April 19, 2024

Singapore bans elective sperm freezing to protect consumer rights

In a recent amendment of regulations on assisted reproduction services, the Singapore Ministry of Health explicitly banned elective sperm freezing without a medical indication. This was a highly unusual move – for better or for worse, there do not seem to be any other developed countries which ban sperm freezing.

The Ministry explained that its decision was based on the fact that there is insufficient evidence that male fertility reduces drastically after a certain age. Hence there is no need for this service.

On the face of it, this ban appears to be heavily gender-biased and discriminatory against men. Hadn’t Singapore recently permitted elective egg freezing for all women between 21 to 37 years of age, regardless of marital status?

After all, collecting sperm for freezing does not require medical intervention and surgical procedures, which thus makes it relatively risk-free and much cheaper compared to elective egg freezing. Hence such a ban seems unjustified and unreasonable, given that current scientific evidence points to a gradual but non-drastic decline in male fertility and sperm quality with age.

However a closer look shows that the ban on elective sperm freezing is justified and a wise move by the Singapore Ministry of Health to protect consumer rights and prevent exploitative marketing of unnecessary medical services by local fertility clinics.

Socio-cultural factors at play in Singapore would make the population particularly vulnerable to exploitative marketing of unnecessary and wasteful elective sperm freezing services by local fertility clinics.

First, in the predominantly Chinese culture of Singapore, there is a widespread traditional belief based on Taoist philosophy that “Qi” (life force) and “Yang” (male energy) are stronger in younger versus older men, which enables them to beget better quality offspring in terms of health and intelligence. Hence, there is a fear that older sperm would lead to lower quality offspring and this might motivate many younger men to freeze their sperm to ensure that they can beget better quality offspring after marriage.

The pertinent question that arises is whether this is really necessary, given that the overwhelming majority of men would have completed family formation by their mid- to late-forties. 

Men who froze their sperm when they were younger would be tempted to unnecessarily resort to IVF with their younger frozen sperm samples, in the belief that they would beget better quality offspring, even if neither partner has fertility problems. Subjecting healthy and fertile patients to IVF for such spurious reasons would be tantamount to clinical malpractice.

Second, Singapore has had ultra-low fertility rates over the past few years, hitting a record low total fertility rate (TFR) of 1.05 in 2022. This means that on average, married couples in Singapore will only have one child. Hence many men would be motivated to invest more heavily in their future single child, including undergoing elective sperm freezing to ensure they can beget a better quality single offspring in the future.

Third, Singapore has imposed mandatory military conscription (or National Service) for all able-bodied males since 1967. Since its inception, a number of accidental deaths and injuries during peacetime military training has been reported in the local news media. Although these are rare, they have caused both the conscripts and their parents much fear and anxiety. What better way to assuage their fears and anxiety then to promote elective sperm freezing for military conscripts, paid for by their parents?

Fourth, based on Confucian social norms, the predominantly Chinese culture of Singapore emphasises the continuation of family lineage through the male line as an act of filial piety towards one’s parents and ancestors. This might encourage the uptake of elective sperm freezing as a form of “fertility insurance” to guarantee continuation of one’s family lineage, which would be gladly sponsored by parents or grandparents, in view of the risks of accidental death and injury associated with military conscription in Singapore, with most military conscripts often being the only son or child within their families. 

If a conscript were to die in service, this would raise the highly contentious issue of posthumous reproduction and the use of foreign surrogates (surrogacy is banned in Singapore). Indeed, posthumous reproduction is often considered extremely unethical and is banned in many jurisdictions, because this intentionally deprives a child of a parent even before it is born.

One final thought. Elective sperm freezing could even pose a long-term security risk. Aggressive sales pitches and advertising campaigns could exploit fears of dying during national service. Only 42 national servicemen in Singapore have died while in service over past 20 years , which works out to only about two deaths per year. By contrast, the annual death toll attributed to traffic accidents in Singapore typically exceed over 100 per year. Hence elective sperm freezing for military conscripts is completely unjustified and unnecessary.

Nonetheless, fertility clinics, both foreign and Singaporean, would exploit service deaths to hard-sell elective sperm freezing to Singaporean patients, and possibly create negative public perceptions of conscription, which is the bedrock of Singapore’s national security.

Hence without a ban, there will likely be an aggressive advertising campaign by local fertility clinics to encourage the uptake of unnecessary elective sperm freezing, by exploiting such socio-cultural vulnerabilities of Singaporean society.

To circumvent a ban, some Singaporean men may consider traveling abroad to neighbouring countries. They would be advised to think twice before doing so, lest they be hoodwinked by the flashy and deceptive advertisements of foreign fertility clinics.

Alexis Heng