With the increasing trend of late marriages and delayed motherhood in Singapore, coupled with the lifting of age limits in IVF treatment since 2020, there is anticipated to be increasing demand for egg donation by older female IVF patients nearing or past menopause. Such women with diminished ovarian reserves often consider the egg donor option, after having failed IVF due to the reduced number and low quality of their retrieved eggs. In recent years, neighboring Malaysia has emerged as a popular destination for Singaporean IVF patients seeking egg donation, due to close proximity and cost-competitive medical fees. Nevertheless, there are various pitfalls that patients have to navigate through, as highlighted by the Q & A below. Cumbersome travel and quarantine restrictions due to the COVID-19 pandemic are economically unsustainable in the long-term, and it is only a matter of time before borders reopen, and Singaporeans are once again free to travel to Malaysia for IVF treatment.
Is it difficult to find a local egg donor in Singapore?
Yes, because Singapore health regulations require egg donation to be altruistic, and payment can only be made to reimburse direct expenses such as traveling costs. The egg donation process is lengthy, tedious and painful, involving a few weeks of regular hormone injections, frequent blood tests and ultrasound scans, finally culminating in day surgery for egg retrieval. Additionally, there is also the hassle and inconvenience of commuting to and fro for numerous medical appointments. Understandably, without any financial incentives, very few local young women are willing to donate their eggs.
Why go for egg donation in Malaysia?
A large pool of egg donors of different races and educational backgrounds are readily available in Malaysia because of generous financial inducements. Additionally, Malaysia has numerous IVF clinics and donor agencies that offer cost-competitive egg donation programs, which are much cheaper than other foreign countries such as USA, Australia and Taiwan. It is also much easier to source Asian egg donors in Malaysia, compared to Western countries such as USA and Australia. Moreover, Singaporean patients prefer to undergo IVF treatment at a destination close to home like Malaysia.
Are there any legal restrictions on egg donation in Malaysia?
Yes, only non-Muslim patients are allowed to receive egg donation. Shariah laws in Malaysia forbid Muslim patients from receiving egg or sperm donation.
What are the typical costs of egg donation in Malaysia (excluding medical fees)?
At the beginning of 2020, before the outbreak of the COVID-19 pandemic, egg donor agencies in Malaysia typically charge between 20k to 25K Malaysian ringgits, if you approach them directly. Egg donors are typically compensated between 5K to 8K Malaysian ringgits. Hence the gross profit margin of these agencies are typically between 12K to 20K Malaysian ringgits.
Which cities in Malaysia are good for egg donation?
Greater Kuala Lumpur and Penang. Most of the egg donor agencies are located here, and virtually all IVF clinics in Malaysia, even those from other cities and states, depend on these agencies to source egg donors for their patients.
What about egg donation in Johor that is much closer to Singapore?
Singaporean patients must beware that most egg donors in Johor come from out-of-town or out-of-state. As mentioned earlier, the overwhelming majority of egg donor agencies and agents in Malaysia are based in Kuala Lumpur and Penang, and IVF clinics in Johor rely on such agencies and agents to source egg donors for their patients. It is much more difficult to control and monitor the ovarian stimulation cycle of traveling egg donors from out-of-town or out-of-state, who reside far away from the IVF clinic. Such traveling egg donors may commute to the clinic for medical appointments, receive the hormone medications and then return to their hometowns where they are expected to self-inject for several days. Because supervision from the IVF clinic is not near at hand, the egg donor may not be bothered to strictly comply with such a painful and tedious routine of self-injections. If they are extra careless, the expensive hormone medications may not be kept properly refrigerated leading to spoilage and reduced potency. Without strict adherence to the injection protocol and proper refrigeration of hormone medications, the number and quality of eggs obtained from the donor will be severely compromised. Additionally, Singaporean patients must also take note that there are usually additional traveling and hotel costs associated with getting an out-of-town egg donor and her accompanying agency coordinator to travel to Johor.
Is it better to contact egg donor agencies directly, or get your selected IVF clinic to source egg donors from such agencies?
It is cheaper for you to contact egg donor agencies directly, and for them to arrange IVF treatment for you at their affiliated clinics, rather than getting an unaffliated IVF clinic to source egg donors for you from these agencies. Many egg donors agencies in Kuala Lumpur and Penang partner with their affiliated IVF clinic to offer special package deals that include egg donor costs plus medical fees. If you get an unaffiliated IVF clinic in Malaysia (particularly in Johor) to source egg donors for you, the clinic usually takes an extra cut of profit. For example, if the egg donor agency charges RM 25,000, the IVF clinic will charge you RM 30,0000, thereby taking a cut of RM 5,000 as additional profit.
Is embryo genetic testing necessary for egg donation?
Because it is unknown whether the egg donor is carrying any genetic defect, most Malaysian IVF clinics often recommend patients to do highly-expensive genetic testing of IVF embryos (PGS / PGT-A). This is completely unnecessary and a waste of money, if the egg donor is young and healthy, because chromosome abnormalities such as Down syndrome usually appear only in the eggs of older women. To evaluate whether the egg donor is carrying any unknown genetic defect, it is much cheaper to do genetic testing of the egg donor’s blood sample before starting IVF treatment. Moreover, you can also use NIPT (Non-Invasive Prenatal Testing) to screen for genetic defects in your unborn child after getting pregnant, which is also much cheaper than PGS (PGT-A). Although many fertility clinics claim that embryo genetic screening can improve the IVF success rates of older women, this usually refers to older women using their own eggs, which have a high incidence of chromosome abnormalities. PGS (PGT-A) will not improve the success rates of older women using a young egg donor. Patients must also beware of the risks of damaging the embryo during the ‘highly-delicate’ PGS (PGT-A) procedure, which involves extracting cells from the embryo after drilling a hole through the embryo shell (Zona pellucida).The smooth performance of this technique is often highly dependent on the skill and training of the laboratory staff (Embryologist). Even with high levels of training and accreditation, there is still a possibility of human error, particularly in a very busy laboratory that handles several such cases a day. Lastly, one must also beware that Malaysian IVF clinics often manipulate and play on the patient’s biased preference for either a boy or girl child, to persuade them to undertake embryo genetic testing for sex selection.
Should I choose fresh or frozen egg donation?
Some IVF clinics and egg donor agencies in Malaysia offer frozen egg donation as an alternative to fresh egg donation. The advantages of frozen versus fresh egg donation are greater convenience due to simpler logistics, as there is no need to coordinate and synchronize the treatment cycle of both donor and recipient; as well as lower costs due to negating the travel and hotel stay required for fresh egg donation. Another advantage is the greater certainty of the number and quality of frozen eggs available, which are unknown and non-guaranteed for fresh egg donation. Nevertheless, patients should use the same fertility clinic or IVF lab that recruited the egg donor and freeze her eggs. Avoid transferring frozen donor eggs from one medical facility to another. For best results, the thawing protocol must be matching and compatible with the freezing (vitrification) protocol, and only the same IVF lab that performs both the freezing and thawing processes, can ensure this. Patients should also beware that IVF success rates with frozen donor eggs are significantly lower than with fresh donor eggs.
What else should Singaporean patients be wary of when doing egg donation in Malaysia?
A critical piece of information that is often downplayed by Malaysian IVF clinics is the risk of accidental incest between half-siblings conceived by the same egg donor. Although such risks may be minimized in Singapore through safeguards that limit the number of children conceived per egg donor to three, it must be noted that there is no mandatory limit to the number of recipients that a single egg donor can donate to in Malaysia. Additionally, Singaporean patients should also be aware of the lack of appropriate counseling for egg donation in Malaysia. Rigorous counseling will ensure that both husband and wife are agreeable to egg donation, without any misgivings or emotional blackmail from either spouse, and without undue pressure from parents and in-laws. Additionally, they would also miss valuable advice on whether or not to tell their child the truth about his/her conception in the future.
Dr. Alexis Heng Boon Chin
Dr Alexis Heng Boon Chin is an associate professor of Biomedical Science at Peking University, China. He had previously worked in the field of human clinical assisted reproduction research in Singapore, and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies, in addition to also having published more than 250 scientific journal articles.
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