Family planning

PUBLISHED : Tuesday, 03 July, 2012, 12:00am
UPDATED : Tuesday, 03 July, 2012, 12:00am

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Miss Chan, who has a daughter, did not want to leave anything to chance when she decided to have another child a year ago. For a foolproof way to conceive a boy, she turned to a local consultancy which arranges for couples to undergo gender-specific artificial insemination in Thailand and US. After spending HK$180,000 and 10 days in Bangkok, the 26-year-old's wish came true six months ago.

'I had a test after returning from Thailand, and it confirmed that I'm carrying a boy. All the money and procedures are worth it as my mother-in-law wants a grandson very much,'she says.

Chan's treatment consisted of in-vitro fertilisation and pre-implantation genetic diagnosis (PGD) - also known as embryo screening - which tests embryos for genetic diseases and gender.

Gender selection is illegal in Hong Kong, so couples must travel to have the treatment in the US, Thailand, South Africa and the Middle East, the handful of countries where the process is legal.

Consultancies serving as middlemen between local couples and hospitals overseas say more people are turning to them to get a baby of their preferred sex.

One such consultancy, Eden Marriage Registry, offers celebrant services and fertility treatments like egg freezing for career-oriented young women and gender selection services. Its managing director Alfred Siu Wing-fung says it has served over 100 people since it started offering the gender selection services three years ago.

'Many people came to us last year as they wanted to give birth to a baby in the year of the Dragon. Traditional Chinese culture prefers boys to girls. As the process is outlawed on the mainland, we get many clients from there.

'We have also served overseas couples. While they might not prefer male offspring like the Chinese, they want gender selection services for family balance.'

Siu's consultancy acts as the overseas representative of hospitals in the US and Thailand which have years of experience offering gender selection services. He says most locals and mainlanders tend to favour Thailand over America because of the ease of travel. 'The more stress-free the experience, the higher the chance for conception.'

Success depends on the woman's age. Siu says 75 per cent of those aged under 35 succeed on the first attempt, while only 50 per cent of those aged over 35 do. 'While PGD using DNA analysis can deliver 100 per cent success rate for gender selection, we cannot guarantee that women can conceive successfully on first attempt, especially those more advanced in age.'

The procedure starts with a series of daily injections for about 10 days to stimulate the ovaries into producing a number of egg follicles. This is to ensure the availability of multiple eggs for fertilisation prior to gender selection. Next, patients are put under general anaesthesia for egg collection.

The harvested eggs are fertilised with semen to form embryos in the laboratory. The hospital's embryologists will differentiate the gender of individual embryos using PGD. The embryos can also be tested for genetic defects. Finally, the gender-specific embryos are transferred from the laboratory to the uterus using a small catheter.

Of the gender selection treatments available, only PGD is close to 100 per cent accurate. The sex of a baby is determined at the moment of conception by the sex chromosomes X and Y present in the egg and sperm. In PGD, a single cell from an embryo that is three-to-five days old is removed to allow its genes and chromosomes to be analysed. Only embryos carrying the gender-specific chromosomes are implanted into the uterus.

Siu says the treatment costs HK$220,000, which includes lodging and accommodation in Thailand. But most patients will pay an extra HK$50,000 to get a 100 per cent success guarantee. 'The more fertilised eggs are implanted into the uterus, the higher the success rate [for conception].

'But it's illegal to implant more than three embryos. For those who pay the total HK$270,000, we will try until they get the baby of their preferred sex.'

In Hong Kong, the Human Reproductive Technology Ordinance, in effect since August 1, 2007, states that no person shall, by means of a reproductive technology procedure, cause the sex of an embryo to be selected, whether directly or indirectly.

Gender selection can be conducted only to avoid a sex-linked genetic disease. At least two registered medical practitioners must state in writing that the selection is for that purpose and the disease would be sufficiently severe to justify such selection.

The Council of Human Reproductive Technology did not respond to queries on whether middlemen in Hong Kong offering such services are covered by the law, but a spokesman with the council says any person who contravenes the law is liable, on first conviction, to a fine of HK$25,000 and six months in prison.

Siu says their services are not in breach of the law as 'all transactions involving payment are conducted outside Hong Kong'. Several exclusive clinics in Hong Kong also offer similar services, referring clients to overseas hospitals, he adds.

Solicitor Wong Kwok-tung says it's difficult to prosecute such middlemen as there's no precedent for charging them. 'The wording of the ordinance is controversial. The ordinance does not state clearly what parties are covered and in what places it will be applied,' he says.

Overseas fertility treatments sought by locals who want to circumvent the reproductive ordinance have stirred up much controversy recently following the police investigation of Henderson Land Development vice-chairman Peter Lee Ka-kit who reportedly used a commercial surrogate to deliver triplet sons in the US.

Siu says the fact that the investigation was eventually dropped meant that their services are legal. Although such services might not constitute a legal transgression, gynaecologist Loong Ping-leung says there are health risks involved in such procedures.

'Women who get injections to induce ovulation are more likely to give birth to twins or triplets. The likelihood of women suffering from complications from carrying multiple foetuses is higher than those who conceive naturally,' Loong says.

'The injections may make the women produce too many eggs which can lead to enlarged ovaries and ovarian bleeding. In serious cases, a patient's life can be at risk.'

Ovarian hyperstimulation syndrome is particularly associated with injection of a hormone called human chorionic gonadotropin (hCG) which is used to trigger ovulation and increase the chances of pregnancy.

Tina Fong, 31, Siu's wife who co-runs the registry, says there are no risks involved in the treatment so long as patients are properly monitored by professionals. The treatment helped Fong conceive her daughter, now 18 months old. (Siu has three sons with his ex-wife.)

'Every medical process comes with risks,' says Fong. 'There's a case in 2011 when a woman fell ill after receiving treatment at the Union Hospital. She was given too many injections for ovulation and suffered from ovarian over-stimulation. She eventually had to get one of her ovaries removed. It was a medical blunder. However, if the process is monitored well, there are no risks involved.'

Loong, who helped draw up the Human Reproductive Technology Ordinance as a former member of the Council of Human Reproductive Technology, says the act of gender selection is unethical.

'A baby's gender should be designed by nature,' Loong says.

PGD has aroused much controversy since it became available at the start of the 1990s. A 2006 survey carried out by Johns Hopkins University's Genetics & Public Policy Centre in Washington, DC found that almost half of US fertility clinics that offered PGD had done so for non-medically related sex selection.

Nearly half of those clinics said they would only offer sex selection for a second or subsequent child.

But ethicists worry that use of PGD for gender selection will open the way for designer babies.

Loong say it is unethical to make 'designer babies' which are not only free of medical defects but also possess certain desirable traits.

'Artificial tinkering is allowed only for medical reasons. The ordinance lists [around 70] genetic diseases that are exempted.

'Nearly all of the diseases, like muscular dystrophy, are only hidden in the male Y chromosome, which means that they will only pass down to males. If selection is allowed under such circumstances, they can only opt for a female baby.'