Expanding use of Singapore's CPF MediSave for IVF will yield diminishing returns

Singapore faces an unprecedented existential crisis. With its total fertility rate (TFR) plummeting to a historic low of 0.87 in 2025, demographic alarm bells are deafening. In the frantic search for solutions, there are growing calls to expand the use of Singapore's Central Provident Fund (CPF) MediSave scheme to fund fertility treatment. This includes lifting the financial cap on repeated IVF cycles, and permitting its use for elective egg freezing (EEF) and preimplantation genetic testing for aneuploidy (PGT-A).

While adjusting the MediSave financial cap for IVF cycles to keep pace with inflation and rising medical fees is justified, throwing open the floodgates to fund endless failed IVF cycles and controversial add-ons is profoundly wasteful and financially imprudent. This policy trap ignores medical realities, defies the core purpose of compulsory healthcare savings, and risks bankrupting the future of its super-aged society.

The stark clinical reality is that IVF is not a magic bullet, and its efficacy drops precipitously after repeated failures. Couples can currently withdraw up to S$6000 for their first IVF cycle, S$5000 for the second, and S$4000 for subsequent cycles, up to a S$15,000 lifetime limit. This tiered structure reflects clinical consensus: there are diminishing returns in boosting birth rates through endless IVF cycles.

Data from a major UK study shows that while the live-birth rate for a first cycle is roughly 30 percent, chances of conception plummet significantly after multiple failed attempts. For women aged 40 to 42, the live-birth rate for the first cycle is a mere 12 percent, and the cumulative prognosis-adjusted live-birth rate after six cycles is only 32 percent. Simply put, if three rounds of IVF fail, the likelihood that a fourth or fifth will succeed is painfully low.

Even the UK's recently updated NICE guideline – which recommends up to three additional NHS-funded IVF cycles for patients below 40 whose first three cycles failed – represents a last-resort measure contingent on funding availability. As the BBC has reported, roughly 70 percent of areas in England already fall short of even the initial three recommended cycles, underscoring how rarely such extended funding materialises in practice (see the PET NHS Fertility Funding Tracker).

Patients enduring repeated IVF cycle failures often pivot to complex and exorbitant 'add-on' procedures with dubious efficacy, such as PGT-A (see BioNews 1123), endometrial scratch (see BioNews 1055), and time-lapse imaging of IVF embryos. Pumping MediSave funds into these expensive, low-yield avenues will cause a severe depletion of individual accounts, draining resources strictly ring-fenced for a very different demographic reality: the healthcare needs of Singapore's rapidly ageing population.

In 2026, Singapore will transition into a 'super-aged' society, with over 21 percent of its population aged 65 and above. Coupled with the fact that Singaporeans boast one of the highest life expectancies in the world – almost 84 years – the looming healthcare burden on the elderly is staggering. CPF MediSave was fundamentally designed as a critical safety net to ensure citizens have sufficient funds to cover essential medical expenses, long-term care, and chronic disease management during old age.

If Singapore allows premature and excessive depletion of MediSave accounts to chase statistically improbable pregnancies today, it merely shifts the financial burden to tomorrow. When increasing numbers of elderly Singaporeans outlive their depleted MediSave savings, the government will inevitably be compelled to step in and cover the massive shortfall in long-term care and medical fees. Singapore cannot afford to cannibalise its old-age healthcare safety net to fund the diminishing returns of reproductive desperation.

This financial imprudence extends to demands to use MediSave for elective egg freezing. While Singapore legalised EEF for women aged 21 to 37 in 2023, the Ministry of Health rightly maintained that MediSave cannot fund it. EEF is a social and lifestyle choice, not a treatment for an underlying pathological illness, and therefore contradicts the strict medical necessity threshold of MediSave.

More importantly, overseas clinical evidence unequivocally proves it is a remarkably poor investment of national savings. A large UCLA study revealed that while the number of women freezing their eggs skyrocketed, a mere 5.7 percent actually returned to use their frozen eggs for IVF within a seven-year period. Allowing MediSave for an expensive elective procedure where over 90 percent of biological material is never used to create a pregnancy would constitute a gross wastage of CPF Medisave funds that could otherwise be preserved for genuine medical needs.

Similarly, Singapore must firmly resist the push to permit MediSave utilisation for PGT-A. Touted as a way to screen embryos for chromosomal abnormalities to improve IVF success, PGT-A has become a highly lucrative add-on for fertility clinics. Yet, its clinical value is fiercely contested. A multicentre randomised trial demonstrated that PGT-A fails to improve cumulative live-birth rates compared to conventional IVF among women with a good prognosis (see BioNews 1124).

Worse still, PGT-A is plagued by severe controversies surrounding misdiagnosis and the tragic discarding of potentially viable, healthy embryos – often erroneously labelled as mosaic (see BioNews 1312). This profound failure to deliver on its grand promises of higher success rates sparked a wave of class-action lawsuits in the USA against IVF genetic testing companies, alleging consumer fraud, breach of warranty, and misleading claims preying on vulnerable patients (see BioNews 1261). Subsidising such a controversial, legally embattled, and clinically questionable procedure with mandatory national savings is the absolute antithesis of prudent and responsible healthcare financing.

The crash of Singapore's TFR to 0.87 is an undeniable crisis, and the desire to support couples struggling with infertility is noble. However, public policy must be guided by hard clinical evidence and long-term fiscal responsibility, not just empathy and desperate hope. The Singapore government must remain extra prudent and cautious with CPF MediSave funds, guarding them fiercely against well-meaning but ultimately destructive expansions.

Expanding its scope to cover endless cycles of failed IVF, highly underused elective egg freezing, and controversial PGT-A testing offers negligible demographic benefits while posing a catastrophic threat to Singapore's elderly healthcare financing ecosystem.

Singapore must not sacrifice the dignity and medical security of our super-aged future on the altar of a demographic quick fix that the medical literature tells us simply will not work.