INFERTILITY is still a taboo subject in Hong Kong. Many patients hide the fact they are seeking treatment even from their parents. 'We did research early on and found that of the couples who came to us, the majority were Hong Kong Chinese and did not talk to friends or family,' says Dr William So, consultant in Obstetrics and Gynaecology at Queen Mary Hospital. 'I don't think they have changed that much.' The number of patients seeking treatment here is comparatively small, partly because many prefer to protect their privacy by having treatment overseas. According to Dr Milton Leong, medical director at Hong Kong Sanatorium's IVF Clinic, 'Those who can afford to do it may not want to do it in Hong Kong. If it is successful they can say they were just on a business trip. And if it isn't, they can still say it was a business trip.' Procedures like IVF and ICSI have been available for some time in Hong Kong but there is still a major problem with finding sperm and egg donors. In 1994, the Family Planning Association (FPA) ran a campaign to get more men to contribute to its sperm bank but only managed to attract 150 new donors. The FPA estimates only 10 per cent of donated sperm actually gets used; the rest has to be thrown away either because donors forget to come back six months later for the required follow-up AIDS tests, or because the donated sperm fails a sperm count. The lack of donors has created a chicken-and-egg situation: the fewer donors there are, the harder it is for local hospitals to justify additional funding, which is why none of the public hospitals have the resources to run a sperm bank.
Egg donation is even more problematic. The Assisted Human Reproduction Unit at Sha Tin's Prince of Wales Hospital does not offer the service at all. 'We can't help women without their own eggs,' says Professor Edward Loong, who believes the process of collecting the eggs is an invasive and potentially dangerous procedure. At the Hong Kong Sanatorium's IVF Centre supplies are 'haphazard', admits Dr Leong, and rely on patients agreeing to donate their spare eggs. This has happened in just five of the centre's 1,800 cases. And at Queen Mary Hospital a cross-donation system has been implemented to ensure that egg donors remain anonymous: each patient must find a donor but receives eggs from a donor found by another patient.
Hong Kong's legal system has been unable to keep up with leaps in technology and, in the absence of legislation, doctors have opted to err on the side of caution. The most controversial move in the field was the opening of the Gender Selection Clinic in 1993, not by a doctor but by a biochemist. Concerns that the clinic would be used to produce boys, reflecting the traditional Chinese preference for sons, were validated when the clinic announced last year that 18 of the first 20 births were boys.
But proposed legislation, currently being drafted by the recently formed Provisional Council on Reproductive Technology, restricts sex selection to medically recommended cases, such as the carriers of genetic conditions which affect only one sex. The council, comprising two groups of doctors and lawyers working on a Reproductive Technology Bill and a Code of Practice for Doctors, also plans to ban commercial payment for surrogacy and trafficking in donor eggs. There will be guidelines on how many embryos can be transferred back to the mother at any one time, how long clinics can keep fertilised frozen 'extra' embryos and what should be done with them if they are not used. Clinics will have to be licensed and have to register all donors to enable children produced by donated eggs to check that they are not related to potential spouses. And with the legal definition of 'natural parents' challenged by egg and sperm donation and surrogacy, there may even have to be adjustments to adoption laws.
Lorna (IVF and adoption) Lorna is 40. She and her husband have been trying to have a baby for nearly 10 years. She has tried IVF three times. Now they have decided to try adopting a child.
I STARTED having tests in 1990 and my doctor recommended medication to increase egg production. Then they did an internal examination and found that one of my fallopian tubes was scarred and blocked. On paper, that isn't a cause of infertility but because of my age, it was recommended that I went straight on to to IVF. I had the first IVF at Prince of Wales Hospital, Sha Tin, two years ago. We did think of adopting then but it says on the adoption form that you have to stop pursuing natural contraception if you want to adopt. Now we've given up on IVF and are hoping to adopt. It was hard to accept that I'll never have my own children.
The age factor made us stop IVF. We were told to try again but the odds of having a handicapped baby or the pregnancy not going to full-term increase as you get older. I read about a woman in Britain who tried 17 times before she was successful. But we pretty much decided to stop if the third one didn't work.