It was recently announced that, as of 2023, Singaporean women between the ages of 21 and 35 will be able to undergo elective egg freezing. Given the years of debate that preceded this decision, it’s no wonder that the shift is a monumental win for many Singaporean women.
Until now, egg freezing—which involves the retrieval and preservation of a woman’s eggs so that they may be used for in vitro fertilisation (IVF) at a later stage to try for pregnancy—had been limited to married couples and women with fertility-impacting medical conditions in Singapore. With egg freezing now set to become available for single women in Singapore (provided that they fall into the approved age groups—and with the condition that actual IVF processes may only be undertaken when or if they marry), it’s an undoubted step forward for women to take more control of their fertility journeys. We’re no stranger to the prevalence of IVF in popular culture, thanks to open experiences of famous figures such as Michelle Obama and the Queen of Malaysia who recently revealed that she had undergone 16 rounds of IVF before finally becoming pregnant.
However, while egg freezing can certainly assist in achieving pregnancy, this isn’t to say that the process is an easy or simplistic one. With considerable risks, resources and further steps involved in this pathway to becoming pregnant, there is much that women thinking about the procedure may be unaware of. In light of National Infertility Awareness Week this 24 to 30 April, Vogue Singapore spoke to four inspiring women from non-profit community Fertility Support SG who have undergone egg extraction. Here, they share what they didn’t know—and what they wish they had—prior to the procedure.
Egg freezing: Managing your expectations
Think of egg freezing as an expensive but for many, necessary lottery ticket. Egg freezing is no guarantee of becoming pregnant. The chances of becoming pregnant from one full cycle of IVF are approximately 40 per cent for women under 40, but fall to around 15 per cent once women reach 40, according to figures reported by the Advanced Centre for Reproductive Medicine and the Health & Fertility Centre for Women. These figures are dependent upon both a woman’s age at the time of egg freezing (with an older maternal age correlated with a lower likelihood of full-term pregnancy) and number of frozen eggs.
Business transformation executive Rafidah Jalil, who underwent egg extraction in her early 30s, wishes more woman knew, “Egg retrieval is just one small part of the entire IVF procedure.”
“The number of eggs retrieved does not equate to the number of embryos you will eventually produce.”
“Women undergoing this process need to [educate themselves] on the full end-to-end process of IVF, studying success rates and understanding the risks involved,” Jalil cautions.
There may be several rounds of both egg retrievals in the wider IVF process. For entrepreneur Velda Tan, who also underwent egg extraction in her early 30s, “I think the hardest part of egg extraction was to accept the high attrition rate. At my last round of retrieval, I managed to extract 15 eggs, of which seven were considered viable for fertilisation. Eventually only one of these made it to the blastocyst stage.” Sadly, she then miscarried. This closely reflects the uncertainty that is likely to be faced across each round of egg freezing and IVF. Given the several stages involved—from retrieval to freezing, then in IVF thawing, fertilisation and development—the count of viable eggs can be expected to drop across each.
As admin executive Josephine Foong, who had her first IVF procedure in the same age range of her early 30s, points out, “You may be able to retrieve a good number of eggs, but not all will survive the next stages.”
How to improve egg quality
Echoing these sentiments, Sueanne Yao, a financial consultant who first went through egg extraction in her late 20s, wishes she had known more about the importance of egg quality as opposed to merely quantity. “In my first egg retrieval, I retrieved 14 eggs, and in my second retrieval 13 eggs. Within each round, only two reached day six of the blastocyst stage. None made it further as they were of poor to average quality. After implantation failures and miscarriages, I did my own research and changed my diet completely.”
These included avoiding sugar, processed carbohydrates, gluten, and additives such as pesticides added to non-organic fruits and hormones added to meat. In addition to her diet changes, Yao also “stopped using plastics, as BPA affects fertility negatively too.” Yao then replaced plastics with glass water bottles or flasks. The changes paid off, as Yao’s third egg retrieval yielded five good quality eggs, from which her two daughters were conceived.
Books such as Rebecca Fett’s It Stars with the Egg is oft-cited as a valuable resource for those on their egg freezing journey and outline supplements such Coenzyme Q10, vitamin D and R-Lipoic Acid for boosting egg quality.
Similarly, Tan shares, “I wish I had known that it requires hard work to produce good quality eggs.”
Jalil expresses regret over the lack of information officially provided, saying, “I wish I’d had a full list of resources such as foods and supplements I could have taken to improve my egg count and quality.”
Often, women undergoing egg extraction and freezing will need to take it upon themselves to research such advice independently. Other fertility-enhancing tips include ensuring you have the recommended seven to eight hours of quality sleep a night to manage both stress and hormone levels; and avoiding common chemicals found in fragrance—not only in perfumes but other scented products from soaps to lotions—such as phthalates, oxynols and parabens.
What to expect when freezing your eggs
“The process of egg freezing usually lasts between 12 to 14 days and it is important to be relaxed and have minimal stress before starting the cycle,” advises leading obstetrician and gynaecologist Dr Shakina Rauff of Gynecology Associates. “Self-injectable hormones will be prescribed and started on the second or third day of your period – the aim of these medications are to stimulate the growth of multiple follicles. A second type of injection will be added about one week into the cycle to prevent the follicles from ovulating.
“During the 12 to 14 days, you will be monitored by serial ultrasound scan every three to four days to ensure the follicles are growing appropriately and to adjust the dosages of medication if necessary. Side effects of these injections may cause bloating, pelvic heaviness, bruising, soreness and mood swings etc—these side effects will resolve once the egg retrieval is over and your next period ensues,” Dr Rauff explains.
In the lead up to egg retrievals, some may choose to consult a TCM doctor for regular acupuncture sessions in order to increase blood flow to the uterus.
The process of extracting the eggs however, is fairly straightforward and can take anywhere from 30 to 45 minutes. After fasting the evening before, you’ll be wheeled into the operating theatre and be sedated before your eggs are then retrieved from the uterus. You’ll be able to leave your clinic after a few hours of observation and are advised to relax for the rest of the day. After-care involves rest and refraining from sexual intercourse, till a time recommended by your doctor.
The cost of egg freezing in Singapore
As the new egg freezing laws dawn in Singapore, now more women than ever will be able to look into increased options for their fertility journeys. The decision to freeze your eggs is not one to be made lightly. Whether you’re looking to take the public or private route, there’s the cost to consider. While the estimated cost of one egg freezing cycle in Singapore is around $10,000, based on pricing at Mount Elizabeth Fertility Centre, it’s currently unknown whether elective egg freezing will be able to be subsidised. There’s also further costs to consider such as that of IVF—the next step after egg retrieval, which transfers the fertilised egg or blastocyst into the womb and is essential for pregnancy to occur. As an indication of average expected costs for a full IVF cycle in Singapore, Thomson Fertility Centre prices their treatments between $13,000 and $19,000.
Subsidy-wise, Medisave withdrawals for IVF treatment are available for Singaporeans and Permanent Residents, capped at $15,000. Withdrawal limits for individual treatment cycles are $6,000 for a first cycle, $5,000 for a second, and $4,000 for a third.
“It can be very challenging to arrange taking time off from work to go for these appointments, such as regular scans to monitor progress. It’s rather rare for companies to understand and be accommodating,” says Yao
At a time when reducing your workload may be necessary to reduce your stress levels for both your fertility and mental health, it’s important to be aware of exactly what financial and work life adjustments you will need to make.
The role of mindfulness and mental healthcare in your fertility journey
Unsurprisingly, the time, effort, pressure and uncertainty that accompanies egg freezing can take a serious toll on mental health. “It was hard to think that I could have done better in preparing my body to produce better quality eggs,” shares Tan. “There was a lot of self-blame.”
“The most challenging aspect of egg extraction for me was the continuous stress and pressure,” Jalil says of the uncertainty that accompanies constantly waiting on a doctor’s report of the all-important numbers—whether of eggs that can be retrieved, how many eggs can be fertilised, and how many eggs survive at each stage. “When the numbers you hear aren’t high, it’s stressful, because there’s really nothing much you can do.”
During this time, being able to rely upon a strong support network becomes paramount. All four women Vogue Singapore spoke to identified this as a key way that they were able to endure the difficult times. These include supportive partners, family, friends and community groups such as Fertility Support SG. “Knowing people who have been through the same process helps, as they definitely know what you are going through,” says Yao.
Crucially, high stress levels also impact fertility negatively, adding to the need to look after mental health during this period. “I took time off from my high-stress job, used an app called Mindful IVF, sought help from mental health professionals, and booked fertility acupuncture and self-fertility massages to help me relax,” shares Rafidah of the numerous steps she took to look after her mental wellbeing.
Ultimately, practising self-love and prioritising self care are among the most important things that you can do for yourself during this period. While investing so much energy into hopefully bringing a new life into this world, remembering to take care of you is just as important. “For women considering or going through this process, do not be too hard on yourselves,” advises Yao. “There are a lot of things beyond our control.”