Commentary: Have we placed too much faith in science to solve all our fertility problems?
The greater support couples will receive for fertility treatment is to be welcomed but let’s not let up on the focus on fostering family-friendly work environments, says Dr June Goh.
SINGAPORE: The lifting of the age limit for assisted reproduction technology for women has been heartening.
This move is in line with changing patterns of marriages where the median age of marriage for women has reached 28.5, the median age of women giving birth for the first time has risen to 30.3, and the number of babies born to Singaporean parents is also at its lowest for almost a decade.
Clearly, the changes have been made with much consideration over advances in medical technology and care of the older women in pregnancy.
Although IVF success rates fall sharply after 40, these changes will still see some measure of success for women who have tried to conceive for some time to no avail.
LEGISLATION SHOULD SUPPORT NOT LIMIT FAMILY PLANNING
Without this choice in Singapore, some women attempt to undertake the treatment in other countries which adds to the difficulties they face as IVF treatment requires many visits.
This could impact their jobs and careers, and act as a source of pressure on the marriage.
Fertility treatment and assisted reproduction is a stressful and expensive process. Having a time limit imposed on treatments and having to make appeals add to an already fraught process.
A woman going down this path already has so many obstacles in her way that legislation should not be yet another thing to worry about. Taking away the age limit will take away a key stressor.
The cost involved in the process also adds to the psychological burden which will have an impact on the success of the procedure. So co-funding of the less invasive intra-uterine insemination (IUI) is similarly to be welcomed, to dis-incentivise women to go straight for a subsidised but more invasive treatment.
The liberalisation and enhanced subsidy of IVF treatments is a good move but for women above 45 the number of healthy eggs they have is significantly fewer. In order for a significant difference to be made, social egg freezing as well as embryo and oocyte generic screening may need to be available.
NO SILVER BULLET
These changes in rules will also necessitate greater support for couples in making the right decisions.
With the lifting of the age cap on IVF, the restrictions will now be solely determined by their medical specialist in discussion with the couple. Suitability of these procedures in terms of the potential risks must be clearly and carefully explained by their fertility specialist.
Age also ultimately imposes inherent challenges for conception, even if fertility procedures have gotten safer over time. Women must be aware of possible risks of multiple hormonal stimulations on breast and ovarian tissues, and discuss the need for screening or follow-up with their medical specialist.
There is also a small risk of congenital problems for women conceiving after the age of 45, for example Down’s syndrome, however there are tests to detect this.
The best medical expertise and facilities available together with all the information that can aid couples in this area is a necessary supporting infrastructure. So we need to continue good training for our doctors, do high-quality research and fund the facilities and technology required.
If demand for such procedures rise, and funding is only available at assisted reproduction centres in Singapore public hospitals, we must also ensure that the number of medical specialists in this field and the supporting medical ecosystem increase in tandem with needs.
SCIENCE ALONE CANNOT SOLVE OUR LOW BIRTH RATES
Ultimately, these changes can feel like a chicken before egg situation. After all, despite this greater access to fertility treatments, there are other causes of infertility, some that cannot be solved by technology.
While the move to lift the age limit for assisted reproduction technology is crucial, much more is needed to address the other issues that lead to our low birth rate in the first place, and encourage couples to have kids earlier so that they do not need these fertility treatments.
Priority should be placed on ensuring that couples are well supported to start families – and promoting family-friendly work will remain critical. Helpful work policies such as flexible work arrangements can go a long way towards supporting parents who have to juggle the numerous demands of parenthood with their careers.
Another critical thrust is the provision of accessible and affordable, high-quality childcare for peace of mind while parents continue with their jobs. I am heartened to see more being done on this front, such as increasing the subsidies for childcare and expanding the available places.
However, much needs to be done to make a paradigm shift. While supportive government policies are essential, it also falls on society as a whole to create an inclusive and encouraging environment for parenthood.
Fathers have to be more involved. Shared parenting responsibilities should be a norm and not the rarity. We must make a concerted effort to break stereotypes and show that an equal partnership is beneficial.
These changes will encourage couples to start on their journey to parenthood sooner rather than later. After all, the number of viable eggs drops with age.
Therefore although these changes over the last week are to be lauded for the choice these will give couples, it must not detract from the message of encouraging couples to put family as a priority and for employers to pursue family-friendly work policies.
Dr June Goh is President of the Singapore Council for Women’s Organisations.