If you’ve been trying every night but there’s still no bun in the oven, going for in-vitro fertilisation or IVF in Singapore might just be the godsend you were waiting for.

The good news is that IVF is a lot more accessible (and yes, affordable too, thanks to subsidies) these days than it used to be.

Recently, the cap on the number of IVF cycles has been removed and the age limit of 45 will also be lifted. This means more women can go through IVF to conceive a baby.

Here’s a guide to the IVF process and cost of IVF treatment.

WHAT EXACTLY IS IVF?

IVF, or in-vitro fertilisation, is a procedure where eggs are extracted from a woman’s ovaries, then fertilised in a lab dish with sperm retrieved from her husband. (Yes, IVF treatment is only available for married couples in Singapore.)

The embryo(s) are allowed to grow for 3 to 5 days before being implanted into the woman’s uterus. Within 2 weeks, you’ll know if it’s successful.

The odds of becoming pregnant with IVF is 20% to 40%, falling as the woman’s age rises.

Because its success decreases with age, women over 45 years old are not allowed to undergo IVF in Singapore before 2019.

From 1 Jan 2020, this limit will be lifted. 

Currently, a woman can undergo a maximum of 15 cycles, 10 before the age of 40 and 5 after that age. From 1 Jan 2020, this cap will be lifted as well.

IVF is a form of assisted reproductive technology (ART). You’ll see this medical term being used quite a bit when you research the options in Singapore.

WHO IS IVF SUITABLE FOR?

Typically, it’s recommended for couples who are unable to get pregnant despite actively trying for at least a year (or 6 months for women aged 35 and older).

There are many underlying reasons why people have problems conceiving.

Your doctor might recommend IVF if you have any of the following: blocked or damaged fallopian tubes, endometriosis, ovulation problems, uterine fibroids, low sperm count or motility, or just plain old unexplained infertility.

Sometimes, IVF is considered because of illnesses. For example, those undergoing cancer treatment that may affect fertility – chemotherapy and radiotherapy – may opt to freeze their eggs or sperm for IVF later.

Finally, people who are concerned about genetic disorders also opt for IVF as you might be able genetically screen IVF embryos before they are implanted.

However, this is not widely available in Singapore due to fears of people abusing the screening (e.g. choosing the sex of the baby).

It’s currently only available as part of an NUH trial, and is only available to women aged 35 years and up, and have experienced at least 2 failed pregnancies or implants.

WHAT'S THE IVF PROCESS LIKE IN SINGAPORE?

The entire IVF process (called a “cycle”) takes 4 to 6 weeks in total.

Bear in mind that couples usually require at least 2 cycles to become pregnant. Here’s what usually happens during each IVF cycle.

STEP 1: OVARIAN STIMULATION 

The woman has to give herself fertility medication via injections to stimulate multiple eggs to grow in the ovaries rather than the normal single egg each month. 

Multiple eggs are needed because not all will become fertilised or developed after they’ve been retrieved.

There are also injections to prevent early ovulation. In all, you’ll need to give yourself 2 to 3 injections a day, over 10 days or more.

STEP 2: MONITORING 

While this is going on, the woman needs to see the doctor 2 to 3 times for a transvaginal ultrasound to examine the ovaries and the development of the eggs as well as for blood tests to check the hormone levels.

Once ready, the woman is given a hormone injection to prepare the eggs for final maturation so they can be retrieved.

STEP 3: EGG RETRIEVAL

36 hours after the hormone injection, the eggs are retrieved. This is a 5 to 10-minute procedure done under sedation.

An ultrasound probe is inserted into the vagina, and a hollow needle guided beside it is inserted into the pelvic cavity to collect the eggs.

STEP 4: SPERM SAMPLE RETRIEVAL

The man is asked to contribute a sample of his sperm. If the sperm is healthy, it’s prepared with a technology called sperm capacitation that allows it to fertilise the egg outside of the body.

STEP 5: INSEMINATION

A sample of healthy sperm is mixed together with each egg and stored in a laboratory dish for nature to take its course.

If the chance of fertilisation is low, a single sperm may be injected directly into the egg.

This procedure is called intracytoplasmic sperm injection.

Then, the eggs are monitored for 2 to 5 days to confirm that fertilisation has taken place and cell division is under way.

The doctor then selects the most viable embryos for the next stage – implantation.

STEP 6: EMBRYO TRANSFER

The embryo(s) are transferred to the woman’s uterus using a catheter (small tube) that is guided into the cervix via ultrasound.

If it works, implantation usually takes place between 17 to 18 days after egg retrieval.

IVF SINGAPORE COST GUIDE

As with all medical procedures in Singapore, you’ll have to decide between going to a public hospital or a private hospital/medical institution.

If you go the public route, it’s usually cheaper at $10,000 to $15,000 per cycle as the rates are subsidised. You can go to:

• KK Women’s and Children’s Hospital
• National University Hospital
• Singapore General Hospital

For private medical centres, expect to pay higher rates of $12,000 to $20,000 per cycle. However, not all private clinics are more expensive.

For example, Thomson Fertility Centre has a $7,999 package. Here are some of the more popular private IVF clinics:

• Thomson Fertility Centre 
• Mount Alvernia Fertility Centre
• Gleneagles IVF Centre
• Mount Elizabeth Fertility Centre
• Raffles Fertility Centre
• Parkway East Fertility Centre

Each package usually includes ultrasound, egg collection, egg transfer, lab charges, nursing fees, use of the operating theatre and recovery room. Below is a general indication of how the costs break down.

However, IVF packages DON’T always cover the doctor’s consultation, medication, lab fees and optional procedures. 

So you might need to pay more for these.

In the case of optional procedures to improve your chances of conceiving, expect to pay an extra $150 to $600 (for laser-assisted hatching) or $150 to $300 (blastocyst culture).

ARE THERE ANY SUBSIDIES FOR IVF?

Yes, there are! The government really wants Singapore citizens to have babies, so there are a few ways to help keep the costs manageable.

You can get up to 75% of the costs co-funded by MOH. 

You also have the option to pay for your IVF costs by Medisave.

MOH CO-FUNDING

Since 2013, the Ministry of Health (MOH) has a co-funding scheme of up to 75% for assisted reproduction treatments at public hospitals, up to 3 fresh and 3 frozen cycles.

As long as one person in the couple is a Singapore citizen, you are eligible for this co-funding although you enjoy more subsidies if both are citizens.

USING MEDISAVE 

In addition, a Singaporean or PR couple can use their Medisave to help pay for IVF treatment:

There is, however, a cap on how much can be withdrawn for such Assisted Conception Procedures (ACP) – $15,000 per patient in a lifetime.

INSURANCE CLAIMS

There are now more insurers that offer this: AIA, AXA and Pacific Prime Singapore.

But there may be a waiting period of 12 months or more before the coverage applies, so you need to get the policy well in advance.

OTHER CONSIDERATION BEFORE GOING FOR IVF

Apart from costs, there are a few other things to consider before you take the plunge and go for IVF.

IVF SUCCESS RATE 

The success rate of IVF in Singapore is, at best, just 40%.

MULTIPLE BIRTHS (TWINS OR MORE)

The more embryos implanted, the higher the chance of successful life births.

So, the odds of having multiple births with IVF is high (20% to 40%, compared to just 0.8% conceived naturally).

Multiple births come with risks to both mum and the babies who are usually born premature and have lower birth weights.

More babies also means a greater financial and childrearing burden, so be prepared to take on that risk.

IVF TREATMENT COMPLICATIONS

As with any sort of medical treatment, there’s always the risk of complications.

The fertility medication may give you headaches, mood swings, abdominal pain/bloating, hot flashes or (very rarely) ovarian hyper-stimulation syndrome.

The IVF procedure itself might also incur some side effects, such as mild cramping, mild bloating, constipation, breast tenderness and passing a small amount of fluid after the procedure.

COMMITMENT & TIME

Finally, the fertility treatment to extract the eggs requires a rigorous, daily regime of self-administered injections plus visits to the doctor. It takes commitment and time.

The IVF journey isn’t an easy one. But if you consider what could possible be at the end of the road – your own baby or babies, then maybe it might be a trip worth trying.

This article was first published in MoneySmart .