IVF (In Vitro-Fertilization), is a common procedure that many women turn to when they struggle to conceive naturally.
Generally, doctors encourage women to try natural pregnancy for at least 6 months before considering IVF as an option.
In Singapore, women of any age can choose to undergo in-vitro fertilisation (IVF) should they be suitable for the procedure.
IVF is part of a range of measures by the Singapore government to support marriage and parenthood since fertility rate in Singapore stands at 1.14, which is below the replacement rate of 2.1.
One of the reasons for fertility problems in Singapore stems from the fact that Singaporeans are marrying later, thereby negatively impacting fertility rate.
Besides setting up a family at a much later time, fertility problems such as endometriosis, low sperm count, fallopian tube problems, fibroids and polycystic ovarian syndrome (PCOS) are not uncommon to women in Singapore.
The combination of late pregnancy and fertility problems have seen many women in Singapore facing a challenging time conceiving. And thus, many of whom see IVF as a catalyst for starting a family.
This article will explain more about IVF, the procedure, side effects, costs, subsidy, and also alternatives to IVF.
What is In-Vitro Fertilisation (IVF)?
Assisted reproductive technology (ART) is used to treat infertility, and IVF is the most common and effective type of ART.
IVF works by combining the use of medicines and surgical procedures to help the sperm fertilise an egg.
During IVF treatment, mature eggs are retrieved from the ovaries. The highest quality eggs are then selected to be fertilised by sperm in a laboratory, and upon successful fertilisation, the implantation of the embryo into the uterus.
What is the process during the IVF procedure?
Here is the typical treatment process of IVF procedure in Singapore:
Step 1 of IVF: Stimulating your Ovaries
The first day of your period is day 1 in your IVF treatment cycle. You will be prescribed medication specific to your body to stimulate your body to produce the eggs. In a natural cycle, your body normally produces 1 egg, but the goal of an IVF cycle (with hormonal medication) is to produce multiple eggs to increase your chances of getting pregnant. The average number of eggs collected during IVF is between 8 – 20. The most common hormonal medication is follicle-stimulating hormone (FSH) or luteinizing hormone (LH), and is usually in the form of injections.
Step 2 of IVF: Egg Retrieval
Sedation will be administered to ensure comfort during the egg retrieval procedure, and it usually lasts 30 minutes.
Your fertility doctor will guide a needle into each ovary to retrieve the egg. The egg can’t be seen with the naked eye, so your doctor will collect the fluid within the follicles in your ovaries which contains the eggs.
You will be able to walk after the procedure, but you won’t be able to drive.
Step 3 of IVF: Sperm Collection
There are two forms of sperm collection. The first involves frozen sperm, which was collected and stored prior to egg collection. The second involves fresh sperm, and a special semen collecting device may be prescribed to assist with sperm collection.
The sperm will undergo sperm washing to remove chemicals that can cause complications in the uterus, and also to remove dead or low quality sperm to ensure the highest chance of success.
Step 4 of IVF: Fertilisation
The retrieved eggs are placed together with the washed sperm in a special chamber to find each other and fertilise like they would naturally in your body. It could also be injected directly into the egg.
Step 5 of IVF: Embryo Development
If the sperm fertilises an egg, it becomes an embryo. The embryo is then placed into an incubator with ideal conditions to ensure a healthy embryo develops.
Step 6 of IVF: Embryo (Blastocyst) Transfer
The best quality embryo, or known as blastocysts, is then transferred into the mother’s uterus. The blastocyst is placed into a very fine catheter that is passed through the cervix into the uterus. During the next two weeks, you will be advised to have adequate rest and to refrain from strenuous activities.
Step 7: Pregnancy Test
Two weeks after the blastocyst transfer, you will undergo a urine or serum test for pregnancy. If the test shows a positive result, a foetal viability test will be performed a few weeks after to confirm the pregnancy.
Who is IVF suitable for?
IVF is suitable for people with the following conditions:
Endometriosis occurs when the uterine tissue which normally lines the inside the uterus grows outside of it instead. This commonly affects the ovaries, fallopian tubes and the tissue lining the pelvis.
- Fallopian Tube Damage or Blockage
With the fallopian tube damaged or blocked, this makes it difficult for an egg to be fertilised and also for the egg to travel to the uterus. IVF will thus implant the embryo directly into the uterus, bypassing the fallopian tube.
- Low sperm quality
Low sperm quality or poor sperm count can make it difficult for the sperm to fertilise an egg.
Fibroids in the uterus can interfere with the implanting of a fertilised egg in the uterus.
- Genetic Disorder
If you have a risk of passing on a genetic disorder to your child, you can undergo preimplantation genetic testing, a procedure which involves IVF. This allows the egg to be screened for certain genetic conditions, and screened embryos that do not have the genetic condition can then be selected for implantation.
- Previous Tubal ligation
If you had tubal ligation previously, IVF can bypass the fallopian tube for direct implantation into the uterus.
- Unexplained fertility
If after trying for a considerable amount of time and you are still not able to conceive despite no causes of infertility, IVF could be the option for you.
Side Effects of IVF
After the IVF procedure, your doctor will advise you to have adequate rest and to refrain from strenuous activities. However as with most medical procedures, there are potential side effects.
The side effects include:
– Breast tenderness
The side effects of the injectable fertility medicines include:
– Mild bruising from the injectables
– Allergic reaction from the shots
– Abdominal pain
– Breast tenderness
– Mood swings
– Ovarian hyperstimulation syndrome (OHSS)
What is the success rate of IVF in Singapore
IVF success rate is calculated with the number of clinical pregnancies after IVF, or the number of successful live births after IVF.
There are many factors that can affect the success rate of IVF in Singapore, and that includes age, weight and also the cause of infertility. As a general guide, the younger the age, the higher the chance of IVF success. The older the age, the lower the chance of IVF success.
In Singapore, the average success rate of IVF ranges between 40% – 60%.
What is the cost of IVF in Singapore?
In Singapore, IVF is offered in government hospitals, private hospitals and private fertility clinics.
IVF Cost at Government Hospitals
Here are the government (public) hospitals for IVF in Singapore. They are also known as Public Assisted Reproduction (AR) centres.
– KK Women’s and Children’s Hospital – KKIVF Centre
– Singapore General Hospital – Centre for Assisted Reproduction (CARE)
– National University Hospital – Clinic for Human Reproduction
Should you decide to opt for a government hospital for IVF, the rates are subsidised and the cost will range between $8000 – $14000 for one IVF cycle.
IVF Cost at Private Fertility Centres (Hospitals and Clinics)
Here are some of the popular private fertility clinics for IVF in Singapore:
– Thomson Fertility Centre
– Mount Elizabeth Fertility Centre
– Women Fertility & Fetal Centre
– Health & Fertility Centre for Women
Should you decide to go to a private clinic or hospital for IVF, the cost will range between $12,000 – $25,000 or one IVF cycle.
What is the amount of subsidy for IVF in Singapore?
You can decide between the public and private route for your IVF treatment.
Government subsidy for IVF at Public Hospitals
The government has Co-funding for Assisted Conception Procedures (ACP) in public Assisted Reproduction (AR) centres. This means that one can receive up to 75% in subsidy from the government.
The subsidy for IVF under the umbrella of Assisted Reproduction Technology (ART) treatment can be used for a maximum of 3 fresh and 3 frozen ART cycles.
2 co-funded cycles (out of the existing 6 cycles) can be carried out at age 40 or later, as long as the couple has attempted ART procedures before age 40.
The amount of subsidy (co-funding) for IVF depends on the citizenship of the couple.
Co-funding per Treatment Cycle
Singapore Citizen couple
Fresh ART Cycle
75%, up to $7,700
55%, up to $5,700
35%, up to $3,600
Frozen ART Cycle
75%, up to $2,200
55%, up to $1,600
35%, up to $1,000
The co-funding scheme covers ART procedures such as in-vitro fertilisation (IVF) and its variations (with or without intracytoplasmic sperm injection (ICSI), in-vitro maturation, donor cycles and double stimulation cycles), as well as gamete intra-fallopian transfer (GIFT). All the standard procedures, from ovarian stimulation, thawing of the embryo to embryo transfer, can be considered for co-funding. However, initial consultations and investigations prior to a patient’s decision to start ART treatment are not included.
You are eligible for ACP co-funding if you meet ALL of the following criteria:
For ART Co-Funding:
– You are below 40 years of age at the start of the ART cycle (except for the last two cycles of ART for couples who have attempted ART/IUI before age 40, from 1 Jan 2020)
– You have not already received 3 co-funded fresh and 3 co-funded frozen cycles in the past
– You have been assessed by a doctor to have met the clinical requirements for ART
– You OR your spouse must be a Singapore Citizen at the start of the ART cycle.
Government subsidy for IVF at Private Fertility Clinics
Should you choose to go for IVF at a private fertility centre or a private hospital, there is currently NO subsidy (co-funding) available from the Government.
How do I apply for the subsidy (co-funding) for IVF?
Once again, the subsidy is only available if you go to a Public Assisted Reproduction Centre (Public Hospital), which means SGH, KKH and NUH.
To apply, all you need is to fill up a declaration form provided by the hospital, which will be used to check your eligibility for the co-funding scheme.
Once the hospital has verified that you are eligible to receive co-funding, the hospital will incorporate it automatically into your bill.
Can I use Medisave for IVF in Singapore?
Yes you can! If you choose to go to a public Assisted Reproduction (AR) centre at a public hospital, you can also enjoy the subsidy (co-funding) provided by the government on top of using your Medisave.
Regardless of private or public, couples can withdraw the following amounts from Medisave for IVF.
Medisave Withdrawal Limit
3rd treatment (if applicable)
Lifetime Withdrawal Limit
When should you start considering about IVF?
If you’re between 30 and 35, you should try to conceive naturally for at least six months before considering IVF.
Are there other fertility options besides IVF in Singapore?
– Egg freezing
If you choose to freeze your eggs in order to get pregnant in future, egg freezing could be the solution for you. In Singapore, egg freezing is only allowed on medical grounds. Should you decide to freeze your eggs, you would have to do so overseas.
– Intrauterine Insemination (IUI) / Artificial Insemination
IUI involves injecting sperm inside the uterus to facilitate the fertilization of the egg. IUI seeks to increase the number of sperm that reaches the fallopian tubes so as to increase the chances of fertilization. This is a low complexity procedure as compared to IVF. Couples that undergo IUI typically involve a male partner with low sperm count or poor sperm volume.
– Intracytoplasmic Sperm Injection (ICSI)
ICSI is typically combined with IVF as a fertility treatment. ICSI is used for males diagnosed with low sperm count or poor sperm quality. ICSI treatment involves having a skilled embryologist use very fine micromanipulation equipment to inject a sperm into each egg.
– Intracytoplasmic Morphologically-selected Sperm Injection (IMSI)
IMSI is used for males diagnosed with reduced levels of sperm morphology or with mid or high range damaged DNA sperm. If ICSI treatment doesn’t work, IMSI would be the next treatment after ICSI.
This technique allows the scientist to enlarge the image of the sperm by 1200 times. The most appropriate sperm of predefined size and shape is then selected to be injected into the egg.
IVF in Singapore
Since the advent of IVF, it has greatly enabled many couples who were previously not able to have children, to finally have children of their own.
Although the process may be tiring and complicated, the upside to this procedure is that there is financial support available in Singapore.
There is absolutely no shame in lending help from IVF to help you conceive.
Let this article serve as your guide to IVF journey in Singapore, and here’s wishing you a successful pregnancy!