Can Assisted Reproductive Technology (ART) help with Singapore’s languishing fertility record?

Visiting Professor Eric Blyth addressed this question at a seminar in the Department of Social Work on 29 May 2012 that was attended by Department staff and research students, and professionals from local hospitals, the Ministry of Health (MOH), Ministry of Community, Youth and Sports (MCYS) and the National Population and Talent Division. The discussion covered the extent, causes and consequences of nearly 40 years of below replacement fertility in Singapore, and the potential benefits of publicly funded fertility treatments and accessibility to elective oocyte cryopreservation. The latter, frequently described as ‘social egg freezing’ has been suggested as a means of protecting the fertility of young women against ageing and thus increasing their chances of successful conception if they later decide to embark on family-building.

The current ‘state of the art’ was discussed and participants agreed that while clinical expertise in Singapore enjoyed a high international reputation, although the twin and triplet rate following ART appears high by international comparison, essential support and intermediary provision such as  counselling was far less well developed or extensive as in some other countries. Government financial support for eligible couples undergoing ART appears to be meeting current demand although the MOH is reviewing whether extending the upper age limit, the number of funded treatment cycles or types of funded treatment might enhance both the aspirations of individual couples with fertility problems and the government’s desire to boost fertility rates. The experience ofIsrael’s generously-funded ART programme, that is generally perceived as a successful model of state funding that other countries might usefully emulate, was shared. Recent research has highlighted the significant psychosocial pressures to which women whose treatment is not successful are subjected to and identified the unintended negative consequences of unlimited state-funded provision.

As regards elective oocyte cryopreservation, its outcomes have been insufficiently evaluated to warrant making this available as a routine clinical service, despite the aggressive marketing and promotion of the service by American fertility clinics and ‘egg banks’. However, it was suggested that Singaporemight provide an optimum location to initiate a properly evaluated clinical trial. It was agreed that the overall impact of ART on population growth was inevitably likely to be modest but that it could form part of a wider programme to promote family-building that tackled the main disincentives and barriers to family-building in Singapore and ensured that young people grew up with accurate knowledge about conception, family planning and fertility decline as a natural element of the ageing process.

Eric Blyth is Professor of Social Work at the University of Huddersfield, England

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