Tuesday 17 December 2013

More seeking help to conceive despite low success rate

Jump comes after govt funding for couples kicked in
By Poon Chian Hui, The Straits Times, 16 Dec 2013

ALMOST 1,000 more attempts were made by couples who sought help in conceiving last year, compared with 2008, the year the Government started funding assisted births, Ministry of Health (MOH) figures show.

The surge comes despite what doctors lament is a dismal one-in-five rate of success in assisted methods such as in-vitro fertilisation (IVF).

Dr Loh Seong Feei, medical director of Thomson Fertility Centre, described the rates as "a bit of a disappointment", and feels that it should be improved.

MOH's figures showed 2,912 assisted reproduction cycles were carried out on Singaporeans last year, up from 1,916 in 2008.

In all, 16,853 women here have received treatments to conceive over the five-year period. Six in 10 are Singaporeans; the rest permanent residents and foreigners.

Some 1,268 babies were conceived through assisted methods in 2011, 36 per cent more than in 2008. But over the same period, the successful birth rates were only between 21 per cent and 24 per cent, which some doctors said were "way too low".

Dr Loh cited the age of women seeking help as probably the main reason. The chances of pregnancy drop exponentially after a woman is past 35. The problem may also lie with the men as some have low sperm count.

Doctors said the biggest jump in people seeking help happened in the year after the start of government co-funding in 2008. The number of Singaporeans who underwent assisted reproduction cycles jumped 37 per cent in 2009.

From 2008, couples could get 50 per cent co-funding for attempts to conceive, up to three cycles via assisted methods in public hospitals. This was revised in January to up to 75 per cent, with the number of cycles doubled to six.

Dr Yu Su Ling, a senior consultant in obstetrics and gynaecology at Singapore General Hospital, noted the surge at the hospital after co-funding kicked in.

"We have couples who, after the first cycle, are already thinking about the next cycle. People are more willing to try again."

Professor P.C. Wong, who heads reproductive endocrinology and infertility at National University Hospital, said affordability is a key issue, given that two in three women who had sought help get pregnant only after at least three attempts. Yet IVF treatments can be prohibitively costly, with each round costing at least $10,000, he added.

Since 2008, MOH has handed out more than $24 million in co-funding to pay for 8,500 cycles. Its figures also showed that the average age of mothers was 33, indicating women are not leaving it too late to conceive babies.

"It's always good to try early if you need IVF," said Dr Seng Shay Way of Raffles Fertility Centre. Women below 35 can consider medical help if they fail to conceive after trying for one year, while those over 35 should do so after six months, added Dr Seng.

Meanwhile, doctors suggest relooking at certain regulations to further assist couples.

Allowing clinics to do early screenings of embryos for genetic problems, for instance, could help avert miscarriages or abortions, said Dr Ann Tan, specialist in obstetrics and gynaecology at Mount Elizabeth Fertility Centre.

Co-funding should also be extended to private clinics, said Dr Loh. This can lead to "more optimal" use of resources, as eight of the 11 assisted reproduction centres here are in the private sector.

Patients like Madam Lee (not her real name) hope it can be extended to older women. Co-funding is open to women below 40. She was able to tap the scheme only once in 2010. But it took five cycles totalling about $40,000 before she became pregnant.

Said Madam Lee, in her early 40s: "It is a lot of money with no guarantee that it will work."

Rise in assisted treatments and births

Assisted reproduction cycles carried out on Singaporeans

- 2008: 1,916

- 2012: 2,912

Women who received treatments via assisted methods from 2008 to last year: 16,853

- 60% Singaporeans

- 22% permanent residents

- 18% foreigners

Babies conceived through assisted methods

- 2008: 932

- 2011: 1,268

- 63% conceived in public hospitals, 37% in private centres

Successful attempts from 2008 to 2011 (fresh embryo cycles that resulted in live births)

- Between 21% and 24%

2,500 Medisave claims made last year to pay for treatments


Seventh Time Lucky
By Poon Chian Hui, The Straits Times, 16 Dec 2013

WHEN medical tests carried out at Thomson Fertility Centre showed she was pregnant, Madam Thay Putheaneath, 34, asked her husband: "Can you slap me?"

The reaction of the permanent resident was understandable, as she had undergone six failed attempts at conceiving via in-vitro fertilisation (IVF).

"To be honest, after four tries, I did not want to continue any more," said the part-time translator, who is originally from Cambodia. "Every time it failed, I cried - until I felt nothing."

The treatments were also very costly, said her husband, Mr Vincent Toh, 53, a Singaporean businessman.

"We wanted to give up," she recalled. "I even told my parents, I want to surrender."

The difference on her seventh attempt to conceive via IVF, Madam Thay reckons, was the use of traditional Chinese medicine. On the advice of physicians at Thomson Medical, which runs the fertility centre, Madam Thay drank bitter herbal concoctions and underwent acupuncture for nine months.

She is now three months pregnant and counts herself lucky she was able to conceive before 35 - the age after which a woman's fertility generally declines drastically.

The couple paid an estimated $100,000 for the seven rounds of IVF.

"When we spend, what we want the most is to be successful," she added.

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