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More Singaporeans are heading abroad for expensive in-vitro fertilisation treatments that let them choose whether to have a baby boy or girl
 When it comes to fulfilling their long-cherished dream of bearing a son and heir, there is no limit to how far Singaporeans will go. Like Thailand, for example, or even the United States. The attraction of these places has to do with not just their skills in in-vitro fertilisation (IVF) treatment. After all, that is on offer here. But these foreign destinations – initially the US, but increasingly Thailand as well – allow parents to choose the gender of their baby through a procedure known as preimplantation genetic diagnosis (PGD), something barred in Singapore. And having a son is all important – especially to people of Chinese ancestry all over the world. “For Singaporeans, Chinese and Hong Kong people, 90 per cent of them will ask for a boy. If they have a son already, they don’t mind a daughter,” said Ms Tanestee Totem, managing director of Marvel IVF Solutions in Bangkok. “Singaporeans want a boy to have an heir and also because they feel a son can take care of his siblings.”
Marvel, which opened in April last year, treated about 10 Singaporeans in its first year of operation – mostly childless women in their mid- to late 40s who had tried IVF treatment in Singapore without success. Almost all of them asked exclusively for a boy, said Ms Totem. The request for a son is repeated by Singaporean patrons at the Safe Fertility and PGD Centre in Bangkok, which opened five years ago and sees about 10 Singaporeans asking to choose the gender of their baby each year. The same goes for the Fertility Institutes in Los Angeles, which sees about 10 Singaporean couples each year.
Female embryos thrown away
On the distinct preference for male babies, Ms Totem cited the case of a childless Singaporean Chinese woman in her mid-40s, who helps her husband in his business. She flew to Bangkok after she tried IVF in Singapore but failed to get pregnant. During her first cycle of PGD treatment in Bangkok, her embryos were all female. These embryos were “thrown away” as the couple resolutely did not want a daughter. Their second cycle of PGD yielded some male embryos, and the woman successfully delivered a pair of twin boys earlier this year. PGD is carried out with IVF treatment, and in the procedure the embryos are screened for gender or genetic diseases, or both. The desired embryos are then transferred to the mother’s womb. The clinics say the sex selection procedure is almost 100 per cent accurate. Marvel IVF Solutions charges 280,000 baht ($11,380) for one cycle of IVF treatment including PGD. Safe Fertility charges 260,000 baht, while it costs about US$18,000 ($22,000) at Fertility Institutes in Los Angeles. This compares with between $8,000 and $11,000 for one cycle of IVF treatment alone at public hospitals in Singapore, and up to $15,000 at private centres here. Demand for IVF and PGD services in Thailand is growing, said Ms Totem. She added that PGD “took off” in Thailand about a year ago and there are now six IVF centres in the Thai capital catering to patients worldwide.
Controversial issue
Using PGD to create designer babies – with one’s gender of choice and free from genetic defects – has sparked fierce ethical debates in many countries. In a study by the International Federation of Fertility Societies last year, only 15 of the 104 countries surveyed have laws that permit sex selection. These include Belgium, Israel and the United States. Thai laws are silent on gender selection but it is practised in the country. Singapore does not allow the use of PGD to choose a baby’s gender. It is allowed for the screening of genetic diseases only when a doctor determines that there are medical reasons to do so, said a Health Ministry (MOH) spokesman. For example, PGD can be done for patients who are at high risk of diseases such as Alpha thalassemia, haemophilia A, Fragile X syndrome, spinal muscular atrophy, myotonic dystrophy and Huntington’s Disease, according to Dr Yu Su Ling, director of the Centre for Assisted Reproduction at the Singapore General Hospital (SGH) .
Singapore also has strict laws when it comes to IVF treatment, which involves extracting the woman’s eggs, combining it with her husband’s sperm in a laboratory and implanting the resulting embryos in her womb to hopefully grow into babies. Women who want to go for IVF treatment here must be married and below 45 years of age. With more women marrying later or delaying motherhood, more couples are seeking medical help to conceive, especially after the Government introduced a subsidy for IVF treatment in 2008. The Government now subsidises up to $3,000 per cycle of IVF treatment, and up to three cycles for each eligible patient. The treatments must be carried out at a local public hospital. In 2009, 3,271 women used Assisted Reproduction treatments such as IVF – almost double the 1,716 in 2004.
Scarcity of eggs
Despite the subsidy, some Singaporeans are still heading overseas to try their luck. Besides being able to choose their baby’s gender, others go abroad because they are too old to qualify for IVF treatment here, or need to find an egg donor. The two egg banks in Singapore are perennially short of supply due to the onerous process of being a donor here. A donor must undergo 10 to 14 days of daily injections to stimulate her ovaries to produce eggs. After that, a needle is inserted into the ovaries to retrieve the eggs. Dr Yu of SGH says the process is time-consuming and “can be painful”.
Besides, donors are not paid and get only $150 to cover their transport fees and effort, she added. SGH’s egg bank has not had a single donor for the past three years and the wait for a donor’s eggs is “indefinite”. Patients who need eggs must produce their own donors now. Only “a handful” of donors step forward each year at the KK Women’s and Children’s Hospital. And these egg donors “are usually friends or relatives of the egg recipients, whom recipients find using their own resources”, noted Dr Loh Seong Feei, director of the KKIVF Centre. The scarcity of egg donors here means Singaporean women unable to produce eggs, or whose eggs are of poor quality, often have no choice but to head overseas where egg banks have ready stock.
Dr Wiwat Quangkananurug of Safe Fertility and PGD Centre in Bangkok says his centre sees about 30 Singaporeans a year seeking an egg donor, compared with an annual average of 10 Singaporeans five years ago. Johor Baru’s TMC Fertility Centre treated 61 Singaporeans last year – up from an average of 40 a year in the period 2004 to 2009. The centre, which has six branches across Malaysia, opened its Johor Baru branch in 2004 partly to cater to Singaporeans, said its head, Dr Surinder Singh. He added that its egg banks have a ready supply of eggs. The fees for egg donors are privately arranged between coordinators, donors and recipients. The coordinators, who are not TMC staff but private operators, usually charge between RM7,000 (S$2,840) and RM10,000 for donor eggs, said Dr Singh. He added: “Nobody is going to donate eggs if they are not paid a cent. The coordinators will reimburse the donors the cost of donating their eggs, such as their transport and other costs.”
The whole process in Malaysia is also cheaper. TMC in Johor Baru charges about RM16,000 to RM18,000 for one cycle of IVF treatment, which is about 20 per cent cheaper than what it costs here. Doctors in Malaysia are not allowed to use PGD to help couples choose the baby’s gender, but they can use it to screen for genetic diseases such as Down, Edwards and Turner syndromes. Dr Singh said Singaporeans who ask to be screened for genetic conditions are usually older mothers in their 40s worried about having a child with genetic problems, or those who already have a child with a genetic disease. It costs a further RM12,000 to RM15,000, on top of the IVF charges, to screen for genetic problems. Dr Singh added: “Singaporeans want only two or three children at most. So they place a lot of emphasis on their children being healthy.” None of the Singaporeans who went abroad for IVF treatment agreed to be interviewed.
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