Dear ladies, do give some feedback on egg donation in Malaysia:
Egg donation in Malaysia costs just S$16,300 (RM50,000) all inclusive with IVF procedure !!!
S’poreans head to Malaysia, elsewhere to find egg donors
Singaporeans have travelled as far as the United States and Australia to find an egg donor to help them have a baby, but many have also gone to Malaysia, checks by The Straits Times showed. Ms Christine Gautaman, who runs Heart to ART, a firm in Selangor that matches couples to egg donors, told ST about 20 per cent of her clients are Singaporeans who require an egg donor, a surrogate mother, or both. For example, she has had Singaporean couples where the wives were in their 20s but suffered from premature ovarian failure. In such a case, the ovaries stop functioning normally before the age of 40, and the woman would require donor eggs to conceive. Her other Singaporean clients are often older, some in their 40s. She said Singaporeans prefer to use an anonymous egg donor as they have no ties to the donor and can raise the child as their own.
The cost of in-vitro fertilisation (IVF) using an egg donor is about RM50,000 (S$16,300). She said this covers the fees paid to the egg donor, the treatment to retrieve the donor’s eggs and the IVF procedure for the mother-to-be, which is performed in Malaysia.
Ms Gautaman did not say how much the donors are paid. She added that the egg donors at her agency are generally between the ages of 21 and 32, and many are degree holders. Some are even doctors, lawyers and accountants, she said. “These ladies are very well aware of the gift of life they are giving to their recipients and although they do receive some remuneration for their time and effort, they generally are doing this to help others,” said Ms Gautaman.
From January next year, women aged 45 and older will be allowed to undergo IVF here. Doctors cheered the move but they pointed out that many of these older women would need donor eggs to conceive even if they are allowed to undergo IVF here.
Dr Sadhana Nadarajah, senior consultant of the reproductive medicine department at the KK Women’s
and Children’s Hospital, explained that women in their late 40s and 50s will have to use donor eggs to
get pregnant. For women in that age group, if they are not menopausal, most of their eggs may be genetically abnormal by then, and it will be challenging to conceive using their own eggs, she said.
However, there are some women in their 20s who suffer from premature menopause and will also need
donor eggs to conceive. Doctors say egg donors in Singapore are uncommon due to the tedious procedures involved, the fact that they cannot be paid and that people are just uncomfortable with the idea as the child would be biologically related
None of the five women The Straits Times approached who used egg donors was willing to be interviewed.
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?
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. 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.
Overseas egg donors — what Singaporean women should be wary of
Recent news media reports suggest that most Singaporean women requiring egg donation travel abroad for the procedure.
Strict regulations against payment of egg donors have resulted in a persistent shortage of donated eggs in Singapore. At the same time, women in Singapore do not have the option of freezing their own eggs when they are younger, due to the current ban on social egg freezing. This would leave many of them with no choice but to resort to overseas egg donation to conceive a child.
Foreign egg donors often receive generous payment abroad. Hence, there is a large pool of anonymous egg donors of suitable ethnicity to choose from abroad. Moreover, the medical fees of foreign fertility clinics may be much cheaper compared to Singapore.
In fact, some local fertility clinics have collaborative ties with foreign clinics that perform egg donation. Hence, they would be able to advise patients on egg donation overseas, as well as coordinate with foreign clinics in the timing of hormonal injections to prepare the patient’s womb to be receptive for the egg-donation procedure abroad.
However, due to the less stringent regulation of fertility treatment in other countries, Singaporean patients may face a variety of marketing gimmicks and misleading information on the egg-donation procedure. Hence, it is imperative to highlight what Singaporean patients should be wary of, when travelling abroad for egg donation.
Although some claims put forward by foreign fertility clinics appear to have a sound scientific basis, it is important for patients to understand the limitations of such claims. For example, consider the claim that the egg-donation procedure has a much higher success rate compared to standard in-vitro fertilisation (IVF) treatment.
This is generally true to a large extent, simply because the selected egg donors are young and healthy. However, if the recipient patient had previous health problems with her womb that lead to recurrent miscarriages (e.g. endometriosis, uterine fibroids), then her chances of conceiving through egg donation might be much lower than advertised by the fertility clinic.
Other claims may have less scientific basis. For example, many foreign fertility clinics strongly encourage their patients undergoing egg donation to utilise preimplantation genetic screening (PGS) to detect genetic defects in the conceived embryos, due to the unknown genetic heritage of the anonymous foreign egg donor.
Yet they often neglect to tell patients that similar genetic screening of the donor’s blood sample is much cheaper than PGS. Patients must also be aware that PGS is not a fool-proof method to detect genetic abnormalities in embryos, despite its high costs.
There is a only a limited panel of common genetic diseases that PGS will detect, so it is impossible to screen and verify the entire genome of each individual embryo to be free of genetic defects.
One notable example that cannot be detected by PGS is Autism Spectrum Disorders that are caused by multiple genes interacting with multiple factors within the birth environment.
Additionally, if the egg donor is very young, it is unnecessary to utilise PGS to screen for Down syndrome that usually arises from genetic abnormalities in the eggs of older women.
Although many fertility clinics claim that PGS can improve the IVF success rates of older women, this only refers to older women using their own eggs, which have a high incidence of genetic abnormalities. PGS will not improve the success rates of older women using a young egg donor.
It must also be noted that PGS is not completely risk-free. There is a small chance of damaging the embryo as this delicate procedure involves drilling a hole through its protective shell (zona), to extract cells for genetic testing.
An important fact that is often downplayed by foreign fertility clinics is that the recipient patient’s age does really matter in egg donation. Recent much-hyped news reports about elderly women successfully giving birth in their 60s and 70s have led to many misconceptions.
It is well-established in the medical literature that the risks of medical complications during pregnancy increase with maternal age.
Another factor to consider is whether the expected remaining lifespans of the recipient couple are sufficient for raising a child to adulthood.
Older patients travelling abroad for egg donation should ask themselves whether as elderly parents, they would be able to cope with the physical rigours of child-rearing.
Yet another critical piece of information that is often downplayed by foreign fertility clinics is the risk of accidental incest between half-siblings conceived by the same egg donor.
Although such risks may be minimised in Singapore through safeguards that limit the number of children conceived per donor to three, it must be noted that there is no limit to the number of Singaporean recipients that a single foreign egg donor can donate to abroad.
The risks of accidental incest may be further compounded by the much reported phenomenon of ‘Genetic Sexual Attraction’, which is sexual attraction between close-relatives that first meet as adults, for example siblings that are separated at birth and adopted by different families.
This is particularly significant for Singaporean patients, given the small size and high population density of their country.
Patients should also take note of a deceptive marketing gimmick that claims a woman receiving egg donation passes some of her genetic material to the conceived child.
This misconception came about because of misleading news reports a few years ago, about the gene expression behaviour of embryos being influenced by the nurturing fluid produced by the womb lining. This is due to the embryo taking up a molecule known as microRNA, which is a chemical relative of DNA.
Being closely-related to DNA, microRNA can very broadly and loosely be considered a form of genetic material. However it is extremely short-lived and fragile, and does not transmit genetic inheritance from parent to child.
Some foreign fertility clinics may offer frozen egg donation as a cheaper alternative to fresh egg donation. The lower expenses are due to simpler logistics, as there is no need to synchronise the hormonal stimulation cycles of the donor and recipient patient, as well as cost savings from negating the travel and hotel stay required for fresh egg donation.
However, the significantly lower success rates of frozen versus fresh egg donation, are often downplayed.
Last, but not least, Singaporean patients should also be aware of the lack of appropriate counselling for egg donation overseas. Rigorous counselling 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.
Perhaps, to avoid the perils and hassles of overseas egg donation, the Ministry of Health in Singapore should look at various ways to boost the local supply of donated eggs.
One solution may be to permit adequate monetary compensation for egg donation, which is a tedious and painful procedure. Another solution may be to permit social egg freezing with certain conditions, such as age limits of 35, which would negate the need for egg donation.
At the same time, permitting social egg freezing will also likely lead to an accumulated surplus of unused frozen eggs that can potentially be donated to infertile women.