by Dr Alexis Heng Boon Chin

In recent years Singapore has emerged as a hub of medical tourism in Asia, due to its high-tech medical facilities and well-trained doctors. The ability of most doctors here to readily communicate in Mandarin, has made Singapore particularly attractive to foreign patients of Chinese ancestry, especially from mainland China.

One particular medical treatment procedure that could be well-placed to be a star attraction for medical tourists from China is elective egg freezing, which is due to be permitted in Singapore later this year in 2023.

This is because elective egg freezing will likely remain banned in China for the near foreseeable future, which has led to much frustration among the growing numbers of highly-educated single women throughout the country, who are increasingly delaying marriage and motherhood in pursuit of career advancement and lifestyle pursuits.

Skyrocketing property prices, together with the rising costs of living, childcare and education in many large Chinese cities, would make it mandatory for young couples to accumulate a substantial amount of savings before starting a family, which would thus necessitate delayed child-bearing for many working women.

Hence, providing an avenue for them to preserve their fertility through overseas egg freezing would thus represent big business opportunities. Nevertheless, higher costs and stringent regulation of elective social egg freezing might hinder Singapore from tapping into the China medical tourism market.

Firstly, egg freezing costs in Singapore are much more expensive than other destinations such as Thailand or Malaysia, which also have many excellent fertility clinics. Typically, an egg freezing cycle costs around S$10,000 to S$12,000, or CNY 50,000 to CNY 60,000. Besides higher medical fees, daily living expenses and hotel accommodation costs are also much higher than cheaper destinations such as Thailand or Malaysia. This is significant given that the egg freezing procedure requires a few weeks to complete.

Secondly, social egg freezing is restricted to women below 37. This would thus disqualify many older single Chinese women who are more likely to have the necessary financial resources to fund the procedure due to them having more accumulated savings than younger women.

Thirdly, it is intended that only married women will be permitted to undergo the IVF procedure with their frozen eggs in Singapore. This would thus imply that foreign patients who had frozen their eggs in Singapore but who are still unable to find a suitable husband, will be permanently barred from using their frozen eggs to conceive a child of their own.

They will then have to either discard or donate away their eggs or alternatively export their eggs to a more liberal jurisdiction such as Australia or USA, where they can pursue single motherhood with donor sperm.

Nevertheless, exporting frozen eggs from one medical facility to another carries risk. Human eggs are extremely delicate and fragile, so the thawing procedure must be matching and compatible with the freezing procedure, or else this might result in irreparable damage to the eggs.

To ensure optimal results, it is best that only one IVF lab perform both procedures, and patients would be well-advised to avoid transferring their frozen eggs from one medical facility to another, which would likely not have matching and compatible freezing and thawing protocols.

A more remote risk is the possibility of frozen eggs being irreversibly damaged during the transport process due to unforeseen delays, accidents and malfunctioning equipment.

Lastly, routine genetic screening of IVF embryos with PGT-A (Preimplantation Genetic Testing – Aneuploidy) is still not approved as mainstream clinical treatment in Singapore.

This is because the Singapore Ministry of Health (MOH) is well-aware of the results of several high-profile clinical trials that have proven conclusively that PGT-A does not improve IVF success rates, and that it is an invasive procedure that risks damaging the embryo upon extraction of cells for genetic testing (biopsy). Moreover, the local clinical trial of PGT-A in Singapore has demonstrated inconclusive results with a high attrition rate of 72%.

Nevertheless, highly-educated Chinese single women are well-aware and extremely apprehensive of the higher risks of genetic defects in older mothers such as Down syndrome, which is heavily stigmatized and scorned in China. They would certainly want to test their IVF embryos with PGT-A to avoid such genetic abnormalities, which would not be possible upon returning to Singapore to use their frozen eggs.

In the mindset of foreign Chinese patients, it does not really matter whether PGT-A has no effect in improving their IVF success rates, neither does it matter whether there are risks of damaging the embryo. To put it simply, they are obsessed with avoiding Down syndrome and other genetic defects, due to sociocultural factors within their country.

The overwhelming majority of Chinese women plan to have only one child, stemming from their country’s three-decade long policy that has only been recently abolished, as well as due to the high costs of child-rearing and education. This would thus incentivise them to invest more heavily in their single offspring, including doing highly-expensive genetic testing of IVF embryos with PGT-A.

Probably, they think that it would be wiser to spend a little extra money on expensive genetic testing to ensure a normal healthy child, rather than undergoing abortion or wasting more money on the healthcare and special education of a Down syndrome child that would ultimately be a burden to society and embarrassment to themselves and their families.

Given the mindset of Chinese patients, IVF clinics in more liberal jurisdictions can capitalize on their concerns about genetic defects and aggressively advertise that PGT-A testing is available in their locality, while it is not available in Singapore, resulting in the loss of many foreign Chinese patients to other countries.

Hence, although there is certainly a high demand for overseas egg freezing by mainland China patients, higher costs and strict regulation of elective social egg freezing in Singapore would likely make it a less attractive destination for Chinese medical tourists.

Update on 23/7/2023: Article edited in line with most recent news and changes in government policies

Dr. Alexis Heng Boon Chin is an Associate Professor of Biomedical Science at Peking University, China. He had previously worked in the field of human clinical assisted reproduction research in Singapore, and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies, in addition to also having published more than 280 scientific journal articles, which have garnered a cumulative H-index of 53.

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