SINGAPORE – Couples undergoing in-vitro fertilisation (IVF) who wish to have their embryos screened for serious genetic disorders before they are implanted in the womb may get financial help for it if an ongoing review finds it feasible to subsidise such procedures.
The Health Ministry is currently working to make pre-implantation genetic diagnosis (PGD) a mainstream clinical service for couples who need it, and is studying whether it is cost effective to make it eligible for subsidies, said Parliamentary Secretary for Health Rahayu Mahzam on Monday (Jan 4).
Ms Rahayu was responding to an adjournment motion by Mr Louis Ng (Nee Soon GRC) on ways the Government could give more support to couples trying to conceive through IVF, a process Mr Ng said is costly and often emotionally trying.
PGD is an option offered to patients at risk of passing on serious inheritable diseases that are due to single gene mutations or chromosomal structural rearrangements.
Undergoing PGD may increase the likelihood of a successful pregnancy by ensuring the implanted embryo is free from such genetic defects and lower the overall costs as fewer IVF cycles would then be needed, argued Mr Ng, in making his case for extending subsidies to such screenings and letting couples use their MediSave to pay the balance.
PGD is currently not subsidised and cannot be paid for through MediSave. Ms Rahayu said the ministry would study Mr Ng’s suggestion to allow MediSave be used.
Mr Ng said one couple had told him they had paid $10,000 out of pocket for PGD in order to prevent another miscarriage after finding out that a genetic condition was responsible for three previous miscarriages.
He said another couple paid $18,000 for PGD as it was the only way to prevent their second child from inheriting a rare genetic disease that can lead to liver failure.
“My proposal is that we extend the current IVF subsidy structure to PGD. For Singaporean couples, this means a 75 per cent subsidy for PGD for subsidised IVF cycles,” Mr Ng said.
“PGD is needed only by a small percentage of couples, so overall subsidy costs for the Government are likely to be limited.”
In his adjournment motion, which allows MPs to speak for up to 20 minutes at the close of a Parliament sitting, Mr Ng said: “Fertility is an existential problem for Singapore. The Government has done much, such as expanding the Baby Bonus Scheme, to provide more support to couples in their decision to have children and to lighten the financial costs of raising children, but I don’t think we are doing enough for those who want but struggle to have children.”
Citing figures from KK Women’s and Children’s Hospital, Mr Ng said 15 per cent of couples are unable to conceive within a year of trying for a baby.
The number of couples opting for IVF has also risen in recent years, from about 5,500 in 2013 to over 7,700 in 2017, he added.
Mr Ng also revealed that his three daughters were conceived through IVF, and that he and his wife were only able to have their first child on their seventh attempt.
He noted that the Government currently subsidises the first six IVF cycles and couples will have to foot the bill in full from the seventh attempt onward, which can cost up to $15,000 at public hospitals.
He suggested subsidies could be extended to the seventh and eighth cycles, even if the subsidy amount is reduced.
Remove quotas on types of IVF treatment and give couples fertility leave
Mr Ng also suggested that quotas on “fresh” and “frozen” cycles for subsidised IVF treatment be scrapped.
These refer to different methods of embryo transfer used in IVF. Currently, the six subsidised cycles must consist of three “fresh” and three “frozen” cycles.
Mr Ng said this requirement adds unnecessary stress for couples undergoing IVF, noting that some may need one fresh cycle and five frozen cycles, while others may need five fresh cycles and one frozen cycle.
He said the quotas should be dropped and couples should have the flexibility to opt for either method.
Couples should also get fertility leave so they can take time off work to go for IVF treatments, Mr Ng suggested, noting that countries like South Korea have such schemes.
He said employees could be required to provide medical certificates from fertility clinics to prove they are using the leave for its intended purpose, and clinics could also give men MCs when they accompany their wives for IVF appointments.
MOH to review subsidy and MediSave use for PGD
In her response, Ms Rahayu said the Government has made efforts to improve the affordability of assisted reproduction technology (ART) by increasing the subsidy cap progressively over the years.
She said couples can also use MediSave to offset out-of-pocket costs at both private and public ART centres, subject to a lifetime limit of $15,000 which can come from either the wife’s or the husband’s MediSave account.
On Mr Ng’s suggestion to increase the number of subsidised IVF cycles, Ms Rahayu said co-funding subsidies need to be feasible and take into account the fact that the success rate of IVF treatments decreases with each successive cycle.
“We will monitor the clinical evidence and review this criteria if new data suggests improved outcomes,” she said.
She also said that though the subsidy for IVF cycles covers three fresh and three frozen cycles, the ministry already allows some flexibility for couples to claim funding for more of one or the other.
“For example, a patient who has utilised one fresh cycle and three frozen cycles can request co-funding for an additional frozen cycle, since there are two unutilised fresh cycles remaining.”
She said that in this scenario, the amount of co-funding will be based on the $2,200 cap for frozen cycles rather than the $7,700 cap for fresh cycles. The patient will then have one remaining fresh cycle that can be co-funded.
On the other hand, a patient who has already undergone one frozen cycle and three fresh cycles can request funding for a fourth fresh cycle, but the subsidy will still be capped at the lower $2,200 limit.
On the suggestion to implement fertility leave for both men and women, Ms Rahayu said women undergoing assisted conception procedures can already use their hospitalisation leave allowance.
She said some employers will also allow men a day off work if they get a memo from the doctor for accompanying their wives to the clinic.
“We encourage employers to be sensitive to the needs of couples who may need to make use of these existing provisions,” she said, adding that a balance must be struck between meeting employees’ needs and the operational constraints faced by employers in introducing new leave schemes.
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