Fertility Treatments in Hong Kong 101 | IVF, IUI and PGD

Fertility diagnostics

Natural cycle monitoring

Cycle monitoring is often the first step women take when they visit a fertility clinic with suspected fertility issues. Cycle monitoring looks at your ovulation cycle and requires you to visit the clinic a few times a month, to track the progress of the follicle and endometrium. It can also help to diagnose abnormalities with the uterus and ovaries. Ultrasounds and blood tests help to determine exactly when you are ovulating and any underlying hormonal imbalances that may contribute to your infertility. Fallopian tubal patency checking should also be done. This is the first step in diagnosing any fertility issues.

Semen analysis

This is the male equivalent of cycle monitoring. In order to gauge any existing issues, the man is required to -ahem – produce a sample of sperm to be analyzed in the lab. Lucky guys, it’s a whole lot easier than visiting the clinic multiple times a month!

Preparing for fertility treatment

Ovarian stimulation and cycle monitoring

In order to stimulate the ovaries to produce an increased number of eggs, women will be prescribed oral medications or injectable hormonal stimulants. The more eggs a woman produces, the higher the chance one will be inseminated, whether it be natural, artificial or in vitro insemination but the tradeoff is multiple pregnancies. Like natural cycles, a stimulated cycle must also be monitored to determine when a woman is ovulating.

Sperm washing

Sperm washing involves removing any mucus and non-motile sperm in the semen to improve the chances of fertilization by concentrating the more “healthy” sperm. Sperm washing occurs before a semen sample is used to fertilize an egg during IVF or IUI and ideally perform after sexual abstinence for more than two but less than five days prior to collection.

Assisted reproductive treatments (ARTs): IUI and IVF

Intrauterine insemination (IUI)

IUI is generally seen as the less expensive form of assisted reproductive treatments (ARTs) but the pregnancy rate is lower than IVF – in fact it only returns the patient’s fertility chances to the equivalent to a woman of her own age. In an IUI procedure, treated sperm (washed semen) is inserted into the cavity of the uterus so that it is nearer the ovaries right before ovulation to increase the chance of fertilization. The IUI technique is often used for unexplained infertility, ovulatory problems, sexual dysfunction, lower sperm count, decreased sperm motility, cervical scarring or mucus issues. In some cases, IUI is accompanied by ovarian stimulation to ensure ovulation and increase the chance of conception.

In Vitro Fertilization (IVF)

IVF is the most well known assisted reproductive treatment. It refers to when a sperm fertilizes an egg outside the body. The IVF process takes four to six weeks and consists of six stages:

• Ovarian stimulation: Like we’ve described above, your fertility specialist will prescribe a hormonal (or combination of several hormones) to stimulate your ovaries to produce eggs. You will be closely monitored with ultrasounds and blood tests until your follicles and hormones are at the correct level, at which time a shot of the human chorionic gonadotropin (HCG) will be given to release your eggs.
• Sperm collection: Sperm collection occurs on the day of the egg collection. It is often washed to encourage better results.
• Egg retrieval or ultrasound directed follicular aspiration (UDFA): Your eggs will be retrieved between 34-38 hours after your HCG shot. This is a mildly invasive procedure so is done under anesthesia. Your fertility specialist will be able to tell you how many eggs were retrieved.
• Egg fertilization: Within a few hours of your eggs being retrieved, they will be inseminated with washed sperms. The next day you would know how many has fertilized. The embryos will then be cultured to day 3 or day 5 depending on the numbers and quality, and can be transferred back fresh on these days or frozen for frozen embryo transfer at a later date. PGD/PGS can be carried out if you wish to select for normal ones prior to transfer at this stage by taking a biopsy of the embryo – preferably on day 5 for a more accurate result.
• Embryo transfer: Your fertility specialist will transfer your viable embryos into your uterus using an ultrasound to guide him or her. If you have excess viable embryos after a fresh transfer, they may be frozen for future use.
• The IFV waiting game: Like any other pregnancy, you will have to wait to find out whether you are pregnant. Your blood will be taken between 9-14 days post-transfer to see whether the embryo has successfully implanted and initiated a pregnancy. Most fertility specialists will also prescribe additional progesterone to take post-transfer to increase your chances of getting and staying pregnant.

Some more infertility-related vocabulary

Intracytoplasmic sperm injection (ICSI)

ICSI is a technique used in the egg fertilization stage of IVF where one individual sperm is injected into an egg. ICSI is most often used in cases of male infertility.

Preimplantation genetic diagnosis (PGD)

PGD enables diagnosis of an embryo to see whether they have a particular genetic issue before implanting the embryo into a woman. This requires IVF and occurs three to five days after fertilization. People who are carriers of a genetic disorder should discuss whether PGD is an appropriate path for them.

Dr. Alexander K. Doo 杜堅能醫生 practiced in Hong Kong for over two decades. He was a member of various international reproductive organizations and the Vice President of the Asian Pacific Fertility Preservation Society. He had also been a Council Member of the Hong Kong Society for Reproductive Medicine for over ten years. He was Honorary Consultant at the Matilda International Hospital as well as the Director of The Women’s Clinic and Director of The IVF Clinic.