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Babies made in MalaysiaMore relaxed guidelines, lower costs and shorter waits are drawing childless couples in Singapore to JB in search of fertility treatment.
More childless couples in Singapore are crossing the Causeway not just for food and shopping, but also in-vitro fertilisation (IVF) in the hope of having a test-tube baby or two, a check with three fertility experts there shows.
These include Singaporean couples who could not find a sperm or egg donor in Singapore and Singaporean women who are aged 45 and above. They also include expatriates who do not qualify for IVF subsidies in Singapore.
Dr Fabian Kurian, 46, at the Tropicana Medical Centre (TMC) Fertility Centre in City Plaza in Johor Baru, Malaysia, saw 39 Singaporeans and Singapore permanent residents - or about 14 per cent of its assisted reproduction cases - in the first six months of this year.
This was up from 51 such patients, who made up about 9 per cent of his total number of assisted reproduction cases in 2008.
About 240 patients underwent assisted reproduction treatments at the centre, mainly for IVF or a version of it called intracytoplasmic sperm injection (ICSI) last year (see story on page 15).
Dr Tan Jui Seng, 48, at the Women and Fertility Clinic in Taman Century, said he has seen a 20per cent increase in the number of Singaporean patients since he started his clinic in 2001.
Dr Thokha Muhammad, 52, said he has seen a 10 per cent increase in the same group of patients since he started his obstetrics and gynaecology clinic at Singapore-owned Regency Specialist Hospital in Masai in 2009.
Both now see about 10 Singaporean couples a year for mainly IVF and ICSI. Their clinics handle a total of about 490 and 100 cases of assisted reproduction treatments respectively last year.
Even in Singapore, the number of women going for IVF has grown, as it has become more affordable, with the Government offering subsidies in public hospitals since August 2008.
In 2009, 3,271 women here sought IVF, almost double the 1,716 who did so in 2004.
MORE DONOR SPERMS AND EGGS
A number of childless Singaporean couples have gone to Johor Baru because donor sperms and donor eggs are more widely available there.
Dr Fabian said such couples make up as many as 70 to 80 per cent of those on the donor egg programme at his fertility centre, while Dr Tan said he sees a few of such couples a year.
The two doctors also receive occasional requests from Singaporean couples for donor sperms.
TMC Fertility Centre has its own sperm bank, with about 100 sperm samples from about 20donors shared by three other centres in Kuala Lumpur and Penang.
Requests for sperm samples can be met immediately if there is a suitable sample in the bank, said Dr Fabian.
The Women and Fertility Clinic links patients up with cryo sperm banks in the United States - the wait can take up to six weeks. At least one private centre in Singapore also does the same.
But, in general, donor eggs and sperms are in perennial shortage here and the wait is indefinite.
Those looking for donor eggs especially need to find their own donors, who may be someone known to them, such as a relative or friend.
One patient in her early 40s was put on a donor egg programme in Singapore. She underwent six weeks of injections to "downregulate" or switch off her own reproductive cycle to prepare her uterus to receive the embryos, only to be told that the donor had backed out.
She then sought help at TMC Fertility Centre, where she continued receiving the injections. In less than a month, a donor was confirmed for her and she is now pregnant with her first child.
EASIER WITH LESS RESTRICTIONS
Childless couples in Singapore are also drawn to the more relaxed guidelines surrounding fertility treatments in Johor Baru.
Though surrogacy and sex selection are usually not allowed there either, women aged above 45 can go for IVF and there is no limit to the number of embryos that can be transferred to the woman's womb, though the doctors interviewed said they do not usually transfer more than three. Two are transferred if the woman is young and the quality of the embryos is good.
Dr Fabian said he may allow four embryos to be transferred if the woman is older than 40 years old and the embryo quality is poor.
In Singapore, revised guidelines by the Health Ministry last year mandated a maximum of two embryos to be transferred into a woman through IVF, instead of three previously.
Having more embryos transferred increases the chances of a woman having a multiple birth - or giving birth to more than one baby from a single pregnancy. Multiple pregnancies are associated with problems such as premature births and low birth weights.
Under the revised guidelines, women aged above 45 also have to get an authorised doctor to appeal to the authorities if they want to have IVF. They were not allowed to undergo IVF previously.
The doctors in Johor Baru said they allow women aged above 45 to go through IVF only if they are fit for pregnancy.
Dr Tan said: "They need to undergo tests to show that they are not in menopause, that they are still producing eggs and that their reproductive system is still healthy."
They also need to be free from infectious diseases and other diseases such as heart and kidney diseases which may compromise the pregnancy, said Dr Thokha.
TMC Fertility Centre requires couples to produce a letter from a Singapore doctor to show that they are fit for pregnancy.
It is now treating a 50-year-old Singaporean woman undergoing IVF using donor eggs.
But the number of older women who managed to have a baby through IVF at the centres has been low, said the three doctors.
Of the handful of Singaporean women above 45 who have gone through IVF in their centres, none were successful.
CHEAPER FOR SOME
For certain groups of people in Singapore, having IVF in Johor Baru may also be cheaper, said Dr Tan.
These include expatriates, who, unlike Singaporeans, do not have the compulsory medical savings account, Medisave.
Singaporeans can withdraw $6,000 from their Medisave to pay for their first IVF attempt.
Dr Tan said he has been seeing a steady rise of expatriates from Singapore, from a handful a few years ago, to one to two every month. They include Japanese, Russian and Swiss women.
In Malaysia, each IVF attempt costs between RM$14,000 (S$5,600) and RM$20,000.
In Singapore, an unsubsidised IVF cycle costs between $8,000 and $11,000 at public hospitals, and up to $15,000 at private centres.
It also helps that the centres boast of comparable IVF success rates to Singapore, ranging between 35 and 50 per cent.
And when the Causeway is not clogged up by cars, travelling there can be a breeze.
Some patients who live in the northern part of Singapore said it takes only 20 to 30 minutes to reach their clinics in Johor Baru.
The waiting time is usually not more than an hour and the service is more personalised, they said.
As IVF becomes more widespread in Malaysia, the guidelines will probably also become stricter.
But until that happens, people in Singapore will continue to cross the Causeway to seek fertility treatments, said the doctors.
However, Professor P.C. Wong, head and senior consultant at the division of reproductive endocrinology and infertility at the National University Hospital, sounded a word of caution for Singapore couples who wish to seek fertility treatment in Johor Baru.
He said: "Couples need to consider factors such as the overall cost of treatment and the travelling time between Singapore and the overseas centre each time a review is required."
For instance, IVF patients typically need to make three to five visits per treatment cycle.
More embryos transferred at a time also increase the chances of multiple pregnancies and its associated problems, he said.
Women above 45 who hope to undergo IVF in JB should also be mindful that their chances of conceiving is less than 0.5 per cent, he said.
In other words, fewer than one in 200 women aged above 45 undergoing IVF will get pregnant.
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