Singapore can justify public egg freezing subsidy by imposing strict conditions

State-sponsored elective egg freezing has recently become a trendy topic of discussion worldwide, with South Korea, Australia, Israel, Cyprus, Japan and Taiwan starting to subsidise the procedure for their female citizens. Additionally, this idea has also being mooted in Hong Kong.

Singapore has permitted elective egg freezing in July 2023, but the procedure is highly expensive, which makes it unaffordable to many young women with limited savings but at the peak of their fertility.

Although some employers are willing to subsidise egg freezing for their female employees, they are relatively rare and are often available only to high-value staff of large corporations in senior management positions.

To enable more equitable access to elective egg freezing and to boost the country's dismal birth rate that hit a new low in 2022, many Singaporean women would certainly like the Government to consider following the examples of other countries in subsidising elective egg freezing.

Such public subsidies will undoubtedly incentivise many women to freeze their eggs at younger ages for their own good, when their egg quality is optimal, which would thus ensure higher chances of their future reproductive success.

A common misconception is that most women freeze their eggs because they want to deliberately delay marriage/childbearing to prioritise their career or various lifestyle pursuits such as traveling.

Nevertheless, sociological studies conducted in other countries reveal that most women freeze their eggs because they encounter significant difficulties in finding a compatible life partner to start a family.

A book published in May 2023 by Yale University Professor Marcia Inhorn entitled 'Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs', outlined that in most countries, women graduate from universities at a significantly higher rate than men. This has resulted in difficulties for highly-educated women finding compatible men that match their expectations in terms of income and academic qualifications.

Singapore is no different, with the Singapore Department of Statistics reporting that in 2021, 64 per cent of women aged 25-34 years have a university degree compared to just 56 per cent of men. 

Hence, due to this 'mating gap', it is anticipated that increasing numbers of young women in Singapore will be seeking to freeze their eggs in the near future, to give them more time to find a compatible life partner to start a family. 

This challenge is further compounded by the fact that unlike Western countries, sociocultural factors and legal restrictions in Singapore on access to public housing for some parents, place significant barriers on women having children outside traditional heterosexual marriage.

Same-sex marriages and de facto marriage with a live-in partner are not recognised by the Singaporean legal system, and children born of such relationships are considered illegitimate and ineligible for various government subsidies and cash gifts offered to newborn citizens.

Moreover, clinical assisted reproduction procedures involving sperm donor insemination are also banned for single women in Singapore.

To make matters worse, there is also strong social stigma against women having children outside traditional heterosexual marriage in Singapore, due to conservative values in the region.

Singaporean women with illegitimate children often find themselves being scorned by their own family members and relatives.

In view of such sociocultural factors that impose significant challenges on women wanting to have children, the Singapore Government may therefore consider following the example of other countries in subsidising elective egg freezing.

As the old saying goes, there is no such thing as a free lunch. Government subsidies always come with conditions and strings attached, in order to ensure that taxpayer's money is well-spent. Hence, if Singapore were to consider subsidising this procedure one day, there will be a need to specify stringent conditions to better justify such spending from public coffers. The following suggestions are thus made:

1. Subsidies should be made available only at IVF centres in public but not private hospitals, consistent with current rebate policies on assisted reproductive procedures. Or else, there will be questions on why the Government is willing to sponsor this elective procedure, but not treatment of life-threatening diseases such as cancer, heart failure and stroke in private hospitals. 
2. Subsidies for egg freezing should be restricted only to unmarried women. Because IVF embryos are more robust and survive the freezing process much better than unfertilised eggs, married women should only receive current subsidies to undergo IVF with their husband and store frozen embryos instead of unfertilised eggs.
3. Subsidised patients must sign a pledge that if they do not eventually use their frozen eggs for IVF treatment, they must either refund the subsidy or donate their unused frozen eggs to infertile patients. Because the rationale for egg freezing subsidy is to boost the birth rate in Singapore, and donation of unused frozen eggs to research or for teaching/training purposes will not fulfill this objective, unlike donation to infertile IVF patients.
4. A much lower age limit and stringent health checks should be specified as conditions for subsidy. To ensure better quality eggs for freezing, the age limit for subsidy should be set at the early 30s, perhaps 32 years old. Additionally, subsidised patients must pass stringent fertility health checks to confirm that their ovaries are healthy and capable of producing a good yield of eggs for freezing. For example antral follicle counts with ultrasound, together with serum Anti-Mullerian Hormone (AMH) levels are widely considered to be good indicators of a woman's egg reserves and her chances of future IVF success. Imposing such a condition will thus serve as an incentive to encourage local women to freeze their eggs at a younger age for their own benefit.
5. Subsidised egg freezing patients should be barred from pursuing single motherhood by exporting their frozen eggs for sperm donor IVF overseas, in accordance with current Government policy to encourage motherhood within marriage. Currently, there are no laws in Singapore to stop single women from exporting their frozen eggs overseas for sperm donor IVF. It may be justified for non-subsidised patients to pursue this option, simply because they are paying for the procedure entirely from their own pockets.

It is hoped that these suggested conditions will ensure that taxpayers' money is wisely and prudently used to subsidise egg freezing, for the ultimate objective of boosting Singapore's dismal fertility rates.