Increasing Number of Patients and Subsidy for Pre-implantation Genetic Screening

Mr Louis Ng Kok Kwang asked the Minister for Health whether the Ministry can allow any patient regardless of prognosis to participate in the pilot for Pre-implantation Genetic Screening (PGS) so as to increase the number of patients enrolled under the pilot study.

Mr Louis Ng Kok Kwang asked the Minister for Health (a) what is the average cost for participating in the pilot for Pre-implantation Genetic Screening (PGS); and (b) whether the Ministry can consider completely subsidising these costs so as to increase the number of patients enrolled under the pilot study.

Under the Ministry of Health's (MOH's) pilot for Pre-implantation Genetic Screening (PGS), the intended objective is to improve in-vitro fertilisation (IVF) success rates leading to live births for specific groups of women who have an increased risk for embryos with chromosomal abnormalities. Any woman who fulfills one of the following clinical criteria is eligible for PGS: (a) 35 years and above, regardless of prognosis; (b) suffered two or more recurrent implantation failures; or (c) experienced two or more pregnancy losses.

These eligibility criteria are not set arbitrarily but developed with reference to available international evidence and aligned with clinical practices in overseas assisted reproduction centres.

PGS is a technically complex procedure which carries potential risks, including damage to the embryos during the biopsy, with impact on their subsequent development, and should be reserved for women who fulfil the eligibility criteria to undergo the procedure.

MOH provides substantial funding for the PGS pilot programme. It has extended $1.7 million in funding to support the manpower and operations of the PGS laboratory, and half of the PGS consumables costs. As a result, participating patients are charged only the remaining costs of the PGS consumables which average about $1,100 per test, as well as the cost of the embryo biopsy to remove cells for PGS testing which ranges from $2,500 to $4,500.

PGS is performed together with in vitro fertilisation (IVF). For IVF, patients can receive Government support through the Assisted Reproduction Technology co-funding scheme as well as tap on their MediSave.

A total of 367 patients were recruited for the PGS study, more than the targeted 300 patients. MOH will continue to assess the clinical effectiveness of PGS, including looking at overseas data and collecting more data from cases here in Singapore. MOH will also explore options for co-sharing of costs of PGS for patients who are keen to be part of the study, but have affordability concerns. If PGS is included as a mainstream healthcare service, it will then be assessed for means-tested subsidies.

I thank the Parliamentary Secretary for the reply. I understand, as the Parliamentary Secretary mentioned, over 300 people enrolled for PGS but only about a hundred actually did PGS. So, could I ask MOH what are the main reasons why people did not proceed with PGS. And, two, what steps MOH is taking to increase the enrolment of PGS and decrease the the drop-out rate. And third, the feedback on the ground is that there is a cost issue. So, I hope MOH can look into this and fully subsidise this so that more people can participate in this trial and, hopefully, we can then nationalise it to benefit more people.

I thank the Member for the question. The high attrition rate of about 71.7% of enroled subjects before reaching the stage of embryo biopsy and PGS testing, indeed, remains a challenge. Prior to the start of the pilot, the evaluation team had determined that the target of 300 patients with PGS testing would be needed to achieve statistical significance.

As of 30 September 2020, as mentioned earlier, 367 patients were enroled but only 104 had enrolled biopsies performed. Almost half of the patients changed their minds after the ovarian stimulation and fertilisation stage, and proceeded with embryo transfer directly without performing PGS or decided to freeze their embryos instead. Other patients did not proceed with a biopsy due to medical reasons, such as poor quality of the blastocyst or embryo arrest. And of these 69 patients with euploid embryos, 60 underwent embryo transfers. This led to 31 pregnancies with 15 livebirths, eight miscarriages and eight on-going pregnancies.

As the Member rightly pointed out, we do need a bit more data to fully study this to understand its clinical effectiveness. MOH is doing its best to try and assist and support as many patients as possible to go through this process and this remains something that we will continue to review.

And as far as the cost is concerned, this is something that we understand is a challenge. For the patients who really need support for this, we will look into this matter. But as it is at the moment, there is limited and inconclusive evidence on the clinical effectiveness. We do need to proceed carefully with this process because there is also an impact on the embryo. There is a low risk, but there is still risk to the embryo and we do need to make sure that the right people proceed for this procedure.