How the Singapore Government can help women finance egg freezing

[Angelica Cheng]

Please see comments at the bottom of this article:

Can egg freezing crack Singapore’s demographic decline? | East Asia Forum

The legislation of elective egg freezing grants Singaporean women more reproductive options, but there are still enduring financial and cultural barriers to fertility.

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How the Singapore Government can help women finance egg freezing

The high costs of egg freezing may make it unaffordable to many prospective egg freezing patients, particularly younger women with less savings, but at the peak of their fertility. Hence, the Singapore government should consider various financial assistance schemes to help such younger women with optimal egg quality for freezing. In this case, direct government subsidies cannot be justified because elective egg freezing for non-medical reasons is non-essential for sustenance of either health or life. Nevertheless, there are various other options that can be considered. Perhaps, it may be wise to set an even younger age limit for such financial assistance to egg freezing patients, for example 30 years of age. This could serve as an incentive to push and encourage women to freeze their eggs even younger for their own benefit, thus boosting their chances of future reproductive success.

Utilizing Central Provident Fund Medisave for egg freezing

In Singapore, the compulsory pension plan that all public and private sector employees must subscribe to is the Central Provident Fund (CPF), the medical component of which is known as Medisave. At present, CPF Medisave can be utilized to fund IVF treatment of married patients who have trouble conceiving. Perhaps, the government should also consider allowing the utilization of CPF medisave for non-medical egg freezing.

Forum: Letter of the week #1 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). Read more at straitstimes.com.

www.straitstimes.com

Medical fee subsidy for egg freezing in return for egg donation - Freeze and Share

In some countries such as the USA and UK, Freeze and Share programs, in which the medical fees of egg freezing patients are heavily subsidized in return for donation of some of their eggs, have already been operating for several years. The advantage of such a scheme is that there are no additional costs to government coffers, as subsidies come directly from IVF patients receiving egg donation. Moreover, Freeze and Share programs can also overcome the persistent shortage of egg donors for IVF patients in Singapore.

Singapore's 'freeze and share' conundrum faces would-be mothers - UCA News

The city-state will allow social egg freezing from 2023 but there are numerous ethical issues associated with it

www.ucanews.com

Government-funded low interest-rate loans for egg freezing patients

Yet another option is for the Singapore government to provide loans to younger women freezing their eggs, with low interest rates equivalent to current government loans for university tuition fees and public housing.

Forum: Permit social egg freezing and let younger women pay using their CPF money

I strongly agree with Ms Malavika Menon that permitting social egg freezing in Singapore would expand family planning choices for young women and allow them to undergo this difficult and painful medical procedure within the comfort and security of their home environment (Dilemma of social egg...

www.straitstimes.com

Employer-sponsored egg freezing

Perhaps some companies in Singapore might consider sponsoring elective egg freezing for their female employees as a corporate perk, to attract and retain human capital. Indeed, this is already being practiced by tech giants such as Apple, Google and Facebook within the USA.

Company-sponsored egg freezing should be strictly regulated if Singapore permits procedure

During the debate on the Ministry of Health’s budget last week, Tampines Group Representation Constituency Member of Parliament Cheng Li Hui reiterated her call that egg freezing be allowed here in view of Singapore’s ageing demographics.

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Refund of medical fees for donation of unused frozen eggs

The Singapore government can also consider allowing women who donate their unused frozen eggs to be refunded medical fees by recipient IVF patients. In this case, ethical problems associated with undue financial inducements, and commercial egg trading are not applicable, because these women are just being reimbursed medical fees that they had already spent.

Forum: Consider donating unused frozen eggs to IVF patients

I applaud the Government's decision to allow women to undergo non-medical freezing of their eggs (Singapore to allow women, including singles, to freeze their eggs for non-medical reasons, March 28). Read more at straitstimes.com.

www.straitstimes.com

 

[Angelica Cheng]

Payment for donation of unused frozen eggs is unethical - UCA News

It should be viewed as an undue financial inducement that could potentially trespass on donors’ autonomous decision-making

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Payment for donation of unused frozen eggs is unethical

Recent years have seen an increasing occurrence of age-related female infertility worldwide, as more highly-educated women delay marriage and motherhood in pursuit of educational, career and lifestyle objectives. However, many older women often face severe difficulties in conceiving a child due to a sharp decline in their fertility above the age of 35, as menopause approaches. This in turn has led to increasing demand for clinical assisted reproduction services.

For many older women without viable eggs in their ovaries, their only means of getting pregnant would be to utilize donated eggs from younger women. Nevertheless, there are profound moral and ethical problems with egg donation; such as the fractured personal identity of donor-conceived children, and the lack of awareness of their family medical history.

In countries where payment for egg donation is banned, such as Australia and Singapore, there is often a severe shortage of voluntary egg donors who are altruistically motivated. However, an alternative major source of donated eggs would be the leftover unused frozen eggs of women who had undergone elective egg freezing for non-medical or social reasons, which have been increasing over the past few years.

Indeed, a number of studies have demonstrated conclusively that the overwhelming majority of women who elect to freeze their eggs for non-medical reasons, do not eventually use them. It was estimated that at best, only one in five patients will return to use their eggs for IVF treatment. Hence in many countries that permit social egg freezing, there would be an accumulated surplus of unused frozen eggs available for donation.

Studies have reported that the majority of patients (some 50 percent) prefer to donate to research, about 25 percent to 30 percent prefer to donate to another patient, while around 10 to 20 percent prefer to discard their eggs.

For women who opt to donate their unused frozen eggs to another patient, the pertinent question that often arises is whether it is morally and ethically justifiable for them to receive monetary compensation or reimbursement from recipient patients.

This is a particularly contentious issue in countries where payment for egg donation is banned, such as Australia and Singapore.

Before addressing this question, it must be noted that there are some differences in ethical issues between the donation of unused frozen eggs versus conventional egg donation. For example, prospective donors of unused frozen eggs tend to be much older at the time of donation, compared to conventional egg donors, which would drastically lower their chances of having a biological child after the donation process. Hence they need to think much more carefully about their choices.

Another key difference is that prospective donors are not paying any medical fees in conventional egg donation, whereas in the donation of unused frozen eggs, they would have already spent a substantial sum of money on medical fees.

On the one hand, it can be argued that payment in return for donation of unused frozen eggs would just constitute refund of expensive medical fees that women had already spent on freezing their eggs, so moral and ethical problems associated with commercial egg trading and undue financial inducements do not apply.

On the other hand, it can be counter-argued that such reimbursement/compensation trespasses on the patient’s autonomous decision-making process, and cloud their independent judgment on whether or not to donate their unused frozen eggs.

Many women become emotionally vulnerable when the time comes for them to decide what to do with their unused frozen eggs. Very often, due to changing life circumstances, such as natural conception after getting married, the majority of women who undergo elective freezing for non-medical reasons find that they no longer need to utilize their stored frozen eggs. However, after investing money, time and effort in egg freezing, and paying for expensive storage fees over several years; they would naturally feel a sense of loss if their unused frozen eggs were simply discarded or donated for research.

The offer of compensation/reimbursement in return for donation of their eggs to other patients could thus exploit the vulnerable emotional state of these women in despair over the impending wastage of their hard-earned money, and in dilemma on what to do with their unused frozen eggs, by cajoling them to recoup their losses via donation.

To further ‘sweeten the deal’, fertility clinics and doctors may also exploit the ‘feel good’ factor of doing a kind deed, by convincing prospective donors that they are bringing much joy and happiness to an infertile woman trying to conceive a child.

Indeed, medical professionals may have a hidden agenda and conflicting interests in wanting their former patients to donate their unused frozen eggs because additional medical fees will be earned by performing the egg donation procedure on other patients.

Most disturbingly, the offer of reimbursement/compensation could push prospective donors to make hasty decisions that they may regret later in life. In particular, there may be some women who might have a change of heart, of no longer wanting to have children after freezing their eggs.

For such childless women deciding to donate their unused frozen eggs, there is no turning back the biological clock once the eggs have been donated; so they may possibly later regret having lost their only chance of having a biological child in the future, as well as deal with psychological issues of remaining childless while being unsure of whether they have an unknown donor-conceived offspring out there. Even prospective donors who already have children of their own may later regret losing the opportunity of having additional children with their frozen eggs.

Moreover, there are also other social and psychological issues, which would require much hard thinking and soul-searching by women contemplating donating their unused frozen eggs. For example, they may have to consider whether their partner, children and other family members should know and approve of their donation.

There is also a risk of accidental and unintended incest between unknown donor offspring and natural children of the donor, which could be exacerbated by the phenomenon of genetic-sexual attraction (GSA) that has been widely reported in the news media.

Prospective donors must also be mentally and emotionally prepared for unexpected contact with their unknown genetic offspring in the future, even in countries where donor anonymity still remains in force; because the advent of widespread direct-to-consumer genetic testing and associated online genomic databases has made the concept of donor anonymity obsolete.

Additionally, restrictive criteria and varying levels of compensation/reimbursement in the donation of unused frozen eggs may spark accusations of unfairness. Very likely, only women who had frozen their eggs at a young age would be eligible for compensated donation, while those with older and lower-quality eggs would most likely be excluded.

The compensated donation may also be subject to market forces, such as the preference of recipient patients for certain races/ethnicity, or even socially-desirable traits like high education, well-paying jobs and beauty standards related to height and complexion. This could in turn lead to more ‘desirable’ donors receiving higher levels of compensation/reimbursement for their unused frozen eggs, which could spark much dissatisfaction and controversy.

A particularly sensitive issue would relate to egg donors of certain races, ethnic groups, or even castes (Indians and other South Asians) receiving higher levels of reimbursement/compensation over others, simply due to higher market demand for their donated eggs. This may in turn lead to accusations of racial or caste discrimination.

In conclusion, compensation/reimbursement for donation of unused frozen eggs should be viewed as an undue financial inducement that could potentially trespass on donors’ autonomous decision-making. It could also exploit the vulnerable emotional state of these women over the impending loss and wastage of their hard-earned money, together with the undeclared conflicts of interest and hidden agendas of fertility clinics and medical practitioners.

 

[Angelica Cheng]

Oma Fertility Announces Shared Egg Freezing Program, Furthering Commitment to Make Parenthood Possible for More People

/PRNewswire/ -- Oma Fertility, a full-service chain of fertility clinics that combines AI and robotics in the lab and human-centered care in the clinic, today...

www.prnewswire.com

Oma Fertility Announces Shared Egg Freezing Program, Furthering Commitment to Make Parenthood Possible for More People


Patients who freeze their eggs with Oma and donate a portion to the Oma Egg Donor Program will receive the entire procedure at no cost

SAN JOSE, Calif., Jan. 17, 2023 /PRNewswire/ -- Oma Fertility, a full-service chain of fertility clinics that combines AI and robotics in the lab and human-centered care in the clinic, today announced a new Shared Egg Freezing Program that will help democratize access to egg freezing services and meet a rising demand for egg donors across the United States. The program enables patients to freeze and store their eggs for free, including medications, and donate a portion of the eggs retrieved to the Oma Egg Donor Program to help others on their journey to parenthood.

Oma's program is being introduced at a time when egg freezing services are in high demand and the need is greater than ever. The American Society of Reproductive Medicine (ASRM) estimates egg freezing increased a staggering 2,695% from 2009 to 2018 and shows no signs of slowing down. By 2025, almost 10 million couples will encounter problems having a baby, and approximately 20% will rely on IVF over the next two decades.

Today, the national average cost for one complete cycle of egg freezing (including ultrasound monitoring, doctor supervision, and injectable medications) is upwards of $14k, not including the supplemental, annual cost for egg storage which can range anywhere from $500 - $1K per year.

"At Oma, we understand these costs are out of reach for many," said Gurjeet Singh, co-founder, and CEO of Oma Fertility. "Our empathetic approach to affordable and accessible fertility care through programs like this provides our patients with the opportunity to plan for their own family while making parenthood a possibility for those who aren't able to conceive on their own."

Those who wish to apply for the program must complete a donor application and an initial doctor consultation. If accepted, the patient's entire egg freezing procedure - including 5 years of storage - will be offered at no cost (a $9,500 value at Oma).

For more information about Oma Fertility, please visit www.omafertility.com.


ABOUT OMA FERTILITY

Oma Fertility, a division of Oma Robotics, was founded in 2020 by a team of engineers, AI experts, and fertility specialists who believe that combining AI and robotics in the lab and human-centered care in the clinic will make parenthood possible for more people. The company's first innovation is Oma Sperm InSight™, which uses AI to help pinpoint the most promising sperm cell for use in IVF. Oma Fertility opened its first fertility clinic in Santa Barbara, California, in 2021 and has plans to expand nationally through 2023. Oma Fertility was recently named to Fast Company's second annual Next Big Things in Tech list, honoring technology breakthroughs that promise to shape the future of industries.


The company was founded in 2020 by Gurjeet Singh, Ph.D., previous founder of Ayasdi, Dr. Sahil Gupta previous founder of Aveya Fertility, and Kiran Joshi, Ph.D., previous founder of Koko. www.omafertility.com


MEDIA CONTACT
Lauren Torjussen
[email protected]


SOURCE OMA Fertility

 

[Angelica Cheng]

Singapore's 'freeze and share' conundrum faces would-be mothers
https://www.ucanews.com/news/singapores-freeze-and-share-conundrum-faces-would-be-mothers/96777

After much debate, it was recently announced that Singapore will permit elective egg freezing from 2023 onward for fertility preservation of women without medical indications, commonly referred to as social egg freezing. All women aged 21-35 are eligible to undergo this procedure, regardless of marital status, but they must be married in order to subsequently utilize their frozen eggs for IVF (in vitro fertilization) and other assisted reproduction procedures. Nevertheless, it must be noted that this elective medical procedure is highly expensive, which would likely make it unaffordable to lower-income women.
Direct government subsidies for elective egg freezing are difficult to justify given that it is non-essential for the sustenance of life or health. There is no country in the world where social egg freezing is being subsidized by the state.
One scheme to make this procedure more affordable is “freeze and share,” in which medical fees are heavily subsidized for women freezing their eggs in return for a donation of some of their surgically extracted eggs to other patients. Because financial subsidies come directly from recipient patients, there are no additional costs to government coffers, and the problem of shortage of donated eggs for IVF treatment can readily be overcome. However, there are numerous ethical pitfalls to such a scheme.
First, subsidies on medical fees can be viewed as a form of undue financial inducement for women to undergo this invasive procedure without a valid medical reason while exposing them to unnecessary risks from ovarian hyperstimulation syndrome (OHS), a medical condition whereby the body overreacts to injected hormones, which can potentially be life-threatening.
The patient’s judgment and perception of such medical risks may potentially be blurred and clouded by the offer of generous medical fee subsidies, thereby trespassing on her autonomous decision-making process.
Worse still, the offer of generous financial subsidies might create cognitive dissonance because it is not just about freezing their eggs, as there is going to be a baby with their genetic material out there.
In the future, on reflecting on their actions, women who participated in “freeze and share” programs may realize that they value such genetic connection more than a direct donor, who may see the egg as merely a cell.
Because such programs offer immediate savings on the costs of egg freezing, this might appear attractive to lower-income women. Nevertheless, they often do not anticipate future costs such as storage fees and the high price of doing IVF when attempting to conceive a child.
If women participate in “freeze and share” programs because they are poor in the first place, what are the chances of them using their frozen eggs through IVF in the future, if they still remain poor?
Second, the asynchronous nature of “freeze and share” would mean that the egg donor will only learn much later if she is unable to conceive with her own frozen eggs while still being unsure of whether any offspring had been born from her donation.
It must be noted that the chances of having a child through egg freezing are in no way guaranteed due to its relatively low success rates of 2-12 percent per frozen egg, according to the American Society for Reproductive Medicine (ASRM).
By contrast, donated eggs would most likely not have been frozen when used for IVF, which would translate to significantly higher success rates.
This poses an ethical problem because women who ultimately fail to get pregnant with their frozen eggs would undoubtedly suffer from immense psychological problems due to the unsettling possibility of them having unknown anonymous donor offspring.
Third, “freeze and share” programs are often highly-selective and extremely sensitive to market forces, just like commercialized egg donation. Prospective recipient patients would likely prefer certain desirable traits in egg donors, such as high education, good jobs, and beauty standards related to height and complexion.
Hence, “freeze and share” would likely exclude lower-income women with less education and fewer desirable traits. Hence it is unlikely that such a scheme would make egg freezing more accessible and affordable to economically-disadvantaged women.
Fourth, outdated laws on egg donor anonymity in Singapore might create ethical problems with the anticipated surge in egg donation cases if "freeze and share” were allowed.
In many developed countries, donor anonymity has been abolished in view of the inherent legal rights of donor-conceived offspring to know the identity of their donor parent and associated family medical history.
Numerous sociological studies and news media stories have reported that donor-conceived offspring often suffer from psychological problems and identity crises while growing up without knowing the identity of their anonymous donor parent.
More importantly, they are left completely in the dark with respect to their donor parent’s family medical history. It is well known that predisposition to various diseases such as breast cancer, type 2 diabetes, cardiovascular diseases and senile dementia are heritable, and it is only right that donor-conceived offspring should get access to such relevant life-saving medical information.
Additionally, outdated donor anonymity laws in Singapore increase the risk of accidental incest between the egg donor’s legitimate children and unknown offspring from the donation.
In some countries such as Britain, donors and donor-conceived offspring can get access to information on the number of children born from each donor, together with their non-identifying personal information such as sex and year of birth.
This mitigates the risks of accidental incest but is currently not practiced in Singapore. In that case, would it be fair for the future husband of a single woman participating in “freeze and share” programs if he had not consented to accept the risks of accidental incest between his children and his wife’s unknown donor offspring?
More recently, the advent of cheap mail-order DNA testing kits and associated online genealogy databases have made the concept of egg donor anonymity completely obsolete.
In the near future, when genetic testing becomes a universal norm in health care, there will likely be numerous donor-conceived offspring inadvertently and unexpectedly learning the truth of their conception through such tests, resulting in much shock, heartbreak and emotional trauma for both themselves and their legal parents who raised them.
It is anticipated that many of such donor-conceived offspring will have strong yearnings to know their identity and have contact with their anonymous donor parent. Hence, there is the unsettling possibility of “freeze and share” donors being unexpectedly contacted by their unknown offspring in the future via DNA testing and online genetic matching, thereby intruding into their personal lives and privacy.
Fifth, there are inherent conflicts of interests faced by medical doctors and fertility clinics operating “freeze and share” programs.
To boost the availability of donor eggs, fertility clinics may aggressively advertise generous medical fee subsidies for egg freezing, thus abetting and enticing many young women to undergo this invasive procedure at substantial risks to themselves without a valid medical reason so that they would not miss out on such an attractive opportunity.
Worse still, there is the possibility of fertility clinics engaging in covert egg trading and profiteering in “freeze and share” programs — for example, by marking up medical fees to unsuspecting recipient patients.
Moreover, fertility doctors face an obvious conflict of interest in soliciting and encouraging their patients to donate eggs via “freeze and share” programs because they will be earning additional medical fees by performing the egg donation procedure on other patients.
In conclusion, “freeze and share” egg donation programs should not be permitted in Singapore in view of the numerous aforementioned ethical problems associated with it.