A one-in-100 chance of a Down syndrome baby. One-third odds of a miscarriage. A two-fold risk of stillbirth. A dismal 20 to 25 per cent chance of falling pregnant.
For women in their 40s, the odds of starting a family are hardly in their favour, as these scary stats attest. But many relentlessly chase their motherhood dreams – even as their peers are already scouting around for universities for their kids, or stressing over an upcoming National Service enlistment.
Membership to the middle-aged mums club is less of an exception to the rule; not only are women here marrying later in life, they are also having children in their late 30s and through their 40s.
According to figures from the Singapore Department of Statistics, the number of mums-to-be conceiving in their 40s has doubled over the past three decades. Last year, there were nine births for every 1,000 women aged 40 to 44, compared to 4.5 in 1985.
The search for the elusive BFP
For these women, in-vitro fertilisation (IVF) treatments have been the panacea to attain that Big Fat Positive – one of a myriad of abbreviations patients come to be well-versed about.
A small mountain of medication, daily injections and messy suppositories are put up with on a daily basis, and exacerbated by emotional (mood swings, anxiety, stress), physical (bellies bruised from injected drugs, nausea, bloating) and financial (eye-watering costs that run into the high five-figures) strain.
Those who seek treatment here ask for recommendations or trawl online forums usually pick from a select group of doctors associated with high success rates; among them Dr Ann Tan at Women Fertility & Fetal Care Centre, Dr Sadhana Nadarajah at KK Women’s and Children’s Hospital (KKH) IVF Centre and Dr Kelly Loi at Health and Fertility Centre for Women.
But topping this list is Dr Tan Heng Hao. The medical director of Alpha IVF Centre & Alpha Women’s Specialists (Singapore) has performed “thousands of IVF procedures in over 10 years and counting”, and says that women are having babies later in life as a result of choices made out of circumstances that they face.
The former head of the Reproductive Medicine Department and director of IVF services at KKH adds: “The challenges of a developed society are vastly different today as compared to the past. These include job pressures, changing expectations and higher standards of living.”
Greater chances, lower costs
Meanwhile, other women head overseas to Malaysia, Thailand or even India – usually after undergoing one too many failed cycles here. Arguably, the most well-known of them is getai veteran Liu Ling Ling, who made the headlines two years ago for conceiving a baby boy at the grand age of 50 after finding success in Johor Bahru.
For women in her age group, several push factors come into play. Age is arguably the biggest of them; before the rules were relaxed in 2019, the age limit for IVF was 45, and the number of assisted reproduction technology (ART) cycles a woman could undergo was a maximum of 10 cycles up to the age of 40, and five cycles after that age.
Seeking treatment beyond our shores also opens the door to a variety of screening tests – not available here in Singapore – that can help improve outcomes. Such tests are said to boost success rates by as much as 70 per cent. Since older women racing against the clock commonly face the issue of producing embryos with chromosomal abnormalities – which invariably lead to failed cycles – this is a very viable option.
Currency exchange rates are also another boon. Ballpark figures put public fertility clinic treatments at $10,000 to $15,000 per cycle with subsidies, and $12,000 to $20,000 per cycle at private medical centres. These costs cover ultrasound tests, egg collection, egg transfer, lab charges, nursing fees, the use of the operating theatre and a recovery room.
In comparison, the average cost per cycle is $5,000 to $7,000 in Johor Bahru, $6,200 to $12,000 in Thailand and up to $6,4000 in India. Even after factoring in transport and hotel accommodation expenses, overseas treatments are easier on bank accounts.
Holding on to hope
For women still trying to get pregnant, there is much to be optimistic about.
Nee Soon GRC Member of Parliament Louis Ng’s tireless efforts at lobbying for the government to provide more support for couples trying to conceive through costly and emotionally-trying IVF procedures have led to significant progress.
According to Ministry of Healthv(MOH) data, couples may now withdraw $6,000 for the first cycle, $5,000 for the second cycle and $4,000 for the third and subsequent cycles from the patient’s or the patient’s spouse’s MediSave to cover the costs of Assisted Conception Procedures (ACP) treatment. A lifetime Medisave withdrawal limit of $15,000 per patient also applies.
MOH has also made to make the previously unavailable Pre-implantation Genetic Diagnosis (PGD) test a mainstream clinical service for couples who need it.
“Without a doubt, more women are using IVF to get pregnant, and the government can help. If couples get married late, why should they get penalised? Let’s reduce their stress with more subsidies, so more Singaporeans can try IVF,” says Ng. “Why should the government say no?”
Ng’s focus, after successfully pushing for PGD, is advocating that Preimplantation Genetic Screening be nationalised in the private clinics. The procedure extracts cells from an embryo to increase the chances that a healthy embryo is implanted, increasing the success of a pregnancy.
Adds the father of three daughters: “This cause is so dear to me, especially when I see couples who want so much to have a child. On Children’s Day, it really hits home. As a parent myself, I really want to help.
“I’ll keep pushing. If you push hard enough, you get somewhere.”
Meanwhile, Dr Tan says IVF success rates have improved by leaps and bounds in the last few decades, and improvements in drugs and regimes have contributed to better compliance, and lower drop-out rates for patients.
Major advancements made in the laboratory, he says, have optimised the quality of embryos to be transferred. These days, there are better culture medias used, better culture environments and better laboratory techniques, exemplified by the use of time lapse imaging incubators and pulse driven intracytoplasmic sperm injections. All these have led to improvements in the quality and blastulation rates of the embryos.
“My job takes a lot out of me, but it’s something I still look forward to going back to the very next day,” says Dr Tan. “Personal satisfaction comes from being given the privilege of journeying with couples, secure in the knowledge that I have the opportunity to touch their lives positively in some way.”
Perks, problems, playground politics
GENXSingapore meets two women who share the highs and lows of being middle-aged mums.
Michelle Bong Lejtenyi, 47, content marketing manager
All my life, I never wanted kids. The costs, the stress that comes with uncontrollable tantrums, P1 registration. Oh, and global warming! To me, these were all valid reasons to be child-free. Also, I didn’t consider any of my exes to be Daddy material.
When I met my husband, I realised I wanted kids. Problem is, I was already 39 and he was 41. We got married at 43 and 45 respectively, after which we started trying. “Tick tock, tick tock” mocked my uterus as I juggled work responsibilities, a hectic social life and marital bliss.
We knew starting a family at our age was not going to be easy. And we were right. The four-year journey was hellish in most parts. You know how people say the fun is in trying for a baby, because of all the practice it takes? LIES.
There is zero fun in constantly tracking your ovulation, doing the deed while mentally chanting “get pregnant, get pregnant”, or being so focused on not letting yet another precious window of opportunity pass you by that you jump your unsuspecting husband screaming “Hurry up, we have to do it now!”.
Fed up, we turned to Intrauterine insemination (IUI). Three rounds later, we conceded it was a total waste of time and effort. Poorer and even more fed up, we decided on seeking IVF treatment in Johor Bahru.
Concurrently, I did just about everything I could, based on what I had read on forums, heard from friends or researched online; I downed a cocktail of health supplements with a bottle of pomegranate juice daily, did weekly TCM acupuncture sessions complemented by powdered tonics, and even tried vaginal steaming. Driven by desperation, I tried everything.
After months of this routine and a big dent in our finances, we finally got pregnant. It took three attempts. We were so numb to failure by then that when we were told the good news, we simply looked at each other and went “Oh… ok.” And I’m sad to say I spent the rest of my easy pregnancy – I was a super mobile pocket rocket with a giant belly – mentally-detached from everything; right up to my delivery date, I was still convinced something would go wrong.
Since then, the days have flown by in a blur. Our precocious, chatty little James Henry turns two next month. The pandemic seems to have sped time up; in our little bubble, he has grown up quickly. Most of my extended family members have not seen James since Chinese New Year 2020, and we’ve not had a chance to visit Canada. The only silver lining has been all that extra time I’ve been able to spend with him while #wfh.
Is there a greater life purpose now? Yes. Are our creaky bones holding up as we chase, jump and clamber at the playground alongside 30somethings who eye us with some degree of pity? Just about. Do we wake up deliriously happy to spend time with Jamie, only to crawl into bed completely exhausted come 8.30pm each day? You bet.
But it was worth it. All of it. We still have a fourth embryo, snuggled in a freezer in Johor Bahru. The plan is to try again as soon as travel borders open.
Having been on this arduous journey, which has been the most difficult project I have ever undertaken, I still recommend women wanting to be mums to give it a go. There are no guarantees of success, and a tsunami of confusing advice will come your way. At the end of the day, go with your gut (pun not intended) and just do you. Keep that chin up, and stay hopeful.
Helen Eber, 42, HR manager
I was 41 when I had Cameron, who is two and a half now. Being late to the game was not exactly a choice I made. I didn’t meet my husband Darren, now 44, until I was 36; we dated for a year before getting engaged, registered our marriage six months later and had two church weddings three months after that.
I didn’t want to start trying for a baby until we were married, so after the wedding, we started trying straight away. We got checked out by a doctor fairly early on too, as I was conscious of my age and didn’t want to waste time trying if there were any underlying issues that I wasn’t aware of.
Six months later, my doctor suggested we visit the fertility clinic at KKH for advice. Two unsuccessful rounds of IUI later, we started the IVF process. Happily, our first frozen transfer was successful; I had my positive pregnancy test in June 2018, almost two years to the day after our marriage was registered. Cameron was born the following February.
I was lucky to enjoy flexible work hours, so taking time here and there for doctor’s appointments wasn’t too difficult. However, being the plan-ahead type, I found the unpredictability of the cyclical fertility treatments really tough. Trying to plan business trips and holidays that didn’t clash or occur at ill-advised times was quite stressful too.
Socially, it got quite challenging as well. When I wasn’t drinking, people started asking if I was pregnant – which can be fairly hard to manage when you are definitely not but really wish you were. I think it was good for us to have a couple of years of married life before getting pregnant to enjoy life as a pair first.
It’s a bit different as well when you have the fertility stuff ongoing in the background. I’m very much a try-everything-you-can kind of person, so we changed our diet a little, took supplements, avoided plastics, did TCM. Probably a bit full on. But I wanted to feel like we’d given it our best shot if we weren’t successful.
Our family and friends were very supportive and I was lucky to have a couple of friends on similar timelines, which was really helpful. I even met some ladies who were going through the same thing, and now it’s fab to see our kids having play dates together.
My pregnancy was fairly straightforward; other than gestational diabetes partly due to my age, it wasn’t too challenging to manage with diet and light medications. I ended up having a Caesarean-section which wasn’t what I’d envisaged, but it was fairly quick and seemed ok to me.
Having a newborn was very full on, and things got harder after my maternity leave. Balancing full-time work, a baby, a marriage and keeping up with friends was tough – although I do feel very lucky to be in Singapore with a great helper.
After that, the bombshell of Covid-19 had an impact on our lives – making socialising much more difficult, especially with a small family given the limited numbers and personally I’ve found it quite isolating. We really miss our family and friends in the UK, particularly given how quickly Cameron is growing up. We are fortunate that at least Darren’s side of our family is here, but we still miss the pre covid big get togethers.
Everybody’s journey is different so I’m not sure I’d feel qualified to give anyone advice other than go with your own gut and maybe have an idea of how much you are willing to do before you draw a line under it. We would love to have a second child but are conscious it’s a long shot. I have an idea of when I will be ready to say we tried what we could and we are lucky to have what we do already.
