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Genetic testing controversy clouds medical tourism in Malaysia

Wealthy couples from Singapore and China are flocking to Malaysia for IVF genetic testing
Malaysia emerges as medical tourism hub for IVF genetic testing

Malaysia emerges as medical tourism hub for IVF genetic testing. (Photo: Unsplash)

Published: July 05, 2022 10:25 AM GMT
Updated: July 05, 2022 11:06 AM GMT

With many countries reopening their borders as the pandemic recedes due to increasing vaccination worldwide, medical tourism by patients seeking IVF (in vitro fertilization) procedures banned in their home countries but available abroad is once again on the rise. One of the most controversial of these is sex selection by genetic testing of IVF embryos, a procedure known as preimplantation genetic screening (PGS) or preimplantation genetic testing-aneuploidy (PGT-A).

Although PGS (PGT-A) was originally developed to screen genetically defective IVF embryos to prevent birth defects such as Down syndrome, it can also be readily used for sex selection of human embryos. To date, PGS (PGT-A) is currently the best and most effective method of sex selection available in the market. If a woman becomes pregnant through IVF with this technique, the success rate of sex selection is close to 100 percent.

Concerned that such new reproductive technologies would further skew the sex ratio of their populations, many Asian countries with unbalanced sex ratios due to son preference, such as China and India, have banned the use of PGS  (PGT-A) for embryo sex selection in clinical IVF treatment. This is widely deemed to be immoral and unethical as it reinforces traditional gender bias and sexism, and encourages couples to favor having children of one gender over the other — eliciting much controversy in some Asian countries where women are subjected to strong societal discrimination and gender-based violence.

To circumvent such strict regulations, many wealthier couples from countries with such bans travel abroad to more liberal jurisdictions where PGS (PGT-A) for sex selection is permitted. In recent years, Malaysia has emerged as a medical tourism hub for the controversial procedure, with many well-established IVF clinics offering cost-competitive medical fees to foreign patients. Indeed, there have been media reports of many couples from neighboring Singapore traveling to Malaysia for embryo sex selection with PGS (PGT-A), as such a procedure is banned in the city-state. This has caused much concern for Singaporean health authorities, leading to severe restrictions being placed on the import of PGS-tested frozen embryos.

Many patients who seek to do embryo sex selection with PGS (PGT-A) at Malaysian IVF clinics are ethnic Chinese from Singapore and China, as such a procedure is banned in their home countries. Such patients often prefer Malaysia over Western countries, not only because of cheaper medical fees but also because many fertility doctors there can speak Mandarin.

In fact, some foreign fertility clinics in Singapore and China have collaborative ties with Malaysian IVF clinics that do sex selection with PGS/PGT-A. Such clinics are permitted to initiate the IVF treatment process for their patients by performing hormone injections to stimulate egg production while the patient is still overseas, so as to shorten their stay in Malaysia for the PGS sex selection procedure.

Another alternative for Singaporean patients with busy schedules is to do the entire IVF treatment process in Singapore, but freeze all their embryos and export these to a Malaysian IVF clinic for the PGS sex selection procedure. However, they would then have to travel overseas for the transfer of the sex-selected embryos into the womb. By contrast, the export of IVF embryos is banned in China.

Son preference and obsession with having male heirs are deeply ingrained in Chinese culture, more so in the case of traditional Chinese family businesses, which tend to be more conservative than the general population. Although daughters can now be educated and trained to be astute and capable businesswomen, they are not seen to continue and carry the family lineage. Instead, the children that they bear are considered to belong to their husband’s family. Hence, if a traditional Chinese family business has no male heir, their entire wealth is inherited by their sons-in-law, who belong to another family lineage. Moreover, the traditional Taoist/Confucian rite of ancestor worship requires male heirs to carry out prayer offerings to their deceased ancestors, lest their dead family members become “hungry ghosts .”

In the early 20th century, the famous Indonesian Chinese tycoon Oei Tiong Ham  (aka Sugar King of Java) was fearful of his wealth being inherited by his many daughters because Dutch colonial laws stipulated that he cannot draft a will that denied his daughters their rightful inheritance. To evade such laws, he moved to Singapore, where he made a will that passed his entire estate to his sons when he died in 1924.

In the old days, it was common and socially acceptable for a rich Chinese man to have several wives and concubines. By having more sons, a rich family could very rapidly have many descendants through polygamy, efficiently propagating and spreading their lineage throughout the general population. By not having a male heir, the family’s wealth will be passed on to sons-in-law, who in turn will abuse their inheritance to spread their own seed through polygamy.

Although times have changed drastically and such old social norms are long gone, ancient Chinese cultural traits that have evolved over millennia die-hard and still persist. This could explain why son preference and obsession with having male heirs are so prevalent among traditional Chinese business families in Asia.

The views expressed in this article are those of the author and do not necessarily reflect the official editorial position of UCA News.

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