Page 103 - HA Convention 2015

Special Topics

ST9.1 Managing Service Demands – Infertility Services 16:15 Room 228

Infertility Services at Hospital Authority — Its Scope and Limits Monday, 18 May
Cheung LP
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong

Infertility is a common problem in Hong Kong affecting approximately one in six couples. As fertility declines with woman’s
age, the current trend of delayed marriage and childbearing will further exaggerate the problem. Despite the devastating
social and psychological effect associated with it, access to infertility services is impeded by a number of political, economic,
social and cultural constraints. Political and economic factors, in addition to those that shape public policies and health
priorities, have significant impacts in determining access to infertility services.

Infertility treatment services are generally categorised into different levels (level one to three). While some patients may
benefit from the conventional medical or surgical treatments, a significant proportion of infertile patients may eventually
require assisted reproductive technology (ART) such as in-vitro fertilisation (IVF) treatment to conceive. Hospital Authority (HA)
services for infertile couples are generally underdeveloped compared to the private sector, in particular of the under supply
of public IVF services due to the limited service capacity and lack of funding.

This lecture will give an overview of infertility services provided by HA, its obstacles and challenges ahead, and to explore
potential solutions.

ST9.2 Managing Service Demands – Infertility Services 16:15 Room 228

Andrology Service at Hospital Authority — Past, Present and Future HOSPITAL AUTHORITY CONVENTION 2015
Yeung WSB
Obstetrics and Gynaecology Department, The University of Hong Kong/Queen Mary Hospital, Hong Kong

Andrology service in Hospital Authority (HA) hospitals involves performing diagnostic semen analysis (SA) for men attending
subfertility and urology clinics. It was traditionally done by the pathology laboratories of hospitals. With the development of
in-vitro-fertilisation (IVF), SA is increasingly done by IVF centres themselves. Currently, among the three IVF centres, namely
Kwong Wah Hospital (KWH), Prince of Wales Hospital (PWH) and Queen Mary Hospital (QMH) of HA, two of them (QMH and
KWH) perform their own SA in the centres, while the pathology laboratory at PWH performs all SA including those for the
IVF centre at PWH. The arrangement of SA in other HA hospitals varies: done by the pathology laboratory in PMH; done by
private laboratories in Qeen Elizabeth Hospital and Pamela Youde Nethersole Eastern Hospital, or a combination of both in
United Christian Hospital and Tseung Kwan O Hospital.

There are three reasons for the shift of SA done from the pathology laboratories to the IVF centres: (1) The IVF centres are
specialised in gamete assessment, whereas SA is only one of the many diagnostic tests done in the pathology laboratories;
(2) SA has to be done manually. Inter-technician and inter-laboratory variations can be great if it is not properly controlled.
The tests are done by dedicated and trained staff in the IVF centres. Such arrangement can be difficult in the pathology
laboratories; and (3) SA is part of the training for embryologists but not necessarily for medical laboratory technicians.

Looking into the future, a two-phase reform is recommended to improve the andrology service in HA hospitals. In the first
phase, SA is centrally performed in the three IVF centres. The IVF centres are also responsible for providing SA training to
technical staff of other HA hospitals. After completion of the training programme, SA can be done by either in the IVF centre
or the pathology laboratory in the second phase, depending on individual hospital arrangement. To maintain the standard
and reliability of the service, a quality assurance programme has to be implemented.

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