In recent years, Singapore has encountered a demographic crunch due to its extremely low fertility rate and a rapidly aging population, which presents a significant threat to its existence as a nation-state. The emergence of new innovative assisted reproductive technologies (ARTs), including in vitro gametogenesis and synthetic human embryos, could offer new fertility treatment alternatives for local patients, potentially helping to mitigate Singapore's extremely low birthrate.

     In vitro gametogenesis (IVG) is the process of creating artificial sperm and eggs in a laboratory setting from alternative cell types, such as skin cells. By employing sophisticated molecular biology methods, researchers can reprogram skin cells to resemble embryonic stem cells. These reprogrammed cells can subsequently be stimulated with specific chemicals and growth factors in a lab environment to develop into functional sperm or eggs. Research teams in Japan and China have successfully produced healthy live offspring using IVG-derived sperm and eggs from the skin cells of mice and rats, which could in turn reproduce normally and produce subsequent generations of healthy offspring. More intriguingly, researchers were even able to create mice with two “dads” by utilizing IVG technology to derive eggs from one of the male parent. Similarly, mice with two “mums” have also been created by deriving sperm from female mice. It is likely that such scientific advancements will be translated from rodent models to human clinical applications in the near future.

     Synthetic embryos, also known as stem cell-based embryo models (SCBEMs), are embryo-like entities derived solely from stem cells, thus circumventing the fertilization process and eliminating the need for sperm or eggs. A research team from the Weizmann Institute of Science in Israel accomplished this remarkable achievement using mouse and human stem cells in 2022 and 2023, respectively. Reports indicate that these synthetic embryos exhibit brain structures, functioning hearts, and the essential components of all other organs, along with basic extra-embryonic structures such as a placenta and yolk sac that could support their growth and development if implanted in a womb. As of now, no synthetic embryos derived from animals or humans have resulted in live births; however, given the rapid advancements in scientific research in recent years, it is plausible that this challenge will be overcome in the near future.

     Nevertheless, before committing significant resources to the development of IVG and synthetic human embryo technology for assisted reproduction in Singapore, it is crucial for Singaporean healthcare policymakers to assess the potential of these emerging technologies in advancing national interests, particularly to boost the country's dismal fertility rates. Therefore, a rigorous, systematic, and data-informed cost-benefit analysis is necessary to determine how effectively these innovative technologies can tackle Singapore's demographic challenges with low fertility rates and a rapidly aging population.

     Statistical data from other affluent countries with low fertility rates and well-established public and private fertility clinics may offer valuable insights. For example, recent figures from Australia reveal that roughly 1 in every 18 infants is conceived through in vitro fertilization (IVF) and other ARTs. In Japan, this figure is approximately 1 in 11.6 births resulting from IVF and other ART. Consequently, even under optimal conditions, the extensive use of IVF and ARTs is unlikely to increase the overall birth rate by more than 10%. This limited impact would not significantly improve the demographics of any nation struggling to achieve the replacement rate of 2.1 births per woman, as seen in Singapore, where the total fertility rate is around 1.0.

     Additionally, it is crucial to recognize that IVG and synthetic human embryo technology, owing to their significant costs, complexity, and labor demands, are likely to be reserved for the most severe and difficult infertility cases that cannot be resolved through conventional IVF and other standard assisted reproductive technologies. Such highly-challenging cases are anticipated to constitute only a tiny fraction of the total infertility cases in Singapore, thereby significantly limiting the impact of these innovative technologies in boosting the national birthrate.

      Furthermore, Singapore’s stringent regulations prohibiting surrogacy, and discouraging single parenthood and same-sex parenthood may further diminish the potential of these technologies to enhance the birthrate and yield financial returns from research and development efforts. There is anticipated to be robust demand worldwide for utilizing IVG to enable same sex couples to beget offspring that are genetically-related to both partners. Yet another lucrative market is the utilization of IVG for the mass production of donor eggs that are in short supply worldwide, which would be severely curtailed by stringent regulations in Singapore that limit just five  offspring for each egg donor. Hence, Singapore will be unable to exploit such lucrative markets due to her strict laws governing assisted reproduction practice.

     Nevertheless, one could contend that investing in the research and clinical applications of these newly-emerging technologies may fulfill a symbolic political role, showcasing the Singapore government's dedication to addressing the clinical needs of a tiny fraction of local patients facing particularly difficult infertility challenges. Additionally, there is a consideration of national pride and its influence on the collective mindset, as participation in the global research initiatives surrounding these innovative reproductive technologies could bolster Singapore’s reputation as a leading biomedical research center on the world stage.

     However, when it comes to the allocation of taxpayer funds and the use of national resources, policymakers in Singapore must judiciously weigh these ambitious goals against more practical and utilitarian considerations. For instance, it can be argued that the same financial resources might be more effectively directed towards enhancing and subsidizing social services dedicated to increasing the nation’s birthrate, such as the expansion of preschool education and childcare facilities. These initiatives are likely to garner greater public support and appreciation from a much larger pool of prospective parents.

    Ultimately, the Singapore government has a public responsibility and moral obligation to ensure that taxpayer funds are used efficiently and judiciously to meet the nation’s healthcare requirements. Investing in IVG and synthetic human embryos may represent a misguided allocation of public resources, particularly considering the extremely low number of complex infertility cases that necessitate such costly and resource-intensive interventions. Government-affiliated research institutions and grant-funding agencies have to be particularly wary of researchers trying to portray a false narrative of such newly-emerging advanced assisted reproductive technologies as a promising solution for overcoming the country’s dismal birthrates, given the small number of patients requiring such high-end complex treatments.