Foreign egg donor / donation agencies and individual freelance egg donors

Angelica Cheng

Active Member
Please share your experiences with foreign egg donor / donation agencies and individual freelance egg donors.

At a local private fertility clinic that I consulted, a nurse hinted to me that I can secretly use a Malaysian, Thai or International egg donor agency to discreetly send an egg donor to Singapore. But payment must be kept secret. The donor and the recipient couple must sign a form declaring that the donor is unpaid and donating her eggs altruistically to us.

The nurse also hinted to me that the doctor and fertility counselor may suspect or secretly know that we are using a foreign agency and paying the egg donor, but they will be willing to 'close one eye' and look the other way. After all, the signed declaration form stating that the donor is unpaid absolves the doctor and IVF clinic from any legal liability for any secret payment to the donor. All legal liability (criminal perjury and bribery) will now fall on the recipient couple and the egg donor.

Additionally, the nurse also warned me against using individual freelance egg donors who offer their services online, as there is no money-back guarantee. For example, freelance egg donors may renege on their agreement after receiving some payment, and it would be difficult for me to sue her to return my money, as the payment was illegal in the first place and that I would only implicate myself in an illegal transaction if I were to commence legal proceedings. Moreover, it is rather difficult to monitor and ensure freelance egg donors regularly follow the painful and tedious procedure of hormone injections required for ovarian stimulation.

She also pointed out the advantages of using a foreign egg donor agency instead of an individual freelance donor. For example, most egg donor agencies will get a coordinator to accompany the donor on her travel to Singapore, who will ensure that she injects herself punctiliously with fertility hormones during the ovarian stimulation cycle. Many agencies will also give you a new replacement donor free-of-charge, if no eggs are retrieved, or if the donor gets sick and backs out half-way. Furthermore, the agency coordinator will also coach the egg donor to say the right things to the fertility counselor, since it is compulsory for the donor to receive counseling before the egg donation procedure.

In hindsight, I realized that all these must actually be the doctor's idea, and that he was using his nurse to relay such information to me, so as not to breach the medical professional code of conduct and ethics. All legal liability will be on us, since we have signed the form declaring that the egg donation is unpaid and altruistic. The clinic and IVF lab will be free of any legal responsibility for the secret payment, once the appropriate declaration forms have been signed by us and the donor.

The above text was adapted from the following website: https://www.msn.com/en-sg/lifestyle...oices-of-ivf-patients-in-singapore/ar-AAKcvtC


Does anyone have experience with these two international egg donor agencies?

Sunshine Egg Donation Agency: https://www.eggdonors.asia/ivf-in-malaysia/
(The attached image is a sample profile of available Chinese egg donors from this agency)

Asian Egg Donation:

 

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Interesting Straits Times Article:

https://www.straitstimes.com/opinion/egg-donors-payment-ban-can-create-a-black-and-a-grey-market


Egg donors: Payment ban can create a black and a grey market

We are facing a brave new world with the advent of scientific breakthroughs such as the "three-parent" technique where a baby is born using DNA from three people. This is just one of many examples of new reproductive technologies to come, which will likely result in an insatiable demand for donated eggs. If not managed carefully, this can potentially lead to exploitation and abuse of both patients and donors.

Currently in Singapore, health regulations explicitly forbid women who donate their eggs from receiving payment for their contributions; and there has to be a completely altruistic transaction between the donor and recipient. However, the recipient patient is allowed to pay for the cost of reasonable expenses incurred during this process, such as travelling costs.

Such stringent regulations, together with the ban on social egg freezing (where women freeze their eggs when young and fertile, and keep them for future pregnancy) and the increasing trend of late marriages and motherhood, will boost the overwhelming demand for scarce donor eggs. Already, increasing numbers of local patients are seeking such fertility treatment abroad, as reported in The Straits Times a few years ago.

Banning payment of egg donors will not stop commodification, nor will it lead to a more ethically and morally acceptable situation. Instead, the combination of scarce supply, high demand by desperate patients, cash-strapped female university students, Internet technology and increasing globalisation and outsourcing of medical services, will inevitably fuel a black and a grey market for donor eggs.

This is best exemplified by the current situation in other jurisdictions that have banned commercial transaction of donated eggs. In China, for example, there have been tabloid reports of under-the-table payment for egg donation being made to vulnerable schoolgirls and university students by desperate patients, either through illegal brokers or via Internet websites. Reportedly, the amount of payment depended on the academic qualifications and physical beauty of the prospective egg donor.

Similarly in Australia, where most prospective egg donors connect to patients via the Internet, there have been stories of bidding wars in under-the-table payments to the most desirable egg donors. It was reported that one grateful couple "gifted" some dental work to their egg donor.

In Singapore, patients are usually required to seek and find their own egg donor, who may be a relative, close friend or even complete stranger. The pertinent question is whether under-the-table payment to egg donors can be prevented by the current system of donor screening and counselling put in place by the Ministry of Health. Could there also be other undue inducements, such as expensive dining and luxury hotel stay for donors sourced from abroad?

ETHICAL ISSUES

There are also ethical issues surrounding the lack of donor anonymity and its consequent psychological impact on both parents and children, if patients were requested to source their own egg donors.

Recently, numerous egg- donation agencies have sprung up in neighbouring countries which have offered their services in sourcing Asian egg donors for immigrant couples based in Western countries.


The usual practice is for a "coordinator" to accompany the egg donor while travelling abroad and "coach" her on passing rigorous psychological evaluation tests for egg donation. It is possible that some may target Singapore-based couples.

Hence, it would be very difficult for doctors and fertility counsellors in Singapore to discern whether prospective egg donors have been sourced through such foreign agencies and offered illegal under-the-table payments. After all, it is not the job of fertility clinics here to police such illicit activities. Perhaps, it may be in their own interest to turn a blind eye, even if they were secretly aware of such goings-on.


COLLUSION BETWEEN DOCS AND FOREIGN EGG DONOR AGENCIES

There is also a possibility of surreptitious collusion between local fertility clinics and foreign egg donation agencies. For example, doctors or nurses may drop a hint to their patients to seek such agencies, if they fail to solicit egg donation from their own relatives and friends.

Besides an outright black market in the form of illegal brokers and under-the-table payment to egg donors, a grey market may also emerge through ethically questionable practices by fertility clinics and doctors.

For example, in many jurisdictions that ban commercial transaction of donated eggs, there are seldom any laws that prevent local doctors from referring or recommending their patients to receive egg donation at foreign fertility clinics, in which they have a financial interest.

Furthermore, many of these jurisdictions also lack regulations that prevent locally registered fertility doctors from travelling abroad to perform procedures related to commercialised egg donation.

Another dubious practice is to encourage patients to freeze all their unfertilised eggs instead of embryos, on the pretext of preventing destruction of human life upon embryo disposal, as well as to avoid legal entanglements associated with divorce or separation. The excess unused frozen eggs can then be altruistically donated to other infertile couples.

It is often the case that patients who had successfully completed fertility treatment feel a deep sense of gratitude to their doctor. Hence, fertility doctors can easily manipulate the doctor-patient fiduciary relationship based on trust and goodwill, to cajole their former patients to altruistically donate their unused excess frozen eggs.

But in fact, because unfertilised eggs always survive the freezing process less well than embryos, the cumulative success rates for patients are diminished. These doctors may even earn additional medical fees from the egg-donation procedure, even though no commercial transaction of donated eggs has actually taken place between donor and recipient.

Because fertility doctors soliciting altruistic egg donation from their own patients usually control the distribution and allocation of the donated eggs to other patients, this can potentially lead to other abuses.

For example, premium medical fees can be charged to unsuspecting patients receiving egg donation, which could in fact mask the sale of the donated eggs. There is no longer a level playing field, because the patient's choice of fertility clinic would now be influenced by the availability of donated eggs rather than the doctor's skill and expertise.

Moreover, fertility doctors controlling distribution of scarce donor eggs may become the target of bribery. For example, desperate patients can offer to sign up for more expensive medical packages that include antenatal and postnatal care besides fertility treatment, in return for priority in receiving altruistically donated eggs.

Hence the Ministry of Health in Singapore should seriously reconsider a system of financial compensation of egg donors with appropriate checks and balances, similar to that implemented for kidney donors.

Rather than pretending that commodification of donated eggs cannot take place with an outright ban on payment to egg donors, it may perhaps be wiser and more prudent to permit and regulate it under a strictly controlled environment.
 
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Good News for all Singaporean IVF patients requiring Egg Donation !!!

Singapore has permitted import of frozen donor eggs from Egg Bank Asia, based in Penang, Malaysia. This Egg Bank has a wide and excellent choice of Chinese race egg donors. Currently there are 3 clinics in Singapore, which have either imported frozen donor eggs for their IVF patients from Egg Bank Asia, or are in negotiations to do so. These are as follows: (i) Alpha IVF Singapore, (ii) Centre for Human Reproduction at NUH, and (iii) Mt. Elizabeth Fertility Centre.

Website:

Phone number: +60-12-579-2006

WeChat ID: EggBankAsia

Email: [email protected]

However, before importing donor eggs into Singapore, patients should note the following:

(1) Transportation of frozen donor eggs into Singapore is very expensive.
Due to COVID-19 pandemic situation, the only method of import is by air-travel, land transport through the Causeway is prohibited. Current quoted cost of import through courier service: USD$1,800. The current cost of frozen donor eggs are as follows:

Known Egg Donor - USD$1,300 per frozen egg (Minimum order of 8 frozen eggs)

Anonymous Egg Donor - USD$1,000 per frozen egg (Minimum order of 8 frozen eggs)

(2) It is much cheaper to do the egg donation process in Penang (Malaysia), rather than import frozen donor eggs into an IVF clinic in Singapore.
Egg Bank Asia is closely affiliated with Island Fertility Centre based in Georgetown Penang. They offer the following packages:

Entire IVF package with 8 frozen donor eggs, including medical fees - USD$ 11,500

Entire IVF package with fresh egg donation, including medical fees - USD$ 16,500

(More expensive because more than 8 eggs usually obtained from young healthy donor, typically 15 to 20 eggs per cycle)

(3) An older women can afford to wait for egg donation, unlike IVF with her own eggs. The womb (uterus) does not age as fast as her ovaries. Why not wait out the pandemic, to enjoy cheaper costs of IVF treatment at Island Fertility Centre in Penang (Malaysia), which is closely affiliated with Egg Bank Asia?

(4) For best results, it is better to do Egg Donor IVF at Island Fertility Centre in Penang (which is closely-affiliated with Egg Bank Asia), rather than importing frozen donor eggs into Singapore. Avoid using frozen donor eggs that are transferred from an egg bank. If possible, use the IVF lab that is affiliated with that egg bank. This is because the thawing protocol must be matching and compatible with the freezing (vitrification) protocol, and only the same IVF lab that performs both the freezing and thawing processes, can ensure this. Also beware that IVF success rates with frozen donor eggs are significantly lower than with fresh donor eggs (see attached bar chart below).

Please refer to the following video podcast by Dr. John Jain, an American fertility specialist:

 

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Egg Bank Asia says no need for embryo genetic testing (PGS or PGT-A), unless Husband has sperm problem:

All donors have been rigorously screened (blood samples) for genetic diseases:

"Our egg donors are Chinese with an average age of 23 to 28, the optimal age for achieving pregnancy and together we have over 200 donors. All of our donors are pre-screened using advanced genetic carrier screening, the most advanced in Asia as we follow the recommendations of the American College of Obstetricians and Gynecologists and the American College of Medical geneticists and Genomics. Our screening is designed to detect genetic mutations associated with a large number of hereditary disorders with greater than 99.9% accuracy and is performed at our partner lab in the USA."


 
To circumvent COVID-19 travel restrictions, Singapore now allows IVF patients to freeze and transport the husband's sperm to foreign fertility clinics or egg banks, where these can be used to fertilize fresh donor eggs to produce frozen embryos, which can then be imported into Singapore.

This has 3 major advantages over the import of frozen unfertilized donor eggs:

(i) Fresh donor eggs typically produce better quality embryos and higher IVF success rates than frozen donor eggs.


(ii) It is well-known that sperm and embryos, particularly Day 5 Blastocysts are much more hardy and survive the freezing process much better than unfertilized eggs. Therefore, it is always better to transport frozen embryos rather than frozen unfertilized eggs into Singapore.

(iii) Best results are obtained by using the IVF lab affiliated with the egg bank, which recruited the egg donor and froze her eggs. IVF patients should avoid using frozen donor eggs that are transferred to their clinic from an external egg bank. This is because the thawing protocol must be matching and compatible with the freezing (vitrification) protocol (somewhat analogous to a lock and key). Only the same IVF lab that performs both the freezing and thawing processes can ensure this, to attain best IVF success rates.


Please refer to the following video podcast by Dr. John Jain, an American fertility specialist:


Sunfert International Fertility Centre (KL, Malaysia), now accepts frozen sperm samples from Singapore for fertilization of donor eggs to produce embryos, which are then frozen down and transported back to Singapore. Please note that import of IVF embryos into Singapore is only permitted if these have not been genetically tested by PGS / PGT-A.

Sunfert @ Bangsar South
Sunfert International Fertility Centre Sdn. Bhd.
Unit 2-2, Level 2, Nexus, Bangsar South
7, Jalan Kerinchi, 59200 Kuala Lumpur, Malaysia.

T +60 (3) 7622 8688
F +60 (3) 2242 3168
E [email protected]
W www.sunfert.com
S www.facebook.com/sunfert



Details of egg donor program at the Singapore side:

Sunfert International Fertility Centre is currently working with the following fertility specialists in Singapore, for the freezing and export of the Husband's sperm sample into Malaysia, and subsequent import of the produced frozen embryos into Singapore for transfer to patients.

• Dr. Suresh Nair - Seed of Life:

Dr. Christine Yap - Mt. Elizabeth Fertility Centre:

For the exact costs of freezing Husband's sperm sample and subsequent frozen embryo transfer, please contact the above doctors and their affiliated fertility centres.


Details and costs of egg donor program at the Malaysia side -Sunfert International Fertility Centre:

The IVF-Egg Donation Programme Package costs MYR 32,000 + MYR 16,000 (donor's reimbursement via CASH / BANKTRANSFER ONLY).

The egg donation program has many Chinese donors. These donors are selected based on good ovarian reserve (good AMH levels) therefore between 8 - 12 eggs are expected to be harvested. However, there is no guarantee that eggs will be recovered or that fertilization will occur, embryo development / transfer / pregnancy from any fertility treatment.

The egg donation package includes the following:


  • Donor's clinical & blood investigations related to infectious disease screening.
  • Medication for the donor & recipient (up to pregnancy test).
  • Doctor's professional fee & Laboratory charges (IVF/ICSI)
  • Blastocyst culture, Laser Assisted Hatching (if necessary) & Time-Lapse Imaging up to 12 eggs by using one of the best platforms called the EmbryoScope®)
  • Cryofreezing of excess embryos & cryopreservation maintenance charges for the first 6 months
  • Psychological Assessment & Counselling (PAC) session (compulsory 1.5 hour session for all recipient)
  • 1st Frozen Embryo Transfer (FET)

However, the egg donation package price does not include the following:
  • Initial consultation and scan with our specialist, initial blood screening & semen analysis
  • Embryo cryopreservation maintenance charges (MYR 1200 / year)
  • Other adjunct treatment/services such as sperm separation, Pre-implantation Genetic Diagnosis/Screening (PGD/PGS), IMSI & Colorado Protocol
  • Further medications once pregnancy is confirmed by blood test

Costs of export and import of frozen sperm and embryos respectively, by Ulink Sdn Bhd:

The Malaysian company Ulink (Sdn Bhd) can now handle export of Husband's frozen sperm sample to any fertility clinic in Malaysia, together with subsequent import of frozen embryos into a local IVF clinic in Singapore.

Their charges are RM4,500 for one-way, or RM9,000 for to-and-fro transportation, including all administrative fees for custom paperwork, as well as custom duties.

Ulink (Sdn Bhd) company website: ulinkassist.com
Contact person: Ms. Charmaine Khoo
Email address: [email protected]
Tel: +6016 625 2923 +603 7866 0640
Address: 8 Jalan 55 1/9A, Petaling Jaya 47301, Selangor, Malaysia
 
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Alternatively, Thomson Fertility Centre in Singapore, also collaborate with Heart2ART egg donor agency in Malaysia, for export of Husband's frozen sperm sample into Malaysia for in vitro fertilization of donor eggs to produce embryos, which are then frozen down and imported back into Singapore for transfer to the wife.

Information on procedures and costs at the Heart2ART agency side:

Altogether, the entire package cost of donor eggs, including IVF, embryo culture and freezing is RM 50,000.

Heart2ART egg donor agency
Website address:es

Email address: [email protected]
Address:
6-1, Jalan Setia Dagang AK U13,
Setia Alam, Seksyen U13,
40170 Shah Alam
Selangor, Malaysia.
TEL: +603-3362 3729
FAX: +603-3362 5729
Mobile: +6012 389 3840 (Christine)


Information on procedures and costs at the Thomson Fertility Centre Side:

Collection and freezing of Husband's sperm sample: SGD$175 (before GST)

Frozen Embryo Transfer procedure: SGD$3,500 to SGD$4,500 (before GST).
Variability is due to medications and consumables used by individual patients,
as well as whether there is need for Assisted Hatching procedure.


Costs of export and import of frozen sperm and embryos respectively, by Ulink Sdn Bhd:

The Malaysian company Ulink (Sdn Bhd) can now handle export of Husband's frozen sperm sample to any fertility clinic in Malaysia, together with subsequent import of frozen embryos into a local IVF clinic in Singapore.

Their charges are RM4,500 for one-way, or RM9,000 for to-and-fro transportation, including all administrative fees for custom paperwork, as well as custom duties.

Ulink (Sdn Bhd) company website: ulinkassist.com
Contact person: Ms. Charmaine Khoo
Email address: [email protected]
Tel: +6016 625 2923 +603 7866 0640
Address: 8 Jalan 55 1/9A, Petaling Jaya 47301, Selangor, Malaysia
 

Advice and tips for Singaporean patients seeking egg donation in Malaysia

With the increasing trend of late marriages and delayed motherhood in Singapore, coupled with the lifting of age limits in IVF treatment since 2020, there is anticipated to be increasing demand for egg donation by older female IVF patients nearing or past menopause. Such women with diminished ovarian reserves often consider the egg donor option, after having failed IVF due to the reduced number and low quality of their retrieved eggs. In recently years, neighbouring Malaysia has emerged as a popular destination for Singaporean IVF patients seeking egg donation, due to close proximity and cost-competitive medical fees. Nevertheless, there are various pitfalls that patients have to navigate through, as highlighted by the Q & A below. Cumbersome travel and quarantine restrictions due to the COVID-19 pandemic are economically unsustainable in the long-term, and it is only a matter of time before borders reopen, and Singaporeans are once again free to travel to Malaysia for IVF treatment.

Is it difficult to find a local egg donor in Singapore?

Yes, because Singapore health regulations require egg donation to be altruistic, and payment can only be made to reimburse direct expenses such as traveling costs. The egg donation process is lengthy, tedious and painful, involving a few weeks of regular hormone injections, frequent blood tests and ultrasound scans, finally culminating in day surgery for egg retrieval. Additionally, there is also the hassle and inconvenience of commuting to and fro for numerous medical appointments. Understandably, without any financial incentives, very few local young women are willing to donate their eggs.

Why go for egg donation in Malaysia?

A large pool of egg donors of varying ethnicity and educational backgrounds are readily available in Malaysia because of generous financial inducements. Additionally, Malaysia has numerous IVF clinics and donor agencies that offer cost-competitive egg donation programs, which are much cheaper than other foreign countries such as USA, Australia and Taiwan. It is also much easier to source Asian egg donors in Malaysia, compared to Western countries such as USA and Australia. Moreover, Singaporean patients prefer to undergo IVF treatment at a destination close to home like Malaysia.

Are there any legal restrictions on egg donation in Malaysia?

Yes, only non-Muslim patients are allowed to receive egg donation. Shariah laws in Malaysia forbid Muslim patients from receiving egg or sperm donation.

What are the typical costs of egg donation in Malaysia (excluding medical fees)?


At the beginning of 2020, before the outbreak of the COVID-19 pandemic, egg donor agencies in Malaysia typically charge between 20k to 25K Malaysian ringgits, if you approach them directly. Egg donors are typically compensated between 5K to 8K Malaysian ringgits. Hence the gross profit margin of these agencies are typically between 12K to 20K Malaysian ringgits.

Which cities in Malaysia are good for egg donation?

Greater Kuala Lumpur and Penang. Most of the egg donor agencies are located here, and virtually all IVF clinics in Malaysia, even those from other cities and states, depend on these agencies to source egg donors for their patients.

What about egg donation in Johor that is much closer to Singapore?


Singaporean patients must beware that most egg donors in Johor come from out-of-town or out-of-state. As mentioned earlier, the overwhelming majority of egg donor agencies and agents in Malaysia are based in Kuala Lumpur and Penang, and IVF clinics in Johor rely on such agencies and agents to source egg donors for their patients. It is much more difficult to control and monitor the ovarian stimulation cycle of traveling egg donors from out-of-town or out-of-state, who reside far away from the IVF clinic. Such traveling egg donors may commute to the clinic for medical appointments, receive the hormone medications and then return to their hometowns where they are expected to self-inject for several days. Because supervision from the IVF clinic is not near at hand, the egg donor may not be bothered to strictly comply with such a painful and tedious routine of self-injections. If they are extra careless, the expensive hormone medications may not be kept properly refrigerated leading to spoilage and reduced potency. Without strict adherence to the injection protocol and proper refrigeration of hormone medications, the number and quality of eggs obtained from the donor will be severely compromised. Additionally, Singaporean patients must also take note that there are usually additional traveling and hotel costs associated with getting an out-of-town egg donor and her accompanying agency coordinator to travel to Johor.

Is it better to contact egg donor agencies directly, or get your selected IVF clinic to source egg donors from such agencies?

It is cheaper for you to contact egg donor agencies directly, and for them to arrange IVF treatment for you at their affiliated clinics, rather than getting an unaffliated IVF clinic to source egg donors for you from these agencies. Many egg donors agencies in Kuala Lumpur and Penang partner with their affiliated IVF clinic to offer special package deals that include egg donor costs plus medical fees. If you get an unaffiliated IVF clinic in Malaysia (particularly in Johor) to source egg donors for you, the clinic usually takes an extra cut of profit. For example, if the egg donor agency charges RM 25,000, the IVF clinic will charge you RM 30,0000, thereby taking a cut of RM 5,000 as additional profit.

Is embryo genetic testing necessary for egg donation?

Because it is unknown whether the egg donor is carrying any genetic defect, most Malaysian IVF clinics often recommend patients to do highly-expensive genetic testing of IVF embryos (PGS / PGT-A). This is completely unnecessary and a waste of money, if the egg donor is young and healthy, because chromosome abnormalities such as Down syndrome usually appear only in the eggs of older women. To evaluate whether the egg donor is carrying any unknown genetic defect, it is much cheaper to do genetic testing of the egg donor’s blood sample before starting IVF treatment. Moreover, you can also use NIPT (Non-Invasive Prenatal Testing) to screen for genetic defects in your unborn child after getting pregnant, which is also much cheaper than PGS (PGT-A). Although many fertility clinics claim that embryo genetic screening can improve the IVF success rates of older women, this usually refers to older women using their own eggs, which have a high incidence of chromosome abnormalities. PGS (PGT-A) will not improve the success rates of older women using a young egg donor. Patients must also beware of the risks of damaging the embryo during the ‘highly-delicate’ PGS (PGT-A) procedure, which involves extracting cells from the embryo after drilling a hole through the embryo shell (Zona pellucida).The smooth performance of this technique is often highly dependent on the skill and training of the laboratory staff (Embryologist). Even with high levels of training and accreditation, there is still a possibility of human error, particularly in a very busy laboratory that handles several such cases a day. Lastly, one must also beware that Malaysian IVF clinics often manipulate and play on the patient’s biased preference for either a boy or girl child, to persuade them to undertake embryo genetic testing for sex selection.

Should I choose fresh or frozen egg donation?

Some IVF clinics and egg donor agencies in Malaysia offer frozen egg donation as an alternative to fresh egg donation. The advantages of frozen versus fresh egg donation are greater convenience due to simpler logistics, as there is no need to coordinate and synchronize the treatment cycle of both donor and recipient; as well as lower costs due to negating the travel and hotel stay required for fresh egg donation. Another advantage is the greater certainty of the number and quality of frozen eggs available, which are unknown and non-guaranteed for fresh egg donation. Nevertheless, patients should use the same fertility clinic or IVF lab that recruited the egg donor and freeze her eggs. Avoid transferring frozen donor eggs from one medical facility to another. For best results, the thawing protocol must be matching and compatible with the freezing (vitrification) protocol, and only the same IVF lab that performs both the freezing and thawing processes, can ensure this. Patients should also beware that IVF success rates with frozen donor eggs are significantly lower than with fresh donor eggs.

What else should Singaporean patients be wary of when doing egg donation in Malaysia?

A critical piece of information that is often downplayed by Malaysian IVF clinics is the risk of accidental incest between half-siblings conceived by the same egg donor. Although such risks may be minimized in Singapore through safeguards that limit the number of children conceived per egg donor to three, it must be noted that there is no mandatory limit to the number of recipients that a single egg donor can donate to in Malaysia. Additionally, Singaporean patients should also be aware of the lack of appropriate counseling for egg donation in Malaysia. Rigorous counseling will ensure that both husband and wife are agreeable to egg donation, without any misgivings or emotional blackmail from either spouse, and without undue pressure from parents and in-laws. Additionally, they would also miss valuable advice on whether or not to tell their child the truth about his/her conception in the future.
 
Singaporean patients undergoing egg donation should beware of Malaysian IVF clinics trying to hard-sell highly expensive embryo genetic testing (PGS / PGT-A) to them. Some of these hard-selling tactics include:

(i) Playing on their fears of unknown genetic defects being carried by the egg donor. Singaporean patient should note that there are much cheaper alternative methods of genetic screening such as testing of the egg donor's blood sample before starting IVF, or NIPT (Non-Invasive Prenatal Testing), which can be done after getting pregnant. A blood sample contains thousands of white blood cells, from which an abundant amount of DNA genetic material can be extracted. By contrast, only a few cells and tiny amount of DNA are extracted from the embryo during PGS (biopsy procedure). This makes it technically simpler and much cheaper to do genetic testing of the Egg Donor's blood sample, as compared to genetic screening of embryos with PGS / PGT-A.

(ii) Playing on their fears of Down syndrome. In reality, the chances of Down Syndrome with young donor eggs is extremely low. As seen in the attached tables and charts, the chances of Down Syndrome for a 20 year-old donor is 0.05% (1 in 2,000), while that for a 25 year-old donor is 0.083% (1 in 1,200). If patients are really worried about the possibility of Down syndrome, they can always do NIPT (Non-Invasive Prenatal Testing) after getting pregnant, which is very much cheaper than PGS (PGT-A).

(iii) Claiming that PGS (PGT-A) can improve the IVF success rates with donor eggs. This maybe true only for older women undergoing IVF with their own eggs, because of spontaneous genetic abnormalities that occur more frequently in the eggs of older women. Egg donors are typically very young, aged between 20 to 25 years of age, with very healthy eggs. Hence, PGS (PGT-A) will not further improve the already high IVF success rates of older women using donor eggs.

(iv) Playing on their biased preference for either a son or daughter. It is true that PGS (PGT-A) is the most effective method of sex-selection. But the question is whether it is moral and ethical for Malaysian IVF clinics to hard-sell such an expensive technique to Singaporean patients?

(v) Downplaying the risks of damaging the embryo during genetic testing with PGS (PGT-A). This is a highly delicate procedure that involves drilling a hole through the embryo shell (Zona Pellucidae), and extracting a few cells for genetic testing. No matter how well-trained is the lab staff (embryologist) doing the procedure, there is still a risk of human error. The more busy the IVF lab is, the greater the risk of human error, as lab staff are under pressure to complete procedures as fast as possible.

Interesting videos which inform patients that PGS (Preimplantation Genetic Screening), also known as PGT-A (Preimplantation Genetic Testing - Aneuploidy) is absolutely unnecessary for egg donation cycles:



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