Reproductive health

More Hong Kong couples turning to IVF treatment as late marriage trend and work, money constraints delay baby-making

  • 4,000 to 5,000 embryo implants done each year, with couples prepared to pay up to HK$200,000 to have a baby
  • Older celebrity mums have helped dispel lingering taboo that keeps shy infertile couples from trying IVF
PUBLISHED : Saturday, 08 December, 2018, 8:01am
UPDATED : Saturday, 08 December, 2018, 10:06am

After two years trying to have a baby, while taking Chinese medicines and vitamin supplements to improve their chances, Sincere Kan and her husband Roy Chan decided it was time for in vitro fertilisation (IVF).

She was 32 at the time, he was 34 and they had been married for two years. Kan did not want to wait much longer.

“I thought if I want to have a natural pregnancy it might take me another two years, and I wanted to get pregnant as early as possible so the baby could be healthier,” she says.

Although Kan was relatively young for IVF treatment, the full-time urban planner was concerned about the elevated risks for babies of older mothers.

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“Though it was the last resort, I didn’t hesitate,” she says, of starting the process to create an embryo in a lab from her egg and her husband’s sperm, before having it transferred into her womb.

That meant a year filled with visits to the doctor, hormone injections and an operation to remove her eggs.

Her doctor implanted embryos in her womb twice, but both times the procedure failed. The couple were devastated and Kan says she felt depressed.

They tried again, which meant another round of visits to the clinic and procedures to undergo.

“But on the third time, I succeeded” Kan says. She was 33 when she gave birth to a healthy baby girl last year.

In all, it took around 1½ years from the time they opted for IVF until their daughter arrived.  

“The pressure was really high, because every time you are waiting for the result, and then the result may let you down,” she says.  

Trend of low fertility in Hong Kong is here to stay

The pressure was really high, because every time you are waiting for the result, and then the result may let you down
Sincere Kan, mother

Their experience is becoming increasingly common in Hong Kong as working couples put off tying the knot and delay starting a family, a trend experts say is driving up demand for assisted reproductive treatment in the city.

The average age of marriage for women went from 24 in the early 1980s, to just over 29 in 2017. The average for men also rose, from 28 in 1986, to 31.4 last year.

Census statistics show the average age at which women are having their first baby has risen by a full five years in the space of three decades: from 26.6 in 1986 to 31.6 last year.

In 2014, 3,391 babies were born to women aged 40 or above, up sharply from 1,819 in 2005.

“We have an increasing number of women suffering from infertility in Hong Kong,” says Dr Jacqueline Chung Pui-wah, an assistant professor in the department of obstetrics and gynaecology at Chinese University. “More women are seeking higher education and careers, and they delay starting their families, which increases the incidence of infertility.”

The journey to conceive

There were just over 3,000 babies born in Hong Kong through IVF between 2013 and 2016, with between 4,000 and 5,000 couples undergoing treatment each year, according to the most recent data from the Council on Human Reproductive Technology.

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Success rates – and the number of rounds of IVF women undergo before either becoming pregnant or ceasing treatment – depends on a variety of factors including the woman’s age, sperm and egg quality, and pre-existing conditions.

Even younger women like Kan may need several rounds of IVF treatment, and Hong Kong hospitals and clinics did around 5,000 embryo implantations annually between 2013 and 2017.

Chung, who is also a clinician at Chinese University’s Assisted Reproductive Technology Unit at Prince of Wales Hospital in Sha Tin, says she has seen increased demand for IVF, and longer waiting times for couples.

Currently it can take as long as four to five years from the time a couple starts the IVF process until they have a child – if they are successful. The waiting time for the first appointment at Prince of Wales can be up to two years, followed by another 18 months before starting treatment.

Couples can pay around HK$10,000 per round of subsidised IVF treatment at public hospitals for example, Chung says.

Costs and waiting times vary among the three public hospitals offering IVF treatment.

Couples who cannot wait so long, and can afford it, go to private clinics – where first visits are scheduled within a couple of months – with fees that can be up to 10 times higher than in public hospitals.

Kan and Chan, went to a private clinic, and paid around HK$200,000 for three rounds of treatment.

Others travel to regional hotspots for IVF treatment such as Taipei or Bangkok, where waiting times and costs can be lower.

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Dr Ernest Ng Hung-yu, a clinical professor from the department of obstetrics and gynaecology at the University of Hong Kong, says given the trends, more couples are likely to opt for IVF earlier than in the past.

Previously, couples turned to artificial methods after trying to conceive naturally and failing for a number of years. He says he expects more couples will choose IVF even though they are young enough to keep trying to have a baby naturally.

“We expect that in a few years, as women continue to marry at an older age, we will see the number of IVF patients increase,” Ng says.

We expect that in a few years, as women continue to marry at an older age, we will see the number of IVF patients increase
Dr Ernest Ng, clinical professor

In a report released on December 4, the Family Planning Association of Hong Kong encouraged couples to plan early to start their families and seek medical help if they have difficulty conceiving.

In a survey of 1,514 women aged 15 to 49 who were married or co-habiting, along with 1,059 husbands or partners, 52.3 per cent of women and 51.7 per cent of men regarded two children as the ideal number for a family.

Yet, the actual number of children being born to Hong Kong families stood at between 1.2 and 1.3, making for one of the lowest total fertility rates in the world.

Professor Paul Yip Siu-fai, chairman of the association’s research subcommittee, says the city’s fertility rate has declined over the past three decades, in tandem with the rising age of marriage.

“The chance of conceiving a baby as you age decreases substantially,” Yip says.

When it comes to getting married and starting a family, Yip believes Hong Kong couples are affected by financial considerations, the lack of space and demands of the workplace.

“Many would like to get married earlier, but the cost of living is making this difficult for young people,” he says.

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Central to this issue is the price of homes in a city notorious for having the world’s least affordable housing market.

“Another problem is the physical size of flats,” Yip says. “A flat might be big enough for a couple, but when you have one child it starts getting a bit crowded; two, and it’ll be very crowded.”

For many couples, the intense pressure at work leaves little space for family life. “Whether you’re a professional or not, it doesn’t really matter: you’re expected to work long hours,” he says.

Yip says the trends in Hong Kong are also seen in Asia’s high-income cities such as Singapore, Tokyo and Seoul, with couples starting families later in life and having fewer children.

Overcoming taboo

Despite these evolving social norms, there is a lingering taboo around fertility issues in Hong Kong because childlessness is often viewed as a deficiency, particularly on the part of the woman.

Chung, of Prince of Wales Hospital, estimates about one in six couples have difficulty having a baby, yet many find it hard to seek treatment.

“A lot of infertile couples may not want to seek treatment because in Chinese culture it is considered embarrassing. They need a lot of courage to step up,” she says.

Infertile couples may not want to seek treatment because in Chinese culture it is considered embarrassing
Chung Pui-wah, Assisted Reproductive Technology Unit

But attitudes have shifted in recent years, thanks in part to older celebrities using IVF to have babies, according to rumours that have circulated in Chinese media.

Kan, who used IVF treatment to have a baby, hopes that there will be more openness surrounding assisted pregnancies for those who need it.

Because of the taboo, she and her husband kept their IVF attempts hidden from everyone except her parents and one close friend.

“Even at work you aren’t able to tell anyone, you just tell your boss, ‘OK I am going to the doctor,’” she says.

“You have to keep going to the clinic, but you can’t say anything – not because you can't, but you don’t want to do so, because you don’t know how people will look at you and comment about you.”

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It is a lot of psychological pressure, she says, on top of the stress of undergoing the IVF process and the anxiety of waiting to know whether there will be a baby.

Earlier this year, when her baby was nearly a year old, Kan decided to do something to change attitudes and encourage other couples.

In a Facebook post, she revealed she had used IVF treatment with her husband. Later, she started a Facebook page and a group chat for women to discuss their experiences trying to have a baby.

“I wanted to tell people that IVF is not something you should be ashamed of,” she says. “You just want to be a mother, but you can’t have your baby naturally.”