September 26, 2022

Singapore faces legal and ethical challenges with sperm and egg donation

In recent year, Singapore has seen increasing utilization of IVF and other new assisted reproductive technologies, similar to the trend in many developed countries worldwide. One consequence of this is an increasing number of children being born from sperm and egg donation here. However, there are as yet many unresolved legal and ethical issues pertaining to the rights of donor-conceived people and regulation of IVF donation in Singapore.

One contentious issue is the importation of donated frozen sperm and eggs into Singapore from foreign commercial donor banks for the treatment of some infertile IVF patients. There is cognitive dissonance in this case, because commercial trading of donated sperm, eggs and embryos are prohibited by healthcare regulations in Singapore, with strict laws restricting monetary payment of local sperm and egg donors.

In fact, this could represent a contradiction and contravention of statutes within the Human Cloning and other Prohibited Practices Act (2004), as well as Revised licensing terms and conditions on assisted reproduction services imposed under Section 6(5) of the Private Hospitals and Medical Clinics Act [CAP 248] (30th December 2019). For example, section 13 of the former explicitly prohibits commercial trading in human eggs, human sperm and human embryos; while section 5.48 of the latter explicitly states that there shall be no buying and selling of embryos, oocytes and sperm by licensed assisted reproduction centers in Singapore.

The recent decision by the Singapore government to permit social egg freezing from 2023, will likely result in an accumulated surplus of unused frozen eggs available for donation to infertile IVF patients. Indeed, studies conducted in Australia and Israel have confirmed that most women who freeze their eggs, don’t eventually utilize them. At best, it is estimated that only 1 in 5 patients will utilize their frozen eggs in IVF treatment.

The donation of unused frozen eggs faces different ethical issues compared to the donation of fresh eggs. For example, prospective donors of unused frozen eggs would have already spent a substantial sum of money on medical fees upon freezing their eggs; whereas in fresh egg donation, the medical fees are usually borne by recipient patients rather than donors. Hence, there is a more convincing case and pressing need for compensating donors of unused frozen eggs; which should be more appropriately viewed as reimbursement of medical fees, rather than undue financial inducement and commercial egg trading.

Another key difference is that prospective donors of unused frozen eggs tend to be much older compared to fresh egg donors, at the time of donation. This would drastically lower their chances of conception with their own eggs after the donation process. Hence, it may be necessary to mandate that such older women should have at least one child of their own, before being allowed to donate their unused frozen eggs, so as to prevent any future regret.

Yet another ethical issue is the need to make recipient patients aware that there are significantly lower IVF success rates with frozen versus fresh eggs, despite advances in vitrification technology for egg preservation, lest they get a “raw deal” after spending so much money on medical fees. Additionally, there are also inherent conflicts of interests faced by fertility doctors and clinics in encouraging and convincing former patients to donate their unused frozen eggs, because additional medical fees will be earned upon performing the donation procedure on other patients.

A policy decision, still under consideration by the Singapore government, which could have implications for donor-conceived offspring, is the possible establishment of an adoption register to facilitate contact between adopted children and their birth parents in the future. This followed the recent passing of the new Adoption of Children Act (2022) by the Singapore parliament, which made it compulsory for prospective adoptive parents to attend a disclosure briefing, which will equip them with relevant skills and knowledge to tell their child the truth about his or her adoption.

The rationale is that when adoptees suddenly and unexpectedly learn the truth about their parentage, everything that they believed about themselves and their self-identity might crumble and fall apart. This may result in the adoptee feeling that whatever the adoptive parents have told him or her up to that point was a lie, which could lead to estrangement between parents and children. Moreover, because many genetic diseases can potentially be inherited, it is absolutely crucial for adoptees to know and understand their family medical history, because such information can potentially be life-saving.

Indeed, those conceived by sperm or egg donation face exactly the same situation as adoptees, and by a similar logic, there should also be mandatory disclosure briefings for prospective sperm and egg donors, as well as recipient IVF patients. Numerous psychological studies and news reports have attested to similar psychological and identity issues facing both donor-conceived people and adoptees. To maintain legal and ethical consistency, if an adoption register is established to facilitate contact between adoptees and their birth parents, an IVF donor register should also be set up. This would thus accord the same legal rights of adopted children to donor-conceived offspring.

In any case, the notion of sperm and egg donor anonymity is gradually becoming obsolete in an era of widespread DNA testing and online genomic databases. The advent of cheap mail-order DNA testing kits and associated online genealogy and ancestry websites, have increased the possibility of donor-conceived offspring inadvertently learning the truth about their parentage via DNA matching with blood relatives on such publicly-accessible online genomic databases. Hence, it is imperative that prospective sperm and egg donors in Singapore be counseled and warned of the risks of being unexpectedly found and contacted by their genetic offspring in the future through such means, even though their donation was originally intended to be anonymous.

In conclusion, there are currently many unresolved legal and ethical issues pertaining to sperm and egg donation in Singapore. There is a pressing need to resolve such issues soon, via the enactment of appropriate laws and regulations, due to the anticipated surge in the number of donor-conceived offspring within Singapore in coming years.

Dr. Alexis Heng Boon Chin is a Singapore citizen, who is an Associate Professor of biomedical science at Peking University, China. He previously worked in the field of clinical assisted reproduction research in Singapore and has authored 50 journal articles on legal and ethical issues pertaining to new assisted reproductive technologies, in addition to also having published more than 270 scientific journal articles.

Alexis Heng