Singapore’s first surviving IVF quadruplets



Singapore saw the successful delivery of its first surviving in-vitro fertilisation (IVF) quadruplets on 14 May 1989.1 A Mother's Day gift to Mr. and Mrs. H. T. Tan, the quadruplets – girls Chun Ping, Chun Li, Chun Di and their brother Min Bin had healthy birth weights between 1.5 and 1.9 kg, and birth lengths between 42 and 45 cm. The Tans wanted a third child and had sought treatment at the Thomson Medical Centre.2 The medical team that attended to them included Dr. W. C. Cheng, who delivered the quadruplets by caesarean section, and embryologist, Chia Choy May who “assembled” the eggs and the sperm in a petri dish.3

History
In 1979, Thomson Medical Centre was established as a private healthcare provider for women and children, and it was equipped to provide fertility investigations and treatments within its premises, and marketed itself as a convenient one-stop centre for both locals and foreigners.4 In 1987, Thomson Fertility Clinic, the first private IVF clinic in Singapore, was set up at the Thomson Medical Centre.5


Singapore’s first IVF triplets were delivered at the clinic in September 1988, and the Tans’ quadruplets – known as F4 by their friends after a Taiwanese boyband – followed nine months later.6 By 2009, the clinic had treated over 4,000 couples for fertility, and more than 750 IVF babies had been born as a result of the IVF programme.7 The centre also produced one of the world's first pair of twins from frozen eggs and frozen testicular sperm in December 2000.8

Assisted reproduction technology

Between 2009 and 2013, the average success rate of IVF treatment in Singapore that resulted in a live birth was 22 percent in public hospitals and 20 percent  in private hospitals.9  In 2015, there were more than 6,000 assisted reproduction cycles carried out in Singapore compared with 5,519 in 2013 and below 5,000 in 2012.10

At Thomson Fertility Clinic, assisted reproduction entails the steps of preliminary evaluation and subsequent treatment with fertility medication, Clomiphene, to induce ovulation. The fallopian tubes are checked through a laparoscopic examination before the woman undergoes Super-Ovulation and Artificial Insemination (SO-AI). This procedure boosts natural hormones and induces multiple egg growth, before the implantation of sperm in the womb. Should SO-AI fail (such as when the fallopian tubes are blocked or there is insufficient sperm), IVF will be initiated.11

Commonly known as the test tube baby programme, IVF is a method of assisted reproduction in which a woman’s eggs are harvested from her ovaries in a laboratory, and then fertilised with her husband's sperm. The fertilised eggs, also known as embryos, are then implanted into her womb.12

The success of IVF and live birth rates are dependent on several factors such as the patient’s age, medical history and prior fertility treatment history. Younger women below 35 years of age face higher chances of multiple births leading to complications such as premature delivery, while older women face a higher incidence rate of miscarriage, and are more likely to suffer from complications like diabetes and high blood pressure. Under regulations implemented by the Ministry of Health, a woman is allowed to implant up to a maximum of three embryos.13 The IVF age limit in Singapore is 45, and single women are not allowed to undergo IVF.14

ART procedures tend to be costly. In August 2008, the government announced its co-funding scheme for ART procedures, up to a cap of S$3,000. The scheme, which took effect from 1 September that year, covers IVF and gamete intra-fallopian transfer procedures. It is applicable only to Singapore citizens at public hospitals and up to a maximum of three fresh cycles.15 Women above 40 years of age are ineligible for government subsidies.16

Since 1 January 2013, the government has increased the co-funding for ART treatments to 75 percent for eligible patients for a maximum of three fresh and three frozen ART cycles. In addition, from 1 October 2013, the Medisave withdrawal limits for Assisted Conception Procedures (ACP) are $6,000 for the first cycle, $5,000 (for the second cycle and $4,000 for the third and subsequent cycles. There is, however, a withdrawal limit of $15,000 per patient for such procedures.17 

Singapore's IVF quadruplets
The chance of conceiving twins in IVF births is 25 percent  compared with  one percent for natural conception; triplets and quadruplets are rarer.18 The world’s first Gift (gamete intra-fallopian transfer; a variation of IVF) quadruplets were born in Australia in June 1988.19 By 2004, there were at least eight sets of quadruplets  born in Singapore, of which half were conceived using IVF technology.20 The first set – two boys and two girls, were delivered in January 1989 at Thomson Medical Centre. However, only the boys survived.21


Quadruplet births are very rare – occurring in a 1 in 729,000 chance.22 According to the Immigration and Checkpoints Authority, only two sets of quadruplets births were recorded in Singapore since 2006 – one in 2008 and the other in 2012.23


The Tan quadruplets were born on Mother's Day on 14 May 1989, and were delivered by caesarean section. Their weight ranged from 1.5 to 1.9 kg, and body length from 42 to 45 cm.24 Comprising three girls and a boy, they are Singapore and Southeast Asia’s first surviving IVF quadruplets. Mrs Tan spent the last 12 weeks of her 34-week pregnancy in the hospital, as her abdomen had grown too big for her to walk or to lie down properly.25

In July 1989, two months following the birth of the Tan quadruplets, Singapore's second surviving set of quadruplets was delivered at the Kandang Kerbau Hospital.26 Since 1990, the number of implanted embryos in Singapore have been capped at three.27 Therefore, the Tan quadruplets are also one of the last IVF quadruplets born in Singapore.28

The Tan quadruplets
The Tan siblings visited the Thomson Medical Centre for its 25th anniversary celebrations in May 2004. There, they learned about their 15 minutes of fame when they made the headlines 15 years back. Chun Ping, the oldest, is said to be very stubborn with a temper. Chun Li and Chun Di are extroverts, with the former being boyish, and the latter, vain. The youngest and the only boy, Min Bin is reportedly the naughtiest.29




Author
Perpetua Neo




References
1. Nathan, F. (1989, November 14). S-E Asia's first test-tube quads are six months old todayThe Straits Times, p. 3. Retrieved from NewspaperSG.
2. Luo, S. (2004, May 30). Quad squad. The Straits Times, p. 6; Toh, S. (1989, May 18). S’pore’s first surviving IVF quads. The Straits Times, p. 40. Retrieved from NewspaperSG.
3. Luo, S. (2004, May 30). Quad squadThe Straits Times, p. 6. Retrieved from NewspaperSG.
4. Wong, D. (2005, March 16). Growing the baby business. The Straits Times, p. 15; Wong, D. (2004, October 22). Dr Cheng Wei Chen Thomson Medical Centre. The Straits Times, p. 20. Retrieved from NewspaperSG.
5. Leong, S. (2010, November 7). The little hospital that could. The Straits Times, p. 6. Retrieved from NewspaperSG.
6. Wong, D. (2004, October 22). Dr Cheng Wei Chen Thomson Medical Centre. The Straits Times, p. 20; Luo, S. (2004, May 30). Quad squad. The Straits Times, p. 6. Retrieved from NewspaperSG.
7. Emuang, K. G. (2009). Shaping of a vision, Thomson Medical Centre: Celebrating 30 years, 1979–2009. Singapore: Thomson Medical Centre, p. 73. (Call no.: RSING 362.11095957 EMU)
8. Wong, W. K. (2003, August 23). Delivering the goods. The Business Times, p. 3. Retrieved from NewspaperSG.
9. IVF success rates subsidies. (2015, May 11). Singapore Government News. Retrieved from ProQuest via NLB’s eResources website: http://eresources.nlb.gov.sg/
10. Nur Sabrina Azmi & Cheok, J. (2016, September 17). Fertility treatment a potent S’pore business. The Business Times. Retrieved from Factiva via NLB’s eResources website: http://eresources.nlb.gov.sg/

11. Thomson Fertility Centre. (n.d.). Stages in fertility treatment. Retrieved 2016, October 31 from Thomson Fertility Centre website: http://www.thomsonfertility.com.sg/en/content.aspx?cid=28
12. Tan, S. Y. (2004, October 9). The making of a baby. The Business Times, p. 17. Retrieved from NewspaperSG.
13. Thomson Medical Pte Ltd. (n.d.). Understanding IVF statistics. Retrieved 2016, October 31 from Thomson Fertility Centre website: http://thomsonfertility.com.sg/en/content.aspx?cid=30
14. Chai, H. Y. (2013, October 25). Pregnancy carries increased risks for older women. The New Paper; Koh, F. (2012, April 11). Banking on IVF. The New Paper. Retrieved from Factiva via NLB’s eResources website: http://eresources.nlb.gov.sg/; Thomson Medical Pte Ltd. (n.d.). Understanding IVF statistics. Retrieved 2016, October 31 from Thomson Fertility Centre website: http://thomsonfertility.com.sg/en/content.aspx?cid=30
15. Tan, H. L. (2008, August 21). New subsidy scheme ‘welcomed’. Today, p. 6. Retrieved from NewspaperSG.
16. Nur Sabrina Azmi & Cheok, J. (2016, September 17). Fertility treatment a potent S’pore business. The Business Times. Retrieved from Factiva via NLB’s eResources website: http://eresources.nlb.gov.sg/
17. Ministry of Health. (2016, March 24). Marriage and parenthood schemes. Retrieved 2016, December 20 from Ministry of Health website: https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Marriage_and_Parenthood_Schemes.html; Nur Sabrina Azmi & Cheok, J. (2016, September 17). Fertility treatment a potent S’pore business. The Business Times.  Retrieved from Factiva via NLB’s eResources website: http://eresources.nlb.gov.sg/

18. 800 twins born each year. (1995, July 15). The Straits Times, p. 7. Retrieved from NewspaperSG.
19. World’s first Gift quadruplets born. (1988, June 22). The Straits Times, p. 4. Retrieved from NewspaperSG.
20. Luo, S. (2004, May 30). Quad squadThe Straits Times, p. 6. Retrieved from NewspaperSG.
21. Toh, S. (1989, May 18). S’pore’s first surviving IVF quads. The Straits Times, p. 40. Retrieved from NewspaperSG.
22. Tan, T. M. (2016, February 18). Strike Toto? You’re more likely to… The New Paper. Retrieved from Factiva via NLB’s eResources website: http://eresources.nlb.gov.sg/
23. Lee, X. E. (2012, July 25). 1st quadruplets born in S’pore since 2008. The Straits Times, p. 2. Retrieved from NewspaperSG.
24. Emuang, K. G. (2009). Shaping of a vision, Thomson Medical Centre: Celebrating 30 years, 1979–2009. Singapore: Thomson Medical Centre, p. 35. (Call no.: RSING 362.11095957 EMU)
25. Birth of quadruplets makes local history. (1989, May 18). The Business Times, p. 2; Luo, S. (2004, May 30). Quad squadThe Straits Times, p. 6. Retrieved from NewspaperSG.
26. Toh, S. (1989, July 26). Second set of test tube quads born – at KK. The Straits Times, p. 20. Retrieved from NewspaperSG.
27. Toh, S. (1990, January 3). Embryos implanted in IVF may be limited to 3. The Straits Times, p. 3. Retrieved from NewspaperSG.
28. Luo, S. (2004, May 30). Quad squadThe Straits Times, p. 6. Retrieved from NewspaperSG.
29. Luo, S. (2004, May 30). Quad squadThe Straits Times, p. 6. Retrieved from NewspaperSG.



The information in this article is valid as at 2016 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

 

Subject
Quadruplets--Singapore
Fertilization in vitro--Singapore
Health and medicine>>Human anatomy and physiology>>Reproduction and development
Events