Singapore’s Ban on Social Egg Freezing & “Profoundly Selfish Act” Comment by National Council of Churches of Singapore
Singapore's Ban on Social Egg Freezing: "Profoundly Selfish Act" - National Council of Churches of Singapore

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The topic of social egg freezing in Singapore is suddenly revived with fervour due to an SCMP article titled “Singapore’s egg-freezing ban forces women to head abroad for fertility treatment” on 4th June 2021. It later appeared on Yahoo News.

Many women (and some men) are offended after reading the article and understandably so. As someone who had previously undergone social egg freezing / Elective Oocyte Freezing, I will attempt to explain here why women are upset, balanced and comprehensive ethical and moral arguments and why wanting to have the choice of preserving one’s fertility is not “profoundly selfish”.

(Background: In November 2020, I wrote an 8000-word article detailing my personal journey of egg freezing in Singapore in 2018, complete with photos, videos & everything you need to know about my experience. Despite fearing blowback, I mustered the courage to write and share the article publicly, in hope that it will be a useful resource for other women to make an informed decision.)

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CONTENT

Why are women upset about the article?
What this article is NOT about

  • Moral & Ethical acceptability of fertility preservation for non-medical reasons

    (Reasons for & against social egg freezing in Singapore)
    1. Modern working women’s dilemma
    2. Egg freezing/ovarian or oocyte preservation as an insurance
    3. Genetic relatedness to child
    4. Medical risks of late pregnancy for mother and child
    5. Primum non nocere (“First do no harm”)
    6. Technical considerations
    7. Oocyte preservation as an alternative to less-morally desirable options
    8. Gender equality in reproduction

  • “Profoundly selfish act” – understanding the statement by the National Council of Churches of Singapore

Context to which the comment is made
Why the unnecessarily harsh comment?

  • Addressing & providing alternate views to the statement

    1. Ethical and social issues
    a) Caring for parents who might be aged or sick
    b) Financial debts & commitments
    c) Readiness of the male partners
    d) Penalty to women’s career
    2. False hope
    3.Pressure on women
    4. Risks
    5. Children’s welfare
    6. Medicalisation and commodification

  • Why should we deny such treatment to women who are planning ahead for their families?
                                                —– 

Why are women so offended by the article?

Two reasons:
1. The longstanding ban on egg freezing by the Ministry of Social and Family Development
2.  “Profoundly selfish act” – a comment by the National Council of Churches of Singapore (“NCSS”) about egg freezing

What this article is NOT about

Before we venture further, I have seen, read, and heard many arguments on this and some have stated:
a) The state regulations and/or the church was made by men
b) Old men who are not up with the times
c) Misogynistic rules
d) Outdated doctrines

I’d like to strongly state that personally, to me, I don’t think that the gender of the church or government leaders that made the statements have any bearing on the whole egg freezing discourse. I also don’t want to go down the rabbit hole if this is misogynistic or anti-women.

I’d like to focus on the discourse of why social egg freezing is still banned (and why is it such a divisive issue?). Below, I expound on the ethical, moral and personal reasons women go for egg freezing, and for many-layered reasons, the choice for freezing one’s eggs might not be a “profoundly selfish act”.

It can be argued that egg freezing is a more selfless than selfish act as it entails invasive physical, emotional and psychological risks to the mother/ woman who’s merely trying to conceive later on in life and give the prospective child the best genetic chance possible.

Ban on social egg freezing in Singapore

Many women feel that the ban on social egg freezing in Singapore is an archaic and outdated regulation that should be reconsidered Many believe that in this day and age, a woman’s body and choice about her fertility preservation should be hers alone. It shouldn’t be dictated by the State (or condemned by any religious body). We are not trying to play God or alter DNA by freezing our eggs.

For many single women, they find it exasperating is that while there is technology available that can afford them time to possibly find someone right for themselves, and still have a child eventually, but regulations are getting in the way of that. To them, even if they don’t end up meeting someone right or choose to have a child, at least that’s a life decision/path that they have chosen themselves. Not an option that was taken off the table for them arbitrarily.

One thing is clear, women in Singapore are strongly and loudly making the point: My body, my eggs, my right and freedom to choose.

On Instagram, there are a few accounts debating fervently about the ban on social egg freezing. On myeggsmytime, many women stated reasons why they will consider egg freezing in Singapore. As women, we are already bounded by many rules and expectations. When these regulations and careless comments are “imposed” upon us, we refuse to be unfairly moulded to fit into anyone else’s moral rulebook. No one likes to be told what to do or what we can do by the authorities, especially about our bodies.

I find it extremely exasperating that in all these debates or comments by authorities, a large premise of the arguments is that women are selfish as we view and want egg freezing as either fertility insurance, quick fix, easy solution or selfish decision. This is a problematic narrative that can’t be further from the truth. I can safely say that for most of us women, we will definitely prefer natural conception and birth. I had conversations with at least 200+ women and most of them are afraid of the process. They shiver in trepidation at the thought of having to inject themselves.

If given a choice, will I go through egg freezing? A resounding NO. Why would I/any woman put our bodies through the disparaging emotional and physical torture, knowing fully well that there are future ramifications that I might not see?  Why will I electively choose to inject myself daily and eat hormone pills? It is an invasive, expensive and tiring process.

In case you wish to argue that “but that’s your own decision, just own it”. I am and I do own it but I don’t wish egg freezing to be seen as something trivial or selfish. This is not some quick fix aesthetic procedures I am making. These are serious decisions women are making (and sometimes, struggling) with our bodies, our health and finances. For our future. For our unborn child that we might wish to have and may not be able to.

So, what are some of the ethical and moral arguments that have prevented the lift of the ban on social egg freezing in Singapore, even in 2021?

Moral & Ethical acceptability of fertility preservation for non-medical reasons

Reasons for & against social egg freezing in Singapore

  • Modern working women’s dilemma

Most modern societies are organized in ways that make it difficult for women to have children at what would be biologically the best age for reproduction. In modern societies, many women enter the workforce in their mid-20s and it takes a few years before they achieve sufficient social and financial stability to start a family in a planned and responsible manner.

Natural fertility for women tends to decline at around the age of 35. The early decline is present in a proportion of women who may be genetically predisposed to early menopause – they won’t be aware of this until it has already happened and it will be too late to start a family.

Natural fertility in men tends to decline at a later age. 

  • Egg freezing / ovarian or oocyte preservation as an insurance

It is already morally acceptable practice to preserve oocytes or ovarian tissue in women with catastrophic illness (e.g. ovarian cancer, breast cancer) to permit them to start families when their treatment is completed

In women who are well, oocyte or ovarian preservation does not serve a clear and present need, but insurance that they still retain the ability to start a family should they be struck with a catastrophic illness.

  • Genetic relatedness to child

Women who for various reasons, are only able to attempt starting a family later in life, may find themselves to be infertile hence compelling them to undergo IVF or adopt children; the children are genetically unrelated to them and they have been deprived of an opportunity to have an offspring that is genetically related to them by early oocyte harvest or ovarian preservation

  • Medical risks of late pregnancy for mother and child
  • Mother
    • Pregnancy at a later age, natural or artificially assisted, is associated with a higher incidence of risks and complications
  • Child
    • Negative consequences on the psychosocial development of the child for mothers who have children very late in life
    • Early harvesting of oocyte and ovarian tissue ensures the best quality oocytes used for subsequent pregnancies and minimizes chances of genetic abnormalities as compared with women who have children later in life using oocytes available at that current age – this is a selfless act by a mother acting in the interest of her future child, the mother bears the risk of ovarian stimulation/harvesting surgery
  • Technical considerations

Mature oocytes are known to be especially vulnerable to cryopreservation – better to harvest young oocytes. 

  • Primum non nocere (“First do no harm”)

Medical professionals are obliged to do no harm to the patients. Oocyte retrieval without an immediate plan for pregnancy incurs risks to the patient without the immediate benefit of pregnancy.

However, this is balanced against the benefit of early oocyte retrieval minimizing genetic abnormalities to the future child, as well as the ability to preserve childbearing as insurance against women who may accidentally find that they are subfertile at a later age.

  • Oocyte preservation as an alternative to less-morally desirable options
  1. Proactive IVF

Proactive IVF involves the creation of embryos without an immediate plan for pregnancy and involves the use of donor sperm to fertilize the retrieved oocyte. The creation and storing of human embryos may be more morally sensitive than oocytes.

Despite this, the creation and storage of human embryos is already a common practice in IVF cases – multiple embryos are normally created, and amongst them, a few are selected for implantation.  This is not seen as a morally unacceptable practice. Some of the difficulties encountered in cases of proactive IVF in women who are doing this for non-medical reasons – the creation of embryos is using donor sperm, who may not be genetically related to the woman’s future spouse

  • Gender-equality in reproduction

In some countries, preservation of sperm is well-accepted practice for men in jobs (e.g. working in toxic environments) or doing sports (e.g. football, cycling) that pose a potential threat to their fertility. These are men without medical problems and preemptively preserve their sperm for future use.

The window of opportunity to exercise the right to establish a family is much smaller for women than for men due to biological reasons; ovarian preservation permits women extension of their fertility period to enable them to start their families when in better socioeconomic situations if required.

Understanding the statement by the National Council of Churches of Singapore

“Profoundly selfish act”

Social Egg Freezing: Ethical and Social Issues: A Statement by the National Council of Churches of Singapore (full statement)

I’d like to give a proper context to which this comment appeared officially as a statement by the National Council of Churches of Singapore, on the circular “Social Egg Freezing: Ethical and Social Issues”, dated 10 March 2019, attached above. The full paragraph that contains the comment:

Children’s Welfare Underlying the often heady rhetoric that champions the autonomy and rights of the contemporary woman, some commentators have rightly discerned elective egg freezing to be in essence a profoundly selfish act because it sees career as more important than the interests and welfare of the child. Children must be given the healthiest and best start in life. This surely includes parents who are young and energetic enough to nurture them. In many ways this is more important than financial stability, an argument often used to support egg freezing and deferred motherhood.

In addition, women in their 40s and even 50s who use this technique often place on their children the heavy burden of having to take care of their geriatric parents (often burdened with chronic health conditions) when they are just about to start out in life as working adults, amidst all the attendant responsibilities and challenges at this stage of their life (marriage, career, mortgage, starting a family, etc.).

To be fair, the church did not categorically state that they found elective egg freezing as a “profoundly selfish act” but that “some commentators have rightly discerned” it to be. I don’t usually make any political or religious comment but found the formal statement baffling. I personally believe that this is an unnecessarily harsh formal statement by a highly-esteemed religious organisation. I understand if NCSS is not FOR egg freezing and wishes to encourage women to have children earlier in life but why make a blanket categorisation about women who want to preserve their fertility?

In addition, since Singapore is a largely secular country and as this is a formal statement by the National Council of Churches of Singapore, a religious organisation, does this only apply to followers?

For clarity purposes, this was a statement the NCSS made two years ago. Does it still stand? Does the National Council of Churches of Singapore still think this way? Well, we have to wait for another statement from them. In the meantime, let’s dissect the arguments brought forward in this statement.

Addressing & providing alternate views to the statement by the National Council of Churches of Singapore

  • Ethical and Social Issues

    While the Council appreciates the tensions that contemporary women face between pursuing a career and a child …The NCCS statement presupposes that women who undergo oocyte preservation do so out of purely personal selfish reasons. This may be untrue in some circumstances.

  1. Caring for parents who might be aged or sick
    In modern society where many people have children at a late age, many women who graduate from school face the prospect of caring for their aged parents immediately upon entering the workforce.
    Accompanying social and economic pressures arising from this prevent women from starting relationships and starting a family at a young age. To defer childbearing for purposes of caring for aged or sick parents is not a selfish act.
  2. Financial debts & commitments 
    Women are attaining higher levels of education and entering the workforce at a later age. Many may be saddled with debts and not ready to start childbearing, which itself is a large financial commitment.


    The Church advocates responsible parenthood, and timing childbearing to an age where a woman may provide well for the children is an extension of responsible parenthood.  The converse is true: women who enter unplanned pregnancies early in life (even in the context of marriage) are prone to multiple social and economic problems that affect themselves and their children, the latter are unwitting victims of poor parenthood planning.
  3. Marrying later
    Women are marrying later as a result of entering the workforce later and entering committed
    relationships later.
    The woman has a responsibility to ensure that she is in a stable committed relationship before embarking on parenthood for the sake of the prospective child.
  4. Readiness of the male partners
    Why do all the responsibility of childbearing and caregiving fall under the woman? How about the male partners? What if the male partners are not ready themselves? From my conversations with other women, there are women who are ready for children but not their partners. Some may have younger male partners, or that the male partners are simply not ready to have children despite being married.
  5. Penalty on Women’s CareerEncouraging women to have children early will not only have societal implications but also economic as what basically needs to happen is for women to put their career in the backseat. It’s no secret that women’s careers are often penalised in various industries if they have kids. Most women just have no time to do it all – career, children, housework, caring for parents, husbands, social life – especially for those that cannot afford help.
A common social conundrum of the modern woman

For example, in my own case, while my career is important to me and I don’t deny focusing on it, I am also the primary breadwinner of my family. I graduated at 24 and we were in debt. I had to work hard to clear off the debt and work towards buying a 3 bedroom HDB as a family home. I was not in any financial situation to be able to have and care for a child.

Also, I also did not have the opportunity to meet the right partner. If I had, I would have settled down and focused on family planning earlier. I didn’t want to rush into a marriage because “time is running out” or that I am “over the hill”. I am cognizant that to have a stable family environment and provide for a child, I need to have the right life partner. I’d rather wait and marry later than be stuck in an unhappy marriage that ends up in a divorce or having the kids bear the brunt of it. 

My story is not unique. A lot of my female peers are facing the same issue – that they do desire to marry and settle down with a partner but have not found the “Right One”. Of course, detractors will then argue “she’s too picky”, “she’s too career-focused” but what is wrong with a woman wanting to better her life? Or to wait until she’s emotionally, financially, and psychologically ready for a child? Why put undue whole time pressure on women to have children, which in turn causes a lot of bad decisions to be made? 

  • False hope

The NCCS statement opines that the probability of achieving a pregnancy from a preserved oocyte is between “4.5 to 14% per egg”.  This is not an insignificant figure and cannot be disregarded as false hope. This is also why during the extraction and harvesting, the medical doctors always advise keeping more eggs.

To an older woman who is facing a diminishing prospect of a successful pregnancy, oocyte harvest at a younger age does indeed offer her a better chance at successful childbirth than natural conception at that age.

Egg freezing is an invasive, exhausting and expensive treatment. Most women who are going through this have to struggle to overcome their fear. Those that go through the process will be advised not to see this as total “fertility insurance” as the odds are not in our favour. But we are also aware that the older our eggs are, the lower our chances are. I know of many women who are struggling to conceive naturally, even as they start family planning in their late 20s. If this is an added chance and women are aware of the probability, why are we so against letting women have that additional peace of mind?

  • Pressure on women

The NCCS statement states that legalising this technology will place undue pressure on women to use this technology for future pregnancies. As with all medical therapies, patients only receive such treatment when they seek and agree to the treatment after receiving appropriate consultation and counselling. 

There is no added pressure on women any more than new treatments such as using new classes of antibiotics or chemotherapy agents.

  • Risks

While the NCCS detailed the risks of egg freezing, they ended this point with “The pressing ethical issue here is that, in the case of social egg freezing, healthy women have opted to take these unnecessary risks for themselves and their offspring because of certain lifestyle preferences.”

Again, why are women judged on their choices on preserving their fertility, lifestyle or career preference? Why should we deny treatments to women who are planning ahead for their families?

One shouldn’t be hasty in generalising and making a moral judgment that consists of many personal, emotional, and psychological layers. There may be a multitude of considerations for a woman who chooses to undergo ovarian preservation, many of which cannot be considered as “profoundly selfish”.

(If you are curious about the risks, my Egg Freezing in Singapore – Procedure, costs, benefits, risks & side effects article actually states the facts and risks in great detail.) 

  • Children’s welfare

The NCCS statement states that children must be given the “healthiest and best start in life”, which “surely includes parents who are young and energetic enough to nurture them”. The NCCS statement argues that this is “in many ways, more important than financial stability”. Well, how about emotional maturity and stability? Are these not critical factors to raise children? 

What, and who is, to determine what is the “healthiest and best start in life” that NCSS refers to? Many research has consistently reported the social inequity divide for children that are from less privileged financial backgrounds. This affects the children’s education and social mobility. While money and income are not the most critical factors for raising a child, I am certain that most of us agree that financial stability is 

From a Organisation for Economic Co-operation and Development (OECD) report, has shown that “far too many children, students and adults from socio-economically disadvantaged backgrounds fall behind. In many countries, substantial learning gaps exist between students at opposite ends of the socio-economic scale, and these differences tend to increase in the transition into adulthood.” (Educational Opportunity for All – Overcoming Inequality throughout the Life Course, OECD)

“Children growing up in poorer families emerge from school with substantially lower levels of educational attainment. This is a major contributing factor to patterns of social mobility and poverty. (Poorer children’s educational attainment: how important are attitudes and behaviour?)

How about one from home? From Straits Times in 2018, “Nearly half of low-income students in Singapore are concentrated in the same schools, a report by the Organisation for Economic Cooperation and Development (OECD) has highlighted.

The report, released yesterday, found that 46 percent of disadvantaged students in Singapore were attending “disadvantaged schools” in 2015, up from 41 per cent in 2009. The OECD average is 48 percent. Disadvantaged students are those in the bottom quarter of the socio-economic index within their country, while disadvantaged schools are defined as those which take in the bottom quarter of the country’s student population.

The report, titled Equity In Education: Breaking Down Barriers To Social Mobility, said poorer students in such schools face a double disadvantage, as these schools may not have the best of resources, whether in teacher quality or financial resources. It recommended spreading out the share of low-income students across schools and improving social diversity in schools by reshaping school admission policies.”

  • Medicalisation and commodification

The statement argues that social egg freezing, like other Assisted Reproductive Technology (ART), “furthers the medicalisation and commercialisation of women’s bodies”. Commodification is not a strong argument. In vitro fertilisation (IVF) already exists, is widely practised and widely accepted. Oocyte preservation is already done for women with cancer and desiring future pregnancy.  Oocyte preservation is not commodifying fertility any more than IVF or oocyte preservation for medical purposes.

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In summary,  no one should be hasty in generalising and making a moral judgment that consists of many personal, emotional, and psychological layers. There may be a multitude of considerations for a woman who chooses to undergo ovarian preservation / social egg freezing, many of which cannot be considered as a “profoundly selfish act”.

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I own the full copyright to this article. I do NOT agree to any distribution to any media/blogs/ news agencies without my consent. You may not copy, reproduce, republish, download, post, broadcast, transmit, make available to any publications, or otherwise any use of the content below in any way. Any use of this content requires my prior written permission and consent.

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10 replies on “Singapore’s Ban on Social Egg Freezing & “Profoundly Selfish Act” Comment by National Council of Churches of Singapore”

Don’t skirt the issue of “Single Motherhood by Choice” when discussing social egg freezing
https://www.theonlinecitizen.com/2021/03/19/dont-skirt-issue-of-single-motherhood-by-choice-when-discussing-social-egg-freezing/

In a recent parliamentary session on 25th February 2021, Member of Parliament for Tampines GRC Cheng Li Hui called for permitting social egg freezing in Singapore. At the same time, she also suggested banning women who remain unmarried from using their frozen eggs for IVF treatment, which is akin to sweeping the entire issue of “single motherhood by choice” under the carpet.

This is an intractable and tricky problem that is unlikely to go away. Because single women who freeze their eggs do so with the strong expectation of using these to conceive children in future, regardless of their future marital status.

Not every single woman who freeze their eggs can be expected to successfully find their “Mr. Right” in the future. Under such circumstances, banning unmarried women from using their own frozen eggs is bound to create much resentment and discontent in future, among those that remain single.

It is likely that such a group of disgruntled single women may band together to file a “representative action” or “class action” legal suit against the government to allow them to utilize their frozen eggs to become “single mothers by choice”. Worse still, there is a risk that such single women may even be compelled to enter ‘sham’ or ‘temporary’ marriages just for the sake of achieving their dream of motherhood with their frozen eggs.

A politically expedient solution that the government might possibly consider, is to discreetly allow single women to export their frozen eggs to overseas fertility centers for IVF with donated sperm, thus leaving an open backdoor to “single motherhood by choice”. But this is clearly unsatisfactory, because this would mean unclear and misaligned policy direction by the government on the issue of “single motherhood by choice”. Either permit it openly, or use all means to stop it from occurring.

Hence, it is imperative that there should be more extensive, open and honest debate on the issue of “single motherhood by choice”, when discussing whether or not to permit social egg freezing in Singapore.

Tighten rules for doctors referring women to overseas facilities for social egg freezing

The ban on social egg freezing in Singapore was recently debated in Parliament. The procedure refers to women choosing to freeze their eggs for non-medical reasons.

It was reported that there is a growing number of women here who travel abroad to freeze their eggs because it is not allowed in Singapore unless there is a medical reason.

In recent years, there have been fertility doctors in Singapore who have taken a more active role in this process, by providing medical screening services to assess ovarian reserves and giving advice and referrals for women planning to freeze their eggs overseas.

What may have been largely overlooked are the possible financial interests that fertility doctors may have in foreign medical institutions that could bias their advice to patients, in particular their recommendations of suitable foreign fertility clinics for egg freezing.

It would thus be good that the following safeguards be implemented.

First, there should be strict standardised guidelines on informing patients about the medical risks and failure rates of egg freezing.

In particular, older women should be made aware that they need to undergo multiple egg collection and freezing cycles to obtain a sufficient number of frozen eggs to have a reasonable chance of future pregnancy.

For women who freeze their eggs overseas and make that trip just once, they would be in for a very big disappointment should they fail to conceive in the future with their own eggs.

Scientific data published in reputable medical journals claim high success rates of in-vitro fertilisation (IVF) with frozen eggs, but these may be misleading to patients who lack specialised knowledge in this area.

For example, patients are often ignorant that many of such published studies were comparing frozen and fresh donated eggs of young women between 20 and 25 years of age, which were collected specifically for use by infertile patients.

This is certainly not reflective of older career women freezing their eggs, who are typically aged from mid-30s to early-40s, with lower-quality eggs.              

Perhaps, the Ministry of Health should prepare a standard booklet, pamphlet or website page of relevant information for women intending to do egg freezing overseas.

Second, it must be made mandatory for fertility doctors to advise their patients against egg freezing, if certain factors are present that would drastically lower their chances of conceiving with frozen eggs.

These include being above 40 years of age, or if medical screening were to diagnose certain conditions, including exceptionally low ovarian reserves, health problems with their ovaries such as polycystic ovary syndrome or health problems with their womb such as extensive uterine fibroids, scarring or adhesions.

Third, for greater transparency, for fertility doctors recommending or referring patients to do egg freezing overseas, it should be compulsory for them to openly declare their financial interests in relevant foreign medical institutions, such as shareholding or joint proprietorship.

How to make egg freezing affordable to women of all socio-economic classes? https://www.straitstimes.com/forum/letters-in-print/allow-use-of-cpf-to-pay-for-egg-freezing

Allow use of CPF to pay for egg freezing

I applaud the Government for reconsidering its ban on social egg freezing (Govt reviewing ban on women freezing eggs for non-medical reason, Oct 22).
Single women who want to freeze their eggs face many financial constraints due to the high cost of the procedure.
Hence, a pertinent issue that the Government has to consider is how to help them pay the medical fees for such a procedure.
Government subsidies would probably be out of the question because social egg freezing is an elective procedure.
However, the Government may consider permitting the prudent use of CPF savings under conditions based on three criteria for reproductive success.
First, an age limit of 35. Most doctors agree that there is a steep decline in a woman’s fertility after age 35.
Second, CPF use should be permitted only if the woman’s ovaries are healthy and she has an adequate ovarian reserve, which would enable her to produce a sufficient number of good-quality eggs for freezing.
This can be determined through a medical screening for polycystic ovary syndrome, and to check her serum levels of anti-Mullerian hormone.
While it may seem harsh to disallow women with such medical problems from utilising their CPF savings for elective egg freezing, it would alert them to any fertility problems early, and avoid wastage of their CPF savings.
Third, reimbursement of the cost of egg freezing using CPF should be permitted only if a minimum threshold number of eggs of reasonable quality are frozen for the patient.
This may require multiple cycles of ovarian stimulation with hormones.

https://www.todayonline.com/voices/tighten-rules-doctors-referring-women-overseas-facilities-social-egg-freezing

Tighten rules for doctors referring women to overseas facilities for social egg freezing

The ban on social egg freezing in Singapore was recently debated in Parliament. The procedure refers to women choosing to freeze their eggs for non-medical reasons.

It was reported that there is a growing number of women here who travel abroad to freeze their eggs because it is not allowed in Singapore unless there is a medical reason.

In recent years, there have been fertility doctors in Singapore who have taken a more active role in this process, by providing medical screening services to assess ovarian reserves and giving advice and referrals for women planning to freeze their eggs overseas.

What may have been largely overlooked are the possible financial interests that fertility doctors may have in foreign medical institutions that could bias their advice to patients, in particular their recommendations of suitable foreign fertility clinics for egg freezing.

It would thus be good that the following safeguards be implemented.

First, there should be strict standardised guidelines on informing patients about the medical risks and failure rates of egg freezing.

In particular, older women should be made aware that they need to undergo multiple egg collection and freezing cycles to obtain a sufficient number of frozen eggs to have a reasonable chance of future pregnancy.

For women who freeze their eggs overseas and make that trip just once, they would be in for a very big disappointment should they fail to conceive in the future with their own eggs.

Scientific data published in reputable medical journals claim high success rates of in-vitro fertilisation (IVF) with frozen eggs, but these may be misleading to patients who lack specialised knowledge in this area.

For example, patients are often ignorant that many of such published studies were comparing frozen and fresh donated eggs of young women between 20 and 25 years of age, which were collected specifically for use by infertile patients.

This is certainly not reflective of older career women freezing their eggs, who are typically aged from mid-30s to early-40s, with lower-quality eggs.              

Perhaps, the Ministry of Health should prepare a standard booklet, pamphlet or website page of relevant information for women intending to do egg freezing overseas.

Second, it must be made mandatory for fertility doctors to advise their patients against egg freezing, if certain factors are present that would drastically lower their chances of conceiving with frozen eggs.

These include being above 40 years of age, or if medical screening were to diagnose certain conditions, including exceptionally low ovarian reserves, health problems with their ovaries such as polycystic ovary syndrome or health problems with their womb such as extensive uterine fibroids, scarring or adhesions.

Third, for greater transparency, for fertility doctors recommending or referring patients to do egg freezing overseas, it should be compulsory for them to openly declare their financial interests in relevant foreign medical institutions, such as shareholding or joint proprietorship.

https://www.straitstimes.com/opinion/forum/forum-no-guarantee-egg-freezing-will-produce-a-viable-pregnancy

No guarantee egg freezing will produce a viable pregnancy

Ms Malavika Menon seems to favour a rethink of current policies on non-medical reasons for egg freezing (Dilemma of social egg freezing for women in Singapore, July 11).

Those in favour of social egg freezing seem to think that women should no longer be punished with childlessness for not finding a partner, and should not feel pressured into a relationship because of their declining fertility.

It is natural for women in their 20s to worry that their biological clock might run out of time.

Presenting egg freezing as an insurance against future infertility is the strategy many egg-bank companies use to sell egg freezing to women.

Freezing your eggs could buy you time and give you more choices for the future, but such aggressive marketing may be misleading.

The American Society for Reproductive Medicine estimates that even for younger women below the age of 38, the live birth rate is between 2 per cent and 12 per cent.

If a woman who froze her eggs in her early 20s waited until her late 30s to use them, there is no guarantee that those eggs would produce a viable pregnancy.

Egg banks are offering fertile women a solution for potential infertility that they may not even face.

https://singaporenewsnetwork.com/singapore/forum-social-egg-freezing-option-should-also-be-extended-to-married-women/

FORUM: Social egg freezing option should also be extended to married women

The government is presently considering to lift the ban on social egg freezing, as mooted by the Youth and Women’s wing of the ruling People’s Action Party, in response to the continual slide of the country’s fertility rate. However, virtually all discussion have so far focused on single women (either never married or divorced), with no talk of extending this elective procedure to married women.

Currently married women undergoing treatment at fertility clinics in Singapore, are expected to have all their retrieved eggs fertilized by their husband’s sperm to produce embryos, some of which are transferred into the patient’s womb, with excess embryos being frozen for future use. It is only under exceptional circumstances that IVF clinics would freeze the unfertilized eggs of married women.

Firstly, failure to obtain a usable sperm sample from the husband on the day of egg extraction surgery, for example ejaculation failure due to stress. Secondly, excess unfertilized eggs are allowed to be frozen, provided the couple have strong conscientious objections against the disposal (culling) of unused frozen embryos, which is perceived by some religions to be wanton destruction of human life.

Nevertheless, married women may want to undergo elective egg freezing due to certain personal circumstances. Most notably, women in the midst of undergoing a divorce may want to preserve their fertility.

Under Singapore law, three years of separation is required for divorce with both parties’ consent; while for contested divorce by one party, there is a mandatory separation period of four years. Even for divorce due to desertion by one spouse, there is a minimum waiting period of two years. Hence, such “legally still married” women maybe placed in limbo and be unable to undergo elective egg freezing for fertility preservation, even if the current ban on the procedure is lifted.

Moreover, it must be also be noted that not all women are financially ready to have children immediately or shortly after marriage. Due to high property prices and expensive childcare costs, some couples may prefer to delay childbearing to build up their savings to start a family. Current IVF regulations established by the Ministry of Health (MOH), are not conducive for such couples to preserve their fertility by freezing their embryos or unfertilized eggs.

Hence, it is imperative that current deliberations by the government to lift the ban on social egg freezing, should also consider married women under these circumstances.

https://www.bionews.org.uk/page_160205

The egg freezing conundrum in Singapore – not all social and ethical issues can be regulated by law

Unlike in the West, many Asian countries adopt conservative and traditionalist policies towards motherhood and female reproduction. In Singapore, official government policy explicitly discourages and penalises reproduction by single women and same-sex couples, by excluding them from tax rebates, housing, and childcare subsidies that are accessible only to traditional families formed by married heterosexual couples. To date, elective egg freezing for the fertility preservation of single women is still banned in Singapore, as the Government fears that permitting the procedure might encourage delayed marriage and childbearing among the younger generation.

In 2020, Singapore recorded its lowest ever Total Fertility Rate (TFR) of 1.1. Although this anomaly may be partly attributed to disruption of normal social and economic life by the COVID-19 pandemic, the country’s TFR has been sliding downwards over the past few years, due to the increasing societal trend of late marriages and delayed childbearing within the country. This in turn has caused much consternation among government policymakers, as Singapore’s future economic prospects, social stability and available manpower for military conscription may be severely jeopardised by the impending transition into a super-aged society brought about by this demographic crunch.

To counter this worrying demographic trend, the Youth and Women’s wing of the ruling People’s Action Party called for lifting of the ban on social egg freezing, where eggs are harvested from single women and stored for future use without a medical need. Proponents of this elective medical procedure often point to the fact that the competitive and fast-paced society of modern Singapore, coupled with the high costs of living, childcare and education, exert unique pressures on women that make it difficult for them to start a family at a younger age. Instead many are forced to wait or prefer to wait until their financial situation becomes more secure with further career progression and accumulation of more savings.

Hence, the Singapore Government is presently considering lifting the ban on social egg freezing. Although this will undoubtedly be a boon to some women having difficulties in finding a suitable life partner, doubts have been raised on whether new reproductive technologies such as egg freezing could have any significant long-term impact in raising the country’s TFR. A few years ago, a Singaporean academic Dr Leong Chan Hoong (National University of Singapore Institute of Policy Studies) warned that Singapore’s IVF fertility drive that focused on a minority of older couples is largely symbolic and ultimately impotent. His warning seems to have been borne out by the continual slide of the country’s fertility rate, despite generous government subsidies of IVF treatment for married couples.

Lifting the ban on social egg freezing would require the Singapore government to draft comprehensive laws and regulations to address the various potential ethical problems and social issues associated with this elective medical procedure, as I wrote in an article in The Home Ground. Nevertheless, it is must be noted that not everything can be regulated by law.

One potential issue is the possibility of an increased generation gap between parents and children, and the reduced ability of older parents to cope with the physical rigors of raising young children. Moreover, there is also the unhappy prospect of young adults being burdened with the care of elderly parents, when they are just finishing their studies and embarking on their careers. Under Singapore law, it is obligatory for adult children to financially support their elderly parents. Hence delayed parenthood through egg freezing may not exactly be in the best interests of the child, and yet the child has no say or choice in this matter.

A potential social ill that is difficult to resolve is the frustration of single women who want to opt for single motherhood with their frozen eggs, after failing to find a suitable life partner. It must be noted that most single women who freeze their eggs, do so with the strong expectation of using them one day, regardless of their eventual marital status. Yet, there are strict laws that ban single women from undergoing IVF procedures in Singapore, which are near impossible to amend, given that both the Singapore Government and society-at-large are vehemently opposed to single motherhood by choice. If social egg freezing is permitted in Singapore, it is very likely that single women will be banned from exporting their frozen eggs abroad for IVF with donor sperm. This may possibly drive such single women with frozen eggs to undergo sham or temporary marriages out of desperation, to fulfill their dreams of motherhood. Otherwise, they have to face the agonising dilemma of disposing of their frozen eggs after spending so much of their hard-earned money as well as time and health risk, if they eventually decide to remain single rather than marry an incompatible life partner in order to be able to access IVF.

Then, there is also the unhappy prospect of some women being unable to conceive any children with their frozen eggs after spending so much money, and the consequent heartbreak and emotional distress that they have to undergo. No doubt, some laws and regulations can be implemented to weed out poor candidates for egg freezing, such as women above 40 years of age, or those with pertinent fertility problems. But at the end of the day, the results of egg freezing are still highly unpredictable, and there will definitely be some women who will fail to conceive children with their frozen eggs. Can any laws and regulations be drafted to provide consolation to these women?

Yet another contentious social issue is unequal accessibility to elective egg freezing, given the high costs of the procedure, which would likely make it unaffordable to poorer women. The only way to guarantee equal access to women of all socio-economic classes would be for the government to heavily subsidise it, which is difficult to justify, given that it is an elective medical procedure based on personal life choices that is not essential for sustenance of life or health. Hence to date, there is no country in the world where social egg freezing is being subsidised by the state. There are of course some employers who are willing to subsidise egg freezing for their workers, for example tech firms such as Apple and Facebook. Yet, such privileges are often restricted to highly-educated and high-value employees, which could spark accusations of elitism.

The spectre of employer-subsidised egg freezing thus brings about another potential social ill that is difficult to regulate by law, which is the unfair expectation that some employers place on women to put aside their plans of having kids, so that they can devote more of their time and energy to the company. There is probably a dark side to company perks on subsidised egg freezing for their female employees. The unwritten rule if such perks are around, is that female employees are expected not to take maternity leave and should deliberately delay having kids; or else they should expect to not be promoted, and be the first to be laid off when the opportunity arises.

To provide some financial assistance for egg freezing, Singapore may consider the much-vaunted freeze and share scheme that is available in some countries such as the UK and USA, which provides heavily subsidised egg freezing for single women in return for donation of some of their eggs to infertile patients. Nevertheless, such a scheme is unlikely to equalise accessibility of this expensive procedure to poorer and disadvantaged women. Because like commercialised egg donation, freeze and share is also subjected to market forces, and prospective recipient patients would definitely prefer certain desirable traits in donors, such as high education, good jobs, and beauty standards related to height and complexion. Hence, freeze and share is in fact highly-selective and would likely exclude poorer women with less education and fewer desirable traits.

Finally, there is also an increasing trend for single women to expect and demand their parents to help pay for social egg freezing, as highlighted by stories in the American news media. There is a subtle element of emotional blackmail here, as it would be like saying: ‘Help me pay to freeze my eggs, or you may never have any grandchildren’.

Therefore, it is just not enough for the Singapore Government to focus only on potential ethical problems and social ills that can be regulated by law. Instead, they should look at the ‘big picture’ and have a far-sighted holistic view of what permitting social egg freezing would entail for Singapore in the long-term, and its lasting ramifications on society.

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