Egg Donation in Singapore and Malaysia - New Video Podcasts

[Angelica Cheng]

Here are some new video podcasts on egg donation in Singapore and Malaysia:

Egg Donation Singapore - Options and Choices

Various options for Singaporean IVF patients seeking egg donors are discussed, ranging from overseas egg donation, importing frozen donor eggs from abroad, engaging in secret payments or foreign agencies, and utilizing unused surplus frozen eggs donated from former elective egg freezing patients.

communities.springernature.com

Egg Donation Malaysia - Exploitation of Foreign Patients

In recent years, Malaysia has become a popular destination for commercialized egg donation, particularly among ethnic Chinese patients from Singapore and China. However, due to egg donation being largely unregulated in Malaysia, both local egg donors and foreign IVF patients are often exploited.

communities.springernature.com

 

[Angelica Cheng]

Please refer to the following articles:​

Egg Donation In Malaysia: Pitfalls That IVF Patients Should Avoid​

Unregulated, Profit-Driven Egg Donor Agents Pose Risks To IVF Patients​

Fresh Vs. Frozen Egg Donation: Which Is A Better Choice For Singaporean And Malaysian IVF Patients?​

Advice and tips for Singaporean patients seeking egg donation in Malaysia​

Foreign Patients Seeking Egg Donors in Malaysia Must Beware of Numerous Pitfalls​

Many foreign patients, particularly from Singapore and China, travel to Malaysia for IVF egg donation treatment due to the ready availability of paid egg donors. Currently, in Singapore and China, payment for egg donation is banned, and donor eggs are not readily available. Due to the large ethnic Chinese minority population in Malaysia, it is relatively easy to source Chinese egg donors. Nevertheless, due to lax regulation of egg donation, foreign patients often have to navigate a complex web of marketing gimmicks, misleading information, and ethical pitfalls. Hence, it is imperative to emphasise what they should pay attention to and be wary of.

First and foremost, patients should be careful not to be duped into performing unnecessary genetic testing of IVF embryos, a technique known as preimplantation genetic screening (PGS) or preimplantation genetic testing – aneuploidy (PGT-A).

This procedure is very expensive, and often increases the total medical fees by up to 50 per cent. Many Malaysian fertility clinics often exploit IVF patients’ fear of unknown genetic diseases carried by egg donors to hard-sell embryo genetic testing (PGS/PGT-A).

Nevertheless, patients must beware that the PGT-A technique only screens for large chromosomal abnormalities in IVF embryos but does not detect monogenic (single-gene) disorders. Hence, it is completely useless for preventing the transmission of most heritable genetic diseases from the egg donor to the offspring.

In fact, it may be completely unnecessary to utilize PGT-A for egg donation cases, because in most cases the donors are young and therefore have very low chances of having chromosomal abnormalities in their eggs, unlike older women who are at high risk of conceiving a Down syndrome baby.

Very often, Malaysian IVF clinics exploit the fear of recipient patients regarding unknown genetic diseases carried by the egg donor to encourage them to take up the expensive PGT-A technique, while deliberately neglecting to tell them of the possibility of genetic carrier screening of egg donors through a simple blood test.

Instead, ignorant patients are often pushed to do expensive PGT-A in egg donation cases, in the mistaken belief that PGT-A also screens for various other genetic diseases besides chromosomal abnormalities. Besides genetic testing of the egg donor’s blood sample before starting IVF, patients also have the option of doing NIPT (Non-Invasive Prenatal Testing) to detect genetic disorders in the fetus after getting pregnant.

Although many Malaysian fertility clinics claim that PGT-A can improve the success rate of IVF among older women, this often only refers to older women using their own eggs and will not improve the success rates of older women using young egg donors.

Furthermore, it must also be noted that PGT-A is not completely risk-free. Because this delicate technique involves drilling through the embryo’s outer shell (Zona Pellucida) to extract cells for genetic testing, there is an inherent risk of damaging the embryo. The smooth performance of this technique is often highly dependent on the skill and training of the laboratory staff (embryologist).

Even with high levels of training and accreditation, there is still a possibility of human error, particularly in a very busy laboratory that handles several such cases a day. Lastly, patients must also beware of fertility clinics manipulating their biased preference for either a boy or girl child, to persuade them to undertake highly expensive embryo genetic testing for sex selection.

Some Malaysian fertility clinics may offer frozen egg donation as a cheaper alternative to fresh egg donation. This has simpler logistics, as there is no need to synchronize the hormone stimulation cycles of donors and recipients, and saves transportation and hotel accommodation costs required for fresh egg donation. Another advantage is the greater certainty of the number and quality of frozen eggs available, which are unknown and non-guaranteed for fresh egg donation.

However, the success rate of frozen egg donation is significantly lower than that of fresh egg donation, which is often downplayed and overlooked. Patients should also avoid using frozen eggs transferred from an egg bank to another IVF lab. Because human eggs are very sensitive, the thawing technique needs to be compatible with the freezing technique, which is similar to the relationship between a lock and a key. Hence, patients should preferably use the same IVF lab that performs both the freezing and compatible thawing procedures to achieve good IVF success rates with frozen eggs.
Some Malaysian fertility clinics utilize traveling egg donors from other towns or states. The overwhelming majority of egg donor agencies and agents in Malaysia are based in the Klang Valley and Penang, and IVF clinics in other parts of Malaysia (such as in Johor and Melaka) often rely on such agencies and agents to source egg donors for their patients.
This is not ideal for recipient patients because it is very difficult to monitor the hormone stimulation cycle of egg donors traveling to and from other towns. Some doctors may directly hand over expensive hormone drugs (requiring refrigeration) to out-of-town donors to inject themselves under the supervision of their agents.

 

[Angelica Cheng]

They will return to the clinic for an ultrasound scan of the ovaries at a designated time or perform the final egg retrieval operation. Because supervision from the IVF clinic is not near at hand, the egg donor may not be bothered to strictly comply with such a painful and tedious routine of self-injections.

If they are extra careless, the expensive hormone medications may not be kept properly refrigerated, leading to spoilage and reduced potency. Without strict adherence to the injection protocol and proper refrigeration of hormone
medications, the number and quality of eggs obtained from the donor will be severely compromised.

Additionally, foreign patients must also take note that there are usually additional traveling and hotel costs associated with getting an out-of-town egg donor and her accompanying agency coordinator to travel to an IVF clinic located outside Penang or the Greater Kuala Lumpur region, for example, those located in Johor state.

Therefore, patients should use egg donors residing within the same city as the fertility clinic, and also preferable to have the egg donor regularly receive recorded hormone injections from the fertility clinic itself, rather than do self-injections.
Furthermore, it must also be noted that egg donor agents and agencies in Malaysia are completely unregulated.
One unethical and fraudulent practice that prospective recipient patients have to be particularly wary of in fresh egg donation is the switching of donors after patients have made their choices.

It must be noted that egg donation in Malaysia is anonymous, and patients are not allowed to meet donors. Based on anecdotal evidence from blogs, such fraud cases have already occurred in Malaysia, committed by several small-time egg donor agents and agencies.

This is because it is not easy to match the work or study schedule of prospective egg donors with that of recipient patients.

For example, the patient’s selected egg donor may have a sudden and unexpected change in their schedule that leaves them with no time to participate in the lengthy and tedious fresh egg donation cycle requiring numerous medical appointments.

In that case, some unscrupulous small-time agents may find it convenient to just switch to another available donor with the same blood group, without informing the recipient patient.

To prevent such fraudulent practices, it is recommended that the patient check with their clinic on the recorded height, weight and age of the egg donor, when she has her first medical appointment for health checks and blood testing for HIV and other infectious diseases.

Her weight may vary a little, but her height and age should match the donor profile selected by the recipient patient.
Additionally, patients should be aware that it may be cheaper to directly contact Malaysian egg donor agencies and undergo treatment at their affiliated fertility clinics. If unaffiliated fertility clinics are requested to source egg donors, they often take an extra cut of profit by charging extra fees unscrupulously. Normally, when you ask an unaffiliated fertility clinic to find an egg donor for you, they will contact many different external agencies and obtain several matching egg donor profiles.

You choose an egg donor, and the clinic will coordinate with that specific egg donor agency. You do not pay directly to the egg donation agency. Instead, you give your money to the fertility clinic. They will pay the egg donation agency and keep a sizeable portion of your payment to themselves as an additional profit, often euphemistically labeled as “administrative fees”.

Foreign patients must also beware that Malaysian IVF clinics often downplay the risk of accidental incest between half-siblings conceived by the same egg donor. Although such risks may be minimized in Singapore through safeguards that limit the number of children conceived per egg donor to five, it must be noted that there is no mandatory limit to the number of recipients that a single egg donor can donate to in Malaysia.

Yet another key issue that recipient patients must consider is whether to tell their children the truth about their conception in the future. Most experienced fertility counselors will advise them to tell the truth to the child when they are of school-going age. Many psychological studies and news reports have documented the emotional trauma and identity crisis experienced by donor-conceived teenagers and adults when they accidentally learned the truth about their conception, for example, through a family quarrel. In many cases, this often leads to the estrangement of parent-child relationships.

More recently, the popularization of direct-to-consumer genetic testing kits and associated genealogy and ancestry websites has made it much harder to conceal from donor offspring the truth about their conception. There is a possibility of the offspring inadvertently learning the truth about his/her conception through contact with DNA-matched relatives on such websites.

With the rapid advancement of medical technology, it is anticipated that DNA testing will one day become a routine practice in health care. Ultimately, it is up to recipient patients to decide whether or not to tell their child the truth. Telling the truth will reduce their psychological burden and give them peace of mind.

 

[Angelica Cheng]

Unregulated, Profit-Driven Egg Donor Agents in Malaysia Pose Risks To IVF Patients​

Presently, guidelines established by the Malaysian Medical Council (MMC) on Assisted Reproduction prohibit commercial trading in gametes (eggs and sperm), semen, or embryos (Section 15).

However, MMC guidelines are not strictly legally binding and do not carry as much weight as legal statutes enacted by the Malaysian Parliament.

In practice, MMC guidelines are mainly adhered to by public medical facilities funded by the government, while not being strictly followed by the private health care sector.

Subsequently, in 2012, the Ministry of Health (MOH) promulgated ‘The Standards For Assisted Reproductive Technology Facility – Embryology Laboratory and Operation Theatre‘ to provide proper guidelines for the setting up of IVF centres throughout the country.

There was, however, no mention of the regulation of surrogacy, as well as sperm, egg, and embryo donation in this document.

Previously on several occasions, the MOH had proposed passing an ‘Assisted Reproductive Technology Technique Services Act’, most notably in 2009 and 2016, to address issues such as surrogacy, sperm and egg banking, and donation, in consultation with various stakeholders, including religious groups, non-governmental organisations, doctors, and government officials.

Some Malaysian university academics have also stressed the importance of such legislation. Nevertheless, to date, such badly needed legislation on the regulation of assisted reproduction techniques in Malaysia has still not come to fruition.

Consequently, due to the current lack of regulations, commercial trading in donor eggs is quite rampant in Malaysia, with numerous agents and agencies that are based mainly in the Klang Valley and Penang.

Because such profit-driven egg donor agents and agencies are completely unregulated, their unethical and exploitative business practices pose a substantial risk to IVF patients.

 

[Angelica Cheng]

Here, the personal experiences of a Singaporean couple whose egg donor IVF cycle in Malaysia went badly due to the lack of regulatory oversight will be shared with readers. Their story was originally reported in a publicly available blog on the Singapore Motherhood Forum website.

This Singaporean couple had enrolled in an egg donation programme at a fertility clinic located in the Klang Valley in Malaysia.

They were introduced to their egg donor agent by their fertility centre and were provided with five donor profiles to choose from.

However, only one donor matched the same blood group as the wife. This particular matching donor happened to cost the highest among the profiles that were shared.

As the couple was keen to select a donor with the same blood group as the wife, they called the agent to find out more about the donor. The agent claimed that this particular donor had very good egg quality and had donated once before at another well-known IVF centre in Kuala Lumpur with 16 blastocyst-grade embryos and seven Euploids (normal chromosome counts).

The agent told the couple that the previous IVF centre was calling her back for a second donation, and that his business partner may also want her. The agent thus pressured the couple to make the decision fast if they wanted to select her.

Although the couple felt a little pressured, they did not want to miss the chance, as they had been searching for a suitable donor for a long time.

Based on the donor information the agent provided them and the last donation event, which was on January 10, 2023, they promptly signed the contract with the agent the next day and paid the required agent fee two days later on May 8, 2023, to book and secure the donor.

Subsequently, the Singaporean couple paid the clinic the required donor check-up fees for her medical check-up two days later. The donor’s blood test report showed elevated Haemoglobin F, which suggested the possibility of a blood disorder and Alpha Thalassemia.

Hence, the doctor advised the couple to put the donation on hold and for the donor to complete a genetic screening test before proceeding further.

The couple then paid an additional sum of more than RM3,800 to the IVF clinic for the donor’s genetic carrier screening test. They were advised by their doctor not to ask the agent to directly arrange genetic testing of the donor because egg donor agents cannot be fully trusted.

There have been previous cases where agents had altered the historical health reports of donors before submitting them to IVF clinics. Therefore, tasking the agent to bring the donor to do genetic testing outside of the IVF clinic is risky.

For example, how would the couple know if the same donor went to do the genetic testing? Does the genetic report truly belong to the donor or someone else?

How would the doctor know if the genetic report results have not been modified?

As the donor is anonymous, there are various areas in which the Singaporean couple and their doctor do not have visibility or control over the process.

Due to the egg donor’s upcoming examination in June, the Singaporean couple raised a call to discuss with the doctor and consented to wait for her exams to finish before the agreed donation in her July cycle.

The couple kindly told the agent to reassure the donor not to worry too much about the genetic testing and to let her focus on her exams first.

While waiting for her examination to be completed, the couple passed messages to the agent from time to time, asking her how she was doing and to take good care of herself. The Singaporean couple, therefore, placed a lot of hope and faith in their egg donor.

Unfortunately, without the couple’s knowledge, the donor went back to the previous IVF centre to do another egg donation cycle on June 2, 2023 (ovum pick-up) before her examination.

While she was on the stimulation injections for another recipient, she returned to the fertility centre to do the genetic screening blood test on May 25, 2023, running two donations at the same time.

Subsequently, in July, the donor’s menstrual cycle came later than usual. Unaware that the donor had already donated at another IVF centre in June, the doctor proceeded with her stimulation for the Singaporean couple’s donor cycle in July.

The result was horrendous. Two different IVF centres using different protocols and medication, one month after the other, left the couple with three embryos, and all were mosaic (a mixture of normal and abnormal chromosomal counts).

Uncovering the truth was devastating to the couple. They found out about her second donation in late August and learned that the agent had also lied to them about the donor’s January donation results as well: eight blastocysts were deceptively presented as 16 blastocysts; and five euploids and two mosaics were deceptively presented as seven euploids.

The couple reported the incident to the doctor on September 1, 2023, and had a meeting with both the doctor and the agent. However, the agent denied knowing anything about the donor’s second donation in June.

The couple requested a refund from the agent, but he had absconded and blocked them on WhatsApp, not replying to any of their messages or calls. The couple then followed up with the IVF clinic week after week regarding the agent’s whereabouts, but the clinic did not provide them with any updates.

The couple sought redress with their doctor but were given defensive answers, who disclaimed responsibility while stating that the donor’s poor result was likely cyclical.

The IVF clinic replied to them by email, saying that, “Here at XXX Fertility, potential donors are asked if they have previously donated their gametes, whether at XXX Fertility or other fertility centres. It is expected of them to be truthful”.

Subsequently, the couple learned that the donor’s result one month before them had six blastocysts, with four euploids of good grades.

But during the couple’s egg collection time, the embryologist had commented that the donor’s eggs were “not that normal” in their donor cycle and the outcome was below the norm.

It seemed that her body was under stress and her July menses were also delayed much later, while her May menses were on time. Her egg quality had been compromised.

Another doctor had also commented that it is very rare for such an outcome of three mosaic embryos from a 23-year-old donor. Hence, the couple did not believe that their donor cycle outcome was cyclical and not impacted by her secret donation one month shortly before them.

Altogether, the Singaporean couple had exhausted part of their hard-earned savings to purchase the donor eggs, incurring a sum of RM55 000.

They felt that their donor’s secret donation one month before their donor cycle had breached the trust and integrity of the donor programme that they had signed up for. Their agent had also fabricated the donor’s past donation results to deceive them.

Hence, tighter regulation of egg donation through the enactment of appropriate legislation is needed to prevent future cases of such botched egg donor IVF cycles, which would avoid much distress for both Malaysian and foreign couples.

Tabling the Assisted Reproductive Technology Technique Services Act through Parliament will not only protect the rights and welfare of patients, but can also protect the international reputation of Malaysia as a hub of fertility treatment in Asia.