Speech by Mos Rahayu On the Adjournment Motion On Fertility Preservation for Young Cancer Patients

MOH Response to Adjournment Motion on Fertility Preservation for Young Cancer Patients, 6 August 2024

1. Mr Speaker, Sir, I would first like to thank Dr Tan Wu Meng for raising the plight of young cancer patients who desire fertility preservation. These patients already suffer the misfortune of a cancer, and the side effects of cancer treatment.

2. We deeply empathise with the anxiety and emotional distress that they face.

Past Policies to Support Fertility

3. Mr Speaker, Sir, the Government has supported - and remains committed to supporting - the parenthood aspirations of all Singaporeans.

4. In 2008, the Government introduced co-funding for Assisted Reproduction treatments such as In-Vitro Fertilisation, or IVF, at public Assisted Reproduction centres, or AR centres. Any couple where at least one spouse is a Singapore Citizen would be eligible for this co-funding.

5. Over the years, we have made enhancements to further support couples requiring Assisted Reproduction treatments. We raised the Government co-funding quantum in 2013, and again in 2018. We also increased the number of co-funded cycles. Today, a Singaporean citizen couple can enjoy up to 75% in Government co-funding for up to three fresh cycles and three frozen cycles. This is subject to a dollar cap of up to $7,700 for each fresh cycle, and up to $2,200 for each frozen cycle. On top of co-funding, we allow MediSave use of up to $6,000 for the first cycle, $5,000 for the second cycle and $4,000 for the third and subsequent cycles, with a lifetime limit of $15,000.

6. In 2020, we expanded our co-funding coverage to include Intra-Uterine Insemination, or IUI, to provide better support to couples who may prefer less invasive procedures. The Government would co-fund up to three IUI cycles, subject to a dollar cap of up to $1,000.

7. We also recognised that couples who marry late also have parenthood aspirations, and wanted to give them the best shot at it. In 2020, we removed the statutory age limit of 45 years old which restricted when a woman may go for Assisted Reproduction treatments. This allowed more couples to undergo procedures like IVF, as long as they were considered suitable for the procedure by their doctor. We also allowed couples to tap on up to two out of six co-funded Assisted Reproduction treatments above the age of 40, as long as they had attempted Assisted Reproduction before the age of 40. This was so that we do not inadvertently encourage couples to start their families too late, given the higher likelihood of clinical complexities associated with late pregnancies.

8. Last July, we took a further step. Women between the ages of 21 to 37 are now able to undergo elective egg freezing. Prior to last July, women were only allowed to do so on medical grounds. This shift came after careful consideration, recognising that there may be women who desire to preserve their fertility because of personal circumstances, such as being unable to find a partner while they were younger.

9. The policy shifts we have made in over these years reflect the Government's ongoing commitment to support fertility and parenthood. This is an ongoing journey. We will continue to refine our policies to ensure these continue to meet Singaporeans' aspirations and needs in this area.

Response to Proposed Recommendations

10. On this note, I thank Dr Tan for his recommendations on financing fertility preservation procedures among young cancer patients.

11. We note that some young married couples are facing a situation where one of them is afflicted with cancer and will be receiving treatment, yet they are still currently trying to start a family. Today, these couples are eligible to tap on Government co-funding and their MediSave for embryo freezing as part of their Assisted Reproduction treatments, to preserve the option of having children in the future.

12. For singles who want to undergo fertility preservation so that they can have children in future, we recognise these procedures can be quite expensive. For example, egg freezing alone can cost up to $10,000. Other fertility preservation procedures, like egg storage or ovarian tissue storage, can cost several thousand dollars over the course of five years. Today, young women can already tap on MediSave for egg freezing, if it is done on medical grounds, such as due to their cancer treatment. If they get married in future, and would like to use their eggs for Assisted Reproduction treatments, they can also receive Government co-funding support and use MediSave for their treatments.

13. The Ministry of Health will study Dr Tan's proposals to extend government co-funding and insurance, bearing in mind there may be other medically necessary treatments for conditions besides cancer that could affect fertility of young Singaporeans.

14. I would also like to acknowledge Dr Tan's other recommendations, such as to support philanthropic initiatives in the fertility preservation sector, and to collaborate with financial institutions to provide interest-free loans for fertility preservation.

15. To bolster philanthropic efforts in the fertility preservation sector, Dr Tan has proposed enhancing the current 250% tax deduction rates for donations, and introducing government matching grants, similar to the approach taken for the Rare Disease Fund. Today, donations made to Institutions of a Public Character, or IPCs, that focus on supporting cancer patients, will qualify for a tax deduction of 250%. This is consistent with other IPCs in Singapore, which is high compared to other jurisdictions. We appreciate the support that existing cancer charities provide to patients, such as the support from the Singapore Cancer Society, Breast Cancer Foundation and Children's Cancer Foundation. But we also note that they may encounter difficulties in prioritizing fertility treatments for these patients if it means diverting funds from other cancer patients.

16. As for the suggestion of interest-free loans, like the Tuition Fee loans, we note that these are ultimately financed, and subsidised, by Government, similar to the co-funding support that is currently already available for Assisted Reproduction treatments.

17. We will continue to review the adequacy of co-funding and other support to address the fertility treatments for these patients, and welcome any additional support that charities can provide alongside, to address affordability issues.

18. Thank you, Mr. Speaker.