Social Egg Freezing

Hi Ladies, do give your opinion on Social Egg Freezing, since the Singapore government is considering lifting its ban. Here is a Forum letter recently published in the Straits Times:

Permit social egg freezing with age limit

The Straits Times’ social affairs correspondent Theresa Tan described the dire situation of older women having dismal outcomes from fertility treatment due to the lack of viable and healthy eggs (Good to lift IVF age limit, but will women still have eggs?, Oct 11).

This, in turn, has sparked calls for social egg freezing to be permitted in Singapore, in tandem with the lifting of age restrictions on IVF treatment. However, the Ministry of Health (MOH) is reluctant to do so, fearing that the procedure could lead to disappointment for many couples who delay marriage and parenthood only to find out later that they are unable to conceive using this method.

The main challenge with social egg freezing is that most women freeze their eggs when they are too old and the quality of their eggs has substantially declined. The high financial costs of social egg freezing tend to deter many younger women from freezing their eggs until they feel desperate after growing older. Hence, it is common to read in the media that most women freeze their eggs in their late 30s or early 40s.

The solution to this problem is to impose an age limit on social egg freezing so as to ensure a good outcome in future fertility treatments. A suitable cut-off age is 35, since most medical publications have reported a steep decline in female fertility after that.

This may seem a bit harsh from an individual point of view, but looking at the big picture, imposing such an early cut-off age would in fact encourage and push more women to freeze their eggs when they are much younger for their own benefit. This would ensure a much better outcome in future fertility treatment, thereby allaying the MOH’s concerns and reluctance to permit social egg freezing.

Additional incentives for women to freeze their eggs at even younger ages could also be put in place. For example, let women who freeze their eggs before 30 years old be eligible to donate some of their eggs to infertile couples in return for heavily discounted medical fees for egg freezing. Because such subsidies will come directly from infertile couples receiving the donated eggs, there would be no additional costs to the Government. Moreover, such a scheme would also overcome the persistent shortage of donor eggs in Singapore.
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Here is another interesting article on social 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).

Single women who want to freeze their eggs face many financial constraints due to the high cost of the procedure.

Hence, a pertinent issue that the Government has to consider is how to help them pay the medical fees for such a procedure.

Government subsidies would probably be out of the question because social egg freezing is an elective procedure and not a medical necessity, unlike in-vitro fertilisation for infertile couples.

However, the Government may consider permitting the prudent use of CPF savings under conditions based on three criteria for reproductive success.

First, an age limit of 35. Most doctors agree that there is a steep decline in a woman's fertility after age 35.

Second, CPF use should be permitted only if the woman's ovaries are healthy and she has an adequate ovarian reserve, which would enable her to produce a sufficient number of good-quality eggs for freezing.

This can be determined through a medical screening for polycystic ovary syndrome, and to check her serum levels of anti-Mullerian hormone.

While it may seem harsh to disallow women with such medical problems from utilising their CPF savings for elective egg freezing, it would alert them to any fertility problems early, and avoid wastage of their CPF savings.

Third, reimbursement of the cost of egg freezing using CPF should be permitted only if a minimum threshold number of eggs of reasonable quality are frozen for the patient.

This may require multiple cycles of ovarian stimulation with hormones.
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Interesting Straits Times article:

Forum: Safeguards needed if social egg freezing is allowed

As the Government deliberates on permitting social egg freezing in Singapore, it needs to consider legislating various safeguards (Govt reviewing ban on women freezing eggs for non-medical reason, Oct 22).

Besides rigorous counselling of patients, the following pertinent issues also need to be addressed.

First, possible failure in storage resulting in irreversible damage to or destruction of the frozen eggs. Currently, most local fertility clinics store either frozen eggs or embryos in cryotanks that need to be topped up regularly with liquid nitrogen. There is a possibility of human error, for example, if laboratory staff forget to top up liquid nitrogen during a holiday.

Patients should store their eggs in a big well-managed facility with lots of fail-safes and power-failure backups, such as the ones managed by private cord-blood banks. Should there be an insurance or compensation scheme to cover accidental loss of frozen eggs?

Second, the conflict of interest faced in the donation of leftover unused frozen eggs to infertile patients. Currently, this is permitted in Singapore and comes mainly from a small minority of couples undergoing IVF who choose to freeze their unfertilised eggs instead of embryos due to religious or personal reasons.

Doctors and clinics persuading former patients to altruistically donate their unused frozen eggs face a conflict of interest because they stand to earn additional fees from performing the egg donation procedure on other patients.

The doctor-patient fiduciary relationship can easily be abused during the consent process if doctors know that their former patients are grateful to them for successful fertility treatment.

There is also the issue of distributive justice if doctors and clinics exclusively control the allocation of donated frozen eggs to other patients.

This prerogative should instead be exercised by a government agency based on a centralised registry and waiting list of patients.

Third, social egg freezing may inadvertently encourage single motherhood.

Are there any laws to stop single women from later exporting their frozen eggs to an overseas fertility clinic? If single women freeze their eggs because they "can't find Mr Right", what can guarantee they find him in the future?
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