Singapore is staring down a demographic cliff. With our total fertility rate plunging to a historic low of 0.87 in 2025 (far below the replacement level of 2.1), the government is pulling out all the stops to encourage parenthood.
From Baby Bonus cash gifts to MediSave grants, the state is investing heavily in the next generation. Now, one idea gaining significant traction is extending government co-funding for in vitro fertilization (IVF) to private clinics.
Currently, eligible couples can get up to 75 per cent of their IVF costs covered at public assisted reproduction centres. But the reality on the ground is challenging.
Public hospitals are operating at near capacity, and couples often face agonising waiting times of four to eight weeks just to get started. For older women, every month counts, as their fertility declines sharply with age.
This bottleneck has sparked a legitimate demand to extend subsidies to the private sector, where treatment can begin almost immediately.
It sounds like a win-win: give couples more choices and faster access to treatment while easing the burden on public hospitals. But behind the glossy marketing of private fertility clinics lies a multi-million-dollar industry built on desperation.
If the government isn’t careful, extending subsidies to private clinics could end up lining corporate pockets rather than helping Singaporeans build families.
The “Hope Technology” Trap
Infertility is an agonising, emotionally draining journey. For couples who have already endured the heartbreak of failed IVF cycles at public hospitals, the intense desire for a biological child can make them uniquely vulnerable to exploitation.
Enter the lucrative and highly unregulated world of IVF add-ons, which are optional, non-essential procedures marketed as cutting-edge ways to boost the chances of a successful pregnancy.
From time-lapse embryo imaging and preimplantation genetic testing (PGT-A) to endometrial scratching, immunological treatments, and EmbryoGlue, these extras sound like medical miracles. They are pitched to patients as the missing puzzle piece that will finally result in a baby.
In reality, the science tells a very different story. A landmark 2026 meta-analysis by Lensen and colleagues, published in The Lancet Obstetrics, Gynaecology, and Women’s Health rigorously reviewed the evidence and found that most add-ons offer absolutely no proven benefit.
In fact, out of 157 trials examined, nearly half had to be excluded due to trustworthiness concerns, including possible data fabrication. The remaining trustworthy data was unambiguous: the vast majority of add-ons do not improve live birth rates.
In some cases, such as routine PGT-A for all patients, they may even reduce the number of viable embryos available for transfer.
Yet, these unproven extras are a massive cash cow for private clinics. In a highly competitive market, clinics use add-ons to differentiate themselves and pad their profit margins.
Patients, desperate for a breakthrough, often spend thousands of dollars on these procedures, sometimes outspending the cost of the core IVF treatment itself.
The Subsidy Paradox
Herein lies the danger of extending government co-funding to private clinics without strict, watertight safeguards. If the government subsidizes the basic cost of an IVF cycle, it effectively frees up a couple’s disposable income.
In the hands of aggressive marketing and the power dynamic of the doctor-patient relationship, that “saved” money could easily be funneled right back into the clinic through the purchase of expensive, unproven add-ons.
A notorious example is the use of time-lapse imaging (TLI) systems for purportedly selecting the best IVF embryos. However, the landmark TILT trial published in The Lancet in 2024 demonstrated conclusively that it does not significantly increase the live birth rate.
Yet another controversial add-on is PGT-A, which has been the subject of multiple class-action lawsuits in the United States and Australia, due to allegations of misdiagnosis that have robbed IVF patients of their chances of parenthood.
Hence, instead of making IVF more affordable and effective, public subsidies could inadvertently fuel the consumption of dubious treatments.
It is a phenomenon seen elsewhere: when Australia introduced uncapped Medicare rebates for ART, private providers simply raised their fees to absorb the subsidy. We cannot allow Singapore’s public funds to be siphoned off in the same opportunistic way.
A Smarter Way Forward: The No-Frills Tender Model
So, how do we expand access to private IVF without falling into the add-on trap? The answer lies in a model Singapore already excels at: competitive public procurement.
Just as the Singapore government uses the GeBIZ portal to secure the best value for public projects, the Ministry of Health (MOH) should invite private IVF clinics to bid for government co-funding.
But this shouldn’t be a free-for-all. The tender must be strictly for basic, no-frills IVF cycles: the core, evidence-based procedures like ovarian stimulation, egg retrieval, fertilisation, and embryo transfer.
Here’s how a competitive tender model should work:
Strict Price Caps: The MOH must set a firm price ceiling for the basic IVF package, based on the actual cost of delivery plus a reasonable profit margin.
Private IVF clinics bidding for co-funding must agree to charge at or below this cap, preventing arbitrary fee hikes.
Zero Add-Ons in the Package: All add-on procedures must be explicitly excluded from the co-funded package. If a clinic wants to offer an add-on, it must first be proven to be effective, based on solid medical and scientific evidence.
These must be billed entirely separately, out-of-pocket, with total transparency about its cost and therapeutic effectiveness.
Performance-Based Accreditation: The lowest bid shouldn’t automatically win. Clinics must prove they can deliver genuine clinical results. Approval for co-funding should require clinics to demonstrate audited live birth rates that meet or exceed those of public hospitals, adjusted for patient age.
If a clinic’s success rates drop below the benchmark, they lose their accreditation. This ensures public money only goes to clinics providing high-quality care, not just cheap care.
Protecting The Vulnerable With Radical Transparency
To make this framework succeed, we need radical transparency and robust regulation. The United Kingdom’s Human Fertilisation and Embryology Authority (HFEA) uses a highly effective traffic light system to rate IVF add-ons based on clinical evidence. Singapore should adopt a similar framework immediately.
The table below summarises the HFEA ratings and 2026 meta-analysis findings by Lensen and colleagues for the IVF add-ons discussed, together with the recommended policy position for the proposed co-funding scheme.
| IVF Add-on | HFEA Rating | Lensen & Colleagues 2026 Meta-Analysis | Recommended Policy Position |
|---|---|---|---|
| Time-lapse imaging | Black | No effect (TILT trial) | Exclude from co-funded cycles; consider restricting commercial offering |
| PGT-A | Red | No effect on live birth rate, may harm IVF embryos due to invasive biopsy | Exclude from co-funded cycles |
| Endometrial receptivity testing (ERA) | Red | No effect (moderate certainty) | Exclude from co-funded cycles |
| IVIG | Red | Safety concerns (not in meta-analysis) | Exclude; restrict to research settings |
| Corticosteroids | Red | No effect (moderate certainty) | Exclude from co-funded cycles |
| PRP (intraovarian/intrauterine) | Red | Unclear (very-low certainty) | Exclude from co-funded cycles |
| Intralipid | Grey | Unclear (very-low certainty) | Exclude from co-funded cycles |
| Acupuncture | Grey | Unclear (very-low certainty) | Exclude from co-funded cycles |
| PICSI | Black | No effect on live birth (low certainty) | Exclude from co-funded cycles |
| Endometrial scratching | Yellow | Possible small benefit (moderate certainty) | Exclude for now; monitor evidence |
| EmbryoGlue | Yellow | Possible benefit (low certainty) | Consider incorporating into standard protocol |
Add-ons with a red rating — meaning there are safety concerns or evidence they reduce IVF success — should be banned from routine clinical use and restricted strictly to ethical research settings.
For all other add-ons, clinics must be mandated to provide plain-language, written counseling before a patient signs the dotted line. Patients deserve to know exactly what they are paying for and what the science actually says.
Furthermore, Singapore needs a mandatory national IVF registry. Every clinic, public or private, should be required to submit detailed outcome data for every cycle.
This isn’t just about auditing clinics for co-funding; it’s about giving patients the transparent, reliable data they need to make informed choices about their healthcare.
The Bottom Line
Singapore’s existential demographic challenge requires bold, innovative action, and helping more couples access IVF quickly is a necessary step. But public funds must be spent on evidence-based medicine, not corporate upselling.
By implementing a rigorous, price-capped tender model and cracking down on the exploitation of vulnerable patients, the government can ensure that every dollar spent on IVF co-funding actually goes toward what matters most: helping Singaporeans bring healthy babies into the world.
Let’s expand access to the private sector, but let’s do it right.
The author is an associate professor at Peking University, China.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
