LETTERS: I read with great interest the article entitled "Malaysia a top destination for fertility treatment" last Thursday in the New Straits Times.
With many countries reopening their borders as the Covid-19 pandemic recedes due to increasing vaccination worldwide, medical tourism, particularly by patients seeking IVF (in vitro fertilisation) procedures banned in their home countries but available abroad, is once again on the rise.
One of the most controversial of these is sex selection by genetic testing of IVF embryos, a procedure known as preimplantation genetic screening (PGS) or preimplantation genetic testing - aneuploidy (PGT-A).
Often, the need to prevent birth defects such as Down syndrome and other genetic diseases, has been widely abused as a pretext or convenient excuse for justifying the widespread application of PGS (PGT-A) in IVF treatment for sex selection.
No doubt, this technique is extremely useful for detecting the presence of genetic defects in IVF embryos, but at the same time it also reveals the sex of the embryo, thus giving patients the choice of selecting the sex of their offspring.
To date, PGS (PGT-A) is currently the best and most effective method of sex selection available in the market. If a woman becomes pregnant through IVF with this technique, the success rate of sex selection is close to 100 per cent.
Concerned that such new reproductive technologies would further skew the sex ratio of their populations, many Asian countries with unbalanced sex ratios due to male preference, such as China and India, have banned the use of PGS (PGT-A) for embryo sex selection in clinical IVF treatment.
This is widely deemed to be immoral and unethical in reinforcing traditional gender bias and sexism, and in encouraging couples to favour having children of one gender over the other.
This has elicited much controversy in some Asian countries where women are regularly subjected to strong societal discrimination and gender-based violence.
To circumvent such strict regulations, many affluent couples from countries with such ban travel abroad to more liberal jurisdictions where PGS (PGT-A) for sex selection is permitted.
In recent years, Malaysia has emerged as a medical tourism hub for such a controversial procedure, with many well-established IVF clinics offering cost-competitive medical fees to foreign patients.
Indeed, there have been news reports of couples from Singapore coming here for embryo sex selection with PGS (PGT-A). This has caused much concern to Singaporean health authorities, leading to severe restrictions being placed on the import of PGS-tested frozen embryos into Singapore.
It must be noted that many patients who seek to do embryo sex selection with PGS (PGT-A) at Malaysian IVF clinics are ethnic Chinese from Singapore and China. The procedure is banned in their home countries.
Such patients often prefer Malaysia due to cheaper medical fees and because many fertility clinic doctors can speak Mandarin.
In fact some foreign fertility clinics in Singapore and China have collaborative ties with Malaysian IVF clinics that do sex selection with PGS/PGT-A.
Another alternative for Singaporean patients is to do the entire IVF treatment process in Singapore, but freeze all their embryos and export these to a Malaysian IVF clinic for the PGS sex selection procedure.
However, they would then have to travel overseas for transfer of the sex-selected embryos into the womb.
By contrast, the export of IVF embryos is banned in China. Son or male preference and obsession with having male heirs are deeply ingrained in Chinese culture.
Although times have changed drastically and such old social norms are long gone, ancient Chinese cultural traits that have evolved over millennia die hard and still persist.
This could explain why preference for sons and an obsession with having male heirs are so prevalent among traditional Chinese business families in Asia.
DR ALEXIS HENG BOON CHIN
Associate Professor, Peking University, China
The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times