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Upon legalization of social egg freezing in Singapore from 2023 onwards, compulsory pre-procedure counselling is mandated for all prospective patients to enable informed choice about whether to undergo the procedure. Being a newly introduced medical procedure in Singapore, there are currently no clear directives on what pre-procedure counselling for elective egg freezing should entail. Due to pervasive media and internet influences, prospective egg freezing patients could be misled into believing that the procedure represents a guaranteed path to future motherhood, contrary to statements by professional bodies such as the American Society for Reproductive Medicine (ASRM) and the British Fertility Society (BFS). Hence, comprehensive counselling is recommended to provide women with evidence-based information (e.g. success rates of social egg freezing for women of their age) to ensure they make informed decisions and to avoid possible decision regret. For this purpose, a systematic protocol and methodology for pre-procedure counselling of women considering elective egg freezing was developed, incorporating flowcharts and decision trees that are specifically tailored to the unique sociocultural values and legal restrictions in Singapore. Questions relating to the why, what, how, where and when of the egg freezing procedure should be addressed, which could serve as a roadmap to facilitate informed decision-making by women considering elective egg freezing. [ABSTRACT FROM AUTHOR]

With social egg freezing being permitted in Singapore, there is expected to be an accumulated surplus of unused frozen eggs (vitrified oocytes) available for donation in coming years. A comprehensive update of current healthcare regulations pertaining to frozen egg donation is needed to resolve various pertinent ethical issues. In particular, the issue of egg donor anonymity should be addressed, together with the lack of sharing of medical and family information about the donor to prospective recipient patients and donor-conceived offspring. Rigorous and comprehensive genetic testing of prospective egg donors must be mandated to protect the welfare of recipient patients. Older women above 35 years of age should be required to have at least one child, before being allowed to donate their unused frozen eggs, to prevent any future regret and psychological problems of remaining childless, while being unsure of whether they have an unknown genetic offspring out there. New regulations drafted to address these ethical issues must also prevent potential conflicts of interests. For example, fertility doctors soliciting and encouraging former patients to donate their unused frozen eggs face an obvious conflict of interest, because additional medical fees will be earned by performing the egg donation procedure on other patients. A centralized donor registry should be established by the Singapore government to oversee the distribution and allocation of donated unused frozen eggs to infertile IVF patients. Such a registry could also facilitate sharing of vital health information about the donor to recipient patients and donor-conceived offspring. [ABSTRACT FROM AUTHOR]

Currently in Singapore, prohibitive restrictions on monetary reimbursement and compensation of egg donors have resulted in a severe shortage of donor oocytes for fertility treatment and scientific research. Financial compensation for egg donation has attracted considerable attention and debate in recent years as a practical solution to the growing demand for donor oocytes in Singapore. Some ethical guidelines and legislation for the recruitment and financial compensation of egg donors are proposed and discussed, including: first, egg donors should be reimbursed up to a limit for all direct expenses incurred, such as travel and accommodation costs; second, claims for loss of earnings and childcare expenses should be accompanied with documented proof and evaluated on a case-by-case basis; third, further compensation based on minimum wages or fixed-sum payment given to clinical trial volunteers is ethically justifiable, owing to the inconvenience, discomfort, pain, loss of time and medical risks faced by the egg donor. Nevertheless, payment of foreign egg donors from poorer countries should be prorated according to their actual wages, to avoid undue inducement; fourth compensation should be given for time spent in the program, even if the donor does not complete the program; fifth, medical professionals and scientists directly involved in fertility treatment or research should be completely excluded from the recruitment and compensation of egg donors; sixth, the import of donor eggs should be prohibited, to ensure legal and ethical consistency in donor compensation and informed consent policy; seventh, ovarian stimulation of foreign egg donors should not take place abroad; eighth, egg donors should preferably be restricted to Singapore citizens and permanent residents. Healthcare policymakers in Singapore should actively consult the views of medical professionals, biomedical scientists, religious and community leaders, as well as the general public, before reaching any decision on the recruitment and financial compensation of egg donors. [ABSTRACT FROM AUTHOR]

The rising incidence of age-related female infertility in Singapore, coupled with the prohibition on commercialized oocyte donation and egg sharing, has resulted in a severe shortage of donor oocytes. Infertile women are routinely encouraged by fertility doctors here to seek their close relatives and friends as prospective oocyte donors, which does not alleviate the shortage. A number of alternative solutions are discussed. The use of substantial financial remuneration to encourage oocyte donation is rejected as being legally, ethically and morally incompatible with present day Singaporean society. Egg sharing in return for subsidized fertility may have a strong case for ethical justification, but implementation would need amendment of the current legislation in Singapore. Cross- and mirror-exchange oocyte donations face less of a legal challenge in Singapore and also have a strong case for ethical justification. However, special consideration must be given to the unique socio-cultural values of Singaporean society, i.e. traditional Chinese culture. Finally, if no changes are made to restrictive regulations governing oocyte donation in Singapore, and shortage of donor oocytes still persists, then reproductive tourism abroad may be the solution for some patients; referrals by local fertility doctors are unlikely to be allowed in Singapore. [ABSTRACT FROM AUTHOR]