Angelica Cheng
Active Member

Singapore must impose safeguards on unused frozen egg donation- UCA News
The Ministry of Health should remain vigilant in preventing potential abuses and exploitation by doctors, fertility clinics
www.ucanews.com
Singapore must impose safeguards on unused frozen egg donation
An article in Channel News Asia highlighted the severe shortage of donated human eggs for IVF treatment in Singapore.Elective egg freezing has been permitted in Singapore since 2023, hence unused surplus frozen eggs can be a promising new source for altruistic donation in IVF treatment.
Studies have shown that most women who freeze their eggs do not eventually use them, with around 25 to 30 percent of former egg-freezing patients opting to donate their unused frozen eggs for IVF treatment of other patients.
However, it is imperative that the health authorities in Singapore exercise vigilance in preventing potential abuses in unused frozen egg donation by local fertility clinics and doctors.
The most pressing ethical issue revolves around the conflict of interest faced by fertility clinics, doctors, and their affiliated counselors in persuading former patients to donate unused frozen eggs.
There is a risk of the doctor-patient fiduciary relationship being abused during the donation consent process, especially if doctors had developed a level of trust and rapport with their former egg-freezing patients.
By "sugar-coating" altruistic egg donation as a kind deed, doctors and fertility counselors can mask their conflicting interests and exploit the "feel-good" factor of bringing joy to others in need.
It is well-known that donated eggs from Asian women are in high demand worldwide, particularly in mainland China and many Western countries, due to the presence of Asian immigrant communities.
Indeed, it was widely reported in the American news media that Asian egg donors typically receive higher levels of monetary compensation than Caucasian egg donors in the USA.
In mainland China, there is a shortage of donated eggs due to laws that human eggs can only be altruistically donated by IVF patients undergoing treatment.
In Singapore, monetary payment for egg donation is prohibited, but if there is an accumulated surplus of unused frozen eggs, local fertility clinics can capitalize on the high worldwide demand for Asian donors' eggs by offering them to foreign patients, who are likely more inclined and willing to pay higher medical fees.
Local fertility clinics may take the opportunity to practice “covert egg trading” by surreptitiously marking up their medical fees for egg donation, particularly to foreign patients.
This could mask the sale of altruistically-donated frozen eggs, which are in high demand but in short supply worldwide.
Besides violating medical ethics, this could result in a lack of distributive justice for Singaporean IVF patients in need.
The situation is further complicated by the fact that doctors often advise older women to freeze more eggs to have reasonable chances of success because the eggs of older women tend to be of lower quality.
Hence, older women who have conceived naturally may have more unused frozen eggs available for donation, which means more opportunities for unscrupulous fertility clinics to divide up the eggs from one donor for allocation to multiple recipients and treatment cycles.
Confusion and misconception can easily arise from the common practice of commercial egg banks recommending much fewer frozen eggs for a single donation cycle because these eggs are usually derived from much younger women and hence are of much higher quality.
Hence, the utilization of six good-quality and young frozen eggs for a single donation cycle, as recommended by a commercial egg bank, can easily be confused with six lower-quality eggs donated by a much older former egg-freezing patient.
Ethical breaches can also arise from fertility clinics and their affiliated psychological counselors withholding or downplaying key information relating to sociological risks in egg donation.
In particular, issues relating to the obsolescence of donor anonymity and confidentiality due to widespread DNA testing, as well as increased risks of accidental incest among donor-conceived offspring due to “Genetic Sexual Attraction."
The proliferation of cheap DNA home collection/testing kits and associated ancestry/genealogy websites, which enable individuals to trace unknown blood relatives worldwide, has rendered egg donor anonymity and confidentiality obsolete.
Although egg donors may not have done such DNA tests themselves or uploaded their genomic DNA profiles on these websites, some of their family members or more distant relatives may have done so. It means that their unknown donor-conceived offspring could track them down.
Therefore, in countries like Singapore that still mandate egg donor anonymity, prospective donors must be advised to be mentally and emotionally prepared for the possibility of future unintended contact with their donor-conceived offspring, despite repeat assurances by their fertility clinics and counselors that their anonymity and confidentiality will be well-protected.
Additionally, prospective egg donors must also be made aware of the risks of accidental incest occurring among their natural and donor-conceived offspring due to the phenomenon of “Genetic Sexual Attraction." This refers to sexual attraction between close relatives, such as siblings or half-siblings separated at birth, who meet for the first time in adulthood.
In the natural family situation, due to psychological imprinting of the “Westermarck effect,” siblings of the opposite sex who have been familiarized with each other as children, do not mutually attract each other.
The risks of accidental incest due to “Genetic Sexual Attraction” may be further exacerbated by the small size and high population density of Singapore, which increases the chances that the egg donor’s offspring might inadvertently meet and sexually attract each other.
Hence, the Singapore Ministry of Health must remain vigilant in preventing such potential abuses and exploitation by fertility clinics to protect the welfare of patients and ensure that their doctors act in their best interests.
One solution may be to ban fertility clinics and doctors from controlling the distribution of donated frozen eggs from their former egg-freezing patients to other patients in need. Instead, a government-run centralized egg donor registry and a waiting list of prospective recipient patients would better manage this, ensuring a more equitable distribution of altruistically donated frozen eggs.