in-vitro fertilisation (IVF) for women has managed to achieve 56 live births out of 131 patients who underwent embryo transfers.

This represents a success rate of 42.7 per cent from the pilot, which uses a procedure known as pre-implantation genetic screening (PGS). It is meant for women aged 35 and above, or those who had experienced at least two implantation failures or pregnancy losses.

In comparison, based on statistics from 2014 to 2018, women who undergo assisted reproduction technology procedures — including IVF — without PGS experienced success rates of:

• 17.1 per cent for those aged 35 to 39
• 6.7 per cent for those aged 40 and above

Parliament heard on Thursday (Feb 29) that despite the higher success rates with PGS, more patients need to be recruited for the pilot before it can be rolled out nationally for mainstream clinical services.

PGS is a technique that involves assessing the health of embryos created through IVF by testing and identifying genetic defects. This is done before IVF implantation (the process whereby a fertilised egg implants in a woman's womb after its transfer there).

The aim of such a screening process is to help women, especially those who are of an advanced maternal age or have weakened reproductive health, to avoid miscarriages or termination during the IVF process.

PGS is a restricted service in Singapore and is only allowed under the pilot programme, which is administered by the Ministry of Health (MOH).

Ms Rahayu Mahzam, Senior Parliamentary Secretary for Health and Law, was giving the information above to a question from a Member of Parliament (MP). Mr Louis Ng of Nee Soon Group Representation Constituency (GRC) had asked whether this screening test can be included as a mainstream healthcare service.

As of last month, 590 patients are enrolled in the study, which is only eligible for one of the following groups of women:

• those aged 35 and above
• those with two or more recurrent implantation failures
• those who had had two or more pregnancy losses

Out of these, 195 patients have undergone PGS and 131 have completed their embryo transfers. 

This has led to 70 pregnancies, with 56 live births and five ongoing pregnancies. 

The need for more support for couples undergoing IVF has made recent headlines. Earlier this month, TODAY reported that restricted access to PGS has led some couples to seek out such services in Malaysia.

Advocates have also argued that Singapore should do more to suppose these couples as a way to stem the decline in its fertility rate.

On Wednesday, Ms Indranee Rajah, Minister in the Prime Minister’s Office, revealed that Singapore's total fertility rate for 2023 is projected to be 0.97, the first time in the country's history that the rate has gone under 1.0.

The level of fertility has to be 2.1 for a population to exactly replaces itself from one generation to the next.

WHAT WILL IT TAKE FOR PGS TO GO MAINSTREAM?

More patients are needed for "a robust evaluation of the clinical efficacy of PGS" to be made, but the technique will remain accessible to eligible patients under the pilot programme, Ms Rahayu said.

To this, Mr Ng asked when the pilot programme would end, noting that the study has been going on for seven years. The MP also asked whether MOH was looking to achieve a specific number for the pilot, and if it can be expanded to private clinics to increase enrolment figures. 

Ms Rahayu replied that MOH still needs a “good statistical reference” of 300 patients and work has been in progress to try and increase the numbers.

Even though there were 590 patients who enrolled initially, not all followed through with the pilot " for many different reasons”, she added. Only 195 patients eventually went through with PGS.

As for involving private clinics, Ms Rahayu said that MOH is looking into this area.

The PGS pilot programme remains accessible to patients in private settings, because patients can be referred to public assisted reproduction centres if they meet the enrolment criteria.

There are several tests and screens that are available, apart from PGS.

The Government takes into account factors such as adverse side effects when deciding what kinds of tests to make available. This includes the possibility of side effects during the screening procedure, in which the embryo is subject to biopsy and a freezing process.

"Just because early detection may be valuable for certain circumstances, this does not mean we should deploy all of them and we should subsidise all of them," she said.