Below population replacement fertility rates: Can assisted reproductive technology (ART) help reverse the trend?

Objective: This paper considers the potential contribution that assisted reproductive technology (ART) may make to population replenishment in countries that have experienced extended periods of below-population-replacement Total Fertility Rates (TFR), by focusing on the specific situation of Singapore, which has recorded ‘ultra-low’ TFRs for many years. Methods: The factors contributing to ultra-low TFRs in Singapore, the economic and social consequences of endemic below-population-replacement fertility rates and remedial measures initiated by the government are critically analysed, focussing specifically on the government’s subsided ART provisions of the ‘Marriage and Parenthood’ package. In addition the paper provides a close analysis of available contemporary data regarding ART and ART outcomes both in Singapore and internationally. Results: Despite limited public accessibility to data concerning ART outcomes in Singapore, it is possible to make some assessment of the potential contribution of publicly-funded ART provision and the possible extension of access to elective oocyte preservation to population replenishment. Conclusions: Subsidised ART can - at best – make a marginal contribution to government population policy.