IVF for Ovulation Disorders in Hong Kong: Requirements and Success Rates

Ovulation disorders occur when ovarian or hormonal abnormalities prevent the regular release of mature eggs. They are an important cause of female infertility. Common causes include polycystic ovary syndrome (PCOS), hyperprolactinaemia, thyroid dysfunction, hypothalamic or pituitary disorders, diminished ovarian reserve, abnormal body weight, prolonged stress, and excessive exercise.

IVF may become an important fertility option for patients who have not conceived after repeated ovulation induction or ovulation induction combined with intrauterine insemination (IUI). However, an ovulation disorder does not automatically mean that IVF should begin immediately or that surrogacy is required. Doctors should first identify the cause and assess the patient’s age, ovarian reserve, fallopian tubes, uterus, and the male partner’s semen quality.

A Common Clinical Scenario

Mrs Chan, aged 32, had long experienced irregular menstrual cycles, sometimes menstruating only once every two or three months. During two years of trying to conceive, she completed several cycles of oral ovulation induction and two IUI cycles. Although a dominant follicle developed during some cycles, pregnancy did not occur.

Further examinations showed features of PCOS, including a high antral follicle count and elevated AMH. Her husband’s semen analysis was generally normal, and both fallopian tubes were open. After discussing the results with the couple, the doctor recommended IVF.

Because Mrs Chan had many follicles, the aim was not to increase the medication dose. Instead, treatment focused on retrieving an appropriate number of mature eggs while reducing the risk of ovarian hyperstimulation syndrome (OHSS). After egg retrieval, the doctor reviewed her hormone levels and ovarian response. The embryos were frozen so that transfer could take place after her body had recovered.

This situation illustrates that having many follicles does not guarantee good egg quality. A higher medication dose also does not necessarily produce a higher IVF success rate.

What Causes Ovulation Disorders?

PCOS may cause infrequent or absent periods, acne, excess hair growth, weight gain, or elevated androgen levels. When no other infertility factors are present, lifestyle management and medication for ovulation induction may be considered first. International evidence-based guidance identifies letrozole as a first-line medication for ovulation induction in anovulatory women with PCOS. If oral medication is unsuccessful, gonadotrophin treatment, IUI, or IVF may be considered. 

Hyperprolactinaemia may suppress ovulation. Medication effects, thyroid dysfunction, and pituitary disorders should be investigated. Some patients resume ovulation and conceive naturally after appropriate treatment.

Being underweight, inadequate nutrition, excessive exercise, and prolonged stress may cause hypothalamic ovulatory dysfunction. Thyroid abnormalities may also interfere with menstruation and ovulation and should be controlled before fertility treatment.

Patients with low AMH, elevated baseline FSH, or a low antral follicle count require a different approach from patients with PCOS. If the patient is older or ovarian reserve has declined significantly, doctors may recommend limiting repeated ovulation-induction attempts and considering IVF earlier.

What If Repeated Ovulation Induction Has Failed?

Unsuccessful ovulation induction may involve:

• An inadequate follicular response;

• Ovulation without pregnancy;

• An unsuitable endometrium;

• Excessive follicular development and cycle cancellation;

• Tubal blockage, endometriosis, or abnormal semen parameters;

• Age-related decline in egg quality.

Before progressing to another treatment, doctors should review previous medication and monitoring records, the fallopian tubes, uterine cavity, and semen results. Low-dose gonadotrophin treatment may be considered. If pregnancy still does not occur or additional infertility factors are present, IVF may be appropriate.

What Is Required Before IVF?

Pre-treatment assessments generally include:

• AMH, antral follicle count, and baseline reproductive hormones;

• Pelvic ultrasound and assessment of the endometrium and uterine cavity;

• Semen analysis;

• Infectious disease screening, complete blood count, and liver and kidney function tests;

• Specialist assessment of serious medical or endocrine conditions.

AMH and antral follicle count mainly help predict the ovarian response and guide medication planning. They cannot independently determine egg quality or guarantee success.

Male-factor infertility should not be overlooked even when the woman has a confirmed ovulation disorder. If semen concentration, motility, or morphology is significantly abnormal, intracytoplasmic sperm injection (ICSI) may be recommended.

The IVF Process

IVF generally involves an initial consultation and investigation of the underlying cause, treatment of correctable factors, an individualised ovarian stimulation protocol, follicular monitoring, egg retrieval and semen collection, laboratory fertilisation, embryo culture, embryo transfer, and pregnancy follow-up.

Patients with PCOS may be particularly sensitive to ovarian stimulation medication and have a higher risk of OHSS. Depending on the individual risk, doctors may use a lower starting dose, an antagonist protocol, an adjusted trigger method, or a freeze-all strategy. Patients should never change or stop medication without medical instructions. 

What Is the IVF Success Rate?

There is no single fixed success rate for all patients with ovulation disorders. Outcomes mainly depend on age, egg and embryo quality, ovarian reserve, endometrial health, semen quality, and additional infertility factors.

Younger patients with PCOS, good ovarian reserve, and no other major infertility factors may obtain several eggs and usable embryos, although OHSS risk must be controlled. When an ovulation disorder is accompanied by advanced age or diminished ovarian reserve, egg quality usually has a greater influence on the outcome.

Hong Kong’s 2023 reproductive technology statistics recorded 5,440 non-donor IVF and frozen embryo transfer cycles initiated with the intention of embryo transfer. These resulted in 1,797 clinical pregnancies and 1,484 live-birth events. Because the data include different age groups and causes of infertility, they should not be interpreted as an individual patient’s expected success rate. 

Patients should ask fertility centres to explain clinical pregnancy, live-birth, and cumulative live-birth rates separately. They should also confirm whether the figures are calculated per cycle started, egg retrieval, or embryo transfer.

Do Ovulation Disorders Require Surrogacy?

Usually not.

Ovulation disorders mainly affect follicle maturation and egg release. If usable eggs can be obtained and the patient has a normal uterus and is medically fit to carry a pregnancy, embryos can generally be transferred to her own uterus.

Surrogacy may only become relevant when a woman cannot safely become pregnant or carry a pregnancy to term and no other practicable treatment is available. Examples may include absence of the uterus, severe uterine disease, or a major health risk associated with pregnancy.

Before consultation, patients may prepare menstrual records from the previous 6 to 12 months, previous medication and monitoring results, AMH and hormone reports, fallopian tube and uterine examinations, semen analysis, and records of previous pregnancies and operations. Complete information helps doctors understand why earlier treatment was unsuccessful.

An ovulation disorder does not automatically require IVF or surrogacy. Correctable endocrine conditions should be treated first. When repeated ovulation induction or IUI has failed, age is becoming a concern, or other infertility factors are present, IVF should be assessed without unnecessary delay.

If you are affected by an ovulation disorder and would like to understand IVF procedures and precautions, please contact us. We can provide professional information and guidance according to your individual circumstances.