What is egg freezing? Is it legal in Singapore? How does one go about doing it? We answer these questions (and more) in this guide…
Nowadays, more women in Singapore are putting their careers first and making great strides in the workforce. But this can come at a price: studies show that working women are more likely to get married later, which can delay getting pregnant. As such, Singapore’s birth rate has declined since 2014. And as our biological clocks continue to tick, the number and quality of eggs that women produce each month decreases. So what can be done? Egg freezing is one option, though there are limitations here in Singapore. Read on to find out more about this state-of-the-art fertility treatment…
Freezing your eggs in Singapore: all you need to know
What is egg freezing?
Also known as oocyte cryopreservation, egg freezing is a procedure that retrieves, freezes, and preserves a woman’s unfertilised eggs. These stored eggs may be used for conception later on in life. Freezing one’s eggs prevents declining egg quality, a typical problem women face as they grow older. It’s been said that fertility declines more rapidly after 35 years of age. Thus, egg freezing is recommended before that, ideally when you’re in your 20s.
Why do women freeze their eggs?
There are two reasons why women go through with the procedure:
1. Medical egg freezing
If a woman has to undergo treatment that may affect their fertility, they can freeze their eggs. These treatments include chemotherapy, which can damage eggs; radiotherapy, which can induce premature menopause; and surgery to remove tumours that may affect the ovaries, uterus, or fallopian tubes. Currently, it is only permissible to freeze your eggs for medical reasons in Singapore, but this is about to change…
2. Social egg freezing
Some women choose to freeze their eggs for other reasons – from putting their careers first, not finding a suitable partner, or simply deciding that parenthood is not on the cards yet. This is known as social egg freezing, and previously, it was not allowed in Singapore. Thus, more women travelled overseas to countries such as Malaysia and Australia to have their eggs frozen. However, on 28 March 2022, the government announced that women between the ages of 21 and 35 could undergo elective egg freezing from next year onwards.
Optimising your chances of successful egg freezing
What steps and precautions should you take to maximise your chances of successful egg freezing? We spoke with Dr Alexis Heng, Associate Professor of Biomedical Science at Peking University, to learn more.
What happens in the egg freezing process?
The egg freezing process is conducted similar to the initial stages of the in-vitro fertilisation (IVF) cycle. Firstly, the woman is given hormone injections, which can take up to two weeks. These injections help stimulate the ovaries to grow more eggs. Fun fact: did you know that women lose up to 1,000 (immature) eggs per month during their menstrual cycle? Regular ultrasound scans and blood tests are also carried out to ensure that the woman responds well to the treatment. Once the eggs have matured, they are extracted in a simple outpatient procedure under general anaesthetic.
What happens after the extraction?
After the eggs are retrieved, they are checked by an embryologist before being frozen. Vitrification is a method in which the eggs are “flash-frozen” at sub-zero temperatures (-196 degrees Celsius) in under a minute. This is the preferred process used in most clinics, as frozen eggs have a higher survival rate after being thawed.
When you’re ready to conceive, the frozen eggs are taken out, thawed, and injected with sperm to be fertilised. Once successful, the fertilised eggs are placed back into the uterus as embryos.
Where and for how long are the frozen eggs stored?
The retrieved eggs are kept in storage tanks filled with liquid nitrogen; these tanks are kept in assisted reproduction centres. As for duration, there’s no time limit on how long frozen eggs can be kept in Singapore.
How many eggs are recommended for freezing?
That depends on your age. The older you are, the more eggs you’ll need to freeze to achieve one successful pregnancy. Older women may likely need to undergo multiple egg collection and freezing cycles to obtain a sufficient number of eggs for a reasonable chance of future pregnancy success.
When is the best age to freeze eggs?
Women should freeze their eggs as young as possible, preferably before 35. A woman’s fertility declines sharply after this age, as represented by egg number and quality. Most women make the mistake of freezing their eggs too late – in their late thirties or early forties – when their egg quality has substantially declined. The high costs of egg freezing often discourage many younger women from freezing their eggs until they feel their biological clock ticking away.
How much does egg freezing cost in Singapore?
Be prepared to fork out a large sum of money: one egg freezing cycle is estimated to cost $10,000 upwards. This doesn’t include storing the frozen eggs, which could cost an additional $5,000.
What’s the success rate of getting pregnant using frozen eggs?
It depends on at which age you decided to freeze your eggs. If you freeze after age 35, the risk of chromosomal abnormalities and complicated pregnancies is higher. Egg freezing is not a fail-safe guarantee of starting a family later in life, even though the method is safe.
What common medical conditions will reduce my chances of successful egg freezing?
There are three conditions that you should take note of:
- Low ovarian reserve, determined by blood serum levels of anti-Mullerian hormone (AMH) and ultrasound scans.
- Polycystic Ovary Syndrome (PCOS), often results in low-quality and immature eggs.
- Uterine fibroids and cysts are reported to lower the chances of pregnancy in older women doing IVF with their frozen eggs.
Can changes to diet and lifestyle improve my chances of egg freezing?
Yes. There are commercially-available products that combine various vitamins and dietary supplements into one package to improve egg quality prior to IVF or egg freezing.
What other important advice should women heed to attain successful egg freezing?
In choosing a fertility clinic or IVF lab for egg freezing, do not just consider the price; check that they have a track record of live births with frozen eggs. The gold standard would be for the fertility clinic to have publications in international journals, which prove that they have successfully achieved live births with frozen eggs. Yet, less than 5% of fertility clinics and IVF labs in the USA fulfil such criteria.
Dr Alexis Heng Boon Chin is an Associate Professor of Biomedical Science at Peking University, China. He previously worked in the field of human clinical assisted reproduction research in Singapore and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies and published more than 260 scientific journal articles.
The case of social egg freezing in Singapore
For the longest time, social or elective egg freezing was not permitted in Singapore. This issue has been heavily debated and criticised, both in Parliament and online. In February 2021, Ms Cheng Li Hui, Member of Parliament (MP) for Tampines GRC, proposed that the government rethink its policy on social egg freezing. She also highlighted the number of Singaporean women who had gone abroad to preserve their eggs, asking: “Why do we create this environment where healthy women have to bear the cost and risk of doing this procedure overseas?”
AWARE, a woman’s rights and gender equality group in Singapore, counter-argued against the social egg freezing ban in Singapore. On Instagram, @myeggsmytime was created to start open conversations on the topic. There’s even a petition to legalise social egg freezing in Singapore.
A step in the right direction
When the White Paper on Singapore’s Women Development was released in late March 2022, one major policy shift was the action plan on elective egg freezing. According to Ms Josephine Teo, Minister for Communications and Information, the shift aims to empower women with choice. “When the idea first came up in our ground engagements, it caused some discomfort. There were worries that making elective egg freezing available would send the wrong signal about marriage and parenthood, that they need not be prioritised and can always be postponed,” said Ms Teo. Eventually, through engagement efforts, more people now understood why women decided to go for social egg freezing.
However, there is a caveat – only legally married couples can use the frozen eggs to get pregnant. Also, the procedure is limited to women between 21 and 35 years old. Ms Sun Xueling, Minister of State for Social and Family Development, explained that the age limit aligns with egg quality depreciation.
Most women have applauded this decision, though we know of someone who wouldn’t go through the procedure, given a choice. Stay tuned for that interview…
What are your thoughts on social egg freezing? DM us – we’d love to hear them.