SINGAPORE – For the first time since 2020, when the age limit of 45 for women seeking in-vitro fertilisation (IVF) and other assisted reproduction (AR) treatment in Singapore was lifted, the Health Ministry has revealed just how low the odds of an older woman having a baby through such means are.

The success rate for AR treatment cycles for women aged 45 and older was less than 3 per cent in 2020 and 2021, a Ministry of Health (MOH) spokesman told The Straits Times.

The success rates refer to a baby being born after the mother has gone for AR treatment.

ST had asked MOH for more information about women aged 45 and older who had IVF here after the age limit of 45 was lifted in January 2020.

Doctors interviewed say the success rate for women aged 45 and older is so low because a woman’s fertility declines with age. 

Dr Suresh Nair, who runs Seed of Life, Fertility and Women’s Care Medical Centre, said that the number and quality of a woman’s eggs decline as she ages.

This means there are fewer eggs available for fertilisation, and the eggs also have a higher risk of chromosomal abnormalities, such as Down syndrome.

There is also a higher risk of pregnancy complications for older women, such as gestational diabetes and premature birth. The combination of all these factors has a cumulative effect and makes it harder for older women to have a baby, even with IVF, Dr Nair said.

“Each year of advancing age tends to exacerbate these challenges,” he added.

Professor P.C. Wong, head of the Division of Reproductive Endocrinology and Infertility at the National University Hospital, noted that medical advancements have not reversed the effects of ageing on fertility. 

Dr Lisa Webber, a senior consultant at the Singapore General Hospital’s Obstetrics and Gynaecology Department, said of women aged 45 and older: “Sadly, the chances of having a baby with her own eggs are exceptionally low, and the vast majority of couples undergoing IVF in this older age group will experience heartache and disappointment.

“It is very important that couples have realistic expectations of treatment.”

In a parliamentary reply in 2021, Senior Parliamentary Secretary for Health Rahayu Mahzam said clinical evidence has shown that the success rates for AR treatments performed on women older than 40 years of age decrease significantly.

For women under 30 years old, the success rate is 26.6 per cent.

It falls to 24.6 per cent for women aged between 30 and 34, and 17.1 per cent for women aged between 35 and 39.

For women aged 40 and older, the success rate is 6.7 per cent.

The data is based on women who underwent AR treatment between 2014 and 2018.

The MOH had previously said that with advances in medical technology, this has significantly reduced the medical risk for women undergoing AR treatments, even beyond the age of 45. Hence, the age limit was lifted.

 In the lab, embryologists identify and isolate the eggs under a microscope on a bench that is kept just above 37 deg C so that the eggs are kept at body temperature. ST PHOTO: SHINTARO TAY

Thomson Fertility Centre medical director Loh Seong Feei said the lifting of the age limit has allowed older women to undergo IVF here, instead of travelling to other countries such as Malaysia and Thailand to do so. 

The MOH spokesman said that with the lifting of the age limit, there is now no “upper age limit” for women to try for a child through IVF here.

But the onus is on the centre providing the AR treatment to ensure that the patient can undergo IVF safely, and has to counsel her appropriately, according to her age.

Among other things, the centre also has to tell the patient about the risks of the procedure and pregnancy, given her age, and the prevailing success rates at the patient’s age at the centre she is seeking treatment, the MOH spokesman added.

Dr Liu Shuling, director of the KKIVF Centre at KK Women’s and Children’s Hospital, said an average of 20 women aged 45 and older have tried IVF each year at the centre since 2020.  

However, none of the women who used their own eggs which were collected after they turned 45 gave birth after undergoing IVF, she said.

Over at SGH, Dr Webber said 14 women in this age group have done IVF at the hospital, and the oldest among them was a 50-year-old woman. None became pregnant.

In 2022, a 55-year-old woman gave birth – making her Singapore’s oldest mother to a newborn last year, ST reported in July.

At Seed of Life, Dr Nair had three patients who were all 52 years old when they gave birth. They had used a donor’s egg to conceive through IVF, which means that the babies are not biologically related to them but to the egg donors and the husbands of Dr Nair’s patients.

At Thomson Fertility Centre, 37 women in the 45-and-older age group did IVF in 2022, and more than 10 of them gave birth. However, Dr Loh said he does not have information on whether those who gave birth used donor eggs or their own eggs to conceive.

He said that egg donors are usually in their late 20s and early 30s. They are younger and have more and higher-quality eggs than the patient, and so using donor eggs improves the chances of pregnancy, he explained.

He said patients find their own donors, who include people they know and overseas IVF centres with egg donor programmes.

Doctors caution that pregnancy-related complications increase with age and that pregnancy takes a huge toll on a woman’s health.

Doctors also have to perform thorough medical checks to ensure that the older woman is fit for pregnancy. 

To illustrate, Dr Liu said a 45-year-old woman has a 90 per cent risk of miscarriage, and the risk increases with age. 

Health risks aside, the KKIVF Centre also counsels couples older than 45 on the various social issues of becoming a parent at their age.

They include the possibility that the parent may die when the child is still young, or how the child may have to care for his elderly parents alone from a younger age.