Invitro Fertilisation (IVF) in Singapore

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Invitro Fertilisation (IVF) in Singapore

These are the guidelines by the Singapore Ministry of Health on Artificial Reproductive Technology (ART).

Artificial Reproductive Centres (AR Centre)

All artificial reproductive centres (AR Centre) in medical hospitals and private clinics in Singapore have to be licensed by the director of medical services (Singapore) for ART procedures.

Only medical practitioners or embryologists authorised by the Ministry of Health may carry out AR activities independently in the AR Centre.

Guidelines for Clinical Practice and Patients

A couple may only commence IVF (Invitro Fertilisation) procedures if there are justified indications for the procedure mainly:

• Tubal disease and/or obstruction
• Endometriosis – failed alternative approaches to treatment
• Male factor
• Idiopathic sub-fertility where no cause to be found after full investigation, at least three years of marriage, and having completed alternative approaches to fertility management for at least one year (this will not apply to female patients over 35 years of age)
• Premature ovarian failure
• Other conditions acceptable to the local medical obstetric/gynaecology community

These AR procedures can only be carried out on a married women with her husband's consent regardless of whether the husband's sperms or a donor sperms are used. Documentary proof of married status in mandatory (such as the Marriage Certificate).

Age limit for acceptance into AR programme

Women aged 45 and above may not enter into an AR programme.

Counselling

Prior to the start of any AR procedure the couple must have been adequately counselled with written consent and informed of the following:

1. Risk and complications of AR procedures, these include ovarian hyperstimulation syndrome, multiple births and the medical, social, financial and other consequences of births.
2. For women above 40 years of age there is a higher risk of failure and complications.
3. For women above 35 years of age there is a higher risk of genetic anomalies in the foetus (for example Down's Syndrome).
4. Prior to admittance into the AR Programme, the couple must be informed of the estimated total charges per type of treatment cycle which are likely to be incurred.
5. The need for compulsory insurance coverage for neonatal care (only applicable to local and foreign patients who intend to deliver in Singapore).

Screening Tests

All people undergoing AR procedures, including those who are donating sperms, oocytes (eggs) or embryos, must be screened for the following:

• Hepatitis B antigen,
• Syphilis,
• Rubella antibody
• Human Immunodeficiency Virus (HIV) antibody
• Transmissible disease (only when necessary)

Foreigners who have these tests carried out in another country must have them repeated in Singapore.

Rubella

Vaccination is not compulsory but highly recommended for any couple planning to enter into an AR programme. AR procedures cannot be carried out unless the couple understand the risk of a rubella infection to a foetus during pregnancy. It is advisable not to get pregnant one month after rubella vaccination.

HIV

HIV testing is compulsory for all people undergoing AR procedures. Those who have been tested negative for HIV, need to be screened every six months while still on the programme.

Only HIV antibody negative people may donate sperms, ooctyes and embryos. They must also remain HIV antibody negative six months after donation (to be confirmed with second HIV test), before the donor sperms, oocytes and embryos can be used. If the use of the gametes is within six months the couple must be informed of the risks and be counselled with written consent.

Treatment Cycles

For women entering any AR programme at the age of 40 years and below, the maximum number of consecutive cycles allowed in a nulliparous woman or following a live birth is ten stimulated cycles/natural cycles reaching the stage of embryo transfer. These cycles include those performed in local and foreign centres.

For women entering any AR programme above the age of 40 years, the maximum number of consecutive cycles allowed in a nulliparous woman or following a live birth is five stimulated or natural cycles reaching the stage of embryo transfer. Once a woman turns 45 years of age, all treatment must be stopped.

There is no limit to the number of thawed cycles (frozen embryo cycles) that may be carried out for any woman on the AR programme.

Note: Specific details on AR protocols, timings and costs, are available from the relevant AR centre.

Gametes and Embryo Donation

IVF and AR procedures can be done using donated eggs, sperms or embryos. It is best if a genetic link to one of the parents of the child is maintained. The use of donated embryos is permissible (donor sperm and donor egg) but signed consent from the donating couple is mandatory.

Donor eggs and sperms from the same family cannot be used for AR procedures (such as husband's sister eggs impregnated with his sperms or wife egg's impregnated with her brother's sperms.)

Women egg donors must be between the ages of 18 and 35 years old.

The maximum number of live births allowed for donor sperms, eggs or embryos is three.

Number of Embryos Replaced

The maximum number of embryos that can be replaced back into the patient's body at one time is three. Special permission can be obtained for up to a maximum of four embryos to be replaced if all of the following three conditions are satisfied:

1. All children conceived as a result of the procedure will be delivered and cared for in a hospital which has Level 3 neonatal intensive care facilities.
2. The patient has failed not less than two previous stimulated ART cycles.
3. The patient is above 35 years of age.

Embryo and Foetal Sexing

Embryo and foetal sexing will only be allowed on medical grounds and limited to sex-linked diseases such as haemophilia and muscular dystrophy. Prior approval of the Ministry of Health is required and each case will be considered on a case-by-case basis.

Storage/Disposal/Transfer of Gametes/Embryos

Before starting any AR programme, every couple whose gametes/embryos are stored will be counselled on the options available for storage, use and disposal of the stored gametes and embryos.

The maximal time limit for storage of embryos is five years from the date of fertilisation. Storage can be extended if there is an appropriate indication, this will require written approval from the Ministry of Health Singapore. However under no circumstances shall embryos be used if they have been stored beyond ten years from the date of their fertilisation.

Centre-to-centre transfer of embryos is allowed between local centres and between local and overseas centres.

The following activities may not be carried out in any AR Centre:

• The buying and selling of embryos, ova and sperm
• Surrogacy
• Foetal reduction purely for social and financial reasons
• Sperm sorting techniques in sex selection

Further information

• List of clinics that is approved by the Ministry of Health to perform ART
• See also The AngloFILE Gynaecologists & Obstetricians

Information provided by Dr Seng Shay Way, Fertility Solutions, Suite 03-18 Gleneagles Medical Centre, Singapore 258499 
Tel: (65) 64727988 / Fax:(65) 64725211 / www.sengclinic.com / e-mail
With reference to Singapore's Ministry of Health Directives for Private Healthcare Institutions Providing Assisted Reproduction Services and excerpts from Licensing & Accreditation Branch, Ministry of Health Directives for Private Healthcare Institutions Providing Assisted Reproduction Services.