Rationale for Barring Women Above 45 Years Old from Receiving IVF Treatments

6 Mr Louis Ng Kok Kwang asked the Minister for Health (a) what is the rationale behind barring women above 45 years old from receiving in-vitro fertilisation (IVF) treatments in Singapore; (b) what is the rationale behind limiting the number of IVF fresh cycles for women above 40 years old; and (c) whether the Ministry is planning to review these restrictions.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): The success rates of Assisted Reproduction (AR) procedures decrease and the likelihood of medical complications and adverse pregnancy outcomes increases with maternal age. It is therefore important that patients are well informed of the risks and outcomes of such procedures.

To protect patients’ interests, the current age limit for AR procedures, including in-vitro fertilisation (IVF), is set at age 45. However, MOH considers appeals on a case-by-case basis.

In addition, the current IVF limit is set at 10 fresh cycles for women aged 40 and below, and five fresh cycles for women above 40. This is because there are increased clinical risks with multiple cycles of ovarian stimulation and oocyte retrieval. These risks include ovarian hyper-stimulation syndrome (OHSS), bleeding and infection.

We recognise that recent advancements in AR technology have improved safety of AR procedures in general. The Government reviews these limits regularly and will take into account such technological advancements and other medical and social considerations, including the risk of chronic diseases, pregnancy or delivery complications, and continued low success rates of pregnancy and live births for women of higher maternal age.

Mr Louis Ng Kok Kwang (Nee Soon): I thank the Senior Minister of State for the reply. I understand the concerns and risks that she mentioned but I think these are concerns and risks that parents should consider and decide whether they want to have a child, and not something that the Government should decide.

So, two clarifications. One, whether MOH will review this policy of restricting the number of IVF cycles after 40 and restricting IVF completely after 45; and, two, how long will such a review take?

Dr Amy Khor Lean Suan: Let me say that besides Singapore, some countries like Belgium and Israel also impose AR age limits due to medical and social concerns of pregnancy and child-bearing at older ages.

In Singapore, the current AR age limit of 45 is set based on empirical evidence that shows that the chances of conception are very low at older ages. In fact, for AR success rates, it falls sharply at age 40, from 17.1% for women of ages between 35 to 39, to less than 7% for women from age 40 to 44. And then it falls further to about 4% for women aged 45 and above. In addition, there are also increased medical risks and complications as well as adverse pregnancy outcomes for women of older ages. As I have said in my reply, this is really set to protect the patients' interests. Nonetheless, MOH does consider appeals on a case-by-case basis.

For the treatment cycle limit of five fresh cycles for women above the age of 40, again this is due to concerns of increased clinical risks with older ages, with multiple cycles of ovarian stimulation and oocyte retrieval. Notwithstanding this, as I have also said, we recognise that there have been recent advancements made in AR technology that have actually improved the safety of AR procedures in general, we regularly review these limits and will take into account such technological advancements as well as professional standards of care and other patient factors. It is an on-going review, so we will make the announcements if we decide to change these limits.

Mr Louis Ng Kok Kwang: I just want to make one point. I understand the policy intent but what all this is driving is that these parents who want to have kids are just going to Johor to do the IVF cycles, and that places a lot of undue stress on them to travel to another country to do something that they want to do, which our Government is prohibiting them to do.

Dr Amy Khor Lean Suan: My response will be that, as I have said, even as there are advancements made in AR technology and it is safer, lower risk now to women for the AR procedure, we need to continue to highlight to couples who want children that notwithstanding the advancement in AR technology, the chances of conception, of pregnancy, at older ages have not increased, remain low. The medical risk and adverse pregnancy outcomes also remain. That has to be highlighted, so that they do not have false high expectations of success for such AR procedures at older ages.

Dr Chia Shi-Lu (Tanjong Pagar): Just a quick clarification for the Senior Minister of State. I was wondering if the Senior Minister of State could share with the House for those appeals for IVF, what are some of the considerations that the Ministry takes into account when evaluating the appeals.

Dr Amy Khor Lean Suan: We received about 50 patients' appeal per year over the last five years. Some of the factors we take into account will be the medical conditions of the female patient, the maternal age, as well as the number of fresh cycles that she had previously undergone.