In Vitro Fertilisation (IVF) in Singapore

Information on the process of IVF treatment for couples struggling to have a baby in Singapore: who is eligible, age restrictions for women wishing to become pregnant and Assisted Reproduction Centres...

These are the guidelines by the Singapore Ministry of Health on Assisted Reproduction Technology (ART).

Assisted Reproductive Centres

All Assisted Reproduction (AR) Centres in medical hospitals and private clinics in Singapore have to be licensed for ART procedures by the Singapore Director of Medical Services.

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

Guidelines for Clinical Practice and Patients

A couple may only commence IVF (In Vitro Fertilisation) procedures if there are justified indications for the procedure. These may include:

  • Tubal disease and/or obstruction
  • Endometriosis – where alternative treatment has failed
  • Male sub-fertility
  • Idiopathic sub-fertility – where no cause has been found after a 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 obstetrics/gynaecology community

AR procedures can only be carried out on a married woman and with her husband's consent, regardless of whether the husband's sperm or donor sperm is being used. Documentary proof of married status (such as the Marriage Certificate) is mandatory.

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 and informed of the following:

  1. Possible risks and complications of AR procedures – these include ovarian hyperstimulation syndrome, multiple births and the medical, social, financial and other consequences of having children.
  2. For women above 35 years of age there is a higher risk of genetic anomalies in the foetus (for example Down's Syndrome).
  3. For women above 40 years of age there is a higher risk of failure and complications.
  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

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

  • Hepatitis B antigen
  • Hepatitis C 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 it is 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 attempt to become pregnant for one month after a rubella vaccination.

HIV

HIV testing is compulsory for everyone 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 for six months after donation (to be confirmed with a second HIV test), before the donor sperm, oocytes and embryos can be used. If these cells are used within six months the receiving couple must be informed of the risks, and must give their written consent.

Treatment Cycles

For women aged 40 years and below, the maximum number of consecutive cycles allowed is ten stimulated or natural cycles reaching the stage of embryo transfer is permitted. These cycles include those performed in local and foreign centres.

For women above the age of 40 years, the maximum number of consecutive cycles allowed is five stimulated or natural cycles reaching the stage of embryo transfer is permitted. 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 carried out using donated eggs, sperm or embryos. It is best if a genetic link to one of the child’s parents 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 sperm from the same family cannot be used for AR procedures (for example, a man’s sperm impregnating his sister’s egg or a woman’s egg impregnated by her brother’s sperm).

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

The maximum number of live births allowed for donor sperm, 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 at least one previous stimulated ART cycles or has no good quality embryo available.
  3. The patient is above 37 years of age.

Embryo and foetal gender determination

Embryo and foetal gender determination will only be allowed on medical grounds and restricted to gender-linked diseases such as haemophilia and muscular dystrophy. Prior approval from the Ministry of Health is required and each case will be considered on an individual 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 maximum time limit for storage of embryos is ten years from the date of fertilisation. Storage can be extended if there is an appropriate reason, although this will require written approval from the Singapore Ministry of Health. However, under no circumstances will embryos be used if they have been stored beyond ten years from the date of their fertilisation.

Centre-to-centre transfer of embryos is permitted 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 gender selection

Further Information

Information provided by Dr Seng Shay Way, KM Seng's OG Practice Pte Ltd, Suite 03-18 Gleneagles Medical Centre, Singapore 258499 Tel: (65) 6472 7988 / Fax:(65) 6472 5211 / 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.