Singapore’s Fertility Health Support and Increased Financial Assistance for IVF and other Assisted Conception Procedures must Safeguard against Wasteful Medical Spending
Singapore wants more people to feel able to start families. As it expands fertility health support and increase IVF funding, it must also protect patients from expensive ancillary fertility treatment procedures with dubious value and questionable utility, which may not improve their chances of having a baby.
Singapore’s resident total fertility rate fell to a record low of 0.87 in 2025, while citizen births dropped 10.8 per cent to about 26,100. A Marriage and Parenthood Reset Workgroup is now reviewing how to make family formation more achievable.
Fertility care is part of that agenda. In a parliamentary speech on 6 August, Minister in the Prime Minister’s Office Indranee Rajah said the workgroup was reviewing support for egg freezing, fertility tests and treatment.
This matters. Fertility treatment can be financially and emotionally exhausting. But increased funding and wider access without guardrails may subsidise anxiety rather than parenthood during this uniquely vulnerable moment. Patients need clear, independent information. Otherwise, public money meant to help people become parents may end up subsidizing unnecessary medical procedures with little proven benefit.
Why patients are vulnerable to the sales pitch
People seeking IVF are often making decisions during one of the most anxious periods of their lives. They may worry about age, miscarriage or a child’s medical condition. In a hypercompetitive, society like Singapore, fears and stigmatization of disability such as Down syndrome can intensify. For some religious patients, aversion to abortion of a genetically-abnormal foetus adds another layer of pressure.
That makes it very easy to sell “certainty” and “control” in fertility care. One common example is preimplantation genetic testing for aneuploidy, or PGT-A. The test checks for genetically abnormal embryos, and is commonly used to prevent Down syndrome in older women. It is often presented as a responsible safeguard, but patients may not realise that it may hurt chances of a successful pregnancy, because extracting cells for genetic testing can potentially damage the embryo.
Single women face a different squeeze. In 2021, 64 per cent of Singaporean women aged 25 to 34 held a degree, compared with 56 per cent of men. Researchers have described the difficulty of finding an equal partner as a “mating gap”. For women who want children but have not found the right partner, elective egg freezing can feel like the only way to keep their options open. Since single women in Singapore cannot use donor insemination, the decision can be especially fraught.
Couples who have had failed IVF cycles are also uniquely vulnerable to exploitation. Various IVF “add-on” procedures such as time-lapse imaging, endometrial scratching, immune-related infusions and products such as EmbryoGlue can feel like the missing answer, even when they are experimental, unproven or useful only for a small patient group with specific medical conditions.
What the evidence says
Elective egg freezing can be valuable, but it should not be sold as a promise of a future child. The largest American study to date found that planned egg-freezing cycles nearly quadrupled between 2014 and 2021. Yet only 5.7 per cent of women who froze eggs between 2014 and 2016 returned to use them within five to seven years; among women who froze eggs in their early forties, the rate was about 8 per cent. For many, frozen eggs may be expensive reassurance rather than a pathway to motherhood.
Routine PGT-A is also less straightforward than it is often made out to be. It tests a small sample from the embryo’s outer layer, which later forms the placenta rather than the baby itself. Some embryos have a mix of genetically normal and abnormal cells (mosaic embryos), but can self-correct into healthy births.
Large studies, including the STAR trial and a Chinese study of about 1,200 patients, found no significant improvement in live birth rate from routine PGT-A. An analysis of more than 133,000 United States IVF cycles linked routine PGT-A use to a lower overall live-birth rate. Britain’s fertility regulator has given PGT-A a red rating, indicating that benefits are not clearly established for most patients. Lawsuits in the United States have also accused genetic testing companies of misleading marketing, while Australia’s Monash IVF paid A$56 million to about 700 patients after faulty embryo screening.
The concern extends beyond PGT-A. A 2026 meta-analysis by the University of Melbourne found serious weaknesses in research on common IVF add-ons. Of 10 add-ons reviewed, seven showed no measurable benefit or rested on low-quality evidence. Still, more than 70 per cent of IVF patients in Australia, New Zealand and Britain use at least one. Simply offering an IVF add-on can make patients assume it works.
A notorious example is the use of time-lapse imaging (TLI) systems for purportedly selecting the best IVF embryos. However, the landmark TILT trial published in The Lancet in 2024 demonstrated conclusively that it does not significantly increase the live birth rate.
The way clinics explain risk matters too. A rise in the risk of Down syndrome from 0.1 per cent at age 25 to 1 per cent at age 40 and 5% at age 45 can be described as a “ten-fold increase” and “fifty-fold increase”, respectively. That is technically true, but it is also a 0.9 and 4.9 percentage-point absolute change, respectively. Patients deserve both figures, not just the more frightening one. PGT-A can add 20 to 30 per cent to the cost of a cycle—money that might otherwise fund another standard IVF attempt.
The next frontier: choosing socially-desirable traits
Tomorrow’s question may be even harder. Some American start-ups already market whole-genome sequencing of embryos and scores linked to socially-desirable traits. Polygenic testing promises to help parents choose embryos based on the likelihood of height, intelligence or disease risks.
The promised gains are tiny: mathematical modelling suggest average differences of only around 2.5 centimetres in height and 2.5 IQ points among the very few embryos of a single couple with limited genetic variability. The trade-offs may be larger, because some genes can affect several traits at once; those linked to higher IQ may also be associated with increased risks of autism or bipolar disorder. Singapore should set clear limits before commercial services make these choices seem routine.
Increased public funding should come with robust safeguards
Increased financial support risks freeing spare cash for doubtful medical extras. Singapore must fund evidence-based treatment, not clinic upselling. The Ministry of Health (MOH) should adopt a UK-style traffic-light rating for IVF add-ons, ban red-rated (potentially harmful) medical extras, require plain-language cost-and-evidence disclosures, and publish independently audited live-birth outcomes by age group. Mandatory, unhurried fertility and genetic counselling should empower patients with more information, who must have enough time to reflect before consenting. They should be pointed to cheaper alternatives such as non-invasive prenatal testing and advanced ultrasound for detecting Down syndrome.
Supporting parenthood matters. Protecting patients from being sold false hope that medicine cannot yet deliver matters just as much.