In recent years, there have been intensive debate on permitting social egg freezing for single women in Singapore, due to the increasing trend of reduced fertility arising from late marriages and delayed childbearing.
Indeed, the Singapore news media have reported several cases of local single women traveling abroad to freeze their eggs, due to current ban on fertility clinics performing this procedure on unmarried women without valid medical reasons.
Because egg freezing is such an expensive medical procedure, it would be wise and prudent for Singaporean single women to take necessary precautions before traveling abroad for treatment.
In particular, they have to be wary of misleading advertisements and marketing gimmicks by foreign fertility clinics.
There is a high risk of them being duped by misinformation on egg freezing, which could lead to wastage of their hard-earned money, in addition to them suffering much disappointment upon failing to conceive in the future.
Image source: iStock
Social Egg Freezing Process For Women In Singapore
Here are some advice and warnings for single Singaporean ladies considering egg freezing overseas:
When to freeze your eggs
First and foremost, single women should freeze their eggs as young as possible, preferably before the age of 35. There is strong medical evidence that a woman’s fertility drops sharply after the age of 37 (American College of Obstetricians and Gynecologists Committee).
The overwhelming majority of single women make the mistake of freezing their eggs too late, in their late thirties or early forties, when their egg quality has substantially declined.
The high financial costs of egg freezing often discourage many younger women from freezing their eggs, until they feel the pangs of desperation upon getting older, with their biological clock ticking away.
Check the health of your ovaries
Check the health of your ovaries and your ovarian reserves at a local fertility clinic, before traveling abroad for egg freezing.
Ovarian reserves are determined by measuring your blood serum levels of AMH (Anti-Müllerian Hormone) and FSH (Follicular Stimulating Hormone), together with ultrasound assessment of antral follicle counts within the ovary.
If you are diagnosed with low ovarian reserves, you will likely require more egg freezing cycles to obtain an adequate number of frozen eggs for a reasonable chance of future pregnancy.
This means spending more time and money.
Polycystic Ovary Syndrome (PCOS) occurs in about 10% of women of reproductive age, and is a major cause of infertility.
Although a higher number of eggs are typically recovered from PCOS versus normal patients during assisted reproduction treatment, the eggs are often less mature and poorer in quality, which may compromise the success of egg freezing.
Moreover PCOS patients are more prone to ovarian hyperstimulation syndrome (OHS), which increases the risk of cancellation of egg freezing cycles, leading to wastage of their hard-earned money. To avoid future disappointment, do not freeze your eggs if you have PCOS or low AMH levels.
If you have such medical conditions, the better option maybe to try conceiving a baby as soon as possible (possibly with assisted reproduction techniques), rather than do egg freezing.
Be prepared for multiple egg freezing cycles
To attain a reasonable chance of future pregnancy, be prepared to undergo multiple egg freezing cycles to obtain sufficient number of frozen eggs, especially if you are an older woman with low ovarian reserves.
Even that is no guarantee of having a child in the future.
For many single women who freeze their eggs overseas and make that journey just once, they can expect a very big disappointment should they fail to conceive in the future with their own frozen eggs.
Table. Estimated number of eggs and egg retrieval cycles necessary to conceive one child at different ages (From Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA)
|
|---|
| Age (years) |
21-25 |
26-32
|
33-38 |
39-42 |
|
Estimated minimum number of eggs for a single child
|
10 |
15 |
20 |
25-30 |
|
Estimated number of egg freezing cycles required to reach the above-quoted number
|
1 |
2 |
3-4 |
4-6 |
Check the health of your womb
Check the health condition of your womb with a local clinic, before traveling abroad for egg freezing. One must beware of uterine fibroids that commonly develop in women between 30 and 40 years of age.
Uterine fibroids have been reported to lower the chances of pregnancy in older women doing in vitro fertilization (IVF) with their frozen eggs.
Hence, it is not just the number and quality of your frozen eggs, nor is it just about your age at which you freeze your eggs.
The health condition of your womb at the time that you are using your frozen eggs also matters a great deal. This issue has largely been overlooked and neglected by many single women freezing their eggs.
Adapt a healthy lifestyle
Before traveling overseas for egg freezing, maintain a healthy lifestyle and regularly take fertility supplements and vitamins for a few months to improve egg quality. Supplements and vitamins that can enhance egg quality include:
- Coenzyme Q10 (CoQ10)
- DHEA (Dehydroepiandrosterone)
- L-Arginine
- Myo-Inositol
- Glutathione
There are now commercially-available products that combine all these supplements and vitamins into one package, to specifically enhance female fertility prior to in vitro fertilization or egg freezing.
Image source: iStock
Don’t fall for advertisements
Be extra skeptical of advertisements by foreign fertility clinics that claim high pregnancy success rates with frozen egg.
Many foreign fertility clinics will tell you that high pregnancy success rates (40% to 60%) with frozen egg are published in reputable medical journals, and are achieved using the latest vitrification technology that avoids ice crystallization damage.
What they don’t tell you is that such high pregnancy success rates are based on frozen donor eggs from young healthy women (20 to 25 years of age, with low body mass index and high ovarian reserves).
Egg donors are carefully selected to be the most fertile group of women in the entire population. For example in America, only 5% of female applicants are accepted to be egg donors.
This is not reflective of older career woman freezing their eggs, who are typically aged between their mid-30’s to early-40’s, with variable body mass index and much lower ovarian reserves.
Hence, good results on egg freezing published in reputable medical journals are highly-skewed, because most of these studies compared fresh versus frozen eggs from carefully-selected, young, healthy and highly-fertile egg donors.
Beware that the pregnancy success rates with frozen eggs drop exponentially with increasing age, due to rising incidence of chromosomal abnormalities in the frozen eggs.
As such, the IVF success rates with frozen eggs from older women are very much lower than that advertised by foreign fertility clinics.
In the American news media, there have been many stories of women freezing more than 10 egg, but found that none of these can yield a successful pregnancy, leading to much heartbreak and disappointment.
Check track record of the clinic
When choosing a foreign fertility clinic for egg freezing, do not just consider the price, but also check that they have a track record of live births with frozen eggs.
It is best for the fertility clinic to have publications in international medical journals, which proved that they had actually successfully achieved live births with frozen eggs.
Yet, less than 5% of assisted reproduction clinics in the USA fulfill such criteria.
Despite the much lower costs of egg freezing in the developing countries of Southeast Asia, such as Malaysia and Thailand, one must beware of the reliability and quality of medical facilities and services in such countries.
Image source: iStock
Pick a country that encourages quality control of clinics
Choose to do egg freezing in a country where there are strict regulations and good quality-control of fertility clinics. It is not just about costs!
This is crucial, because there had been catastrophic failures in the refrigeration of frozen eggs, as reported by the American news media.
Developed countries like Australia and America usually have stricter regulations and better quality control of fertility clinics, as compared to developing countries like Malaysia and Thailand.
For example, in Australia, fertility clinics are regularly inspected and audited by the Fertility Society of Australia (FSA) and the Reproductive Technology Accreditation Committee (RTAC) of Australia. Are fertility clinics in Malaysia and Thailand subjected to similar mandatory inspections and audits?
The fact that you can read the news about frozen egg storage failures in the USA confirm that American assisted reproduction clinics are subject to strict regulatory oversight and good quality control.
Hence, they quickly acknowledged their failures publicly, despite knowing that they will likely be sued by patients for millions of dollars.
Can such transparency and honesty be expected of private fertility clinics in developing countries like Malaysia and Thailand, where government regulation and oversight are much less stringent?
Make sure to know about the laws
Some women may remain single and may want to consider single motherhood. In that case, they should initially take note of relevant laws in the country in which they freeze their egg.
For example, Malaysia and Thailand ban in vitro fertilization of single women with donor sperm, whereas this is permitted in Australia, America and most of Europe.
In conclusion, the most important factor that ensures future reproductive success with egg freezing is the age at which a woman freezes her eggs.
Despite technological advancements such as vitrification technique that minimizes damage to frozen eggs from ice crystallization, single women should beware that the pregnancy success rates with frozen eggs is still significantly lower than that of fresh eggs.
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