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Singapore experienced a significant drop in its Total Fertility Rate (TFR), reaching an unprecedented low of 0.97 in 2023. The high cost of living, demanding work culture, and prioritisation of career over starting a family are some causes for this low TFR. Aside from this, couples who are trying to conceive may not always be fertile, and one way to address the gap is through assisted conception. There are 3 main methods of assisted conception: In-Vitro Fertilisation (IVF), Intrauterine Insemination (IUI) and Intravaginal Insemination (IVI). IVF is the most well-known method, where eggs are extracted and fertilised by sperm in a lab. Thereafter, the healthiest fertilised embryos are selected and are placed into the uterus. Multiple embryos can be placed at one time to give a higher chance of success, but this gives a higher chance of twins, which comes with increased risk of complications especially for older women. In Singapore, typically up to two embryos can be placed, and up to three in exceptional cases. The estimated cost of doing an IVF is about $20,000 – $25,000 per cycle. Some clinics offer instalment plans for payment, which will help ease the cash outlay for this. IUI is a procedure which introduces a concentrated amount of good sperm into the woman’s uterus during ovulation. IUI could be conducted naturally, following the woman’s natural ovulation cycle, or it could be stimulated where oral or injected fertility drugs could be used to stimulate ovulation. In the next stage of the process, sperms are put through a process of basic sperm wash to collect and concentrate the healthier sperms, which are introduced directly into the uterus for best results. This procedure costs $1,800 – $3,000 per cycle. IVI is a much simpler procedure and does not require the use of any medications or even trips to the clinic. 95% of sperm do not make it into the cervix due to the harsh acidic environment in the vagina, and IVI is conceptualised to help bypass this by delivering the sperm close to the cervix, which is a much less hostile zone for sperm. The odds of pregnancy for IVI are lower than IUI since IUI concentrates the healthiest sperms and introduces them directly into the uterus with an egg already present. The odds are also lower as compared to IVF, since the procedure performs fertilisation in the lab and allows for the healthiest eggs to be selected before they are introduced into the uterus. Even so, the main benefit of IVI is the significantly lower cost each time. The cost of IVI kits such as the costs just $128 per cycle, with more savings if you purchase more cycles at once. The affordability of this option allows couples to increase the number of tries using IVI, and even use this in between IUI or IVF cycles to increase the odds of pregnancy. While Assisted Conception Procedures are costly, couples undergoing Assisted Conception Procedures in Assisted Reproduction centres can get up to 75% in co-funding from the Government. The co-funding covers up to 3 fresh and 3 frozen cycles of Assisted Reproduction Technology treatments (or ART, which includes IVF) for women who are below 40 years old. Women above the age of 40 are still eligible for up to 2 cycles, however they must have attempted IUI or IVF before 40. The co-funding also covers up to 3 cycles for IUI. Do note that unmarried persons cannot receive IUI or IVF treatment in Singapore, and therefore cannot qualify for co-funding. Either spouse can use Medisave to offset the payments for IUI or IVF. Couples can withdraw $6,000 for the first treatment cycle, and $5,000 and $4,000 for second and subsequent cycles, capped at a total of $15,000 across all cycles. Medisave withdrawals can be utilised with or without Government co-funding for these procedures. The quality of eggs and sperms generally decreases as the woman and man age. As is the case with natural conception, the chances of succeeding with assisted conception falls with age. Along with this, the risk of complications arising from pregnancy increase as women age, especially for women above the age of 40.