AMH <0.5, persistently elevated FSH levels, and increasingly irregular or absent menstrual cycles — these are common signs of diminished ovarian reserve (DOR) or premature ovarian insufficiency (POI). For women experiencing significant ovarian function decline, natural conception may become more challenging due to reduced egg quantity and declining egg quality.

For some women, egg donation may become an important option for achieving pregnancy. For families who wish to avoid long waiting periods for donor eggs, or when the woman’s own eggs are unlikely to achieve successful embryo development, embryo donation may provide another pathway.

In mainland China, access to donor eggs is highly restricted, and many families may face long waiting periods. As a result, some couples explore assisted reproduction programs in regions where relevant fertility services are legally available, including egg donation, embryo transfer, and third-party assisted reproduction options.

For women from Hong Kong, fertility planning often requires consideration of medical conditions, assisted reproduction regulations, and future family arrangements. Assisted reproductive procedures in Hong Kong are regulated under the Human Reproductive Technology Ordinance, and relevant services involving reproductive materials and embryos must be carried out through licensed facilities.

How Can Women with Diminished Ovarian Function Plan Their Fertility Journey?

When ovarian function declines significantly, doctors usually begin with a comprehensive fertility assessment, including:

• AMH (Anti-Müllerian Hormone) testing;

• FSH and reproductive hormone evaluation;

• Antral follicle count assessment;

• Uterine environment examination;

• Overall health evaluation.

If there is still potential to use their own eggs, some women may consider:

• Ovulation stimulation treatment;

• IVF treatment;

• Embryo development;

• Embryo freezing.

However, for women with severely reduced ovarian reserve, the number of eggs retrieved may be very limited. Even after multiple stimulation cycles, obtaining suitable embryos may remain difficult.

In these situations, egg donation may become an important fertility option.

Egg Donation: Providing New Possibilities for Women with Ovarian Function Decline

Egg donation involves using eggs from a screened donor, combining them with sperm from a partner or donor source to create embryos, and then completing pregnancy through assisted reproductive technology.

For women experiencing:

• Premature ovarian insufficiency;

• Severe diminished ovarian reserve;

• Repeated IVF failures;

• Poor egg quality,

egg donation can help overcome limitations caused by egg quantity and quality.

When considering egg donation, families usually need to pay attention to:

• Donor health screening;

• Genetic disease screening;

• Egg quality assessment;

• Embryo development;

• Legal documentation and arrangements.

Different regions have different regulations regarding egg donation, so understanding local medical procedures and legal requirements is an important part of fertility planning.

Embryo Donation: Another Assisted Reproduction Option

In addition to egg donation, some families may consider embryo donation.

Embryo donation generally refers to the use of suitable embryos remaining after another family completes IVF treatment, allowing those embryos to be transferred to another person who hopes to achieve pregnancy.

Compared with egg donation, embryo donation may offer several characteristics:

• No need for egg retrieval from a donor;

• Potentially shorter preparation time;

• Embryos are already created through fertilization.

However, embryo donation also means that the child usually does not have a genetic connection with the intended parents. Therefore, families may need to consider emotional acceptance, family communication, and long-term parenting perspectives.

For women with advanced maternal age, severe ovarian decline, or those hoping to shorten the fertility process, embryo donation may be a pathway worth exploring.

What Should Hong Kong Women Consider When Exploring Surrogacy-Related Assisted Reproduction?

For some women with diminished ovarian function, even after obtaining suitable embryos through egg donation, pregnancy may still be difficult due to:

• Uterine conditions;

• Previous pregnancy complications;

• High-risk pregnancy factors;

• Medical reasons preventing pregnancy.

In these situations, some families may explore third-party assisted reproduction options.

Surrogacy-related fertility planning may involve:

• Egg source selection;

• Embryo creation;

• Embryo screening;

• Pregnancy management;

• Legal arrangements after birth.

It is important to understand that regulations regarding surrogacy vary significantly between different regions. Hong Kong maintains strict regulations regarding assisted reproduction and related third-party arrangements, so some families explore fertility pathways in jurisdictions where relevant programs are legally permitted.

The process involves not only medical considerations but also:

• Parentage recognition;

• Birth documentation;

• Cross-border procedures;

• Long-term family planning.

Early preparation can help families better understand possible challenges and make informed decisions.

Clinic Consultation Story: Rebuilding a Fertility Plan After Ovarian Function Decline

Ms. Wang (pseudonym) is a 39-year-old woman living in Hong Kong.

For several years, she had hoped to have a child but was unable to conceive naturally. After fertility testing, the results showed:

• Low AMH levels;

• Elevated FSH levels;

• Reduced ovarian reserve.

Doctors explained that the quantity and quality of her own eggs might make conventional IVF treatment less likely to achieve the desired outcome.

Initially, Ms. Wang hoped to continue trying with her own eggs. However, after several medical evaluations, she began learning more about egg donation options.

During consultation, she learned that:

Egg donation could allow embryos to be created using screened donor eggs and transferred for pregnancy. If she wanted to explore alternatives that could reduce waiting time, embryo donation was another pathway to understand.

Because Ms. Wang had previously undergone uterine-related treatment, doctors also suggested that she learn more about different assisted reproduction options, including possible third-party pregnancy arrangements in regions where such services are legally available.

After several consultations, she gradually realized that fertility planning does not only mean continuing with one approach. Instead, it involves finding a pathway that matches her medical condition, personal needs, and future family goals.

Fertility Planning Suggestions for Women with Diminished Ovarian Function in Hong Kong

For women with low AMH, elevated FSH, or declining ovarian reserve, early planning can provide more options.

Complete Fertility Assessment Early

Menstrual regularity alone does not fully represent fertility potential. Professional evaluation of ovarian reserve can provide a clearer understanding of reproductive status.

Choose a Suitable Fertility Pathway

Depending on individual circumstances, possible options may include:

• IVF using own eggs;

• Egg donation;

• Embryo donation;

• Embryo genetic screening;

• Third-party assisted reproduction planning.

Consider Emotional and Legal Preparation

Assisted reproduction involves not only medical procedures but also future family arrangements.

Understanding:

• Medical processes;

• Legal requirements;

• Embryo origin;

• Family acceptance,

can help women approach fertility decisions with greater confidence.