是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

SINGAPORE: She used to go to Johor Bahru at least thrice a week for six months, telling herself “to be strong” and think positively “no matter what”.

新加坡:过去六个月里,她每周至少去新山市三次,告诉自己“要坚强”,“无论发生什么事”都要积极思考。

Driven by desperation and hoping for success, getai celebrity Liu Ling Ling had done her research — she chose the most popular clinic in town for her treatments.

在绝望和希望成功的驱使下,葛泰名人刘玲玲选择了城里最受欢迎的诊所进行治疗。

The nurse also told me a lot of Singaporeans (make) their babies here,” she said.

护士还告诉我很多新加坡人在这里生孩子。”

That has not changed, six years after she successfully underwent in-vitro fertilization and became a first-time mother at the age of 50.

这一切都没有改变,6年前,她成功地进行了试管婴儿,并在50岁时成为了第一个母亲。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

There is a concentration of fertility clinics just 10 minutes away from Woodlands Checkpoint. And a couple of them disclosed that most of their patients come from Singapore.

离林地检查点只有10分钟路程的地方是生育诊所的聚集地。大多数病人都来自新加坡。

Age is a reason, as IVF for women aged 45 and older is not allowed here. But there are also other reasons Singaporeans are crossing the Causeway for these treatments, the programme Talking Point discovers.

年龄是一个原因,因为这里不允许45岁以上的女性接受试管婴儿。但节目《talk Point》发现,新加坡人跨越柔佛海峡接受这些治疗还有其他原因。

And with fertility clinics seeming to boast high success rates, there is a question whether the reality is as good as promised, or are women pinning too much hope on IVF, overseas or locally?

在生育诊所似乎拥有高成功率的情况下,存在一个问题:现实是否像承诺的那样好,还是女性把太多希望寄托在试管婴儿上,去海外还是本地?

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

LOWER COST, GREATER CHANCES

成本低,成功率大

In the case of Ms Liu, she had tried reproductive treatment in Singapore before she was 45, but it was unsuccessful.

就刘而言,她在45岁之前曾在新加坡尝试过生殖治疗,但没有成功。

When her doctor first told her that she would have to go to Malaysia in order to have more fertility treatments, she felt “lost”, as she did not know where to go.

当她的医生第一次告诉她,她必须去马来西亚接受更多的生育治疗时,她感到“迷茫”,因为她不知道该去马来西亚哪里。

You don’t know about the doctors here; you don’t know whether it’s safe or not,” she recounted. But eventually, she found TMC Fertility Centre and Dr Fabian James Kurian.

你不了解这里的医生;你不知道它是否安全,”她回忆道。但最终,她找到了TMC生育中心和Fabian James Kurian博士。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

She also found out that Johor Bahru was an attractive option for Singaporeans because of the price, which is “less than 50 per cent”.

她还发现新山市(马来西亚)对新加坡人来说是一个有吸引力的选择,因为它的价格“少了50%”。

For those aged below 40, the cost of an IVF cycle at a public hospital in Singapore can be as low as S$2,500, after the government co-funds 75 per cent (up to S$7,700) of the treatment.

对于40岁以下的人来说,在新加坡一家公立医院进行试管婴儿周期的费用可能低至2500新元,此前政府联合资助了75%的治疗费用(最高7700新元)。

But for older women, it usually costs between S$10,000 and $15,000 — with no co-funding — whereas in Johor Bahru, IVF treatment may cost about S$5,000 to S$7,000 per cycle, which is more attractive to this group aged 40 and above.

但对于年龄较大的女性,试管婴儿的费用通常在1万至1.5万新元之间——没有共同资助——而在新山市(马来西亚),试管婴儿每周期的费用约为5000至7000新元,这对40岁及以上的人群更具吸引力。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

There is something else the nearby city offers: The ability to test the embryos before they are implanted in the uterus.

附近的城市还提供了另一种功能:在胚胎植入子宫之前对其进行检测。

This technique, called pre-implantation genetic screening, aims to improve IVF outcomes for women, say, one who has “tried IVF perhaps a few times and has failed”, explained gynaecologist Ann Tan.

这项技术被称为植入前基因筛查,旨在提高女性试管婴儿的效果,妇科医生Ann Tan解释说,女性“可能尝试过几次试管婴儿,但都失败了”。

Embryos with chromosomal abnormalities are the most likely reason for an unsuccessful cycle and are more common among older women.

染色体异常的胚胎是一个不成功的周期最可能的原因,在老年妇女中更常见

But screening for the correct number of chromosomes, so that only those embryos are implanted, can boost success rates to up to 70 per cent.

但是,筛选正确数目的染色体胚胎,植入后,可以将成功率提高到70%。

A pilot programme allowing this in Singapore is underway. But “it isn’t easily available”, said Dr Tan, who has her own clinic, the Women Fertility & Fetal Centre.

新加坡正在进行一项允许这种情况发生的试点计划。但谭医生说:虽然她拥有自己的诊所——妇女生育与胎儿中心,但这并不容易做到。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

“And some can’t wait in line for it. That’s why they’re running elsewhere … to the various centres in the surrounding countries,” she added. “We’re definitely losing some patients because of this, especially the women who are older.”

有些人等不及了。这就是他们去其他地方治疗的原因……跑到周边国家的各个中心,”她补充道。“我们肯定会因此失去一些病人,尤其是年龄较大的女性。”

REALISTIC SUCCESS RATES?

现实的成功率?

Even when there is embryo screening, the IVF process is not easy, what with the injections and the threat of miscarriage. Pictures on fertility clinics’ websites, however, make it look simple. And the success rates they report seem high.

即使有胚胎筛查,试管婴儿的过程也不容易,因为有注射和流产的危险。然而,生育诊所网站上的图片让它看起来很简单。而且他们报告的成功率似乎很高。

One clinic stated that for women aged below 35, it was 69.2 per cent; for the 35 to 39 age group, it was 54.6 per cent. Another stated that for women above 40, it was 48 per cent.

一个诊所说,35岁以下的妇女为69.2%;在35岁至39岁的人群中,这一比例为54.6%。另一组人说,在40岁以上的女性中,这一比例为48%。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

How accurate are these statistics? There are multiple ways of looking at them, according to Dr Hemashree Rajesh, a senior consultant at the Singapore General Hospital’s Department of Obstetrics and Gynaecology.

这些统计数字有多准确?新加坡总医院妇产科的高级顾问Hemashree Rajesh博士说,有多种方法可以观察它们。

“It could be they’re talking about the clinical pregnancy rates, or it could be they’re talking about their live birth rates,” she said.

她说:“可能是他们指的是临床妊娠率,也可能是他们在说活产率。”

“Another thing which you’d have to interpret … is the age of the women they cater for; some of them might cater for much younger women, with pregnancy rates (that) are much better.

“另一件你必须解释的事情是……他们迎合的女性的年龄;其中一些可能适合年轻得多的女性,怀孕率要高得多。

“So unless the public is discerning and fully looks in detail at how a clinic puts up its statistics, it's easy to be mistaken.”

“因此,除非公众有足够的洞察力,并全面详细地了解一家诊所的统计数据,否则很容易出错。”

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

Explaining the challenge faced by women who turn to IVF, she said they “intrinsically have a higher rate of having probably abnormal babies”.

在解释寻求试管婴儿的女性所面临的挑战时,她说,她们“从本质上来说,生不正常婴儿的几率更高”。

“They’re more prone to miscarriages … They’re more prone to preterm births. And if they’re older, they might have other associated complications of pregnancy, like high blood pressure, like diabetes,” she added.

“她们更容易流产……她们更容易早产。如果他们年龄较大,可能会有其他与怀孕相关的并发症,比如高血压和糖尿病。”

While patients come with expectations of having a child, Dr Hemashree said that “if 10 patients see me, probably only three to four of them would walk home with a baby”.

虽然病人们都希望有个孩子,但Hemashree博士说:“如果有10个病人来看我,可能只有3到4个人会怀孕。”

And for women aged over 40, the chance of a live birth is one in 10.

对于40岁以上的女性来说,活产的几率只有10%。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

SADNESS, AND SATISFACTION

悲伤和满意度

Overpromising could cause heartbreak to women longing for a child and willing to go to great lengths to conceive. Sometimes the setbacks are traumatic.

过度的承诺可能会让那些渴望要孩子并愿意努力怀孕的女性心碎。有时挫折是创伤性的。

Ms Felicia Tan is one of the unlucky ones who went through three IVF cycles — which cost her more than S$60,000 over three years — without a successful childbirth, even though she got pregnant twice.

费利西亚•谭是其中一个不幸的人,她经历了三次试管婴儿周期——三年内花费了6万多新元——尽管她曾两次怀孕,却没有成功生下孩子。

“I was 23 weeks pregnant when my water bag suddenly broke … The baby boy had already protruded out, preventing the water bag from healing naturally,” the 41-year-old said of the first miscarriage.

“我怀孕23周的时候,我的羊水突然破了……”41岁的她谈到第一次流产时说。

“Two weeks later, the baby’s position descended … and we were forced to deliver him. So he was born alive, but his heartbeat quickly dropped and therefore we lost him within minutes.”

“两周后,婴儿的位置下沉了……我们被迫接生。所以他出生时是活着的,但是他的心跳很快就停止了,所以我们在几分钟内就失去了他。”

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

Her voice trembling, she added: “Every night, I'd be crying, asking what was wrong … scanning through portals (and) motherhood forums, trying to find answers.”

她的声音颤抖着,补充道:“每天晚上,我都会哭,问出了什么事……浏览门户网站和母亲论坛,试图找到答案。”

In the third cycle, she conceived twins. The delivery, at 21 weeks, “came so quick” that she gave birth in a four-room ward.

在第三个周期,她怀上了双胞胎。21周的时候,分娩“来得太快了”,她在一个有四个房间的病房里生下了孩子。

“I didn’t even have to push hard and the first twin came. We were hoping to hold the second twin, but he came right through shortly after,” Ms Tan said in tears as she described the “hurt, and more guilt”.

“我甚至不用使劲推,双胞胎中其中一个就出来了。我们本来希望抱着第二个双胞胎,但他很快就出来了。”

“As parents, we were very helpless to see the child gasping for air, but no one could do anything.”

“作为父母,我们很无助地看到孩子在喘气,但没有人能做任何事情。”

Her story had a happy ending: She conceived naturally in 2014 and gave birth to Titus. “I told my husband, ‘Congratulations. So now you’re officially a father,’” she recalled. “Finally, it was the baby crying, not us.”

她的故事有一个美好的结局:2014年她自然怀孕,生下了一个男孩。“我对丈夫说,‘恭喜你。所以现在你正式当爸爸了。”她回忆道。

是什么促使新加坡女跨越柔佛海峡新山市(马来西亚)寻求生育治疗?

Ms Liu had a miscarriage too — in a traffic jam on the way to see her doctor in Johor Bahru.

刘女士也流产了——在新山市去看医生的路上遇到了交通堵塞。

The subsequent birth of her son, Xiang Xiang, hit the headlines. And “a lot” of her friends told her, “You’re my idol; we shouldn’t give up”, she recounted. But not all that people had to say was positive.

随后,她的儿子香香的出生成为了头条新闻。“她的很多”朋友告诉她,“你是我的偶像;我们不应该放弃,”她回忆道。但并不是所有人都说的是正面的。

“You’re so old. You still want to have a baby? When (your) son grows up, (he) needs your love (and) you’re already not there,” she cited.

“你太老了。你还想要孩子?当你的儿子长大了,他需要你的爱,而你已经不在那里了。”

Asked by Talking Point host Diana Ser if becoming a parent at that age was selfish, Ms Liu replied: “Half. Because I think I want him to accompany me.”

在被《Talking Point》节目主持人戴安娜•瑟尔(Diana Ser)问及在那个年龄为人父母是否自私时,刘回答说:“一半。因为我想让孩子陪我。”

Certainly, motherhood has been more challenging than she initially thought. She remembers that when he once climbed onto his walker, which she knew was going to flip over, she could not stop it because of a leg problem.

当然,做母亲比她最初想象的更具挑战性。她记得有一次,当他爬上他的助行器时,她知道助行器会翻倒,但因为腿有问题,她停不下来。

“He cried. Then slowly, I (went to) carry him and (pacify) him,” narrated Ms Liu, who also gets mistaken as being her son’s grandmother.

”他哭了。然后慢慢地,我抱起了他,安抚了他。”

But ultimately, it has been “very worth it”, she stressed. “One day, my son (came to) me, kissed me, hugged me (and) told me, ‘Mama, you’re the best mother in the world.’

但最终,她强调,这是“非常值得的”。“有一天,我的儿子来找我,亲吻我,拥抱我,对我说,‘妈妈,你是世界上最好的妈妈。

“That kind of love, when you kiss (your child), is totally different from when (your) husband kisses you.”

“那种爱,当你亲吻(你的孩子)时,和你丈夫亲吻你时是完全不同的。”