SINGAPORE: Getting pregnant through in-vitro fertilisation (IVF) treatments is now safer for older women because of better management of possible age-related complications for mothers and their babies, say doctors.
But advancements in healthcare do not mean women above 45 years old can conceive easily.
Singapore currently imposes an age limit of 45 years old for women undergoing assisted reproduction technology (ART) procedures, including IVF treatments. That cap will be removed from Jan 1, 2020, as part of Government measures announced on Wednesday (Aug 28) to support marriage and parenthood.
Doctors CNA spoke to said that the age limit exists because medical conditions, such as diabetes and high blood pressure, may be more common in older women and their chances of conceiving are lower.
However, advances in the treatment of these conditions have led to good outcomes in complicated pregnancies, said senior consultant at KK Women’s and Children’s Hospital’s Reproductive Medicine department Dr Sadhana Nadarajah.
“Neonatal care has also improved significantly over the years, leading to good outcomes even in high-risk pregnancies,” added Dr Sadhana, who is part of a Ministry of Health committee that looks at assisted reproduction regulations.
Head of Obstetrics and Gynaecology at the Singapore General Hospital (SGH) Associate Professor Yong Tze Tein said complicated pregnancies for older women are handled by multidisciplinary specialists - including those outside her department - such as cardiologists.
They would discuss how to reduce the potential risks for the mother and the baby before starting treatment.
“We are medically better. We can look after older patients better, and deal with the possible complications they may face," she explained.
"Older women have higher risk of miscarriage and they are more likely to have stillbirth. We can offer good detection (and) good support to look after them."
"EXTREMELY RARE" FOR WOMEN ABOVE 45 TO CONCEIVE
Despite the change in regulations, doctors cautioned that the chances of conceiving through IVF are low for women above 45.
Assoc Prof Yong said that after the age of 43, the chances of conceiving through IVF are "a few per cent, a single digit". In comparison, the chances of success are close to 40 per cent for women below the age of 35, she added.
"We recognise that we have all types of women and we do know that with age, our fertility drops, but it's not the same for everyone," she explained.
Sometimes, potential mothers are misguided about their chances of having a baby through IVF when news of elderly women becoming pregnant are published.
In some of these cases, the women get pregnant through egg donors, Assoc Prof Yong said. The older a woman, the lower the number and quality of her eggs, and conceiving through IVF after the age of 50 could be "unrealistic", she added.
“Sometimes we worry about giving false hope,” she said.
Similarly, Dr Sadhana said that although women are generally healthier and live longer, it is “extremely rare” for women above 45 to conceive.
“However, lifting the age limit will allow women to use frozen embryos that they may have created before and did not get a chance to use due to personal or health reasons,” she said.
Medical director of Virtus Fertility Centre Dr Ann Tan warned that if a miscarriage occurs, it may then lead to the need for invasive procedures to remove the pregnancy tissue. Those procedures could potentially damage the uterine environment, further decreasing the women’s chance for fertility.
The doctors encouraged couples to start trying younger.
“We don't want the public to be lulled into complacency. It's safer and better for women to get pregnant earlier. They do better, and the babies do better, and their chances of getting pregnant are higher,” Assoc Prof Yong said.
HELP FOR IUI PROCEDURE
Couples going through the less invasive IUI procedure at public assisted reproduction centres – the Singapore General Hospital, KK Women's and Children's Hospital and National University Hospital – will receive new subsidies from 2020.
Doctors said that it is likely that couples may start trying IUI earlier.
Singaporean couples can get up to S$1,000 co-funding per cycle for three cycles of procedure at a public assisted reproduction centre.
The procedure involves taking ejaculated semen, enhancing its physical features and inserting the semen into the uterus around the time of ovulation.
The co-funding could offset a large bulk of the cost of a IUI cycle, which typically costs about S$1,300 – cheaper than an IVF cycle.
National University Hospital Obstetrics and Gynaecology consultant Dr Shakina Rauff said that without such co-funding, many patients have chosen to bypass IUI and go straight to IVF treatments, which currently have co-funding.
“Now, they don’t have to hold back on doing so or be reluctant to do IUI first anymore just because of cost issues,” she said.
Dr Tan said that the financial help will nudge couples to start on their fertility journey earlier. This will be especially useful when the female is still ovulating and has healthy fallopian tubes, while their partner has semen issues.
For Ms Sumitha Nair, who had her child in 2017 with the help of IVF, the changes signal more support for older women who are still trying.
Ms Sumitha’s four-year journey towards pregnancy was not an easy one, involving oral medications, IUI and IVF.
"I wanted to try IUI first because it was not as invasive and involved fewer injections, but after my second one, I got really dejected. I stopped all procedures and medications," she said.
Ms Sumitha went for two IUI cycles at a private clinic that set her back by about S$6,000. She took a break, and was recommended to another doctor across the border in Malaysia.
"It was long, painful and expensive, but it was all worth it."
The 37-year-old manager said the new subsidies are a good move. "I think it would help those couples trying the IUI route greatly, especially if they need more than one cycle."
Dr Sadhana said it is always best to have a family as early as possible, but acknowledged that the vast majority of patients in their 40s who manage to carry a child to full-term will have a relatively uncomplicated pregnancy, largely due to access to good medical care.
"Couples who are above 40 years should not be discouraged from having children," she said.
"Having said that, it is imperative that the couple understand their risks and chances, so that they can make an informed decision."