Dr Lim Min Yu explains the latest trends in reproductive medicine

Category: Your Fertility
Posted 19 Feb 2018

Explaining infertility trends in Singapore: Dr Lim Min Yu

The below article was first published by Global Health and Travel and has been reproduced with permission. 

Deciphering infertility trends

Dr Li
m Min Yu, an obstetrician and gynaecologist, is the newly appointed Clinical Director at the Advanced Centre for Reproductive Medicine (ACRM), one of Singapore’s leading reproductive health centres. He shared with Global Health and Travel his views on current infertility trends in Singapore, highlighting the benefits of women having children when they are still young due to the effects of age on a woman’s eggs and the embryo. He also discusses the latest technologies for embryo selection that can increase IVF success rates.

Your main area of research interest is in developing methods of embryo selection to improve IVF success rates. Can you elaborate on how to select the best embryos to achieve a pregnancy?

Dr Lim Min Yu: The conventional method of selecting the best embryos is to check the appearance and structure of embryos once every 24 hours to determine which is the most nicely developed. However, an embryo that looks nice does not guarantee a pregnancy and live birth. One of the problems with this method of embryo selection is that it is limited to a snapshot of the embryo once every 24 hours, which is not a good indication of embryo development. Moving embryos between the microscope and the incubator can also increase the potential likelihood of accidents and stress to the embryos due to excessive handling. Incubators are meant to provide optium conditions for embryo growth, so any removal from the incubator affects those conditions.

Newer technologies that can help select the best embryos more effectively are now being adopted, such as time-lapse embryo imaging technology. ACRM offers time-lapse monitoring of embryos. Not all assisted reproduction centres offer time-lapse monitoring. This method uses advanced incubators equipped with an in-built camera under the embryo to take images of its development every 10 to 15 minutes. This continuous monitoring can help determine which embryos are developing at the optimal rate, which appears to improve the chance of pregnancy. Because the embryos are secured under one incubator throughout the process, unlike with conventional techniques, this method is deemed safer to the embryo’s overall development, providing higher potential to achieve a pregnancy.

Birth rates are plummeting in many high-income countries and Singapore is no exception. In 2016, the city-state set the lowest birth rate record in the world again, with a fertility rate of 1.20. Why do you think this is the case? 

Dr Lim Min Yu: In terms of infertility trends, we certainly see that women are choosing to start their families later in life because of various personal reasons, including career advancement or finding the right partner. I think this is a general global trend, mainly in developed countries. Since fertility is very strongly linked to a woman’s age, then the later women decide to start a family, the harder it is to achieve pregnancy, resulting in lower birth rates.

Another important factor is the thought that raising children is expensive, especially for Singaporean couples. Couples feel the need to be more financially secure before having children. This can be a challenging and conflicting factor, however, because as couples spend more time building a financial reserve, fertility declines.

What are possible strategies or methods to address this issue?

Dr Lim Min Yu: There are various governmental incentives to encourage couples to have more children. In Singapore, this includes financial benefits such as baby bonuses and co-funding for assisted reproductive treatments in an attempt to make infertility treatments or having children more affordable.

Preliminary data from the Health Ministry shows that 6,044 assisted reproduction treatments (ART) were performed in Singapore last year, making it the second year that demand had crossed the 6,000 mark. Is this the consequence of a falling fertility rate or other factors?

Dr Lim Min Yu: Falling fertility rates in Singapore due to financial or ageing constraints increase the demand for ART, but another factor could be the additional incentives such as co-funding. By making ART more affordable in Singapore, couples are more encouraged to use it to have children, adding to its demand. But ageing eggs still play the biggest role in the increasing demand for ART.

Is there any misconception about the chances women have to get pregnant in their 30s? Any advice for women?

Dr Lim Min Yu: As I mentioned, fertility is linked to a woman’s age. Given that a woman’s eggs are the same age as she is, as she ages so will the eggs. SO one improtant factor to keep in mind is that ART cannot reduce the effects of ageing eggs.

With older eggs, chromosomal abnormalities are more likely to be present, which can also result in difficulty in achieving healthy pregnancies. Studies have shown that chromosomally abnormal embryos in women under the age of 35 can be as high as 50 precent, while in women 40 or older, that percentage could rise to 80 percent or more. So the most important advice I can give is to start young. Do not delay!

Dr Lim Min Yu
Dr Lim Min Yu, clinical director at ACRM, Gleneagles Hospital.

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