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Singapore need not subsidize elective egg freezing

In a country with one of world's highest life expectancies, taxpayer’s money can instead be used on rapidly aging population
A staff member shows a mock-up of work being done on women's eggs in the laboratory at the KL Fertility Centre in Kuala Lumpur, Malaysia

A staff member shows a mock-up of work being done on women's eggs in the laboratory at the KL Fertility Centre in Kuala Lumpur, Malaysia. (Photo: AFP/ UCAN files)

Published: October 09, 2023 12:10 PM GMT
Updated: October 09, 2023 12:12 PM GMT

Elective egg freezing has been in the news recently with South Korea offering subsidies for the procedure and Japan and Taiwan planning to follow suit, so as to boost their dismal birth rates.

Egg freezing subsidy has also been mooted in Hong Kong to boost the fertility rate. In Singapore, egg freezing was recently permitted in the country in July 2023, but the procedure is as yet not subsidized by the Government.

Like Japan, South Korea, Taiwan, Hong Kong, and Singapore is also facing a demographic crunch due to its dismal fertility rate, which hit a new low in 2022.

Hence, the Singapore Government might one day consider following the examples of these other Asian countries in subsidizing elective egg freezing.

Nevertheless, here are some counter-arguments on why Singapore should not do so.

First and foremost, this elective medical procedure is non-essential for sustenance of either health or life of the patient, but is instead attributed solely to personal life choices.

Hence, using taxpayer’s money to subsidize elective egg freezing is unjustified as it depletes public funds that may be better used to subsidize treatment of life-threatening diseases such as cancer and heart failure.

Second, a clear distinction must be made between deliberate creation of a medical situation versus lifestyle risks. For example, a heavy smoker is at a higher risk of lung cancer, yet is eligible to receive Government subsidies for lung cancer treatment.

Likewise, a construction or shipyard worker is at an increased risk of accidental workplace injury, yet is also eligible to receive public subsidies for treatment of occupational injuries. 

Although there are obvious elements of lifestyle risks and personal choices in the first two examples, there is no deliberate and wilful creation of a medical situation. The smoker and the construction worker are not deliberately choosing to develop lung cancer or have an accident respectively, although the risks are there.

By contrast, in the case of egg freezing, there is a deliberate and wilful choice by a healthy patient to undergo an elective medical procedure that carries risk. Not only is the egg extraction surgery invasive, but there are also risks of ovarian hyperstimulation syndrome, a potentially life-threatening condition where the body overreacts to injected hormones.

Third, elective egg freezing may be too cost-inefficient to warrant public funding from Government coffers. The freezing procedure always causes some damage to human eggs, despite new technological innovations such as ice-free vitrification protocols.

According to the American Society of Reproductive Medicine (ASRM), the pregnancy success rate for egg freezing is relatively low, at around 2 to 12 percent per frozen egg.

Likewise, the Human Fertilisation and Embryology Authority (HFEA) in the UK reported that only about one in five IVF treatment cycles using a patient's own frozen eggs is successful. 

Given such poor success rates and low cost-efficiency, many women often require multiple egg-freezing cycles to obtain sufficient numbers of frozen eggs to have a reasonable chance of a future pregnancy.

How many egg-freezing cycles should the Government be willing to subsidize for the otherwise healthy single woman making a personal lifestyle choice? Would this not rapidly deplete public health funding that may be better utilized for subsidizing the treatment of life-threatening diseases such as cancer?

Fourth, using public funds to subsidize egg freezing might be highly wasteful, if most women who freeze their eggs do not eventually use them, as evidenced by two Australian studies.

In the first study published in 2017, researchers surveyed nearly 100 women who elected to freeze their eggs between 1999 and 2014 for the purpose of delayed childbearing and found that just six percent of women had used their frozen eggs at the time of the survey, with only three percent of them having given birth.

The second study published in 2021, reported similar findings – that of the 4048 women who had stored their frozen eggs in Victoria, Australia, less than four percent (159 women) came back to use their eggs in 2020. Consequently, the second study estimated that at best, only one in five patients will eventually use their frozen eggs.

Last, there is an issue of gender discrimination if women can receive public subsidies for elective egg freezing, while men on the other hand do not receive any subsidies for elective sperm freezing.

In fact, elective sperm freezing without medical indications is banned in Singapore. Given that Singaporean men are required to do mandatory military service for around two years, which in turn incurs the risk of their future fertility being damaged by accidental injuries during military service, it may be a highly contentious issue if women can receive public subsidies for fertility preservation that are denied to them.   

In conclusion, the Singapore Ministry of Health (MOH) has a public duty to ensure that taxpayer’s money is wisely and prudently used. 

Singapore currently has one of the world's highest life expectancies. Hence, it is imperative for the MOH to ensure that there is sufficient public health funding to support medical contingencies faced by a rapidly aging population over their long lifespan. Based on the aforementioned reasons, utilizing public funding to subsidize elective egg freezing may not be in Singapore’s best interests.

Dr. Alexis Heng Boon Chin, an expert in Biomedical Science, had previously worked in the field of human clinically assisted reproduction research in Singapore and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies. The article expresses his personal opinion, which is not connected to any institutions that he is affiliated with. 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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