Hong Kong Fertility Technology&Prenatal Diagnosis Centre

Infertility & Assisted Reproductive Technology

What is infertility? Infertility or subfertility is defined as the failure to conceive following twelve months of regular unprotected intercourse.

In Hong Kong, one in every six couples has infertility problems. Infertility is considered as a medical concern and requires treatment. Apart from fertility technologies, other methods of treatment include advice on having sex around the ovulation day and treatment with medicine or surgery. If couples do not face this problem positively, they may lose the joy of raising their own children, and the fulfilment of the traditional concept of a “complete family”.

In 1978, the first test tube baby was born in England subsequently rewriting the history of treatment for infertility. The lady involved had bilateral blocked fallopian tubes. Thereafter in vitro fertilisation has been employed for treating patients with endometriosis, male infertility and infertility with unknown causes. In 1982, the first in vitro fertilisation- intracytoplasmic sperm injection IVF-ICSI baby was born. The procedure involves injecting one sperm into an egg to achieve better fertilisation rates. The advent of IVF-ICSI has revolutionized the treatment of male infertility and has since been the best treatment for severe male infertility.

Fertility technology treatment employs artificial methods to improve pregnancy rates. Basic technologies include ovulation induction (OI); intrauterine insemination (IUI); in-vitro fertilisation (IVF), embryo transfer (ET) (commonly known as test-tube baby) and intracytoplasmic sperm injection.

Due to the current development of new medicines for IVF and that the egg retrieval and embryo transfer procedure can all be completed vaginally, this makes the whole process more simple, comfortable and safe. In addition, new developments also include assisted hatching, blastocyst transfer, vitrification method for freezing embryos and for freezing eggs, embryoscopy to monitor development of embryos and choosing the best embryos for transfer, preimplantation genetics diagnosis and preimplantation genetics screening. All these developments have helped to improve the success rate of IVF and decrease the miscarriage rate.

We hope that together with advances in fertility technology, public medical education will play a role in arousing public awareness of the fertility issue early in life so that couples with fertility problems will have a positive attitude towards receiving treatment as the need arises.

Special thanks are extended to Dr. Julio Herrero and Merck Pharmaceutical (HK) Limited for the kind permission of using their photos and videos on this website for educational purpose.

Q&A

Q: How do I know whether I ovulate?

If your menstrual cycle is between 28-35days, most often ovulation do occur.
You can have ovulation assessed in 3 ways

Blood LH surge tests at around ovulation time
Follicle tracking by ultrasound at around ovulation time
Blood progesterone test 7 days after ovulation

Q: If I have regular menstrual cycles, will oral ovulation induction medicine improve
my pregnancy rate?

Probably not. Regular monthly cycles indicate that you most probably ovulate regularly. Oral ovulation induction medicine like clomid may decrease the thickness of the inside lining of the uterus, making implantation of the embryo difficult.

Q: Is there medicine that can improve semen parameters?

Poor semen parameters is usually genetic in origin. Taking medicine like clomid, testosterone or steroid will not improve semen parameters. Male infertility usually necessitates in vitro fertilization treatment, with or without intracytoplasmic sperm injection (ICSI).

Q: If a couple has been diagnosed as being suffered from infertility, is the chance of
getting pregnant very slim?

No, on the contrary, if you get appropriate management of your infertility problem early, the chance of pregnancy is still pretty high. Although simple advice and measures can help for the initial stage, aggressive treatment may have to be employed at a later stage. According to Nice guideline (Feb2013), in vitro fertilization (IVF) will be offered to women with unexplained infertility, mild endometriosis and mild male infertility who have not conceived after 2 years.

Q: Will I have premature menopause after a few cycles of IVF, since many eggs have been
used up during each treatment cycle?

No. Each woman have 400,000 eggs at puberty and one egg will reach maturity to ovulate every menstrual cycle. There is a total of 400-500 menstrual cycles for the whole reproductive life span. The rest of the eggs will become atretic. Infertility treatment recruits some of the eggs that will regress anyway. Menopause is a stage when all the eggs have naturally regressed and therefore you do not have to worry about premature menopause.

Q: I have tried intrauterine insemination (IUI) for 3 times, why am I still not pregnant?

Usually, IUI is considered a milder form of treatment for infertility if the fallopian tubes are normal. The success rate is around 10 percent per cycle even if gonadotropins injection is employed. You do not have to be discouraged even if you have failed to get pregnant after 3 cycles of IUI. We can employ in vitro fertilization for treatment as the success rate is 3-4times higher than IUI. Some cases do require IVF for success.

Q: Will ovarian stimulation medicine cause ovarian cancer?

Up to date, literature has shown that ovarian stimulation will not increase the chance of ovarian cancer.

Q: What is considered completion of one cycle of in vitro fertilization?

One cycle of ovarian stimulation for in vitro fertilization may result in producing many embryos. For every subsequent cycle, we put back 1-2 embryos into the uterus, if pregnancy has not been achieved. It is not until we have put back all the frozen embryos that it is considered we have completed one full cycle of IVF.

Q: Is the pregnancy rate employing frozen thaw embryos less than fresh embryos?

No. Nowadays, we employ ultra rapid method (vitrification) for freezing embryos, which will not lead to crystal formation that is damaging to the embryos. Moreover, we usually employ natural non stimulated cycle which involves a lower estradiol levels, when we put back frozen thaw embryos and this result in a better pregnancy rate.

Q: Usually how many IVF cycles should I undergo?IVF

Usually we will advise at least 3 cycles of IVF before giving up as the cumulative pregnancy rate increases. Of course, it depends on assessment after each cycle.