Why Early Fertility Planning for Women Matters Now: Reproductive Choices in Singapore

From egg quality to IVF success, knowing your reproductive options early gives women in Singapore the power to plan their future on their terms.

When people think about menopause, they often picture symptoms arriving around age 50. But hormonal changes, declining fertility, and perimenopausal symptoms can begin well before most women expect them.

A recent Straits Times article debunking menopause myths highlights the realities of reproductive ageing and opens the door to a bigger conversation: how women can take proactive steps to preserve fertility before their biological clock starts winding down.

Changing Parenthood Trends in Singapore

Declining marriage rates and the decision to delay parenthood are characteristics of Singapore’s family planning landscape today. While many couples may wish to delay parenthood to focus on careers or financial security, the shift in family planning also introduces age-related fertility challenges, higher pregnancy health risks, and a shorter reproductive window. For those who hope for more than one child, delayed parenthood can also make falling pregnant again more difficult, in a condition known as secondary infertility.

The Reality of Age and Fertility

A woman's fertility naturally declines with age and cannot be reversed. It affects the chances of conceiving, whether naturally or through assisted reproductive techniques such as IVF.

“In Singapore and most parts of the world, advanced maternal age typically refers to women who are 35 and above,” Dr Roland Chieng, medical director, Virtus Fertility Centre explains. “This is when fertility starts to decline noticeably, and the chances of pregnancy, whether naturally or via IVF, begin to drop.”

According to the Ministry of Social and Family Development (MSF)’s report, the median age for first-time mothers has increased to 31.9 years in 2024 from 30.4 years over a decade ago.

Although there is no strict upper age limit for IVF, the odds grow slimmer with age. Success rates for women aged 45 and above are often below 5% per cycle[1], primarily due to diminished egg quality and ovarian reserves. This underscores why couples need to be aware of the biological limits of fertility, even with modern technology.

Why Early Fertility Planning Matters

One clear benefit of early fertility planning is the opportunity to detect and treat gynaecological conditions through screenings. Issues such as endometriosis or polycystic ovary syndrome (PCOS), which affect fertility, can be picked up earlier, allowing treatment options to be more effective and helping improve long-term reproductive health.

In Singapore's urban lifestyle, fertility is not only influenced by biology but also by the pressures of urban living: stress levels, long working hours, and exposure to environmental pollutants[2]. Studies have linked air pollution to reduced fertility, with some showing up to a 20% higher risk of infertility from increased exposure to fine particulate matter.

With takeout and convenience foods a daily norm for many Singaporeans, chemicals like PFAS in Styrofoam and disposable packaging can build up in the body. Research[3] shows that women with higher PFAS levels may face up to a 40% lower chance of conceiving within a year. It highlights how modern lifestyles and environmental exposures are making fertility challenges even more complex in Singapore.

Furthermore, considering options such as egg freezing at a younger age can reduce the number of IVF cycles needed later, improve fertilisation success, and increase the chances of a healthy pregnancy.

By being proactive in understanding fertility health and exploring available options, couples can then make informed choices about when and how to start a family, rather than leaving it to chance.

Pause the Biological Clock Early and when Healthy

For years, elective egg freezing in Singapore was only allowed for medical reasons. While many diseases, such as cancer, do not inherently reduce egg quality, treatments like chemotherapy, radiation, or surgery can damage eggs and lower ovarian reserve.

Egg freezing for medical reasons can also be more complex than for social reasons. Health conditions and treatments may affect the timing and approach of the procedure, and additional medications may be required. And, having a medical condition could affect the quality of the eggs.

“For instance, someone with a hormone-dependent cancer like breast cancer may benefit from extra medication to keep hormone levels safe during ovarian stimulation,” Dr Chieng explains.

This changed in July 2023, when the Ministry of Health allowed women aged 21 to 37, regardless of marital status, to freeze their eggs for non-medical reasons.

This shift isn’t just about reproductive rights—it’s also about science. Studies show that women who freeze their eggs before 35 have significantly higher chances of success later on. Freezing 15–20 eggs before age 35 can yield a 70–90% chance of achieving a live birth when those eggs are used in the future.

He notes. “Egg freezing offers a way to pause the biological clock while career, education, or personal milestones fall into place. Your best eggs are the ones you have today.”

Common Questions Explained

Many women have questions about egg freezing, such as how many eggs to freeze, whether one cycle is enough, and what success looks like.

“Generally, the more eggs you freeze, the better, but you need to be realistic. Any number is better than none, though we don’t usually encourage freezing more than 20 eggs,” he advises.

Age is another key factor. “Younger women have better outcomes, but we encourage egg freezing after 30, when they are more financially and emotionally prepared for the process and potential uncertainties.”

Regarding health risks, Dr Chieng assures that they are low. “Medications are safe, and ovarian hyperstimulation syndrome (OHSS) is rare. Overall, the procedure is fast, simple, and uncomplicated.”

Even after the procedure, patients may still conceive naturally. The unused eggs can remain in storage or will be respectfully discarded upon discussion with the patient. In Singapore, a marriage certificate is required to use stored eggs, though they can also be transported abroad where regulations differ. Storage is legally allowed for up to 10 years, with extensions possible.

Understanding the Limits

Egg freezing is not a guarantee. It is an option. The outcomes depend on age at freezing, number of eggs retrieved, and overall health.

Fertility counselling is mandatory in Singapore before elective freezing. Dr Chieng explains why.

“I emphasize three points during consultations,” he says. First, the expectations for the number of eggs per cycle vary by individual. Secondly, success rates shouldn’t be judged solely on live birth probability, as other factors, such as the sperm quality of their partners, also play a role. Lastly, globally, only around 9–12% of women return to use their frozen eggs. Many conceive naturally, change plans, or never need them.

Sitting through these sessions helps the woman gain clarity when deciding to freeze her eggs, with realistic expectations, and addresses medical, emotional, and legal considerations.

“It is not about selling hope, but providing clarity of choice,” he adds.

[1] Cakmak H. When is the right time to stop autologous in vitro fertilization treatment in poor responders? Fertil Steril. 2022 Apr;117(4):682-687. doi: 10.1016/j.fertnstert.2022.02.027. PMID: 35367012. https://pubmed.ncbi.nlm.nih.gov/35367012/

[2] Jain M, Carlson K, Singh M. Environmental Toxins and Infertility. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK576379/

[3] https://mountsinaiexposomics.org/study-finds-exposure-to-pfas-found-in-everyday-products-is-linked-to-significantly-reduced-fertility/