Given the advances in assisted reproductive technologies and medical care for pregnant women, the Ministry of Health's removal of the age limit for women pursuing in-vitro fertilisation (IVF) treatment is a positive move.

However, there are still important considerations for menopausal women aged over 45 going for IVF (Woman had twins at 58 - after reaching menopause, Sept 22).

A woman becomes menopausal when her eggs are totally depleted through ovulation, but largely through natural cell death. Hence, IVF which requires retrieval of eggs is not possible for this group of women. The only alternative to conceive is through egg donation, where a younger woman donates her eggs, which are then fertilised with the sperm of the menopausal woman's husband.

The resultant embryo is then placed in her womb and she continues with the pregnancy.

For some women, there may still be a psychological barrier because the child is not biologically related to her.

Older pregnant women are at higher risk of pre-eclampsia, diabetes, pre-term deliveries, still births and maternal mortalities.

So, these women need to be medically fit.

Singaporean egg donors are not allowed to donate to more than three families to minimise the risk of consanguinity, which leads to specific risks in subsequent offspring. Couples must inquire about this policy.

There can be ethical concerns where the welfare of the offspring is compromised when the aged parents fall critically ill or pass away while they are still very young. These issues came to light in the recent IVF twin pregnancy of a 74-year-old woman in India whose husband suffered a stroke a day after the babies were born.

Consideration must be made to transfer a single embryo to reduce the risks associated with multiple pregnancies.

It is imperative that guidelines are drawn up so that patients can be adequately counselled and managed to ensure a safe and optimal outcome for the family.

The College of Obstetricians and Gynaecologists, Singapore will be working with the Health Ministry to do this for this special group of women.

Tan Heng Hao (Adjunct Assoc Prof)

Section Chairman of Reproductive Medicine

College of Obstetricians and Gynaecologists, Singapore