This document provides background information and objectives for a study on elective oocyte freezing in Singapore. It discusses how oocyte freezing has been used internationally and notes that major medical societies in the US and Europe no longer consider it experimental. However, they do not endorse its routine elective use. The objective of the study is to evaluate the need for and position on elective oocyte freezing in Singapore by examining factors like the medical risks and limited data on success rates and child outcomes. The scope includes assessing perspectives from the public and fertility experts through surveys.

1. Photo:
The
Straits
Times
Photo:
TIME
Photo:
Santa
Monica
Reproduc8ve
Technologies
9th
April
2013
Survey
Conducted
to
Evaluate
the
Posi8on
on
Elec8ve
Oocyte
Freezing
in
Singapore

2. 2
Table
of
Contents
 Defini(on
of
Terms
3
 Defini(on
of
Acronyms
4
 Chapter
1:
Study
Background,
Objec(ves
and
Scope
5
 Chapter
2:
Evalua(ng
the
Need
for
Elec(ve
Oocyte
Freezing
9
 Chapter
3:
Regulatory
Scenarios
of
Selected
Countries
30
 Appendix
36
2

3. 3
Defini8ons
of
Terms
Terms
here
are
defined
for
beKer
understanding
of
the
following
report:
Term
Defini8on
Assisted
reproduc(on
technology
(ART)
treatments
Clinical
and
laboratory
techniques
that
involve
the
mixing
of
oocytes
and
sperms
outside
the
body
to
enhance
fer(lity
Elec(ve
oocyte
freezing
Cryopreserva(on
for
non-­‐medical
purposes
Ever-­‐married
Status
of
having
been
married
at
least
once,
regardless
of
current
marital
status
Intracytoplasmic
Sperm
Injec(on
(ICSI)
ICSI
is
a
form
of
Assisted
Reproduc(ve
Technology
(ART)
In-­‐vitro
fer(lisa(on
(IVF)
IVF
is
a
form
of
Assisted
Reproduc(ve
Technology
(ART)
Medisave
Singapore’s
na(onal
healthcare
saving
scheme
which
helps
individuals
set
aside
part
of
their
income
to
meet
future
healthcare
expenses
No
Religion
The
status
of
not
being
affiliated
to
any
par(cular
religion,
of
which
free
thinkers
are
included
Pre-­‐implanta(on
Gene(c
Diagnosis
(PGD)
Gene(c
profiling
of
embryos
or
oocytes
prior
to
fer(lisa(on
Resident
popula(on
Singapore
Ci(zens
and
Permanent
Residents
Respondents
Persons
who
had
supplied
informa(on
for
Clearstate
or
BELRIS
surveys

4. 4
Defini8ons
of
Acronyms
Acronyms
here
are
defined
for
beKer
understanding
of
the
following
report:
Term
Defini8on
ART
Assisted
Reproduc(on
Technology
ASRM
Society
for
Assisted
Reproduc(ve
Technology
BELRIS
Bioethics
Legal
group
for
Reproduc(ve
Issues
in
Singapore
ESHRE
European
Society
of
Human
Reproduc(on
and
Embryology
ICMR
Indian
Council
of
Medical
Research
ICSI
Intracytoplasmic
Sperm
Injec(on
IVF
In-­‐Vitro
Fer(lisa(on
KICs
Key
IVF
Centres
KOLs
Key
Opinion
Leaders
MOH
Ministry
of
Health
MSQH
Malaysian
Society
for
Quality
in
Health
PGD
Pre-­‐Implanta(on
Gene(c
Diagnosis

5. 5
Photo:
The
Straits
Times
Photo:
TIME
Photo:
Santa
Monica
Reproduc8ve
Technologies
5
Chapter
1
Study
Background,
Objec8ve
and
Scope

6. 6
Study
Background
Freezing
oocytes
(also
referred
to
as
‘freezing
eggs’),
or
cryopreserva(on,
is
a
process
which
has
been
used
in
various
parts
of
the
world
for
various
reasons
to
perserve
a
woman’s
fer(l(y.
The
process
many
(mes
involves
In-­‐
Vitro
Fer(lisa(on
(‘IVF’),
and
the
cooling
of
eggs
to
sub-­‐zero
temperatures
(vitrifica(on).
In
October
2012,
the
Prac(ce
Commicee
of
the
American
Society
for
Reproduc(ve
Medicine
(‘ASRM’)
and
the
Society
for
Reproduc(ve
Technology
announced
that
oocyte
freezing
should
no
longer
be
considered
experimental.*
However,
notably,
ASRM
did
not
endorse
the
technique
for
rou(ne
elec(ve
use.
Similarly,
the
European
Society
of
Human
Reproduc(on
and
Embryology
(‘ESHRE’)
has
recently
stated
that
arguments
against
using
the
technology
are
not
convincing.**
The
process
of
oocyte
freezing
starts
in
a
similar
manner
as
does
regular
IVF
treatment.
It
involves
the
s(mula(on
of
a
woman's
ovaries
with
fer(lity
medica(on
before
the
oocytes
are
harvested.
However,
instead
of
crea(ng
embryos
immediately,
as
is
in
the
case
in
regular
IVF,
the
oocytes
are
frozen
to
be
used
to
create
embryos
at
a
later
date.***
References:
*The
Prac(ce
Commicee
of
the
American
Society
of
Reproduc(ve
Medice
and
the
Society
of
Reproduc(ve
Technology.
Mature
oocyte
crypreserva(on:
a
guideline.
Fer0lity
and
Sterility
2012
Oct
12.pii:
S0015-­‐0282(12)02247-­‐9.
**ESHRE
Task
Force
on
Ethics
and
Law,
W.
Dondorp,
G.
de
Wert,
G.
Pennings,
F.
Shenfield,
P.
Devroey,
et
al.
(2012).
Oocyte
cryopreserva(on
for
age-­‐related
fer(lity
loss.
Oxford
Journals
***NYU
Fer(lity
Center.
(n.d.).
About
the
Egg
Freezing
Process.
Retrieved
March
19,
2013,
from
hcp://www.nyufer(litycenter.org/egg_freezing/cryopreserva(on_process
Photo:
The
Straits
Times

7. 7
Study
Objec8ve
and
Scope
As
with
any
IVF
procedure,
there
are
inherent
medical
risks
to
women
such
as
ovarian
hyper-­‐s(mula(on.
With
regards
to
children
born
from
the
procedure,
as
with
IVF,
there
is
limited
data
on
the
success
rates
of
fer(lisa(on
and
live
births,
as
well
as
the
perinatal
outcomes,
i.e.
whether
there
are
any
long-­‐term
effects
on
children
born.
In
addi(on,
there
are
important
issues
about
whether
access
to
this
procedure
should
be
a
macer
of
choice
or
policy,
and
whether/what
type
and
extent
of
regula(ons
should
be
in
place.
Finally,
there
are
issues
of
‘fer(lity
tourism,’
and
related
ethical
concerns.
In
Singapore,
only
married
women
under
the
age
of
45
can
undergo
IVF
treatment.
Oocyte
freezing
may
be
considered
for
married
women
as
part
of
the
IVF
procedure
if
necessary,
e.g.
while
the
couple
is
wai(ng
for
a
sperm
donor.
Single
women
in
Singapore
are
not
allowed
to
undergo
IVF
treatment
unless
medically
necessitated
in
order
to
perserve
fer(lity
(e.g.
in
cases
of
cancer).*
References:
*Ministry
of
Health.
(2006).
Direc0ves
for
Private
Healthcare
Ins0tu0ons
Providing
Assisted
Reproduc0on
Services.
Singapore:
Licensing
&
Accredita(on
Branch,
Ministry
of
Health
.
See
also,
The
Straits
Times
.
(2012,
April
12
).
Freezing
the
Egg
to
Delay
Motherhood.
Retrieved
March
19,
2013,
from
Health
Xchange
:
hcp://www.healthxchange.com.sg/News/Pages/freezing-­‐egg-­‐delay-­‐motherhood.aspx
Study
Objec8ve:
Evaluate
the
need
for
elec8ve
oocyte
freezing
in
Singapore
 To
understand
Singaporeans’
perspec(ves
on
elec(ve
oocyte
freezing
 To
understand
regulatory
scenarios
in
selected
countries
(Malaysia,
Thailand,
India
and
Australia)
on
elec(ve
oocyte
freezing
 To
iden(fy
and
compile
sta(s(cal
informa(on
related
to
elec(ve
oocyte
freezing

8. 8
Source
of
Informa8on
Evalua8ng
the
need
for
elec8ve
oocyte
freezing
in
Singapore
done
through
various
primary
and
secondary
research
methodologies
Secondary
Research
Secondary
Sources
Reviews:
Clearstate
also
gathered
informa(on
from
regulatory
reports
and
medical
journals
related
to
oocyte
freezing,
newspaper
ar(cles
on
policies
or
ini(a(ves
undertaken
by
government
bodies,
views
of
KICs
and
KOLs
on
discussion
forums
and
any
sta(s(cal
informa(on
related
to
oocyte
freezing.
Primary
Research
Clearstate
Quan8ta8ve
Survey
of
Resident
Women:
The
sample
size
for
the
survey
was
410
respondents
aged
between
20
to
45
years
(95%
confidence
level
and
5%
confidence
interval
for
a
target
popula(on).
Clearstate
prepared
its
own
independent
and
anonymous
contact
list
to
ensure
that
the
anonymity
of
respondents
is
maintained.
BELRIS
Survey
of
Resident
Women
and
Men:
The
sample
size
for
the
survey
was
206
respondents
aged
between
aged
above
18
years.
The
survey
was
conducted
online
at
www.belris.sg.
Clearstate
had
u(lised
the
data
from
this
survey
as
an
addi(onal
data
source
for
analysis
purposes.
Clearstate
Qualita8ve
Interviews
of
Key
IVF
Centres
in
Selected
Countries:
Clearstate
conducted
interviews
with
Key
IVF
Centres
(‘KICs’)
in
Australia,
India,
Malaysia
and
Thailand
to
understand
their
perspec(ves
on
this
topic.
Clinicians
from
approximately
2-­‐4
IVF
centres
were
interviewed
in
each
of
the
above-­‐men(oned
countries.
Clearstate
Qualita8ve
Interviews
of
IVF
Clinics
in
Singapore:
Clearstate
conducted
interviews
with
IVF
clinicians
in
Singapore
to
understand
their
perspec(ves
on
this
topic.
5
of
such
interviews
were
conducted.
Clearstate
Qualita8ve
Interviews
of
Key
Opinion
Leaders
in
Singapore:
Clearstate
conducted
interviews
with
Key
Opinion
Leaders
(‘KOLs’)
in
Singapore
to
understand
their
perspec(ves
on
this
topic.
KOLs
from
diversified
backgrounds,
who
represent
key
women’s
organisa(ons,
were
interviewed
for
this
study.
3
of
such
interviews
were
conducted.

9. 9
Photo:
The
Straits
Times
Photo:
TIME
Photo:
Santa
Monica
Reproduc8ve
Technologies
9
Chapter
2
Evalua8ng
the
Need
for
Elec8ve
Oocyte
Freezing
in
Singapore

10. 10
Rising
median
age
of
marriage,
rising
propor8on
of
singles,
and
decreasing
age-­‐specific
fer8lity
rates
of
women
below
35
are
seen
to
impact
popula8on
trends
in
Singapore
10
References:
*Department
of
Sta(s(cs,
Ministry
of
Trade
&
Industry.
(2012).
Popula0on
Trends
2012.
Singapore
 According
to
the
Popula(on
Trends
2012
report
published
by
the
Singapore
Department
of
Sta(s(cs,
a
total
of
27,258
marriages*
were
registered
in
2011,
which
was
12%
higher
than
the
24,363
registered
in
2010.
 However,
age-­‐specific
marriage
rates
fell
for
those
below
30
years
of
age
in
2011;
men
aged
25
to
29
years
and
women
aged
20
to
24
years
experienced
the
largest
fall
compared
to
2001
(Chart
1).
 Over
the
past
decade,
there
had
been
an
increase
in
the
median
age
for
first
(me
marriages
for
both
genders.
In
2011,
the
median
age
for
first
marriage
for
males
was
30.1
years
as
compared
to
28.8
on
2001.
Similarly
for
women,
the
median
age
for
first
(me
marriage
in
2011
was
28.0,
an
increase
from
26.2
in
2001.*
 Sta(s(cs
published
in
the
report
also
indicate
that
in
2011,
the
propor(on
of
singles
among
total
resident
popula(on
had
increased
to
32%
from
30%
in
2001.*
 Age-­‐specific
fer(lity
rates
had
fallen
for
resident
women
aged
below
35
years
over
the
past
decade.
In
2011,
those
within
the
age
group
of
25
to
29
years
registered
the
largest
drop
to
73
births
per
1,000
women,
down
from
96
per
1,000
women
in
2001
(Chart
2).
Chart
1:
Age-­‐Sex
Specific
Marriage
Rate#
Source:
Popula8on
Trends
2012,
Singapore
#Age-­‐Specific
Marriage
Rate
is
defined
as
the
number
of
marriages
registered
within
a
specific
age
group
during
the
year,
out
of
every
thousand
unmarried
popula8on
in
the
same
age
group
Chart
2:
Age-­‐Specific
Fer8lity
Rates##
Source:
Popula8on
Trends
2012,
Singapore
##Age-­‐Specific
Fer8lity
Rates
is
defined
as
the
number
of
births
registered
within
a
specific
age
group
during
the
year,
out
of
every
thousand
female
popula8on
in
the
same
age
group

11. 11
Rising
number
of
childless
or
one-­‐child
families
for
ever-­‐married
women
in
Singapore
11
References:
*Department
of
Sta(s(cs,
Ministry
of
Trade
&
Industry.
(2012).
Popula0on
Trends
2012.
Singapore
 Sta(s(cs
from
the
Popula(on
Trends
2012
report
reflect
an
increase
in
the
propor(on
of
childless
ever-­‐
married
women
in
their
thir(es
and
for(es
over
the
past
decade.*
 The
propor(on
of
ever-­‐married
resident
women
aged
30
to
39
years
who
were
childless
increased
from
15.3%
in
2001
to
20.9%
in
2011
(Chart
3).
 The
propor(on
of
ever-­‐married
resident
women
aged
40
to
49
years
who
were
childless
increased
from
6.7%
in
2001
to
9.1%
in
2011
(Chart
3).
 There
is
an
increasing
trend
of
families
with
only
one
child.
Among
ever-­‐married
women
aged
40
to
49
years
who
were
likely
to
have
completed
child-­‐
bearing,
the
propor(on
with
one
child
increased
from
15.7%
in
2001
to
19.4%
in
2011
(Chart
3).
 BELRIS
survey
results
indicate
a
trend
towards
delayed
family
forma(on
with
the
majority
of
married
resident
popula(on
(men
and
women)
sta(ng
they
had
their
first
child
between
the
age
of
31
to
35
years
(Chart
4).
(Chart
4)
BELRIS
Survey,
Ques(on:
What
age
did
you
have
your
first
child?
Base,
Respondents
who
are
married
n=135
30%
0%
15%
39%
9%
6%
15%
6%
28%
42%
10%
0%
No
Children
18
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
Men
(n=33)
Women
(n=102)
Chart
4:
Age
when
First
Child
was
Born
Source:
BELRIS
quan8ta8ve
survey
Chart
3:
Ever-­‐Married
Resident
Women
by
Age
Group
and
Number
of
Children
Born
(2001
versus
2011)
Source:
Popula8on
Trends
2012,
Singapore
46.7%
15.3%
6.7%
3.8%
42.7%
20.9%
9.1%
4.4%
15
-­‐
29
30
-­‐
39
40
-­‐
49
Above
50
2001
2011
No
children
Years
31.1%
24.5%
15.7%
10.4%
36.0%
28.4%
19.4%
12.9%
15
-­‐
29
30
-­‐
39
40
-­‐
49
Above
50
2001
2011
1
Child
Years

12. 12
Unmarried
respondents
had
indicated
that
their
ideal
age
to
start
having
children
is
between
31
to
35
years
old,
with
job/financial
security
as
the
most
men8oned
reason
for
delaying
pregnancy
 Of
a
total
of
71
unmarried
respondents
in
the
BELRIS
survey,
50%
of
men
and
41%
of
women
stated
that
their
ideal
age
to
start
having
children
is
between
31
to
35
years
old
(Chart
5).
 Of
a
total
of
202
respondents
(both
married
and
unmarried)
in
the
BELRIS
survey,
the
most
men(oned
reason
for
delaying
pregnancy
was
‘job/financial
security’
which
was
men(oned
by
88%
of
men
and
74%
of
women
(Table
1).
 54%
of
men
and
65%
of
women
indicated
looking
for
‘rela(onship
stability’
as
a
reason
for
delaying
pregnancy
(Table
1).
 Overall,
34%
of
respondents
indicated
they
would
delay
pregnancy
based
on
their
belief
that
there
will
be
no
problems
having
children
in
the
late
30s
(Table
1).
Chart
5:
Ideal
Age
to
Start
Having
Children
5%
0%
35%
50%
5%
5%
0%
6%
0%
25%
41%
18%
6%
4%
Does
not
want
Children
18
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
Above
45
Men
(n=20)
Women
(n=51)
Source:
BELRIS
quan8ta8ve
survey
Table
1:
Reasons
for
Delaying
Pregnancy
Reasons
for
Delaying
Pregnancy
Total
(n=202)
Men
(n=52)
Women
(n=150)
Job/Financial
security
78%
88%
74%
Rela(onship
stability
62%
54%
65%
Belief
that
there
will
be
no
problem
having
children
in
the
late
30s
34%
38%
33%
(Chart
5)
BELRIS
Survey,
Ques(on:
At
what
age
do
you
want
to
start
having
children?
Base,
Respondents
are
NOT
married
n=71
(Table
1)
BELRIS
Survey,
Ques(on:
If
you
wished
to
have
children,
what
would
be
the
reasons
for
delaying
gevng
pregnant?/
(Table
1)
BELRIS
Survey,
Ques(on:
What
do
you
feel
are
the
reasons
for
women
delaying
gevng
pregnant?
Base,
Respondents
who
are
married
+
Respondents
are
NOT
married
and
want
to
have
children
n=202
Source:
BELRIS
quan8ta8ve
survey

13. 13
 Based
on
the
Clearstate
survey,
10
out
of
410
respondents
had
undergone
oocyte
freezing
over
the
past
5
years.
 Table
2
indicates
a
mix
of
respondents
who
had
their
oocytes
frozen
either
for
medical
reasons
or
as
part
of
fer(lity
treatment
(i.e.
IVF
treatment).
Low
oocyte
freezing
experience
rate
in
Singapore
13
Number
of
Respondents
Marital
Status
For
Medical
Reasons
Preserving
eggs
prior
to
receiving
cancer
treatment
3
(30%)
2
single
and
1
married
Either
family
history
of
early
menopause,
endometriosis
or
premature
ovarian
failure
1
(10%)
All
married
For
Fer8lity
Treatment
During
IVF
treatment
6
(60%)
All
married
Singapore
Assisted
Reproduc8on
Guidelines:*
Based
on
current
guidelines
by
Ministry
of
Health
on
Assisted
Reproduc(on
(AR):
-­‐ Procedures
to
have
oocytes
frozen
for
elec(ve
reasons
for
single
women
is
not
allowed
-­‐ Only
married
women,
under
45
years
old,
with
the
consent
of
her
husband,
may
undergo
IVF
treatments
or
other
AR
treatments
Table
2:
Reasons
Given
for
Resident
Women
having
Undergone
Oocyte
Freezing
over
the
Past
5
Years
Source:
Clearstate
quan8ta8ve
survey
Reference:
*Source:
Licensing
&
Accredita(on
Branch,
Ministry
of
Health.
(2006).
Direc0ves
for
Private
Healthcare
Ins0tu0ons
Providing
Assisted
Reproduc0ve
Services.
Singapore.
(Table
2)
Clearstate
Survey,
B31:
Why
did
you
get
your
eggs
frozen
for
medical
reasons?
Base,
Respondents
who
have
undergone
egg
freezing
n=10

14. 14
(Chart
6)
Clearstate
Survey,
C5:
Please
indicate
‘Yes’
if
you
are
aware
that
egg-­‐freezing
can
be
used
for
each
of
the
following
and
“No”
if
you
are
not
aware
(Table
3)
Clearstate
Survey,
C3:
On
a
scale
of
1-­‐5,
how
would
you
rate
your
overall
knowledge
of
egg-­‐freezing
technology
for
women?
1
is
no
knowledge
at
all
and
5
is
have
lot
of
knowledge
Base,
Respondents
who
have
NOT
undergone
egg
freezing
n=400
1%
20%
72%
7%
0%
20%
40%
60%
80%
100%
Never
heard
of
it
I
am
aware
of
the
existence
of
egg-­‐freezing
but
do
not
have
any
details
of
the
technology
I
have
some
knowledge
of
the
technology
I
have
detailed
knowledge
of
the
technology
Chart
6:
Familiarity
with
Oocyte
Freezing
Technology
(n=400)
Source:
Clearstate
quan8ta8ve
survey
 72%
of
respondents
stated
that
they
believe
they
have
‘some
knowledge’
of
oocyte
freezing
technology
(Chart
6).
 The
average
ra(ng
when
respondents
were
asked
to
rate
their
level
of
overall
knowledge
of
oocyte
freezing
technology
on
a
scale
of
1
to
5#
was
2.45
(Table
3).
1
2
3
4
5
16%
40%
32%
12%
1%
No
Knowledge
At
All
A
lot
of
Knowledge
Table
3:
Ra8ng
of
Overall
Knowledge
of
Oocyte-­‐Freezing
Technology
Source:
Clearstate
quan8ta8ve
survey
Majority
of
respondents
indicated
having
‘some
knowledge’
of
oocyte
freezing
technology
#1
is
having
'no
knowledge
at
all'
and
5
is
having
'a
lot
of
knowledge

15. 15
An
increasing
number
of
women
in
Singapore
are
seeking
IVF
treatment
in
recent
years
Reference:
*Data
source
from
Ministry
of
Health
(MOH),
The
Straits
Times.
(2011,
July
23).
Fer(lity
business
booming
in
Singapore.
Retrieved
March
19,
2013,
from
Health
Xchange,
hcp://www.healthxchange.com.sg/News/Pages/Fer(lity-­‐
business-­‐booming-­‐in-­‐Singapore.aspx
**Clearstate
qualita(ve
interviews
with
Singapore
KICs
 According
to
a
Straits
Times
ar(cle
published
in
July
2011,
sta(s(cs
from
the
Singapore
Ministry
of
Health
showed
that
the
number
of
women
op(ng
for
Assisted
Reproduc(on
Technology
(ART)
treatments
(with
IVF
being
the
most
common)
had
increased
between
2006
and
2009
from
1,933
to
3,271
(Chart
7).*
 Propor(onal
to
the
increase
in
number
of
women
seeking
ART
treatments,
sta(s(cs
from
the
Singapore
Ministry
of
Health
also
showed
that
the
number
of
babies
born
via
ART
increased
by
65%
from
717
babies
in
2006
to
1,158
babies
in
2009
(Table
4).*
 Fer(lity
specialists
in
Singapore
interviewed
by
Clearstate
had
stated
that
an
increase
in
awareness,
and
women
becoming
more
forthcoming
in
seeking
IVF
and
other
ART
treatments,
have
contributed
to
an
increase
in
the
number
of
babies
born
via
ART.**
“It
is
not
a
(social)
s0gma
anymore
in
Singapore
to
seek
fer0lity
treatment.
Once
they
(women)
realized
the
possibility
of
a
fer0lity
issue,
they
are
likely
to
seek
treatment
immediately.”
–
Fer8lity
Specialist,
Singapore
“Awareness
level
is
higher
among
more
educated
people
as
they
are
typically
the
ones
making
the
enquires,
the
recent
newspaper
ar0cles
(on
oocyte
freezing)
have
also
helped
raising
awareness
in
Singapore.
Hence
the
demand
of
IVF
is
on
the
rise
in
the
country.”
–
Fer8lity
Specialist,
Singapore
Year
Total
Number
of
Babies
2006
717
2007
804
2008
927
2009
1,158
Table
4:
Number
of
Babies
Born
to
Mothers
through
Assisted
Reproduc8on
Technology
(ART)
Treatment
1,933
2,179
2,627
3,271
2006
2007
2008
2009
Chart
7:
Number
of
Women
Op8ng
for
Assisted
Reproduc8on
Technology
(ART)
Treatments
Source:
The
Straits
Times
(Data
from
Singapore
Ministry
of
Health)
Source:
The
Straits
Times
(Data
from
Singapore
Ministry
of
Health)

16. 16
 According
to
the
ICMART
(Interna(onal
Commicee
for
Monitoring
Assisted
Reproduc(ve
Technologies),
there
is
an
es(mate
of
approximately
1.5
million
ART
cycles
(IVF
inclusive)
performed
globally
each
year.*
 In
Singapore,
the
number
of
ART
cycles
is
lower
than
certain
developed
na(ons.
A
comparison
of
figures
from
2009
indicate
that
Singapore
performed
approximately
656#
cycles
per
million
popula(on**
as
compared
to
some
European
na(ons,
such
as
Denmark
and
the
United
Kingdom
which
performed
2,726
cycles
per
million
and
879
cycles
per
million
respec(vely
(Table
5).*
 The
number
of
ART
cycles
per
million
popula(on
in
the
United
States
was
approximately
3.5
(mes
higher
than
Singapore
at
2,361
cycles
per
million.***
 Prior
to
2013,
the
Singapore
government
had
a
co-­‐funding
limit
of
S$3,000
per
ART
cycle
for
Singaporeans,
up
to
three
cycles
only.****
European
countries
like
Belgium
provide
reimbursement
for
six
ART
cycles
before
the
age
of
43.*****
 Star(ng
from
January
2013,
the
Singapore
government
co-­‐funding
limit
has
increased
to
six
ART
cycles
in
public
hospitals.
Couples
are
eligible
for
up
to
three
fresh
(maximum
co-­‐funding
of
S$6,300)
and
three
frozen
cycles
(maximum
co-­‐
funding
of
S$3,000)
of
ART
treatments.
Medisave
can
also
be
used
to
reduce
the
out-­‐of-­‐pocket
expense.****
 In
addi(on
to
the
men(oned
enhanced
government
support,
Singaporeans’
recep(vity
to
IVF
may
also
raise
IVF
rates
in
coming
years.
Country
ART
Cycles
Per
Million
Popula8on
Denmark
2,726
Belgium
2,562
Sweden
1,800
Germany
830
Italy
863
United
Kingdom
879
United
States
2,361
Singapore
656#
Table
5:
Comparison
of
ART
Cycles
Per
Million
Popula8on
(2009)
Sources:
European
Society
of
Human
Reproduc8on
and
Embryology's
IVF
Monitoring
Consor8um,
United
States
Assisted
Reproduc8ve
Technology
Surveillance
Report
and
The
Straits
Times
(Data
from
Singapore
Ministry
of
Health)
Singapore
IVF
rates
are
lower
than
certain
developed
na8ons;
Enhanced
government
support
may
raise
IVF
rates
in
Singapore
#Number
of
ART
cycles
per
million
popula8on
for
Singapore
is
obtained
by
number
of
women
who
used
ART
over
total
popula8on
in
2009
Reference:
*European
Society
of
Human
Reproduc(on
and
Embryology's
IVF
Monitoring
Consor(um
(2012,
July
1).
European
Society
of
Human
Reproduc0on
and
Embryology.
Retrieved
March
19,
2013,
from
Science
Daily:
hcp://
www.sciencedaily.com-­‐
/releases/2012/07/120702134746.htm
**The
Straits
Times.
(2011,
July
23).
Fer(lity
business
booming
in
Singapore.
Retrieved
March
19,
2013,
from
Health
Xchange:
hcp://www.healthxchange.com.sg/News/Pages/Fer(lity-­‐business-­‐booming-­‐in-­‐Singapore.aspx
***Na(onal
Center
for
Chronic
Disease
Preven(on
and
Health
Promo(on,
Division
of
Reproduc(ve
Health.
(2012,
November
2).
Assisted
Reproduc0ve
Technology
Surveillance
—
United
States,
2009.
Retrieved
March
19,
2013,
from
Centers
for
Disease
Control
and
Preven(on:
hcp://www.cdc.gov/mmwr/preview/mmwrhtml/ss6107a1.htm?s_cid=ss6107a1_e
****Ministry
of
Health.
(2013).
Hey
Baby.
Retrieved
March
19,
2013,
from
Enhanced
Co-­‐Funding
For
Assisted
Reproduc(on
Technology
(ART)
Treatment:
hcp://www.heybaby.sg/havingchildren/art.html
*****The
Business
Times.
(2012,
June
02).
When
0me
is
of
the
essence.
Retrieved
March
21,
2013,
from
The
Business
Times
lifestyle:
hcp://www.business(mes.com.sg/archive/thursday/lifestyle/wellness/when-­‐(me-­‐essence

17. 17
Singaporean
recep8vity
to
IVF
is
likely
to
accelerate
ART
use
in
the
future
 71%
of
respondents
to
the
Clearstate
survey
(includes
singles
and
ever-­‐married
respondents
who
have
not
conceived
any
children
via
IVF)
indicated
that
they
would
consider
IVF
if
the
need
arose
(Chart
8).
 The
percep(on
of
success
by
respondents
if
IVF
treatment
was
used
to
have
a
baby
was
5%
believing
it
would
be
‘extremely
successful,’
while
80%
believing
it
would
be
‘some(mes
successful’
(Chart
9).
(Chart
8)
Clearstate
Survey,
A7:
Would
you
consider
In
vitro
fer(liza(on
(IVF)
if
need
arises?
Base,
Respondents
who
are
Single,
Never
married
or
Married/Divorced/Widowed/Separated
(with
no
children
or
children
conceived
via
natural
pregnancy)
n=407
(Chart
9)
Clearstate
Survey,
A8:
How
successful
do
you
think
IVF
treatments
are?
Base,
All
respondents
n=410
Chart
8:
Percentage
of
Respondents
Who
Would
Consider
IVF
(n=407)#
Yes
71%
No
29%
Source:
Clearstate
quan8ta8ve
survey
Has
complica(ons,
12%
Not
successful;
3%
Some(mes
successful;
80%
Extremely
successful,
5%
Chart
9:
Percep8on
of
IVF
Success
(n=410)
Source:
Clearstate
quan8ta8ve
survey
#Includes
respondents
that
have
gone
through
IVF
treatment
but
have
yet
successfully
had
a
child

18. 18
IVF
success
rates
(both
live
births
and
clinical
pregnancies#)
are
seen
to
decline
with
the
increase
in
age
in
Singapore
 Ms
Tan
Su
Shan,
Nominated
Member
of
Parliament
(NMP),
directed
the
following
ques(on
on
the
live
birth
success
rates
of
IVF
treatment
at
different
ages
in
Singapore
to
Mr
Gan
Kim
Yong,
Minister
of
Health
during
a
Sivng
of
Parliament.
Oral
Answer
by
Mr
Gan
Kim
Yong,
Minister
of
Health,
to
Parliamentary
Ques8on
on
Success
Rates
of
IVF
Treatment
NMP:
Ms
Tan
Su
Shan
To
ask
the
Minister
for
Health
what
are
the
success
rates
of
live
births
arising
from
In-­‐vitro
fer(lisa(on
(IVF)
for
Singapore
women
aged
below
35
years
of
age
and
those
above
35
years
of
age.
Answer:
The
success
rate
of
live
births
from
In-­‐vitro
fer(lisa(on
(IVF)
using
fresh
embryos
was
23%
based
on
most
recent
data
from
2010.
In
par(cular,
the
success
rate
of
live
births
from
IVF
for
women
below
35
years
of
age
was
34%,
while
for
women
35
years
of
age
and
older,
the
success
rate
of
live
births
was
14%.
These
rates
have
been
fairly
consistent
over
the
last
five
years,
from
2006
to
2010.
 On
a
similar
note,
the
clinical
pregnancy
success
rate
of
IVF
treatment
for
women
35
years
of
age
and
younger
is
higher
than
that
for
women
older
than
35
years
of
age,
as
observed
in
the
clinical
pregnancy
success
rates
of
IVF
treatment
reported
by
2
clinics
in
Singapore
(Chart
10
and
Chart
11).
Source:
Clearstate
qualita8ve
interviews
with
Singapore
KICs
43.0%
66.7%
28.6%
28.6%
20
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
Chart
10:
IVF
Clinical
Pregnancy
Success
Rates
Reported
By
A
Private
Clinic
in
Singapore
By
Age
(2011)##
42.0%
38.0%
16.0%
11.0%
20
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
Chart
11:
IVF
Clinical
Pregnancy
Success
Rates
Reported
By
A
Public
Clinic
in
Singapore
By
Age
(2012)##
Source:
Clearstate
qualita8ve
interviews
with
Singapore
KICs
#A
successful
clinical
pregnancy
is
a
pregnancy
where
the
fetal
sac
is
seen
in
the
uterus
with
an
ultrasound
aner
the
IVF
procedure
has
taken
place
##IVF
success
rate
varies
between
individual
clinic
due
to
factors
such
as
pa8ent
volume,
health
condi8ons
of
pa8ents
etc.

19. 19
IVF
live
birth
success
rates
using
fresh
versus
frozen
embryos
from
pa8ent
oocytes
46.2%
38.4%
27.4%
16.6%
6.5%
39.3%
35.7%
30.3%
24.5%
16.5%
Under
35
35
-­‐
37
38
-­‐
40
41
-­‐
42
Above
42
Fresh
Embryos
from
Pa(ent
Oocytes
-­‐
Percentage
of
transfers
resul(ng
in
live
births
Thawed
Embryo
from
Pa(ent
Oocytes
-­‐
Percentage
of
transfers
resul(ng
in
live
births
Chart
12:
IVF
Live
Birth
Success
Rates
Using
Fresh
versus
Frozen
Embryos
from
Pa8ent
Oocytes
(2011)
Source:
Society
for
Assisted
Reproduc8ve
Technologies
(SART),
the
United
States
#
#The
ages
of
the
women
at
point
of
embryo
freezing
were
undetermined
Reference:
*Society
for
Assisted
Reproduc(ve
Technology.
(2011).
Clinic
Summary
Report.
Retrieved
March
19,
2013,
from
SART:
IVF
Success
Rates:
hcps://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0
 While
it
has
been
generally
accepted
that
IVF
success
rates
are
seen
to
decline
with
the
increase
in
age
of
a
woman,
a
clinic
summary
report
conducted
on
all
American
Society
for
Assisted
Reproduc(ve
Technology
(SART)
member
clinics
suggests
that
IVF
live
birth
success
rates
also
differ
when
using
fresh
or
thawed
embryos
from
pa(ent
oocytes.*
 The
IVF
live
birth
success
rates
for
fresh
embryos
from
pa(ent
oocytes
declined
at
a
faster
rate
with
the
passing
of
age
compared
to
the
IVF
live
birth
success
rates
for
thawed
embryos
from
pa(ent
oocytes
(Chart
12).
 Notably,
frozen
embryo
transfers
among
women
aged
38
and
over
resulted
in
a
higher
number
of
live
births
that
fresh
embryo
transfers
(Chart
12).

20. 20
The
response
in
Singapore
for
providing
single
women
with
the
op8on
of
elec8ve
oocyte
freezing
is
generally
posi8ve
Educa8on
Level
Primary
&
lower
Secondary
Diploma
University
Post-­‐
graduate
#
of
Respondents
4
72
127
175
32
Supports
Elec(ve
Oocyte
Freezing
75%
75%
85%
82%
72%
Religion
Buddhism
Chris8anity
Hinduism
Islam
Taoism
No
Religion
Others
#
of
Respondents
127
91
11
42
31
107
1
Supports
Elec(ve
Oocyte
Freezing
86%
75%
64%
74%
84%
83%
100%
Table
6:
Support
for
Oocyte
Freezing
for
Single
Women
across
Marital
Status,
Age
Groups,
Educa8on
Levels
and
Religions
(n=410)
Table
6.4:
Breakdown
by
Religion#
Source:
Clearstate
quan8ta8ve
survey
Marital
Status
Single,
never
married
Married/Divorced/
Widowed/Separated
#
of
Respondents
172
238
Supports
Elec(ve
Oocyte
Freezing
90%
74%
 81%
out
of
410
respondents
from
the
Clearstate
survey
support
single
women
being
given
the
op(on
to
undergo
elec(ve
oocyte
freezing
in
Singapore.
 Further
analysis
of
the
Clearstate
survey
indicate
that
a
large
majority
of
respondents
across
marital
status,
age,
religion
and
educa(onal
backgrounds
support
elec(ve
oocyte
freezing
for
single
women.
 There
is
a
higher
propor(on
of
single,
never
married
respondents
(90%)
suppor(ng
elec(ve
oocyte
freezing
compared
to
ever-­‐married
respondents
(74%)
(Table
6.1).
 More
than
80%
of
women
aged
between
20
to
35
support
elec(ve
oocyte
freezing
while
less
than
80%
of
women
aged
above
35
support
elec(ve
oocyte
freezing
for
single
women
(Table
6.2).
 Support
for
elec(ve
oocyte
freezing
for
single
women
has
largely
been
consistent
amongst
all
educa(on
levels
(Table
6.3).
 Across
religions,
86%
of
Buddhist
respondents,
75%
of
Chris(an
respondents,
64%
of
Hindu
respondents,
74%
of
Muslim
respondents,
84%
of
Taoist
respondents
and
83%
of
respondents
without
religious
affilia(on
support
single
women
being
given
the
op(on
to
undergo
elec(ve
oocyte
freezing
in
Singapore
(Table
6.4).
Table
6.3:
Breakdown
by
Educa8on
Level#
Table
6.2:
Breakdown
by
Age
Group#
Table
6.1:
Breakdown
by
Marital
Status#
Age
Group
20
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
#
of
Respondents
71
72
87
94
86
Supports
Elec(ve
Oocyte
Freezing
93%
82%
84%
72%
76%
(Table
6)
Clearstate
Survey,
E4:
Do
you
think
women
who
can’t
find
partners
to
marry
un(l
a
certain
age
(say
30)
should
be
given
the
choice
to
freeze
their
eggs
for
future
use?
Base,
All
respondents
n=410
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

21. 21
(Chart
13)
Clearstate
Survey,
E2:
What
implica(ons,
if
any,
do
you
think
egg-­‐
freezing
will
face
if
it
is
allowed
in
Singapore
for
elec(ve
purposes?
(Quotes
from
respondents)
Clearstate
Survey,
E2.1:
Could
you
please
elaborate
on
your
answer
to
the
ethical,
religious
or
moral
issues
that
egg-­‐
freezing
will
face
if
it
is
allowed
in
Singapore
for
elec(ve
purposes?
Base,
All
respondents
n=410
 With
regard
to
to
the
poten(al
implica(ons
of
elec(ve
oocyte
freezing
on
society,
66%
of
the
Clearstate
survey
respondents
stated
they
believed
that
Singaporeans
would
delay
gevng
married
while
60%
stated
they
believed
there
would
be
an
increase
in
pregnancy
risks
(Chart
13).
 48%
of
respondents
believed
that
allowing
elec(ve
oocyte
freezing
would
have
ethical,
religious
or
moral
implica(ons
on
society
(Chart
13).
Chart
13:
Belief
Regarding
Implica8ons
of
Elec8ve
Oocyte
Freezing
on
Society
(n=410)
2%
60%
66%
57%
48%
Others
Increase
in
pregnancy
related
risks
Singaporeans
will
be
gevng
married
later
Increase
in
healthcare
cost
Ethical,
religious
or
moral
issues
Source:
Clearstate
quan8ta8ve
survey
“With
Singapore
women
becoming
more
career
minded,
this
service
might
be
exploited
by
both
the
medical
prac00oners
and
women
who
might
want
to
delay
pregnancy.
Success
rate
is
unknown
and
the
side
effects
on
the
children
is
also
unrepresenta0ve.”
–
Clearstate
quan8ta8ve
survey
respondent
“Will
this
eventually
end
up
raising
other
ques0on
as
to
whether
one
can
actually
sell
the
frozen
eggs
to
some
other
want-­‐to-­‐be
mothers
who
are
not
able
to
produce
eggs
even
during
their
younger
days?”
–
Clearstate
quan8ta8ve
survey
respondent
“There
will
be
a
lot
of
outcry
from
religious
organisa0on
and
society
on
the
availability
and
how
it
can
encourage
people
to
go
through
it
despite
knowing
that
the
ac0on
would
be
frown
upon
or
even
not
allowed
in
some
religion”
–
Clearstate
quan8ta8ve
survey
respondent
“Firstly
I'm
a
Catholic
so
IVF
itself
is
not
an
op0on”
–
Clearstate
quan8ta8ve
survey
respondent
Respondent
belief
regarding
the
poten8al
implica8ons
of
elec8ve
oocyte
freezing
on
society

22. 22
The
belief
that
elec8ve
egg
freezing
has
poten8al
implica8ons
in
society
for
ethical,
religious
or
moral
reasons,
differs
across
age
groups,
educa8on
levels
and
religious
backgrounds
 The
31
to
35
age
group
contains
the
greatest
propor(on
of
respondents
(56%)
who
had
indicated
that
ethical,
religious
or
moral
issues
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
7.1).
 The
post-­‐graduate
educa(on
level
group
contains
the
greatest
propor(on
of
respondents
(53%)
who
had
indicated
that
ethical,
religious
or
moral
issues
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
7.2).
 The
Muslim
respondent
group
contains
the
greatest
propor(on
of
respondents
(76%)
who
had
indicated
that
ethical,
religious
or
moral
issues
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
7.3).
Chart
13:
Belief
Regarding
Implica8ons
of
Elec8ve
Oocyte
Freezing
on
Society
(n=410)
2%
60%
66%
57%
48%
(198)
Others
Increase
in
pregnancy
related
risks
Singaporeans
will
be
gevng
married
later
Increase
in
healthcare
cost
Ethical,
religious
or
moral
issues
Source:
Clearstate
quan8ta8ve
survey
Table
7
:
Belief
that
‘Ethical,
Religious
or
Moral
Issues’
have
Poten8al
Implica8ons
on
Elec8ve
Oocyte
Freezing
in
Society
across
Age
Groups,
Educa8on
Levels
and
Religions
(n=410)
Age
Group
20
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
#
of
Respondents
71
72
87
94
86
Indicated
34%
51%
56%
49%
49%
Religion
Buddhism
Chris8anity
Hinduism
Islam
Taoism
No
Religion
Others
#
of
Respondents
127
91
11
42
31
107
1
Indicated
42%
57%
27%
76%
39%
42%
100%
Educa8on
Primary
&
lower
Secondary
Diploma
University
Post-­‐
graduate
#
of
Respondents
4
72
127
175
32
Indicated
25%
46%
44%
52%
53%
Table
7.3:
Breakdown
by
Religion#
Table
7.2:
Breakdown
by
Educa8on
Level#
Table
7.1:
Breakdown
by
Age
Group#
(Chart
13/Table
7)
Clearstate
Survey,
E2:
What
implica(ons,
if
any,
do
you
think
egg-­‐
freezing
will
face
if
it
is
allowed
in
Singapore
for
elec(ve
purposes?
Base,
All
respondents
n=410
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

23. 23
The
belief
that
elec8ve
egg
freezing
has
poten8al
implica8ons
in
society
by
increasing
healthcare
cost,
differs
across
age
groups,
educa8on
levels
and
religious
backgrounds
 The
31
to
35
age
group
contains
the
greatest
propor(on
of
respondents
(60%)
who
had
indicated
that
an
increase
in
healthcare
cost
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
8.1).
 The
secondary
educa(on
level
group
contains
the
greatest
propor(on
of
respondents
(61%)
who
had
indicated
that
an
increase
in
healthcare
cost
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
8.2).
 The
Muslim
and
Hindu
respondent
groups
contain
the
greatest
propor(ons
of
respondents
(64%
each)
who
had
indicated
that
an
increase
in
healthcare
cost
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
8.3).
Chart
13:
Belief
Regarding
Implica8ons
of
Elec8ve
Oocyte
Freezing
on
Society
(n=410)
2%
60%
66%
57%
(234)
48%
Others
Increase
in
pregnancy
related
risks
Singaporeans
will
be
gevng
married
later
Increase
in
healthcare
cost
Ethical,
religious
or
moral
issues
Source:
Clearstate
quan8ta8ve
survey
Table
8:
Belief
that
‘Increase
in
Healthcare
Cost’
has
Poten8al
Implica8ons
on
Elec8ve
Oocyte
Freezing
in
Society
across
Age
Groups,
Educa8on
Levels
and
Religions
(n=410)
Age
Group
20
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
#
of
Respondents
71
72
87
94
86
Indicated
59%
58%
60%
55%
53%
Religion
Buddhism
Chris8anity
Hinduism
Islam
Taoism
No
Religion
Others
#
of
Respondents
127
91
11
42
31
107
1
Indicated
57%
51%
64%
64%
55%
59%
100%
Educa8on
Primary
&
lower
Secondary
Diploma
University
Post-­‐
graduate
#
of
Respondents
4
72
127
175
32
Indicated
50%
61%
56%
58%
47%
Table
8.3:
Breakdown
by
Religion#
Table
8.2:
Breakdown
by
Educa8on
Level#
Table
8.1:
Breakdown
by
Age
Group#
(Chart
13/Table
8)
Clearstate
Survey,
E2:
What
implica(ons,
if
any,
do
you
think
egg-­‐
freezing
will
face
if
it
is
allowed
in
Singapore
for
elec(ve
purposes?
Base,
All
respondents
n=410
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

24. 24
The
belief
that
elec8ve
egg
freezing
has
poten8al
implica8ons
in
society
in
that
people
will
get
married
later,
differs
across
age
groups,
educa8on
levels
and
religious
backgrounds
 The
20
to
25
age
group
contains
the
greatest
propor(on
of
respondents
(71%)
who
had
indicated
that
marriage
at
a
later
age
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
9.1).
 The
post-­‐graduate
and
primary
&
lower
educa(on
level
groups
contain
the
greatest
propor(ons
of
respondents
(75%
each)
who
indicated
that
marriage
at
a
later
age
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
9.2).
 The
Buddhist
respondent
group
contains
the
greatest
propor(on
of
respondents
(69%)
who
indicated
that
marriage
at
a
later
age
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
9.3).
Chart
13:
Belief
Regarding
Implica8ons
of
Elec8ve
Oocyte
Freezing
on
Society
(n=410)
2%
60%
66%
(271)
57%
48%
Others
Increase
in
pregnancy
related
risks
Singaporeans
will
be
gevng
married
later
Increase
in
healthcare
cost
Ethical,
religious
or
moral
issues
Source:
Clearstate
quan8ta8ve
survey
Table
9:
Belief
that
‘Singaporeans
Will
Be
Gerng
Married
Later’
has
Poten8al
Implica8ons
on
Elec8ve
Oocyte
Freezing
in
Society
across
Age
Groups,
Educa8on
Levels
and
Religions
(n=410)
Age
Group
20
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
#
of
Respondents
71
72
87
94
86
Indicated
76%
71%
61%
62%
64%
Religion
Buddhism
Chris8anity
Hinduism
Islam
Taoism
No
Religion
Others
#
of
Respondents
127
91
11
42
31
107
1
Indicated
69%
65%
64%
62%
68%
64%
100%
Educa8on
Primary
&
lower
Secondary
Diploma
University
Post-­‐
graduate
#
of
Respondents
4
72
127
175
32
Indicated
75%
64%
65%
66%
75%
Table
9.3:
Breakdown
by
Religion#
Table
9.2:
Breakdown
by
Educa8on
Level#
Table
9.1:
Breakdown
by
Age
Group#
(Chart
13/Table
9)
Clearstate
Survey,
E2:
What
implica(ons,
if
any,
do
you
think
egg-­‐
freezing
will
face
if
it
is
allowed
in
Singapore
for
elec(ve
purposes?
Base,
All
respondents
n=410
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

25. 25
The
belief
that
elec8ve
egg
freezing
has
poten8al
implica8ons
in
society
in
that
it
will
increase
pregnancy
related
risks,
differs
across
age
groups,
educa8on
levels
and
religious
backgrounds
 The
26
to
30
age
group
contains
the
greatest
propor(on
of
respondents
(64%)
who
had
indicated
that
an
in
pregnancy
related
risks
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
10.1).
 Apart
from
the
primary
&
lower
educa(on
level
group,
the
post-­‐graduate
educa(on
level
group
contains
the
next
highest
propor(on
of
respondents
(69%)
who
had
indicated
that
an
in
pregnancy
related
risks
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
10.2).
 The
Taoist
respondent
group
contains
the
greatest
propor(on
of
respondents
(77%)
who
had
indicated
that
pregnancy
related
risks
could
be
a
poten(al
implica(on
of
elec(ve
oocyte
freezing
on
society
(Table
10.3).
Chart
13:
Belief
regarding
Implica8ons
of
Elec8ve
Oocyte
Freezing
on
Society
(n=410)
2%
60%
(246)
66%
57%
48%
Others
Increase
in
pregnancy
related
risks
Singaporeans
will
be
gevng
married
later
Increase
in
healthcare
cost
Ethical,
religious
or
moral
issues
Source:
Clearstate
quan8ta8ve
survey
Table
10:
Belief
that
‘Increase
in
Pregnancy
Related
Risks’
has
Poten8al
Implica8ons
on
Elec8ve
Oocyte
Freezing
in
Society
across
Age
Groups,
Educa8on
Levels
and
Religions
(n=410)
Age
Group
20
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
#
of
Respondents
71
72
87
94
86
Indicated
59%
64%
57%
63%
57%
Religion
Buddhism
Chris8anity
Hinduism
Islam
Taoism
No
Religion
Others
#
of
Respondents
127
91
11
42
31
107
1
Indicated
58%
56%
64%
57%
77%
61%
100%
Educa8on
Primary
&
lower
Secondary
Diploma
University
Post-­‐
graduate
#
of
Respondents
4
72
127
175
32
Indicated
100%
60%
56%
61%
69%
Table
10.3:
Breakdown
by
Religion#
Table
10.2:
Breakdown
by
Educa8on
Level#
Table
10.1:
Breakdown
by
Age
Group#
(Chart
13/Table
10)
Clearstate
Survey,
E2:
What
implica(ons,
if
any,
do
you
think
egg-­‐
freezing
will
face
if
it
is
allowed
in
Singapore
for
elec(ve
purposes?
Base,
All
respondents
n=410
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

26. 26
Perspec8ve
among
respondents
on
elec8ve
oocyte
freezing
for
themselves
is
mixed
 22%
of
respondents
from
the
Clearstate
survey
stated
it
will
be
‘somewhat
likely’
or
‘very
likely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
in
the
future,
while
31%
of
respondents
stated
it
will
be
‘somewhat
unlikely’
or
‘very
unlikely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves.
The
remaining
47%
of
the
respondents
indicated
that
they
are
“unsure”
whether
they
will
opt
for
elec(ve
oocyte
freezing
(Chart
14).
 Of
the
respondents
who
are
likely
to
consider
elec(ve
oocyte
freezing,
the
most
selected
reason
was
to
have
a
‘safety
net’
in
case
of
future
health
problems
(66%),
followed
by
having
the
op(on
to
preserve
their
fer(lity
with
younger
eggs
(65%)
and
to
have
sufficient
(me
to
be
financially
and
emo(onally
prepared
for
children
(60%)
(Chart
14.1).
 Of
the
respondents
who
are
unlikely
to
consider
elec(ve
oocyte
freezing,
the
most
selected
reason
was
high
cost
of
treatment
(54%),
followed
by
health
concerns
such
as
health
risks
involved
(37%),
and
physical
and
emo(onal
discomfort
in
retrieving
eggs
(34%).
22%
of
respondents
indicated
ethical
and
moral
reasons
for
their
hesita(on
towards
considering
elec(ve
oocyte
freezing
for
themselves
(Chart
14.2).
(Chart
14)
Clearstate
Survey,
D3:
If
egg-­‐freezing
for
elec(ve
purposes
is
allowed
in
Singapore,
how
likely
are
you
to
undergo
egg-­‐freezing
in
the
future?
Base,
All
Respondents
n=410
(Chart
14.1)
Clearstate
Survey,
D4:
Why
do
you
think
you
would
undergo
egg
freezing
in
the
future?
Base,
Respondents
who
are
likely
or
somewhat
likely
to
undergo
egg
freezing
n=91
(Chart
14.2)
Clearstate
Survey,
D5:
Why
are
you
unlikely
to
undergo
egg-­‐freezing
in
the
future?
Base,
Respondents
who
are
unlikely
or
somewhat
unlikely
to
undergo
egg
freezing
n=125
Source:
Clearstate
quan8ta8ve
survey
18%
13%
47%
18%
4%
Very
unlikely
Somewhat
unlikely
Not
sure
Somewhat
likely
Very
likely
Chart
14:
Likelihood
of
Op8ng
for
Elec8ve
Oocyte
Freezing
in
the
Future
for
Oneself
(n=410)
1%
66%
60%
65%
Others
Freezing
eggs
as
a
form
of
'insurance'
or
'safety
net'
in
case
of
health
problems
in
future
that
may
affect
or
damage
fer(lity'
It
takes
the
pressure
off
to
rush
into
having
children
un(l
I
am
financially
and
emo(onally
prepared
Preserve
my
fer(lity
with
my
younger
eggs
to
increase
chances
of
pregnancy
later
in
my
life
Chart
14.1:
Reasons
for
Interest
in
Elec8ve
Oocyte
Freezing
for
Oneself
(n=91)
Chart
14.2:
Reasons
for
NOT
Op8ng
for
Elec8ve
Oocyte
Freezing
for
Oneself
(n=125)
15%
35%
14%
22%
37%
34%
54%
Others
I
do
not
think
I
will
struggle
to
conceive
naturally
Planning
to
have
children
in
the
near
future
Ethical/moral
reasons
Health
risks
involved
Physical
and
emo(onal
discomfort
in
retrieving
eggs
for
egg-­‐freezing
Large
expense
involved

27. 27
Perspec8ve
among
respondents
on
elec8ve
oocyte
freezing
for
themselves
differs
across
marital
status,
age
groups,
educa8on
levels
and
religious
backgrounds
Age
Group
20
-­‐
25
26
-­‐
30
31
-­‐
35
36
-­‐
40
41
-­‐
45
#
of
Respondents
71
72
87
94
86
‘Somewhat
Likely’
and
‘Very
Likely’
21%
25%
27%
18%
20%
Unsure
54%
49%
45%
47%
44%
‘Somewhat
Unlikely’
and
‘Very
Unlikely’
25%
26%
28%
35%
36%
Table
11:
Likelihood
of
Op8ng
for
Elec8ve
Oocyte
Freezing
in
the
Future
for
Oneself
across
Marital
Status,
Age
Groups,
Educa8on
Levels
and
Religions
(n=410)
Table
11.2:
Breakdown
by
Age
Group#
Table
11.3:
Breakdown
by
Educa8on
Level#
Educa8on
Level
Primary
&
lower
Secondary
Diploma
University
Post-­‐
graduate
#
of
Respondents
4
72
127
175
32
‘Somewhat
Likely’
and
‘Very
Likely
0%
15%
23%
22%
38%
Unsure
75%
54%
48%
46%
34%
‘Somewhat
Unlikely’
and
‘Very
Unlikely’
25%
31%
%
32%
28%
Marital
Status
Single,
never
married
Married/Divorced/
Widowed/Separated
#
of
Respondents
172
238
‘Somewhat
Likely’
and
‘Very
Likely’
24%
21%
Unsure
52%
44%
‘Somewhat
Unlikely’
and
‘Very
Unlikely’
24%
35%
Table
11.1:
Breakdown
by
Marital
Status#
Source:
Clearstate
quan8ta8ve
survey
Religion
Buddhism
Chris8anity
Hinduism
Islam
Taoism
No
Religion
Others
#
of
Respondents
127
91
11
42
31
107
1
‘Somewhat
Likely’
and
‘Very
Likely’
26%
15%
46%
14%
29%
21%
100%
Unsure
46%
46%
27%
50%
42%
53%
0%
‘Somewhat
Unlikely’
and
‘Very
Unlikely’
28%
39%
27%
36%
29%
26%
0%
Table
11.4:
Breakdown
by
Religion#
(Table
11)
Clearstate
Survey,
D3:
If
egg-­‐freezing
for
elec(ve
purposes
is
allowed
in
Singapore,
how
likely
are
you
to
undergo
egg-­‐freezing
in
the
future?
Base,
All
Respondents
n=410
 As
indicated
by
the
Clearstate
survey,
there
is
a
higher
propor(on
of
single,
never
married
respondents
(24%)
who
stated
it
will
be
‘somewhat
likely’
or
‘very
likely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
as
compared
to
ever-­‐married
respondents
(21%)
(Table
11.1).
 Conversely,
there
is
a
higher
propor(on
of
ever-­‐married
respondents
(35%)
who
stated
it
will
be
‘somewhat
unlikely’
or
‘very
unlikely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
as
compared
to
single,
never
married
respondents
(24%)
(Table
11.1).
 The
propor(on
of
respondents
who
stated
it
will
be
‘somewhat
unlikely’
or
‘very
unlikely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
increases
with
each
ascending
age
group
(Table
11.2).
 36%
of
women
aged
41
to
45
stated
that
it
will
be
‘somewhat
unlikely’
or
‘very
unlikely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
as
compared
to
25%
of
women
aged
20
to
25
(Table
11.2).
 The
propor(on
of
respondents
who
stated
it
will
be
‘somewhat
likely’
or
‘very
likely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
increases
with
higher
educa(on
level
(Table
11.3).
 Notably,
the
propor(on
of
respondents
who
indicated
that
they
are
unsure
decreases
with
the
rise
in
educa(on
level
(Table
11.3).
 There
is
a
higher
propor(on
of
Chris(an
and
Muslim
respondents
who
stated
it
will
be
‘somewhat
unlikely’
or
‘very
unlikely’
that
they
will
opt
for
elec(ve
oocyte
freezing
for
themselves
as
compared
to
respondents
of
other
religious
backgrounds
(Table
11.4).
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

28. 28
The
most
important
reason
selected
by
respondents
for
not
op8ng
for
elec8ve
oocyte
freezing
for
themselves
differ
across
religious
backgrounds
Most
Important
Reason
for
NOT
Op8ng
for
Elec8ve
Oocyte
Freezing
for
0neself
Buddhist
Respondents
Chris8an
Respondents
Hindu
Respondents
Muslim
Respondents
Taoist
Respondents
No
Religion
Respondents
#
of
Responde
nts
%
Distribu8
on
#
of
Responde
nts
%
Distribu8
on
#
of
Responde
nts
%
Distribu8
on
#
of
Responde
nts
%
Distribu8
on
#
of
Responde
nts
%
Distribu8
on
#
of
Responde
nts
%
Distribu8
on
Large
expenses
involved
12
34%
5
14%
1
33%
5
34%
2
22%
7
25%
Physical
and
emo(onal
discomfort
in
retrieving
eggs
for
egg-­‐freezing
6
17%
2
6%
0
0%
0
0%
0
0%
3
11%
Health
risks
involved
4
12%
2
6%
0
0%
2
13%
1
12%
2
7%
Ethical/moral
reasons
1
3%
10
29%
0
0%
1
7%
0
0%
2
7%
Planning
to
have
children
in
the
near
future
2
6%
3
9%
0
0%
2
13%
2
22%
2
7%
I
do
not
think
I
will
struggle
to
conceive
naturally
5
14%
9
25%
2
67%
3
20%
2
22%
8
29%
Others
5
14%
4
11%
0
0%
2
13%
2
22%
4
14%
TOTAL
35
100%
35
100%
3
100%
15
100%
9
100%
28
100%
Table
12:
Most
Important
Reason
for
NOT
Op8ng
for
Elec8ve
Oocyte
Freezing
for
Oneself
by
Religion#
(n=125)
Source:
Clearstate
quan8ta8ve
survey
(Table
12)
Clearstate
Survey,
D5.1:
What
is
the
MOST
important
reason
that
deters
you
from
undergoing
egg-­‐freezing
in
the
future?
Base,
Respondents
who
are
unlikely
or
somewhat
unlikely
to
undergo
egg
freezing
n=125
 The
most
important
reason
selected
by
Chris(an
respondents
for
not
op(ng
for
elec(ve
oocyte
freezing
for
themselves
was
ethical
and
moral
concerns
(29%)
(Table
12).
 On
the
other
hand,
the
most
important
reason
selected
by
Muslim
and
Buddhist
respondents
for
not
op(ng
for
elec(ve
oocyte
freezing
for
themselves
was
the
large
expenses
involved
(34%
for
each
group
of
respondents)
(Table
12).
 Meanwhile,
the
most
important
reasons
selected
by
respondents
without
religious
affilia(on
for
not
op(ng
for
elec(ve
oocyte
freezing
for
themselves
was
the
belief
that
they
will
not
struggle
to
conceive
naturally
(29%)
(Table
12).
#Representa8ve
samples
within
each
category
in
the
Clearstate
survey
are
slightly
higher
or
lower
than
in
the
respec8ve
na8onal
propor8ons
(refer
to
Appendix)

29. 29
There
are
Singaporean
couples
travelling
abroad
to
seek
fer8lity
treatments
such
as
IVF
 Based
on
Clearstate
qualita(ve
interviews
with
fer(lity
centres
in
Singapore,
Malaysia,
Thailand,
India
and
Australia,
Singaporean
couples
are
travelling
abroad
to
seek
fer(lity
treatments
such
as
IVF.
 In
general,
the
reasons
for
doing
so
are:
o Seeking
alterna(ve
IVF
facili(es
overseas
for
treatment
a}er
mul(ple
failed
IVF
cycles
in
Singapore.
o Seeking
lower
costs
of
IVF
treatment,
especially
upon
exceeding
government
subsidy
limit.#
o For
medical
procedures
that
are
restricted
in
Singapore
such
as
the
use
of
PGD
for
gender
selec(on
during
IVF
treatment.
Malaysia
 According
to
fer(lity
clinics
interviewed,
a
large
number
of
Singaporean
couples
travel
to
Johor
Bahru
for
IVF
treatment
due
to
its
closer
proximity
to
Singapore.
 A
reputable
IVF
clinic
in
Johor
Bahru
sees
more
than
30
Singaporean
couples
each
year.
Thailand
 On
the
average,
the
interviewed
fer(lity
clinics
in
Bangkok
see
less
than
10
Singaporean
couples
each
year.
India
 On
the
average,
the
interviewed
fer(lity
clinics
in
Mumbai,
Hyderabad
and
Delhi
see
less
than
5
Singaporean
couples
each
year.
Australia
 On
the
average,
the
interviewed
fer(lity
clinics
in
Melbourne
and
Sydney
see
less
than
5
Singaporean
couples
each
year.
#Prior
to
2013,
the
Singapore
government
had
a
co-­‐funding
limit
of
S$3,000
per
ART
cycle
for
Singaporeans,
up
to
three
cycles
only
Table
13:
Overview
of
Singaporean
Couples
Seeking
IVF
treatment
overseas
from
Clearstate
qualita8ve
interviews
with
fer8lity
centres
Source:
Clearstate
qualita8ve
interviews
with
Singapore
KICs

30. 30
Photo:
The
Straits
Times
Photo:
TIME
Photo:
Santa
Monica
Reproduc8ve
Technologies
30
Chapter
3
Regulatory
Scenarios
of
Selected
Countries

31. 31
Summary
of
ART
Regula8ons
in
Selected
Countries
Australia
India
Malaysia
Thailand
Singapore
Gender
Selec8on
in
IVF
Prohibited
(except
for
medical
reasons)
Prohibited
Prohibited
Unregulated,
yet
prac(ced
Prohibited
(except
for
medical
reasons)
Regula8ons
for
ART/IVF
Regulated
Unregulated,
yet
prac(ced
(legisla(on
ini(ated)
Unregulated,
yet
prac(ced
(legisla(on
ini(ated)
Unregulated,
yet
prac(ced
Regulated
Regula8ons
for
Surrogacy
Allowed
(altruis(c)
Unregulated,
yet
prac(ced
(legisla(on
ini(ated)
Unregulated,
not
prac(ced
Unregulated,
yet
prac(ced
Prohibited
Fiscal
Support
by
Government
Subsidised
(~75%
covered
under
Medicare)
Unsubsidised
(pay
out-­‐of-­‐pocket)
Unsubsidised
(pay
out-­‐of-­‐pocket)
Unsubsidised
(pay
out-­‐of-­‐pocket)
Subsidised
(Medisave)
Regula8ons
on
Oocyte
Freezing
Allowed
Unregulated,
yet
prac(ced
Unregulated,
yet
prac(ced
Unregulated,
yet
prac(ced
Prohibited
(for
elec(ve/
single
women)
Cost
of
treatment
(IVF)
SGD2,500
to
SGD3,000
per
cycle
About
SGD
6,000
per
cycle
SGD4,000
and
SGD
8,000
per
cycle
SGD
6,000
to
SGD
7,500
per
cycle
SGD
6,000
to
SGD
13,000
per
cycle
5. Prohibited:
Banned
by
legisla(on
(law)
6. Regulated:
Governed
by
legisla(on
(law)
7. Unregulated:
Lack
of
exis(ng
legisla(on
(law)
1. Altruis(c:
No
monetary
compensa(on
allowed
2. Medicare:
Australia’s
publicly
funded
universal
healthcare
system
3. Medisave:
Singapore’s
na(onal
healthcare
saving
scheme
4. Pay
out-­‐of-­‐pocket:
Payment
from
individual
funds
Glossary:
Table
14:
Summary
of
ART
Regula8ons
in
Selected
Countries

32. 32
Australia
Australia
has
regula8ons
in
place
for
fer8lity
treatment
Popula8on
size
22,015,576
(July
2012
est.)*
Birth
rate
1.9
births
per
woman
(2011
est.)*
Infer8lity
One
in
six
Australian
couple**
Cost
of
IVF
Treatment
Out-­‐of-­‐pocket
payment
for
an
IVF
treatment
cycle
costs
about
SGD
2,500
to
SGD3,000***
Regula8ons
on
IVF
and
Fer8lity
Treatments
 Australia
is
said
to
lead
the
world
in
having
the
highest
pregnancy
and
live
birth
rates
through
ART.***
 Australians
are
en(tled
to
reimbursement
from
the
Na(onal
Health
Scheme-­‐
Medicare
for
most
fer(lity
treatments
such
as
IVF
and
Intracytoplasmic
Sperm
Injec(on
(ICSI).****
 Gender
selec(on
can
be
done
via
PGD,
for
medical
reasons
(e.g.
to
prevent
the
transmission
of
a
gender-­‐linked
gene(c
disease).
****
 Elec(ve
oocyte
freezing
is
permiced
in
the
Australia.****
 Fer(lity
clinics
adhere
to
the
Na(onal
Australian
Health
Ethics
Commicee
guidelines
when
providing
any
fer(lity
treatment.****
Opinions
of
KCIs
in
Australia
on
Oocyte
Freezing
 Cryo-­‐preserva(on
of
oocytes
is
gaining
popularity,
par(cularly
amongst
younger
women
who
freeze
their
eggs
as
a
form
of
insurance
against
age-­‐related
fer(lity
decline.
“Embryologist
strongly
believe
allowing
oocyte
freezing
at
an
early
age
has
improved
the
success
of
IVF
rates
in
Australia.
There
have
been
several
studies
both
domes0c
and
interna0onal
which
support
this
hypothesis.
One
of
the
key
reasons
Australia
has
higher
success
rates
in
IVF
is
the
progressive
nature
of
regula0ons
in
this
regard.”
–
Embryologist,
Sydney
***
Reference:
*Central
Intelligence
Agency.
(2013).
Australia.
Retrieved
March
19,
2013,
from
The
World
Factbook:
hcps://www.cia.gov/library/publica(ons/the-­‐world-­‐factbook/
**Fer0lity
Society
of
Australia.
(2013).
Retrieved
March
19,
2013,
from
Home
Page:
hcp://www.fer(litysociety.com.au/
***IVF
Australia.
(2012).
Retrieved
March
19,
2013,
from
IVF
Australia:
hcp://ivf.com.au/ivf-­‐fees/ivf-­‐costs
****Na(onal
Health
and
Medical
.
(2013,
February
13).
Assisted
Reproduc0ve
Technology
(ART)
Research
Council.
Retrieved
March
19,
2013,
from
Assisted
Reproduc(ve
Technology
(ART)
Table
15:
Demographics
of
Australia

33. 33
India
India
is
well
known
for
the
provision
of
fer8lity
treatments
but
remains
unregulated
Popula8on
size
1,205,073,612
(July
2012
est.)*
Birth
rate
2.6
births
per
woman
(2011
est.)*
Infer8lity
15
to
20
million
couples
yearly**
Cost
of
IVF
Treatment
One
complete
IVF
cycle
at
an
urban
clinic
about
costs
SGD6,000
Costs
for
freezing
and
storing
the
eggs
will
range
from
SGD600
to
SGD1,000
a
year***
Opinions
of
KOLs
in
India
on
Oocyte
Freezing****
 Cryo-­‐preserva(on
of
oocytes
is
currently
offered
by
doctors
mainly
in
Mumbai,
Bangalore,
Hyderabad
and
Delhi
where
there
is
an
awareness
of
the
availability
of
the
service,
although
it
is
s(ll
not
considered
popular
amongst
women
in
India.
“Egg-­‐freezing
is
s0ll
rare
(...)
Awareness
is
very
low
in
general
public
and
even
amongst
doctors.
Those
who
make
ini0al
enquiries
are
more
familiar
but
s0ll
require
assurances
about
the
process…India
s0ll
largely
being
a
conserva0ve
society,
there
is
s0ll
reluctance
for
women
to
step
forward
and
undertake
fer0lity-­‐related
procedures
before
marriage.”
–
Director,
Private
IVF
Centre
in
New
Delhi
Regula8ons
on
IVF
and
Fer8lity
Treatments
 Provision
of
fer(lity
services
remains
unregulated
across
India
(e.g.
age
limit
of
IVF
pregnancy)
although
most
clinics
in
major
ci(es
adhere
to
interna(onal
recognised
as
well
as
Indian
Council
of
Medical
Research
(ICMR)
guidelines.*****
 The
ART
Regula(on
Bill,
dra}ed
by
the
ICMR
in
2010
to
regulate
and
govern
ART
procedures,
is
s(ll
under
considera(on
by
legisla(on.*****
 Fer(lity
tourism
in
India
is
growing
rapidly,
with
the
reputa(on
of
affordable
fer(lity
treatments
such
as
IVF
and
surrogacy
driving
this
growth.**
Reference:
*Central
Intelligence
Agency.
(2013).
India.
Retrieved
March
19,
2013,
from
The
World
Factbook:
hcps://www.cia.gov/library/publica(ons/the-­‐world-­‐factbook/
**Interna(onal
Ins(tute
of
Popula(on
Sciences.
(2011,
June
27).
Retrieved
March
19,
2013,
from
Infer(lity:
A
growing
concern:
hcp://www.indianexpress.com/news/infer(lity-­‐a-­‐growing-­‐concern/967209
***The
Washington
Post.
(2010,
August
13).
The
Washington
Post.
Retrieved
March
19,
2013,
from
In
India,
age
o}en
doesn't
stop
women
from
seeking
help
to
become
pregnant:
hcp://www.washingtonpost.com/wp-­‐dyn/
content/ar(cle/2010/08/12/AR2010081206876.html?sid=ST2010081300007
****Clearstate
qualita(ve
interviews
with
Singapore
KICs
*****Indian
Council
of
Medical
Research
.
(2010).
Indian
Council
of
Medical
Research
.
Retrieved
March
19,
2013,
from
hcp://www.icmr.nic.in/
&
The
Assisted
Reproduc(ve
Technologies
(Regula(on)
Bill
-­‐
2010
Table
16:
Demographics
of
India

34. 34
Malaysia
Malaysia’s
market
is
presently
unregulated
Popula8on
size
29,179,952
(July
2012
est.)*
Birth
rate
2.6
births
per
woman
(2011
est.)*
Infer8lity
rate
15%**
Cost
of
Treatment
The
cost
for
one-­‐cycle
of
IVF
in
fer(lity
clinics
ranges
between
SGD4,000
and
SGD8,000***
Opinions
of
KOLs
in
Malaysia
on
Oocyte
Freezing****
 No
laws
exist
regula(ng
oocyte
freezing,
thus
cryopreserva(on
of
oocytes
is
currently
offered
for
medical
as
well
as
elec(ve
reasons
by
fer(lity
doctors.
“Egg-­‐freezing
and
embryo
freezing
is
currently
not
illegal
in
Malaysia
and
hence
our
IVF
clinic
supports
demand
from
all
over
Malaysia
and
Singapore.”
–
Infer8lity
Specialist,
Private
IVF
Centre
in
Johor
Bahru
Regula8ons
on
IVF
and
Fer8lity
Treatments
 Fer(lity
treatment
remains
unregulated
in
Malaysia
although
the
Ministry
of
Health
has
ini(ated
legisla(on
in
2011
with
the
proposal
of
the
Assisted
Reproduc(ve
Technique
Services
Act.**
 The
act
will
address
issues
such
as
surrogacy,
sperm
and
egg
banking,
and
sperm
dona(on
to
make
the
Malaysian
market
more
progressive.**
 Fer(lity
centres
will
have
to
be
licensed
once
the
proposed
Na(onal
ART
Act
is
passed.**
 Dra}ing
exercise
for
the
proposed
legisla(on
was
expected
to
be
completed
in
2012.**
 Fer(lity
centres
are
accredited
by
interna(onal
bodies
(such
as
the
Joint
Commission
Interna(onal)
and
Malaysian
Society
for
Quality
in
Health
(MSQH).*****
Reference:
*Central
Intelligence
Agency.
(2013).
Australia.
Retrieved
March
19,
2013,
from
The
World
Factbook:
hcps://www.cia.gov/library/publica(ons/the-­‐world-­‐factbook/
**ASIAONE.
(
2011,
February
27).
ASIAONE.
Retrieved
March
21,
2013,
from
Laws
on
fer(lity
treatment
by
2012:
hcp://www.asiaone.com/Health/News/Story/A1Story20110227-­‐265537.html
***Borneo
Post.
(2012,
April
25).
Retrieved
March
19,
2013,
from
IVF
triplets
born
at
Raja
Permaisuri
Bainun
Hospital:
hcp://www.theborneopost.com/2012/04/25/ivf-­‐triplets-­‐born-­‐at-­‐raja-­‐permaisuri-­‐bainun-­‐hospital/
cp://www.theborneopost.com/2012/04/25/ivf-­‐triplets-­‐born-­‐at-­‐raja-­‐permaisuri-­‐bainun-­‐hospital/
****Clearstate
qualita(ve
survey
of
key
opinion
leaders
*****Malaysian
Society
for
Quality
in
Health.
(2011).
Retrieved
March
19,
2013,
from
Malaysian
Society
for
Quality
in
Health:
hcp://www.msqh.com.my/web/
Table
17:
Demographics
of
Malaysia