Dr Loh Seong Feei was interviewed by the Straits Times, in “More S'pore couples turn to IVF”, by Ms Jessica Jaganathan, 17 Aug 2008, article below and More S'pore couples turn to IVF At least 2,000 women seeking IVF treatment each year, and couples are spending at least $40 million annually on the fertility treatment. Sun, Aug 17, 2008 The Straits Times BY: Jessica Jaganathan MOTHERS like Madam Noor Azlinah Baharudin represent the flip side of Singapore's great baby debate - the ones who pray and wait for babies, without success. Having failed to conceive naturally, she and her husband tried fertility pills and artificial insemination before they finally found joy through in-vitro fertilisation (IVF). Baby Farah Hannah was born in November last year at the National University Hospital (NUH). She is one of the thousands of IVF babies conceived here over the last 25 years. 'It was an emotional roller-coaster ride for me and my husband,' said Madam Noor Azlinah, 36. 'When you see friends and cousins getting married after you and giving birth, it's so frustrating and you ask yourself, why me?' The housewife is now contemplating trying for a second child through IVF. This year marks the 30th anniversary of the birth of the world's first test-tube baby, Louise Brown. She was born in Oldham, near Manchester, England, in 1978. Five years later, Samuel Lee became South-east Asia's first test-tube baby when he was born to Mr Lee Chye Huat and Madam Tan Siew Ee in Kandang Kerbau Hospital, now known as KK Women's and Children's Hospital (KKH). Since then, the industry has boomed. From just KKH in the early days, there are now seven centres offering IVF, and all report brisk business. According to Health Ministry figures, 717 babies were born through assisted reproductive treatment - IVF being the most common - in 2006, the most recent year for which figures are available. This is more than five times the 141 babies born in 1993, a decade after the first IVF birth here. The Straits Times estimates that with at least 2,000 women seeking IVF treatment each year, couples are spending at least $40 million annually on the fertility treatment. 'More patients are aware of IVF now and they are also more open towards it,' said Dr Yong Tze Tein, obstetrician and gynaecologist at the Singapore General Hospital. Increased economic affluence has also allowed more couples to afford the costly treatments, she added. But cost is still an issue for many. Prices have doubled in the last decade from between $3,000 and $5,000 in 1990 to between $7,000 and $14,000 for each treatment now. On average, a couple goes through two IVF treatments, which can set them back by more than $20,000. They can withdraw $6,000 from their Medisave to pay for their first IVF attempt, and $5,000 and $4,000 for their next two. But many, like Madam Noor Azlinah, think that government subsidies should be given so that more can afford it. 'It would also be helpful if the various tests are subsidised as they can add up too,' she said. The housewife and her technician husband had to dig into their savings to pay more than $20,000 for the tests and treatments. The Government has never subsided assisted reproduction because it means less money allocated for the sick, Health Minister Khaw Boon Wan told Parliament in March 2004. The hefty price tag is pushing some Singaporeans to overseas centres like India, where treatments cost 1-1/2 times less. But even as more couples dig deep into their pockets to try for a baby, some doctors wonder if such invasive techniques should not be the last resort, given their high cost and low success rates. Dr Loh Seong Feei, head and senior consultant at the reproductive medicine unit at KKH, feels that it is more important for doctors to consider all options and not offer IVF as the first one automatically. Even with technical advances, success rates for IVF remain low, at about 25 per cent. KKH's Dr Loh Seong Feei, who has helped couples conceive babies through IVF, says the procedure is just one of several options.
One possible reason is that the average age of women seeking IVF treatments now has increased compared to a decade ago, say doctors. As more postpone marriage and parenthood, the average age of a woman wanting IVF now is 30 to 35. A decade ago, she would have been in her 20s. About 13 per cent are women aged above 40. To qualify, they must be below 45. A typical example is 44-year-old Madam Callie A., who gave birth to her first child in March this year on her third attempt. She decided to try for a baby at the age of 35, and was disappointed when her first go at IVF ended in a miscarriage. Her second try in 2006 was also unsuccessful. 'We decided to give it one last try and went for IVF a third time. I'm so glad it worked out,' said the retired project manager. Her healthy baby boy is now five months old. When asked about the age difference, she said: 'I'm concerned that I will look more like his grandma. But it's important to be young at heart, remain active and see it positively.' Professor P.C. Wong, head and senior consultant at the division of reproductive endocrinology and infertility at NUH, cautions women to be aware that the chances of conceiving - with or without assisting techniques - fall with age. 'They should not have a false sense of complacency and fall back on this technology. It cannot reverse the effects of age,' he said. Helping a couple to have babies SOME of the common assisted reproductive methods here: Fertility pills
These are taken in the first phase of assisted reproduction. The drug clomiphene is taken to trigger the ripening of eggs and their release from the ovaries into the fallopian tubes. Cost: Less than $1 for a cycle of five tablets. In-vitro Fertilisation (IVF)
After the ovary is stimulated to release eggs, the eggs are harvested and mixed with sperm in a laboratory dish so they are fertilised. Up to three resulting embryos are transplanted into the woman's body, and excess embryos are frozen for later use. Reproductive surgery
After a patient's problems in conception are assessed, she may be recommended surgery to, for example, clear her blocked fallopian tubes or to ready her womb for pregnancy.
Superovulation and Intrauterine Insemination (SO-IUI)
This procedure stimulates two to three eggs to ripen and be released. It is usually combined with intrauterine insemination, in which sperm is introduced into the womb.
* Rates are based on public hospital prices. This article was first published in The Straits Times on August 15, 2008.
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Curriculum Vitae First Name: Last Name: Marital Status: Married Address: Department of Internal Medicine, Nemazee Hospital, Shiraz, IR-Iran Medical School : Shiraz Uniersity of Medical Sciences Diplomat of American Board of Internal Medicine Diplomat of American Board of Endocrinology and Metabolism Professor of Medicine Publications: Pishdad GR, et al: The effect o