Women seeking treatments for infertility to get help in making informed decisions

SINGAPORE — With the removal of the age limit for women undergoing assisted reproduction technology (ART) from Jan 1 next year, Senior Minister of State for Health Amy Khor announced on Wednesday (Aug 28) that several steps will be introduced to help women make informed decisions.

The requirements to be introduced by the Ministry of Health (MOH) to its licensed assisted reproductive centres include enhancing their medical assessment and social counselling, as well as introducing a compulsory one-week gap between counselling and consent-taking for ART procedures.

This is so that women considering this approach to conceive at an advanced maternal age can take into account professional and clinical advice before making decisions, she said.

For now, ART procedures — which include in-vitro fertilisation (IVF) treatments — are available only to women 45 years old and younger. This age limit will be lifted from Jan 1, 2020 onwards.

In other changes, MOH will remove the cap on the number of ART cycles for all women.

Women aged 40 and above will also be eligible for government co-funding for up to two of the six co-funded ART cycles, as long as the couple had tried assisted reproduction or intra-uterine insemination (IUI) procedures before the age of 40 and are assessed to be medically fit by their doctor to carry a pregnancy to term.

Eligible couples can receive co-funding of up to S$7,700 for each fresh cycle and S$2,200 per frozen cycle for three cycles each.

Explaining the moves on Wednesday, Dr Khor said: “Our assisted reproductive practitioners also shared with us that the risks of women with advanced maternal age in pregnancy have become generally manageable, with careful assessment of the woman’s fitness to carry the pregnancy in the initial medical evaluation.”

She added: “We hope that together with existing healthcare schemes that are available, these extensions of subsidies will collectively provide comprehensive support for Singaporeans at each stage of their marriage and parenthood journey, and we hope that it will create a marriage- and parenthood-friendly ecosystem.”

The changes have been welcomed by members of the healthcare community.

Mrs Joni Ong, president of welfare organisation I Love Children, which advocates for placing a higher priority on having children, said that it was an important step forward.

“Our women now are so educated and capable and are also getting married later.

“But the later they plan their parenthood journey, the smaller the window is to seek fertility treatment,” Mrs Ong said.

Disclosing that she went through IVF to conceive her twin girls, Mrs Ong said that the journey was not an easy one.

“I was considered young then, I was only 30. But even at that age, it wasn’t a walk in the park, so I can only imagine how it is for those who are older. What helped me was advice from my doctors and, essentially, family support,” she said.

RISKS OF LATE PREGNANCY

Associate Professor Yong Tze Tein, head and senior consultant at the department of obstetrics and gynaecology in Singapore General Hospital, agreed that fertility is an arduous journey given the uncertainty.

She explained that older women carry a higher risk of gestational diabetes and hypertension in pregnancy as well as miscarriage and growth restriction of the foetus.

They may also have pre-existing heart or kidney conditions that put them at a higher risk during pregnancy.

“That’s why we have prenatal medical counselling. We have to explain the risk before they embark on the pregnancy,” she added.

Taking the example of a woman who has an existing heart condition, Assoc Prof Yong said that she will have to consult with a cardiologist and calculate the risks before considering the woman’s suitability for a procedure like IVF.

Women below 35 years of age have a 40 per cent chance of becoming pregnant through IVF, while those aged 35 to 40 have a 10 to 15 per cent chance. For anyone over 43, it is a single digit, she added.

Assoc Prof Yong said that she ensures she gives out advice based on the woman’s age so that she can highlight the options the person can take.

“One of the benefits of removing the age limit is that we recognise that we have different types of women who are facing fertility issues,” she explained.

That being said, she would still encourage couples to start building families young so as to better their chances of having children.

The increase in Government funding is also beneficial for many, especially for IVF where the first three cycles are the most important, Assoc Prof Yong said.

“There were several instances where women rush to make appointments right before they turn 40, because they don’t want to miss out on the funding. Especially when it’s such a substantial amount,” she added.