Singapore Now a Leader in Baby-Making

Singapore, once the most successful country at discouraging reproduction, is now a world leader in the science of making babies.

“Our results are one of the best in the world,” said Dr. Maurine Tsakok, head of Singapore General Hospital’s obstetrics and gynecology department. “In Asian terms, we are well ahead.”

National University Hospital claimed a world first recently when it achieved a pregnancy with fertilized eggs kept alive in an “artificial womb” of human tubal cells for two days.

At Singapore General, Tsakok claims a success rate of 28% for each in-vitro fertilization treatment, in which the egg is fertilized outside the body and then implanted in the womb. The success rate elsewhere in the world is 10% to 20%.

Ironically, these advances were made in a country that once told its couples to “stop at two” children and backed up its exhortations with financial disincentives for those who didn’t.

That policy worked too well, however, and when the population began to drop, the government rushed to reverse itself. Now, it urges citizens to “have three, or more if you can afford it.”

One effect of the policy was the quick development of fertility research.

“I think it is because we were so successful at controlling the birth rate,” Tsakok said. “Those who cannot have children cannot find any to adopt. We find it absolutely crucial to have the absolute best in reproductive technology.”

Infertility problems are becoming more common, possibly because of increasing social stresses, including the push for larger families, doctors said.

“Today in infertility, reproductive medicine, I think it would not be an exaggeration to say we are among the top in the world,” said Prof. S. S. Ratnam, chief of National University Hospital’s obstetrics and gynecology department.

Singapore’s stature as a center for infertility treatment has attracted interest from childless couples throughout Asia.

After trying unsuccessfully for nine years to have a baby, the Rahmans, a young Bangladeshi couple, flew to Singapore for treatment, despite the $9,000 cost--about the price of a new Japanese car there.

“I had heard about Prof. Ratnam. He is quite famous in Bangladesh,” said Rahman, a businessman.

At about $1,950 to $2,800 a treatment, Singapore’s IVF costs are among the lowest in the world--in some cases, less than half the cost in the United States, Ratnam said.

About a third of the obstetrics and gynecology patients at National University Hospital, or about 50 a month, are foreigners from nearby Malaysia and Indonesia. Some come from as far away as Africa and Britain, he said.

He said foreign interest increased after National delivered the world’s first baby conceived by micro-injection of sperm into an egg last year.

Techniques such as using an artificial womb constructed with inner-lining Fallopian cells help boost the chances for a successful pregnancy by allowing the embryo to develop before implanting it into the womb.

Most embryos are implanted within 36 hours of fertilization, but with the artificial womb, the embryo can be kept alive for more than five days.

But both Tsakok and Ratnam said that, even in the best case, only about a third of all infertility and IVF treatments result in a baby.

“It is a very stressful program,” Ratnam said. “When they fail, all of them break down.”