LCQ1: Assisted reproductive services
26.4.2023

Following is a question by the Hon Kenneth Leung and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (April 26): Question: It is learnt that the number of live births born to couples making use of assisted reproductive technologies (including artificial insemination by husband and in-vitro fertilisation) in 2019 accounted for 5.8 per cent of the total live births in that year. However, there are views pointing out that assisted reproductive services are still not popular at present, and not only is the waiting time for relevant services in public hospitals long, but the fees charged by private healthcare institutions for relevant services are also expensive, discouraging quite a number of young families originally with family plans from giving birth to children. In this connection, will the Government inform this Council: (1) whether it knows the number of cases of patients seeking consultation relating to infertility received by the Hospital Authority and the Family Planning Association of Hong Kong, and the respective numbers of cases requiring referral or follow-up treatment, in each of the past five years; (2) whether it knows the average waiting time from referral to receiving specialists' diagnosis and treatment for the patients requiring referral or follow-up treatment mentioned in (1) in the past five years; (3) whether it knows the number of patients receiving public assisted reproductive services, the average number of cycles and duration of their treatment, as well as the average fee paid, in each of the past five years, with a breakdown by treatment method; (4) as the information of the Census and Statistics Department indicated that both the median age at first marriage (30.6 in 2021) and the median age at first childbirth (32.6 in 2021) for females in Hong Kong showed upward trends in recent years, whether the authorities will consider providing public assisted reproductive services to females over 40 years old; (5) as there are views that couples receiving infertility treatment will experience stress physically and psychologically, and suffer setbacks during the treatment process, whether the authorities currently will provide counselling services for all couples receiving infertility treatment and follow up their needs, and whether it will consider bringing in integrated Chinese and Western medicine treatment when enhancing assisted reproductive services, so as to increase treatment efficacy; and (6) of the measures put in place by the authorities to assist persons with family plans (including encouraging and subsidising them to undergo relevant check-ups as early as possible, and considering subsidising members of the public to use fertility preservation services, etc), so as to encourage members of the public to give birth to children? Reply: President, At present, both public and private healthcare institutions in Hong Kong provide assisted reproductive services. Healthcare institutions providing assisted reproductive services are subject to regulation by the Human Reproductive Technology Ordinance (Cap 561). Currently, 24 private healthcare institutions have been licensed by the Council on Human Reproductive Technology to provide assisted reproductive services (Note 1). According to the information of the Department of Health (DH), the relevant licensed private healthcare institutions provided 45 300 assisted reproductive service treatment cycles for infertile couples by using their own gametes/embryos during the period from 2017 to 2021. From the healthcare services policy perspective, the provision of assisted reproductive services in the public service system can serve as an opportunity for specialist training and offer certain options to the public. However, in terms of resource allocation prioritisation in the public service system, a proper balance needs to be struck with due regard to trade-offs in the provision of assisted reproductive services vis-&agrave;-vis other life-saving medical services, especially for services which are not available or are charged at a higher rate in the private healthcare sector. In consultation with the DH and the Hospital Authority (HA), the consolidated reply to the question raised by the Hon Kenneth Leung is as follows: (1) to (3) Generally speaking, a couple is considered subfertile preliminarily when they fail to achieve pregnancy within 12 months of regular sexual intercourse without the use of contraceptives. Couples with fertility issues may first approach the HA's General Out-patient Clinics, private medical practitioners or the Family Planning Association of Hong Kong (FPAHK). Where necessary, patients will be referred by healthcare workers to HA's Gynaecology Specialist Out-patient Clinics (SOPC) to follow-up and treatment. The HA does not maintain statistical record on the number of subfertility cases. The number of clients receiving subfertility services at FPAHK and referrals on subfertility made by FPAHK in the past five years are set out below: Year 2018 2019 2020 2021 2022 Number of clients 1705 1618 1087 1250 937 Number of referrals 794 766 504 624 417 There are nine public hospitals (Note 2) under the HA with gynaecology specialist services, providing assisted reproductive services for females aged below 40. Among them, IVF (in-vitro fertilisation) clinics or subfertility assessment clinics are set up at the Queen Mary Hospital (QMH), Prince of Wales Hospital (PWH) and Kwong Wah Hospital (KWH) and provide IVF treatment services. Couples who have been assessed with IVF as the most appropriate treatment will be arranged to receive treatment services for up to three ovarian stimulation cycles. Currently, the waiting time for couples receiving subfertility assessment is 7.5 to 12 months after referral. The waiting time for couples in need of IVF treatment is about four to seven months after the first IVF consultation. KWH provides IVF treatments as a public service, with around 350 treatments annually. Private IVF services are not available at KWH. The two teaching hospitals, QMH and PWH, provide IVF treatments as public and private services. QMH provides approximately 800 IVF treatments annually, while the number provided by PWH is around 500. In terms of charges, the HA will charge eligible public hospital patients for receiving IVF services provided as a public service at the standard fees and charges of public hospitals, i.e. inpatient or outpatient fees (Note 3). Examinations and tests not available at public hospitals or self-financed drugs will be charged separately (Note 4). The charge for services provided as private service will be determined with reference to cost and market price. (4) to (6) The Government has been providing subfertility services and assisted reproductive services to those with family plans through different channels and in accordance with their needs. In particular, the FPAHK has been providing public education on sexual and reproductive health, pre-marital and pre-pregnancy preparation to support couples in parenthood planning. The FPAHK educates the public and encourages couples to make early family and parenthood planning through advertisement, social media and contribution of articles to the media, website and hotline enquiry service, etc. Besides, the FPAHK provides initial investigation for couples with difficulty in childbearing to diagnose the cause on a cost recovery basis. Depending on individual circumstances, medical treatment with clomiphene citrate will be provided for women with anovulation and "artificial insemination by husband" services will be provided for couples with unexplained subfertility or husband having mild male fertility problem. There is no age limit for these services. As for IVF service by the HA, taking into account the expected effects of the relevant treatment, the maximum age for patients to commence IVF treatment as public service is 40 while the maximum age for patients receive IVF treatment as private service to undergo treatment cycle is 45. In addition, the first Chinese Medicine Hospital in Hong Kong, which is expected to commence services in phases from 2025, will provide Chinese medicine (CM) clinical services on the basis of specialised services, covering internal medicine, external medicine, gynecology, paediatrics, orthopedics and traumatology, and acupuncture and moxibustion. One of the special disease programmes under the category of gynecology is "Infertility, prenatal and postpartum care", under which relevant CM professional treatment and support will be provided to patients in need. Medical social workers in public hospitals will also continue to provide appropriate psycho-social intervention and support to patients and their families to help them cope with emotional and life problems arising from illness, trauma or disability. The Government encourages couples who wish to have children to have a fertility check early, and seek help as soon as possible if they encounter fertility issues. Note 1: At present, the Council on Human Reproductive Technology has issued a total of 12 licences to public healthcare institutions to provide various assisted reproductive services. Note 2: These are the Pamela Youde Nethersole Eastern Hospital, Princess Margaret Hospital, Queen Elizabeth Hospital, Tseung Kwan O Hospital, Tuen Mun Hospital, United Christian Hospital, KWH, PWH and QMH. Note 3: $75 admission fees and $120 public ward maintenance fee per day for inpatient service and $135 for the first attendance and $80 per subsequent attendance for specialist outpatient service. Note 4: Including self-financed standard drug package of $4,000 and laboratory service fee for handling gametes and embryos. Charges vary depending on the type of laboratory procedures required and the number of embryos frozen, ranging from $9,000 to $40,000 per treatment cycle. The relevant laboratory services at QMH and KWH are provided by the University of Hong Kong, and the relevant services at PWH are provided by the Chinese University of Hong Kong.