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. I would recommend IVF, although it does depend on the strength of relationship. Now I look back, I don't know how I got through all the ups and downs. I didn't sleep at night. The IVF cycle takes over your life: two weeks of nasal sprays to relax your ovaries, then trips to the hospital every morning for two weeks to have injections to stimulate egg production, and finally a time-release injection at exactly 10 pm, 36 hours before the eggs can be collected for fertilisation. I used to go to the local hospital's accident and emergency department for the last injection. One time I went in and one of my husband's colleagues was there, he had sprained his ankle or something. The nurse came out and said, 'Oh yes, you are here for infertility treatment, aren't you?' It was awful, I was in floods of tears. I felt like I had been branded. The first time was the worst. My doctor said if it doesn't work, your period will start on that day. He was right. It happened as I was walking into a meeting at work, so I couldn't deal with it until I got home that evening. You have to keep up the facade, but inside you crumble. My husband said that we had to believe it could happen. That is the thing with IVF, it is a mindset not a treatment. You have to know you will be all right, despite the disappointments. The drugs make you very emotional, I was quite tearful. In some ways, I think it was hardest for my husband. He was fantastic, he put up with all my mood swings without complaining once. It's entirely personal, I haven't confided in anyone, only a sister. I wouldn't want people asking how it's going. You wouldn't tell people if you were having another kind of medical treatment. People often ask if we are planning a family. I react with extremes of emotion. It happened once in the middle of a dinner party, just after the first IVF treatment had failed. I burst into tears. Some people are just so insensitive, they don't imagine you may have problems. What are you supposed to say? I usually answer, 'Well if it happens, it happens.' I did join a local support group but everybody else there was a success story. I wasn't ... and that made it worse. You join in all the congratulations, but part of you is asking, 'Why isn't it me?' It's something I will never come to terms with - as a woman, I feel a failure. I had a friend in Britain who had treatment by Patrick Steptoe, the doctor who helped Louise Brown's parents [the first baby born through IVF]. She went grey during treatment, and she wasn't successful. I remember we swore at the time we would never go through that. But you want to create the gift of life with your husband, to pass on your wealth to someone else; to make your work worthwhile. Sometimes we come home at night and ask, 'Who are we working so hard for?' I am a Christian, so I believe there must be a reason, I just find it hard to see one. Maybe we are meant to help a child without parents. A woman said to me once that pain doesn't come any deeper than infertility. You have to come through that before thinking of adoption. I feel so much healthier now I've stopped taking the IVF drugs. I'm in control of myself. I used to live with my diary in my hand, counting the days. Now I'm not obsessed any more - I have my life back. Kim (IVF) Kim, 32, conceived 10 weeks ago on her second attempt at IVF. She and her husband stopped using contraception five years ago and have spent $142,000 on fertility treatment. I FIRST went for medical help three and a half years ago when we were living in the United States. I was only 28 so I had all the blood tests and then I had an exploratory laparoscopy, that's where they put a tube through your belly-button and have a look inside. They found adhesions that were preventing the egg from leaving the fallopian tube. When the doctor came and told me that I had zero chance of getting pregnant on my own, I was shocked. It had never entered my mind that something serious could be wrong. I remember going home and feeling so sad, thinking, 'Why has this happened to me?' Then I realised lots of people must feel like this. It was kind of humbling. I have always been such a healthy person, now I felt as if I was in a different category. Then I had another corrective laparoscopy, which removed the adhesions and gave me a 20 per cent chance of conceiving. I tried that for six months but nothing happened. So I tried IVF (which had about the same chance), by which time we were living in Hong Kong. I did think we should try adoption. In fact, we have completed all the paperwork, had our physicals and everything. But once you start IVF you get so focused on that. Some days I would imagine what it would be like to adopt, at least you know that is 80-90 per cent certain, other days I would imagine what it would be like to have my own child. My husband has been very laidback about the whole thing. He has the attitude that whatever happens is meant to be. I feel like I have been the driving force in this. He never complained but I had to set things up for him, tell him where to go. But he did his job. Having children is just something you think is going to happen when you grow up. It was just the way I pictured my life. It may not sound very maternal but that is how it was. When the first IVF didn't work, I began to think what life would be like without children ... and I realised it wouldn't be so bad. The way IVF works is you use a nasal spray every day for two weeks to put your ovaries in a resting state. Following that you have a series of injections at the same time every morning which stimulate egg production. Then, 36 hours before the eggs are collected, that's in the evening, you have another injection to time the release of the eggs. The eggs are fertilised with your husband's sperm and, a day later, you go in for a transfer of embryos: with me they transferred three. After that you go on your way and call in two weeks if you don't get your period. It is such a waiting game. As I hyper-stimulated, I had to wait a few months after I had the eggs removed. The first time it was Christmas. They did the transfer on the Monday and I had my period on the Friday. I kept telling myself it wouldn't work, that it never does the first time. But when I went to the bathroom and saw a spot, I said, 'Oh no, it can't be that.' The next day I woke up wondering when I could start again. The second time - in January - when I didn't have a period by the Friday I began to get excited. Then, on the Monday, I called my doctor, he said to wait a few more days. On Thursday I had a positive test. I was ecstatic. It was funny ... I just laughed. I looked at the stick from the pregnancy-test kit and I thought of how many sticks like that I had looked at before. Beating the stick was almost as good as being pregnant. Twice in the last eight weeks people have asked me when we are going to start a family. And for the first time I smiled to myself and said, 'Oh, we are thinking about it.' It always really hurt me to be asked that before, I guess most people are probably so far from this infertility/IVF thing that they don't think about it. I feel so lucky. I don't want to have to go back and do it again. We would have carried on if it hadn't worked this time, I suppose. I have a lot of embryos frozen: I had a lot of eggs because I hyper-stimulated. We haven't really talked about what we will do with them. My husband is Catholic and quite conservative. We aren't going to dispose of them, we haven't really got that far. When you're on IVF, you have to take it day by day. You don't think about what will happen to the embryos and all those things ... you just think about getting pregnant. I would recommend it. It is worth all the effort, the first five years felt so long but now they feel like nothing at all. I'm so proud; this is quite an accomplishment. But I'm not telling the whole world yet, I don't want to miscarry and find myself thrown back in the IVF odds pool. Local services Prince of Wales Hospital Assisted Human Reproduction Unit, Sha Tin Treatments available: IVF, ICSI, less frequently GIFT and ZIFT. Opened: 1984. Current waiting list: 370 patients. It takes 18 months to get an appointment. Costs: public patients pay an out-patient's fee and the hospital day rate of $60. Private patients pay up to $30,000 per cycle (each cycle may include more than one treatment). Criteria: heterosexual in stable relationship. Public patients must be under 40, private patients can be older but the unit counsels against it. Treatments per year: 60 patients per month; only 20 are public patients. Take-home baby rate: 15 per cent. Support group: no. Queen Mary Hospital, Pokfulam Treatments available: IVF, ICSI, PROST (pro-nuclear stage oocyte treatment, similar to ZIFT), less often GIFT. Opened: 1986. Current waiting list: public patients 15-18 months; private patients three-eight weeks. Costs: public patients pay specialist clinic fees of $40, and the hospital day rate of $60 (to a maximum of $1,000). Private patients pay $30,000-$40,000 per cycle. Criteria: patients must be married with no living children; woman must be under 36, no age limit on man. Treatments per year: 350. Take-home baby rate: 18 per cent pregnancy rate; 20-30 per cent of whom have miscarriages. Support group: yes, a clinical psychologist is also available for counselling. Hong Kong Sanatorium and Hospital, IVF Centre, Happy Valley Treatments available: IVF, ICSI, less often GIFT and ZIFT. Opened: 1986. Current waiting list: none. Criteria: anyone in a stable relationship. No upper age-limit but women over 40 have additional counselling about the possibility of complications in late pregnancy. Costs: $80,000-$90,000 per cycle. Treatments per year: 220. Take-home baby rate: 15 per cent. Support group: no, but a clinic nurse offers counselling. Family Planning Association Fertility Clinic, Wan Chai (tel: 2575-4477 ext 75) Treatments available: first consultation, artificial insemination (AI) of donated sperm. Opened: 1981. Current waiting list: two to three years for AI treatment. Criteria: married couples who have been trying to conceive for one year; woman must be under 35 and man under 50. Costs: $1,000 per insemination, course of six treatments (each includes two inseminations). Treatments per year: 50 inseminations in 1994. Take-home baby rate: 3.5 per cent conception rate (3,960 inseminations between 1981 and 1994 produced 140 pregnancies; no figures available for live births). Support group: no, although advice is available at all clinics.