Age-related Fertility Decline

Ms Tan Su Shan asked  the Minister for Health in light of most women marrying later in life (a) how are Singaporean women being educated on age-related fertility decline; and (b) whether the Women's Health Advisory Committee (WHAC) can be expanded to fully include fertility issues.

Page: 1207

Sir, encouraging marriage and parenthood is a key Government priority to address the population challenge. The Government provides a broad range of measures to support Singaporeans' aspirations of getting married and having children.

There is already general awareness among Singaporeans that fertility declines with age. The 2007 Marriage and Parenthood survey of about 3,000 married respondents showed that 94% were aware that it gets more difficult for couples to conceive as they get older, up from 89% in 2004.

More can and must be done to strengthen awareness of fertility issues and to transform awareness into changes in attitude and behaviour, so that couples are encouraged to get married and have children earlier. These messages are best woven into marriage and parenthood promotion efforts by the Ministry of Social and Family Development (MSF), previously known as MCYS, in a holistic manner.

MSF has been working with voluntary welfare organisations (VWOs) to promote fertility awareness, which provides couples with fertility facts and information to help them make informed parenthood decisions and encourage them to plan early. This is done through public education programmes and activities, including talks, workshops, road shows, resource guides, as well as the sharing of real-life stories through publications and online media. It has also gone upstream to engage youths in tertiary institutions to raise the awareness of age-related fertility decline and the risks of late pregnancies. For couples already planning or expecting a baby, both MSF and HPB conduct programmes to equip and prepare them for pregnancy, as well as caring for their newborns.

We recognise that having babies is not a woman's sole decision, and involves a considered decision between husband and wife, taking many factors into consideration. Hence, MSF plays a leading role in promoting parenthood. However, to complement the efforts of MSF, the focus of the Women's Health Advisory Committee (WHAC) to promote the health of women could also include health issues related to sub-fertility in women, as part of a holistic women's health programme.

Sir, I thank the Minister of State. My supplementary question is this: some countries now consider age-related decline in fertility as a medical condition and, hence, they allow egg-freezing. There is growing evidence that eggs frozen from a woman below age 35 have a higher chance of a successful pregnancy or birth. Will the Ministry, therefore, be open to considering egg-freezing as an option available to more women, including single women before they marry? This may enable more Singaporean women to preserve their fertility till they marry, thereby increasing their chances of a successful pregnancy after marriage.

Page: 1208

Firstly, let me say that I share the Member's concerns about age-related fertility as more men and women delay marriage and parenthood. However, it must be noted that advanced technology, such as IVF, can help women solve their fertility-related problems only to a certain extent. It is not a foolproof or guaranteed solution. Besides the conventional IVF, as the Member has rightly pointed out, there has been an increase in interest in vitrification or ultra rapid egg-freezing, which is a new technology. It is a technique that can help unmarried women to freeze their eggs and store them for future use to overcome the reproductive or ovarian ageing problem.

Currently, MOH only allows egg-freezing for medical reasons, such as women who have to undergo certain treatment, for example, chemotherapy and radiotherapy, which will damage their fertility. There are various reasons why egg-freezing has not been allowed other than for such medical reasons, and they include the fact that there are inherent risks to the women who undergo the egg-freezing procedure, such as ovarian hyper-stimulation syndrome, bleeding and infection.

Furthermore, because the technology is relatively new, there is limited information available on the perinatal outcomes of the procedure, for instance, the success rate, live births, pregnancies, and so on. There is also no information on the long-term effects on children born through AR using vitrified eggs.

Besides these medical implications, there are also potential social and ethical implications, for example, the misconception of the use of egg-freezing as guaranteed fertility preservation as well as over-commercialisation. Notwithstanding this, MOH is reviewing the medical, scientific and ethical implications of egg-freezing with the aim to establish a policy position to develop a regulatory framework with the necessary safeguards, if the eventual policy position is to allow social egg-freezing. Having said that, it is still important to reiterate that egg-freezing, like other AR-related techniques, is really not a foolproof or guaranteed solution.

There is no better substitute to natural child-bearing within marriage for women when they are relatively young and healthy. Lest the men in this House think that age-related fertility problem is a women's issue, let me say that the men are also not spared the ticking of the biological clock and they do suffer from age-related fertility problems.

Page: 1208