Letter: Ministry of Health should do more to prevent Down Syndrome abortions

Letter: Ministry of Health should do more to prevent Down Syndrome abortions

by Dr Alexis Heng Boon Chin

As Singapore commemorates World Down Syndrome Day on 21 March (representing three copies of chromosome 21), we are often reminded of the tragic fact that around 90 per cent of Down Syndrome fetuses are being routinely aborted worldwide.

The risks of Down Syndrome rise with increasing maternal age, which is particularly significant for Singapore, given the increasing trend of late marriages and parenthood in the country.

Expectant couples undergo much shock and emotional trauma upon receiving a positive Down Syndrome diagnosis in prenatal testing and often face an agonizing dilemma of whether to proceed with an abortion, which may conflict with their own religious beliefs and personal conscience. There are severe risks to the mental, physical, and reproductive health of pregnant women undergoing abortions.

Indeed, abortion is viewed as inherently immoral by all major religious faiths in Singapore, which is why medical doctors here can conscientiously object to perform the procedure.

For older women undergoing IVF (in vitro fertilization) treatment, there is a way of avoiding this abortion dilemma and emotional quagmire by genetic screening of IVF embryos prior to transfer into the womb, a procedure known as Preimplantation Genetic Testing – Aneuploidy (PGT-A).

Nevertheless, manual genetic testing is highly expensive, tedious, time-consuming and invasive. There are risks of damaging the embryo upon extracting cells (biopsy) for genetic testing.

Indeed, many experts have pointed out that studies claiming no ill effects of genetic testing are often based on excellent-quality, healthy, and robust embryos rather than more ‘delicate’ lower-quality embryos that might suffer more from the biopsy procedure. Hence, PGT-A poses greater risks to older women who tend to have fewer lower-quality embryos.

Recently, a much cheaper and less invasive alternative was announced, with the publication of groundbreaking results in the reputable medical journal “Human Reproduction”.

A novel artificial intelligence (AI) algorithm called “Life Whisperer Genetics” was successfully developed by American healthcare company Presagen to accurately assess the genetic normality of embryos based only on microscopy images.

Indeed, similar AI-based technologies for screening IVF embryos have also been developed by several other biotech startup companies, such as AIVF, Fairtility and Embryonics.

In fact, one of them (Embryonics Inc.) was featured in the Channel News Asia documentary “The Baby Makers”, which was aired last year.

Hence, the Ministry of Health (MOH) should seriously consider incorporating and subsidizing such novel AI-based screening technologies within the IVF clinics of public hospitals, to reduce the incidence of Down Syndrome pregnancies in older mothers, thereby avoiding the moral dilemma and emotional quagmire of abortion.

Dr Alexis Heng Boon Chin is a native Singaporean who is working as an Associate Professor at Peking University, China. He had previously worked in the field of IVF research in Singapore. 

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