Singapore can do more to help women conceive

In Singapore, most newlyweds want to have children within the first three years of marriage, but most are blissfully unaware of potential fertility issues.

This is especially significant given the trend of people marrying later.

At the same time, the demand from patients over 40 years old for Assisted Reproduction Technology (ART) treatments has been increasing.

The average age of women coming forward to us for ART was 37 in 2016, and this figure has gone up.

Age is the major cause of fertility problems in women.

In Singapore, the total fertility rate registered 1.14 last year - the lowest here since records began in 1960.

The number of babies born here also fell to an eight-year low in 2018.

As part of a range of measures recently announced to support marriage and parenthood, Singapore will remove its age limit for women undergoing in-vitro fertilisation (IVF) treatments from next year.

A cap on the number of IVF cycles will also be removed and there will also be new and enhanced subsidies for ART treatments.

The latest Government measures constitute a step in the right direction as it leaves the choice of childbearing to women.

Removing the IVF age limit allows those who remain healthy and fertile beyond 45 to continue trying for a baby.

This will also be beneficial to women who marry late and want to have children.

The removal of the limit to the number of cycles allowed is also welcome as older women likely have to go through more cycles to obtain healthy eggs.

These measures will reduce the need for women to seek fertility treatments elsewhere.

A moot point would be that even if a woman is fertile, IVF is often needed to achieve a successful pregnancy as more commonly, there is a male infertility factor present.

The male factor contributes to approximately 50 per cent of the reason for the need for IVF.

RISKS

The risks for older women are mainly associated with medical disorders, like hypertension and diabetes, as well as a much higher chance of miscarriage due to the inherent risks of having chromosomally abnormal foetuses.

If miscarriage occurs, there may be a need for invasive procedures to remove the pregnancy tissue.

This can potentially damage the uterine environment, and as a result of the emotional stress, also further decrease the woman's fertility.

As a woman ages, there is also an increased risk of other gynaecological problems like fibroids or endometriosis, which can also reduce the chance of conception.

So what can we do more in the fertility space in Singapore?

As it stands, egg-freezing is only allowed on medical grounds here.

However, many women across the world have the option to preserve their fertility, so that when they are ready to have a baby, they are able to.

Egg-freezing has been accepted as a useful tool - it is not a proposition for everyone, but perhaps it is time to consider adding this option to improve women's chances of conception here.

Preimplantation Genetic Testing for Aneuploidy (PGT-A) could be another tool to help reduce the risk of having an abnormal embryo implanted, and therefore wasting an ART cycle.

To improve the take-home baby rate, checking the embryos to determine which is normal prior to transfer has the potential to reduce cost as well as physical and emotional trauma for a couple.

More importantly, there is a need to educate and stimulate more conversations around fertility even as the provision of financial and emotional support for those having difficulties have improved.

This will go a long way in improving pregnancy and take-home baby rates in Singapore.

The writer is a medical director at Virtus Fertility Centre Singapore and specialises in obstetrics, gynaecology and fertility.