What to expect when facing infertility and trouble conceiving
Deciding to start a family can be an exciting, optimistic and happy time. It can also be stressful, frustrating, heartbreaking and exhausting. If you’ve been trying to conceive for a while, you are probably well into the frustrated stage and looking for answers. While in vitro fertilisation (IVF) isn’t generally the first option for most people who have trouble getting or staying pregnant, going to a fertility specialist who can also perform IVF could be the right choice if you want to establish a relationship with one doctor or clinic that can see you through your entire journey. If you have private insurance, make sure to speak to your insurance provider to understand what is and is not covered prior to booking any appointments. If you just need to know where to get IVF, use the link here. Otherwise, read on to learn more what to expect.
What to Expect
Figuring Out What’s Wrong
Generally speaking, the key parts of the process is the same regardless of which doctor or clinic you choose. You will be best served to have your partner at your first appointment, so the doctor can collect information from you both. The last thing you want is more time lost because the doctor doesn’t have all the right information from the start.
- Lots of Questions: Because infertility can be due to female factors, male factors or a combination of both, you’ll both be asked about your medical and sexual history – make sure you’ve both been honest with one another about your sexual health and past. You don’t want this process to be made even more stressful or awkward by disclosing major information like past miscarriages, abortions or sexually transmitted diseases to your partner for the first time.
- Lots of Tests: Initial tests help to start piece together what might be causing the fertility challenges. They start out basic – a semen analysis, blood tests for hormones, a transvaginal ultrasound – and then progress as needed. Tests to check ovarian reserves, to look for any blockages or abnormalities in your reproductive tract are all possibilities.
- Lots of Options (or not): Pending the results of your tests you might be presented with a progressive approach to help facilitate conception. Your doctor will take into account your medical history, tests, age and the amount of time you’ve been trying to conceive to present you with your options. These options can range from addressing an underlying medical condition to simple fertility medication (usually oral or injectable hormones), surgery to correct any abnormalities, intra-uterine insemination (IUI, where sperm is placed directly in your uterus at the exact right time) or IVF. In some cases, treatments are combined. In rarer cases, the man might need to have surgery to access the sperm needed to perform IUI or IVF.
- Lots of Paperwork: In order to have IVF in Hong Kong you’ll need to be legally married and to produce a marriage certificate (it doesn’t have to be from Hong Kong). The doctor will review all of the risks with you so you are fully aware. You’ll also sign a consent form stating that you understand these risks. There are also forms to consent to any freezing and storage that might be needed for eggs, embryos and sperm. You’ll need to know what you want to do with any extras and will likely be given the option to dispose of them or donate them for research.
The IVF Process
If it is determined that IVF is your best option, you might feel overwhelmed. Between the cost, time commitment, the emotional toll and the possible frustration, or blame of yourself or your partner (or both), there is a lot to deal with. Not to mention you’ve already been trying to have a child for some time now – patience is probably running thin. You might be tempted to rush the process but don’t forget to take care of yourself mentally and physically. Lifestyle can play a role in fertility success so be sure to address any red flags with your doctor prior to proceeding.
Knowing what to expect can also help you feel better:
- What is it exactly? IVF is basically the process of fertilizing eggs outside of your body to create an embryo that is then transferred to the uterus. Your doctor will work with you to establish a timeframe for the entire process. It will likely be dictated by your natural cycle.
- Have realistic expectations. Your doctor can speak specifically to the success rate that correlates to your age and situation, but generally speaking, the “live birth rate” for IVF is 20-30% per cycle. (Statistics via Queen Mary Hospital)
- Step 1 – Stimulation of the ovaries. You will be prescribed fertility medication to trick your body into producing a large number of eggs. The medication is usually self-administered (or you can have your partner do it) via shots in your abdomen or thighs. At set time markers, you will be given transvaginal ultrasounds and blood tests to monitor the progress.
- Step 2 – Egg and sperm collection. Once the eggs are mature, you will give yourself (or be given) a trigger shot to stimulate ovulation during a set timeframe. Usually you will have the shot at night and be expected to arrive for egg retrieval at an exact time. The egg retrieval is a minor surgical procedure, so you might be given antibiotics to prevent infection. The procedure is quick but you are given medication to zonk out a bit and prevent any possible pain. The doctor will use an ultrasound to guide a hollow needle through the pelvic cavity to pick up the eggs and transfer them for storage or insemination. It is recommended to skip work or other responsibilities after the procedure. Take a sick day and try to relax.
- Your partner will be asked to produce a sample of sperm or will have already had any procedures necessary to produce sperm. In some cases that will mean the sperm is cryo-frozen.
- Step 4 – Fertilisation. Now it is time for insemination; the sperm and eggs are mixed together and stored in a lab dish to promote fertilisation. If there are some male factor issues, each egg might need to be injected directly with a single sperm to increase success. This is called intracytoplasmic sperm injection (ICSI). Once the eggs are fertilised (and it is to be expected that not all of them will fertilise) they are considered embryos. Doctors will then wait 3 or 5 days for the embryo to grow before moving on to the next step. While you are waiting, you will continue to take fertility medication if you are going to have a fresh transfer.
- Step 5 – Embryo Transfer. Some doctors like to let your body calm down after the stimulation of the ovaries, especially if you’ve developed any of the possible side-effects from the fertility medication, such as hyper-stimulation. If you aren’t waiting, you’ll have a fresh embryo transfer. You’ll be asked to come to your transfer with an excruciatingly full bladder, which is probably one of the worst parts of the entire process (besides all the needles). Then the doctor does an unbelievably fast procedure to place the embryo into an ideal location within your uterus. If you are doing a frozen embryo transfer (FET) your doctor will give you a timeline for the transfer, as well as any medications to continue on. After the transfer you can proceed with your day as usual.
- Step 6 – The Wait. Even if you hate needles, the wait will likely be the most excruciating part of treatment. You will continue to take fertility medications to support implantation and will be scheduled to come in for a pregnancy blood test about 10-12 days later depending on the stage of embryo that was transferred. Someone from the clinic will call you later in the day after you have the blood test in the morning, usually within a specific time frame. Take into consideration how you will react to the news. Can you handle taking the call at work and getting a disappointing outcome? Can you get positive news and continue on with your work day as normal? Consider taking a half day if you might be derailed by the news in either scenario. For others, getting on with their day as usual might be best.
- Step 7 – Next Steps. If you get a positive pregnancy result, you will be scheduled for additional blood tests at specific dates to monitor your hormone levels. That will tell the doctor if your pregnancy is progressing. From there, if all goes as expected, you will have several early appointments to check that the pregnancy is implanted properly and not ectopic and to monitor the progress. So the bright side of all of this is that you will get to see your baby way earlier than “normal.” About 12 weeks into your pregnancy, you will revert to the standard care timeline. If your fertility doctor isn’t going to be the doctor delivering the baby, you would also generally be released from their care at this time and transferred to the obstetrician that you will deliver with.
If the result is not positive, you will want to set up an appointment to decide on your next steps. If you have viable embryos from this round of IVF and your doctor agrees, you can try again for a FET in the next cycle. If you only had one viable embryo and it was used in the transfer, you will need to undergo the process again.
Clinic Options in Hong Kong
Hong Kong has 3 public hospitals that provide IVF services. In order to qualify for public system fertility treatment, it is important to note that couples must be legally married heterosexual couples and the female partner must be a Hong Kong citizen under the age of 40. While subsidised care is available for qualifying couples, patients are still responsible for the cost of medication and laboratory fees. Also note that the waiting time in the public system can be well over a year. The price range for IVF at public hospitals is based on your treatment plan but could be in the range of $20,000 to $35,000. Here is the public pricing sheet from The Prince of Wales Hospital, to get an idea of specifics. Please contact the hospital directly to confirm the most up to date pricing and wait time.
Centre of Assisted Reproduction and Embryology (CARE), The University of Hong Kong, Queen Mary Hospital, 5/F, Block S, Queen Mary Hospital, Pokfulam, 2255 4182 for public enquiries, 2255 4262 for private enquiries, www.obsgyn.hku.hk
The Prince of Wales Hospital, Assisted Reproductive Technology (ART) Unit, The Chinese University of Hong Kong, 9F, Special Block EF, 30-32 Ngan Shing St, Shatin, N.T., Hong Kong, 3505 1456 for public enquiries, 3505 1456 for private services, www.ivfhk.com
Assisted Reproduction Centre, Kwong Wah Hospital, 25 Waterloo Road, Yau Ma Tei, Kowloon, Hong Kong, 3517 2060, www3.ha.org.hk/kwh/main/en/
Hong Kong has several licensed private clinics across Hong Kong Island, Tsim Sha Tsui and Shatin. This option provides the most flexibility, shortest wait times and least stringent requirements but it is much more expensive. Couples can expect to pay upwards of $150,000 for one round of private IVF treatment. You can also use the public hospital private route. The only qualification is that patients must be legally married at the time of treatment and costs are a little lower than the private clinics. Each clinic’s costs vary and are based on your specific treatment requirements so contact them directly for specific, up-to-date pricing.
Hong Kong Assisted Reproduction Centre, Rm 1502, 15/F, Henley Building, 5 Queen’s Road Central, Central, Hong Kong, 2117 3855, www.hkarc.com.hk
Hong Kong Reproductive Health Centre, Room 1309, 13/F, The Galleria, No. 9 Queen’s Road Central, Central, Hong Kong, 2117 3033, www.hkreproductivehealth.com.hk
Hong Kong Reproductive Medicine Centre Limited, Suites 1228-30, Ocean Centre, Harbour City, 5 Canton Road, Tsim Sha Tsui, Kowloon, Hong Kong, 8200 8168, www.fertility.com.hk (website is not available in English)
IVF Centre/Obstetrics & Gynecology Centre, Hong Kong Sanatorium & Hospital, 6/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong, 2835 8060, web.hksh.com/clinical_services/ivf/en/index.php
ProlIVFic A.R.T. Centre, 16/F, New World Tower 2,18 Queen’s Road, Central, Hong Kong, 2868 3139, pivf.com.hk/home-eng.html
The IVF Clinic at The Women’s Clinic, 13 Floor, Central Tower, 28 Queen’s Road Central, Hong Kong, 2523 3007, www.thewomensclinic.com.hk
Union Reproductive Medicine Centre, 2nd floor, Main Building, 18 Fu Kin Street, Tai Wai, Shatin, N.T., 2608 3363, www.ivfhongkong.com/ivf_english
Union Hospital Reproductive Medicine Centre, Tsim Sha Tsui, Unit 1706-07, Mira Place Tower A, 132 Nathan Road, Tsim Sha Tsui, Kowloon, 2986 1133, www.ivfhongkong.com/ivf_english/
Victory ‘ART’ Laboratory Limited (Central), Suite 1412-1425, Prince’s Building, 10 Chater Road, Central, Hong Kong, 2869 8887, www.victoryivf.com
Victory ‘ART’ Laboratory Limited (TST), Room 1101-02, 11/F, 26 Nathan Road, Tsim Sha Tsui, Kowloon, 3102 2802, www.victoryivf.com
All licensed clinic information is gathered from the Hong Kong Council on Human Reproductive Technology and is accurate as of 12 March 2018. Please note that we’ve only included public and private clinics that perform IVF. There are other licensed laboratories that perform testing and other services that can be a part of the IVF process. The complete list, including labs, can be found here. Sassy Mama also referenced The American Pregnancy Association website, www.americanpregnancy.org, during the writing of this article.
This article is for informational purposes only and is not intended to be a substitute for professional medical advice.
All images courtesy of Unsplash except image # 4 which is courtesy of Getty.