Causes of Infertility

Both men and women can have problems of infertility. Male (sperm) and female (egg/fallopian tubes/uterus) factors each account for one-third of infertility cases, and the remaining one-third are either due to joint problems or unexplained.


Male factors: Unfavourable life habits such as smoking and drinking, undescended testes, varicose vein in the scrotum, or damage of the genital organs from operation or inflammation can affect the production or transportation of sperms and cause infertility. Hereditary factors can also lead to azoospermia or very low sperm count.


Female factors: Infertility can result from ovarian insufficiency, abnormal ovulation due to hormonal disturbances, blockage of fallopian tubes or pelvic adhesion caused by pelvic inflammatory disease or endometriosis, as well as congenital structural abnormalities of the uterus. Besides, women's reproductive potential falls as they get older, especially after age 40.

Treatments for Infertility

Fertility treatments include hormonal treatment, surgical treatment and assisted reproduction.

1.      Hormonal Treatment
For women, hormonal levels can be regulated through oral medication or injection to facilitate normal ovulation and improve the chance of conception.


2.      Surgical Treatment
Infertility due to defects of the genital organs can be treated by corrective operations with regard to the circumstances.

Women who cannot conceive due to previous tubal ligation can go for a reversal surgery which reconnects the fallopian tubes severed or clamped by rings during ligation and restores their function, so that pregnancy may be attempted again.


3.      Assisted Reproduction
The definition of assisted reproduction is very broad. In Hong Kong, it generally refers to procedures in which sperms and eggs are handled in the laboratory. It can be divided into two main types:

Intra Uterine Insemination (IUI)

A semen sample taken from the male partner is processed and concentrated in the laboratory, and then injected into the female uterus to fertilise the egg inside the fallopian tubes.


In Vitro Fertilisation (IVF)

IVF, also known as 'test tube baby', is a procedure that involves retrieval of sperms and eggs from the man and the woman respectively, fertilisation and embryo development in the laboratory, followed by a transfer back to the uterus.​

Who is Suitable for Assisted Reproduction?​

Couples should seek medical assistance as soon as possible for suitable assisted reproduction treatment under the following circumstances:

  • Failure to conceive after one year of regular, unprotected sexual intercourse;
  • Female aged 35 or above;
  • Short menstrual cycle at three-week intervals or less;
  • No period for more than two/three months;
  • History of ectopic pregnancy or pelvic inflammatory disease;
  • Two or more miscarriage experiences;
  • Prostate infection; history of vasectomy reversal; azoospermia or erectile dysfunction in male;
  • Premature ejaculation.
Methods of Assisted Reproduction

1. Intra Uterine Insemination (IUI)

IUI refers to putting selected sperms directly into the uterine cavity through a catheter, which shortens the distance the sperms have to swim to reach the egg. For successful conception through IUI, the woman must have at least one unblocked fallopian tube and a normal uterine cavity, while the sperms have to meet a certain quality standard.

Who is Suitable for IUI?

IUI is especially suitable for couples who have:

  • Poor quality sperm, e.g. low sperm count or motility;
  • Problems with sexual intercourse, e.g. erectile dysfunction, premature ejaculation, etc.;
  • Slight endometriosis;
  • Incompatibility between sperm and cervical mucus;
  • Unexplained infertility.

Procedure of IUI

In order to further increase the chance of conception, the woman needs to take egg-stimulating medication. The dosage must be closely monitored by the doctor to prevent too many eggs being activated.

A semen sample is collected from the spouse about an hour or two before the scheduled insemination. The semen is then processed or “washed” to select sperms with higher motility and separate them from the seminal fluid, which can cause the uterus to contract.

At the time of ovulation, the doctor will insert a small catheter through the vagina into the uterine cavity. The washed semen will then be injected through the catheter directly into the uterus. This procedure will not cause serious discomfort normally and does not require any anaesthetics.

The IUI procedure takes a few minutes to complete. About two weeks after insemination, a self-administered test or a simple blood test at the clinic will confirm whether the woman is pregnant.

2. In Vitro Fertilisation (IVF)

IVF involves retrieving eggs from the ovary, fertilising them with sperms in the laboratory and then transferring the embryo thus formed into the uterine cavity.


Who is Suitable for IVF?

IVF is recommended under the following conditions:

  • Sperm abnormalities or low sperm count;
  • Blocked fallopian tubes;
  • Severe endometriosis;
  • Incompatibility between sperm and cervical mucus;
  • Several failures with IUI treatment;
  • Unexplained infertility and more mature women.


Procedure of IVF

1. Gonadotropin-releasing hormone (GnRH) agonist is used to temporarily stop the brain from sending signals to the ovaries to ovulate.

2. Gonadotropins are used to stimulate the growth of multiple follicles in the ovaries. During this time, the doctor will regularly monitor the proper development of the follicles and identify the best time for egg retrieval. Once the follicles are developed, the doctor will give an hCG injection and arrange for egg retrieval.

3. A professional team including doctor, anaesthetist, nurse and embryologist are involved in the egg retrieval. Anaesthesia, intravenous sedative injection and mild pain reliever may be required. An ultrasound probe is inserted into the vagina to look at the follicles. A thin needle attached to the probe goes through the vaginal wall and into the ovary to draw the fluid and egg from each follicle. The egg is taken from the follicular fluid by the embryologist and placed in the culture medium.

4. Before egg retrieval, the male partner is asked to provide a semen sample. The semen is then “washed” by the doctor, and the sperms are added to eggs in an incubator to allow spontaneous union and embryo formation. The eggs will be checked for fertilisation on the next day by the embryologist, who will monitor the development of the fertilised eggs for another day or two.

5. The doctor will consult the couple about the number of embryos to be transferred. The embryos with the best morphology will be selected for transfer by the embryologist, who will load the embryos into a special catheter and pass the loaded catheter to the doctor. The doctor will transfer the embryos to the uterine cavity with the aid of an ultrasound. Slight discomfort may occur during this procedure. Normal activity can resume after a short rest following embryo transfer.

6. “Luteal phase” refers to the time period after ovulation, when elevated progesterone secretion helps maintain the thickness of the uterine lining to provide an ideal environment for embryo implantation. After embryo transfer, progesterone supplementation can help support the uterine lining and increase the chance of uterine implantation and pregnancy. You will know whether the treatment has been successful about two weeks after embryo transfer with a self-administered pregnancy test or a blood test at the clinic.


Pros & Cons of IVF

The advantages of IVF are a higher chance of egg-sperm fertilisation and a better success rate than IUI.

However, IVF is more complex and technically demanding with the risks of multiple pregnancy and ovarian overstimulation syndrome. Costs are higher as well.

Last Updated: Aug 2017
Please note that all medical health articles featured on our website have been reviewed by Quality Healthcare doctors. The articles are for general information only and are not medical opinions nor should the contents be used to replace the need for personal consultation with a qualified health professional on the reader’s medical condition.