Egg Donation Options And Choices Of IVF Patients In Singapore

Since the beginning of 2020, the Singapore government had lifted previous age limits (45 years old) on women receiving IVF treatment. It is anticipated that there will be a steady increase in egg donation cases in this small city-state, as many older women nearing or past menopause are often unable to produce enough viable eggs for successful fertility treatment.

Due to social egg freezing being banned in Singapore, some women here do not have the option of freezing their own eggs when they were younger, leaving many of them with no choice but to resort to egg donation to conceive a child.

Under Singapore health regulations, egg donors must fulfil the following criteria:

1. Her blood must be tested negative for HIV, Syphilis, Hepatitis B and Cytomegalovirus (CMV).
2. Her donated eggs must not result in more than 3 children being born in Singapore.
3. She must be between 21 to 35 years of age, at the time of donation. It is not necessary for the egg donor to be either a Singapore citizen or permanent resident.

A woman contemplating egg donation needs to ponder over various personal issues, as well as know and weigh all her available options. First of all, she has to do her own soul-searching and ask herself whether she really wants to have a child through the egg donation process. Is she being unduly pressured, coerced or being subjected to emotional blackmail by either her husband or her in-laws?

As the old saying goes, it takes two hands to clap in a successful marriage. If one partner is reluctant, while the other is willing, the marriage will never be happy.

The same applies to child-rearing, except that this time, an innocent party in the form of a child may be adversely affected by the unwilling partner who is unhappily being coerced into the arrangement.

Another key issue to consider is whether she should eventually tell her child the truth of his/her conception through egg donation?

Most seasoned fertility counsellors would recommend that the child be told the truth when they reach school-going age. Numerous psychological studies and news reports have documented the emotional trauma and identity crisis that donor-conceived teenagers and adults go through when they suddenly and unexpectedly learn the truth about their conception, for example through a family spat.

Very often, this leads to strained and even estranged parent-child relationships.

Moreover, the recent popularisation of direct-to-consumer genetic testing kits and associated genealogy and ancestry websites have made it much harder to conceal from donor offspring, the truth about their conception.

There is a possibility of the offspring inadvertently learning the truth about his/her conception through contact with DNA-matched relatives in such websites.

As medical technology advances, it is envisioned that DNA testing will one day become a universal norm in healthcare.

Options Available To Women In Singapore

Here are the various options available to women in Singapore, who are considering egg donation. Each of these have their own advantages and disadvantages, which will be discussed in turn.

Option 1: Seek out your own relatives or close friends as egg donors

The obvious advantage of using a blood relative such as a sibling or cousin as an egg donor, is that you have a genetic link to the conceived child. Additionally, you would also be familiar with any hereditary genetic diseases that run in the family.

However, it may be challenging to find a “young enough” donor among your own circle of friends and relatives, preferably below 30 years old, as recommended by most fertility clinics. Using older egg donors will obviously decrease your chances of success.

Here are the various fractions of DNA that you would share with your child, with different types of blood relatives as egg donor: full sister – 25%, half-sister or niece – 12.5%, first cousin – 6.25%, second cousin – 3.125%. Note that if you were using your own eggs, you would share 50% of DNA with your child.

The advantage of using a close friend is that you know her character and what she looks like, traits that may possibly be inherited by the conceived child.

The disadvantages are the lack of egg donor anonymity, and increased chances of the secret of the child’s conception being leaked out, either deliberately or inadvertently by a third party.

Egg donation from close relatives may possibly cause awkwardness and tension in future family relationships, particularly at family gatherings during major festivals such as Chinese New Year.

Option 2: Import frozen donor eggs from an overseas egg bank

Recently, IVF patients have been permitted to import frozen donor eggs into Singapore from foreign egg banks worldwide, which meet certain requirements, such as rigorous infectious disease and genetic testing of donors.

The advantages are that donor anonymity is maintained, and there is a wide choice of donors available, even Asian and Chinese ones. Increasing demand worldwide has led to egg banks in Western countries recruiting donors of such ethnicity. Closer to home, there are also egg banks in Malaysia that can service Singaporean patients.

The major advantages of utilising frozen versus fresh donor eggs include:

1. Greater convenience, as there is no need to synchronise the timing and hormonal stimulation cycles of egg donors and recipient patients.
2. Cheaper costs due to negating the travel and hotel costs associated with fresh egg donation.
3. Little or no waiting time as frozen eggs are readily available.
4. More certainty, because the exact number of frozen donor eggs is known and guaranteed. By contrast, for fresh egg donation, the number of eggs that will be retrieved from the donor after hormonal stimulation is unknown and non-guaranteed.

However, there are also several disadvantages of using frozen donor eggs:

1. The costs of transporting frozen eggs into Singapore from abroad is very expensive, as it requires a special cryogenic container.
2. The IVF success rates with frozen eggs are still significantly lower than fresh eggs, despite technological advances such as ice-free vitrification protocols.
3. Because frozen donor eggs are highly delicate and fragile, the thawing protocol must be matching and compatible with the freezing (vitrification) protocol, similar to a lock and key. Only the same IVF lab that performs both the freezing and thawing processes, can ensure this. Hence for best results, patients should use the same fertility clinic or IVF lab that recruited the egg donor and freeze her eggs, rather than transferring frozen donor eggs from one medical facility to another.
4. Asian/Chinese donors eggs may be more expensive to procure from Western egg banks, as compared to Caucasian ones, due to the scarcity of Asian/Chinese donors in Western countries. This problem may be overcome by sourcing from egg banks within Asia.

Option 3: Look for an egg donor who is paid secretly, or utilise a foreign agency to send an egg donor to Singapore

Strictly not recommended. Currently, there exists numerous internet websites that allow you to look for your own egg donor. However, it is very unlikely that they will help you free-of-charge, and you will probably have to secretly pay them ‘under-the-table’.

But after receiving some payment, there is no guarantee that they will fulfil their part of the bargain, in which case you have no legal recourse for recovering your money. Because payment for egg donation is illegal in Singapore, in the first place, you will only implicate yourself in an illegal transaction if you decide to sue the would-be donor.

Moreover, it may be difficult to ensure that the freelance egg donor faithfully follows the painful and tedious procedure of daily hormone injections to stimulate egg production within her ovaries.

Utilising a well-established foreign egg donor agency may be a ‘safer’ option, but will be much more expensive.

Besides the agency fees, there are also extra travelling and accommodation costs. Most reputable foreign agencies will insist on having a coordinator to accompany the donor to Singapore, to ensure that the donor punctiliously self-administers hormonal injections to stimulate her ovaries, as well as to make sure she fulfils her part of the contract. This would mean additional travelling and hotel costs for the coordinator.

Furthermore, there is also the issue of illicit payments to the egg donor via the foreign agency. It may be difficult for such secret transactions to leak out, but if it does leak out, one will definitely end up in big trouble. Several years ago, a Singaporean magnate was jailed and fined for paying an Indonesian man to donate his kidney.

Additionally, it must be noted that Singaporean IVF clinics would require both the recipient couple and egg donor to sign a declaration form stating that the donation is altruistic. Hence the crimes of perjury and bribery would be committed by signing a false declaration.

Option 4: Travel overseas for egg donation at a foreign fertility clinic

Currently, this appears to be the most popular option. The medical fees of foreign fertility clinics are often much cheaper compared to Singapore. The disadvantages are that there is no government co-funding and you cannot utilize your Central Provident Fund (pension scheme) for fertility treatment.

Moreover, there is also the hassle and costs of overseas travel and hotel stay. Some local clinics have collaborative ties with foreign clinics that carry out egg donation.

Hence, they would be able to advise you on egg donation overseas, as well as co-ordinate with foreign clinics in synchronising hormonal injections to prepare your womb to be receptive for the egg donation procedure overseas. Moreover, preimplantation genetic screening (PGS/PGT-A) of embryos, which is highly restricted in Singapore, is readily available overseas.

This might be an important consideration for patients receiving donated eggs, since it is unknown whether the anonymous egg donor is carrying any genetic defects.

Nevertheless, Singaporean patients should note that there are much cheaper alternative methods of genetic screening such as testing of the egg donor’s blood sample before starting IVF, or NIPT (Non-Invasive Prenatal Testing), which can be done after getting pregnant.

Singaporean patients should also beware that some foreign IVF clinics take an extra cut of profit when sourcing egg donors for their patients from external agencies. It may be cheaper for patients to directly contact foreign egg donor agencies, and undergo treatment at their affiliated IVF clinics.

Additionally, Singaporean patients should try their best to use egg donors that reside locally within the same city as the foreign IVF clinic. They should avoid using travelling egg donors from out-of-town or out-of-state, who reside far away from the IVF clinic.

It is much more difficult to control and monitor the ovarian stimulation cycle of travelling egg donors from out-of-town. If possible, they should insist that the egg donor regularly receives hormone injections (recorded) by a nurse at the IVF clinic itself.

Option 5: Utilise leftover frozen eggs from local fertility clinics

These are generally scarce, but can be obtained from three sources:

1. Single women facing premature menopause or undergoing medical treatment that will damage their fertility such as chemotherapy are allowed to freeze their eggs.
2. A few married couples undergoing IVF choose to freeze their excess unfertilised eggs instead of embryos for religious or personal reasons, as they view frozen embryos as ‘living entities’ that should not be culled through disposal.
3. Contingency egg freezing is sometimes performed when the husband is unable to produce a usable sperm sample on the day of egg extraction surgery, for example ejaculation failure due to stress. As expected, patients would use their best quality eggs for their own treatment, so the few frozen leftovers would be of questionable quality.

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