When the world’s first ‘test-tube’ baby, Louise Brown, was born in 1978, it was heralded as the dawn of a new era for infertile couples. By using donated eggs, sperm and/or surrogates, they could at last become parents.
But the new era has not been such a simple matter for many couples, particularly in Hong Kong.
For one thing, artificial reproduction technology (ART), such as the in vitro fertilisation (IVF) used to conceive Louise Brown, has a high fail rate of 70 to 75 per cent. For another, only married heterosexual couples in Hong Kong can access ART or surrogates. And if parents opt for a surrogate, they are not allowed to use donated eggs or sperm or pay for the service.
All of this takes a heavy emotional toll on couples who are keen to have a baby, says Dr Celia Chan Hoi-yan of the Department of Social Work and Social Administration, who has been studying the impact and provides infertility counselling and psychological assessments.
“People have high expectations of ART and they experience psychological impacts during and after the process,” she said. Moreover, IVF is invasive because it involves extracting eggs and implanting embryos in women.
Dr Chan’s previous studies have shown that women’s anxiety ahead of IVF treatment can be eased through mind-body relaxation techniques, and their worries after treatment – while they wait to find out if they are pregnant – can be mitigated through self-reflection and better knowledge about the process.
She is now looking at grief, a common response for ART users given the low success rate. Some women undergo 10 or even 20 IVF cycles and pay millions of dollars for the service because couples are only entitled to three subsidised cycles in public hospitals.
“It can be an emotional rollercoaster of hope and disappointment for couples,” she said. “Infertility becomes a blockage to their life development. They don’t know how to move on because they are childless.” Dr Chan has written a booklet on perinatal bereavement for these couples and anyone suffering a miscarriage.
Infertility becomes a blockage to their life development. They don’t know how to move on because they are childless.
Dr Celia Chan Hoi-yan
Surrogacy and ‘parenthood’
Surrogacy is also complicated for couples. Some women turn to this because they cannot carry babies in their uterus even if they can conceive. Hong Kong technically allows married heterosexual parents to arrange surrogacy for altruistic reasons, but they cannot pay for it even if it is conducted in another country, according to Ms Daisy Cheung of the Faculty of Law, who has written about surrogacy in Hong Kong.
Parents who use a surrogate here or abroad must get a parental order within six months of the birth of the child. Until the court issues this, the surrogate mother is recognised as the legal mother and her husband as the legal father. “So even if the genetic material of the baby is yours and your husband’s and you give it to your sister to carry and she has a husband, they would be named as parents in the first place,” Ms Cheung said.
Strangely, none of the centres licensed under the Council on Human Reproductive Technology are listed as providing surrogacy services, but there are anecdotal cases of parents using surrogates in Hong Kong. Others have looked abroad, such as Peter Lee Ka-kit, the son of Henderson Land Development Chairman Lee Shau-kee, who reportedly hired a California-based surrogate mother to give birth to his triplet sons. The case was referred to the police but no charges were made.
“If commercial surrogacy is carried out abroad, it’s very difficult to enforce because you need clear evidence. There is also an argument that it’s not correct to apply extra-territorial criminality to situations that have a moral component to them – where the society may have different views on the morality of these actions,” she said.
Better fertility awareness needed
Ms Cheung also noted that there may be human rights implications regarding the denial of reproductive technology procedures, including both ART and surrogacy, to same-sex and cohabiting couples. However, this has never been tested in the courts.
Even if couples conceive through non-natural means, there is the question of what to tell the child. In Hong Kong, children have a right to know if they are conceived through non-natural means but not to know the identity of the donors or surrogate. Dr Chan said men she has counselled tend to have more issues with donated sperm than women do for donated eggs.
Dr Chan would like to see better fertility awareness among young people so they can make informed choices about when and whether to have a baby. “Young people are not very aware of the fertility clock and their own fertility ability. We want to raise their awareness because after 35, their fertility will drop. Media stories of women giving birth in their 40s are a distortion because those will still be high-risk pregnancies,” she said.
THE LIMITS OF ARTIFICIAL REPRODUCTION AND SURROGACY
Couples that cannot conceive naturally have other options in Hong Kong, but they can face restrictions in accessing them. HKU scholars have been looking at the psychological and legal issues involved.