Hong Kong-How Should Older Women with Declining Ovarian Function Prepare for Pregnancy? AMH Indicators and IVF Options

1. What Is AMH and Why Should Older Women Test for It?

AMH (Anti-Müllerian Hormone) is a hormone secreted by small follicles in the ovaries. It primarily reflects the number of developing follicles available—what medicine refers to as "ovarian reserve" . Unlike other hormones that fluctuate with the menstrual cycle, AMH levels remain relatively stable and can be tested on any day.

Reference ranges for AMH by age group are approximately as follows:

When AMH drops below 1.0 ng/mL, it generally indicates reduced ovarian reserve. Among Hong Kong patients, approximately 28% present with low ovarian reserve (AMH < 1.1 ng/mL). It is important to emphasize that AMH reflects the "quantity" rather than the "quality" of eggs. Egg quality is primarily affected by age—in women over 40, the rate of chromosomal abnormalities in eggs increases significantly. Therefore, fertility assessment should not rely solely on AMH but must integrate age, menstrual cycle regularity, antral follicle count, tubal patency, and partner's semen analysis.

2. When Should Older Women in Hong Kong Undergo Fertility Testing?

Hong Kong reproductive medicine specialists generally recommend:

• Under 35: If no pregnancy after 12 months of regular unprotected intercourse, begin evaluation

• 35–39: If no pregnancy after approximately 6 months of trying, begin evaluation

• 40 and above: Undergo fertility assessment as soon as you start planning for pregnancy — do not wait

For women over 40, time is the most precious resource. Even if menstruation remains regular, it does not mean egg quality is the same as in younger years. Rather than passively waiting, taking proactive steps—early testing, early evaluation, early planning—is essential.

3. If AMH Is Low, Is IVF Absolutely Necessary?

Not necessarily. Low AMH does not equate to inability to conceive naturally. A 32-year-old woman with low AMH may still have a chance of natural conception if she ovulates regularly and has patent fallopian tubes. Conversely, a 42-year-old woman with AMH in the normal range may still have low natural conception rates due to age-related decline in egg quality.

However, for women over 40 with significantly low AMH, IVF can substantially improve the chances of pregnancy. IVF overcomes age-related fertility challenges by stimulating the ovaries to retrieve multiple eggs, fertilizing them in vitro, culturing embryos, and selecting high-quality embryos for transfer.

4. How to Choose an IVF Protocol in Hong Kong?

4.1 Choosing the Right Ovarian Stimulation Protocol

Selecting the appropriate stimulation protocol based on AMH levels is critical:

• AMH > 1.2 ng/mL: Conventional stimulation protocols may be considered

• AMH < 1.2 ng/mL: Mild stimulation protocol is recommended—lower medication doses, less ovarian burden

• Very low AMH (e.g., < 0.5 ng/mL): May require multiple retrievals to accumulate embryos

Women over 40, due to declining ovarian function, typically require 40% to 60% more medication than those under 35, with correspondingly higher costs.

4.2 Third-Generation IVF (PGT)

For older women, third-generation IVF (PGT, or Preimplantation Genetic Testing) is a highly worthwhile consideration. This technology screens embryos for chromosomal abnormalities before transfer, significantly improving implantation and live birth rates.

Clinical data show:

Hong Kong's养和医院 (Hong Kong Sanatorium & Hospital) has demonstrated particular strength in treating older patients (>40), maintaining success rates of 30%–40% through technologies such as oocyte activation. While success rates decline for women over 40, they are by no means zero.

4.3 Overview of Major Reproductive Medicine Centers in Hong Kong

Hong Kong has over 20 licensed正规 IVF service providers. Below are several representative institutions:

Hong Kong Sanatorium & Hospital (HKSH) Reproductive Medicine Centre
A long-established private hospital reproductive centre with advanced embryology laboratories and AI embryo selection systems. Third-generation IVF success rates reach 62%–65% in patients under 35. Extensive experience with older and complex cases. Costs approximately HKD 250,000–300,000 per cycle.

CUHK Fertility Centre, Prince of Wales Hospital
Leveraging university research capabilities, achieves an industry-leading 98% embryo freezing and thawing survival rate. Success rates exceed 75% in patients under 35. As a public sector provider, costs are relatively lower at approximately HKD 150,000–180,000, though waiting times may be longer.

Union Hospital Reproductive Medicine Centre
The first private assisted reproduction facility in the New Territories and Kowloon, with success rates of 55%–65%. Known for personalized protocols and good value, with costs around HKD 120,000–200,000. Specializes in customized stimulation protocols for older patients.

Queen Mary Hospital (Public)
A teaching hospital of the University of Hong Kong. As a public facility, costs are more affordable at approximately HKD 80,000–140,000. However, waiting times are significant—at Queen Mary Hospital, the current wait to see a doctor for the first time is 11 to 12 months.

5. Overview of IVF Costs in Hong Kong

The total cost of a single IVF cycle in Hong Kong varies significantly depending on hospital type, technology choice, and individual circumstances:

• First/second generation IVF: Approximately HKD 80,000–120,000

• Third-generation IVF (PGT) : Approximately HKD 150,000–300,000

• Public hospitals: Approximately HKD 80,000–140,000, with waiting times of 3–18 months or more

• Private hospitals: Approximately HKD 120,000–250,000, with short appointment lead times (typically <7 days)

Cost components include: pre-treatment workup (approximately HKD 10,000–20,000), ovulation induction medications (HKD 20,000–40,000, with imported drugs accounting for a significant portion), egg retrieval and embryo culture (HKD 30,000–50,000), genetic screening (HKD 20,000–40,000), and embryo cryopreservation fees.

6. Legal Framework for Surrogacy in Hong Kong

Hong Kong's Human Reproductive Technology Ordinance (Cap. 561) provides clear legal provisions regarding surrogacy:

• Commercial surrogacy is illegal in Hong Kong and constitutes a criminal offence

• The Ordinance permits non-commercial surrogacy arrangements that do not involve commercial dealing, though such arrangements are not enforceable

• In surrogacy arrangements, the embryo must be created using the gametes of at least one commissioning parent

• As of May 2023, while multiple medical institutions in Hong Kong hold assisted reproduction service licenses, none are authorized to provide surrogacy services

Therefore, older women seeking assisted reproduction in Hong Kong should primarily focus on legally permitted approaches such as IVF.

7. Practical Advice for Older Women Trying to Conceive

1. Act early; do not wait. Fertility in women over 40 declines every year. If you have decided to have a child, undergo fertility assessment as early as possible.

2. Comprehensive assessment; do not test AMH alone. The key to pregnancy preparation at an older age is a full understanding of ovarian function, ovulation status, tubal condition, and partner's semen quality. AMH is just one of several indicators.

3. View AMH values rationally. Low AMH does not mean no hope. Many women with low AMH have successfully conceived through appropriate treatment protocols.

4. Choose the right reproductive centre. Make a reasoned choice between public and private providers based on your age, ovarian function, financial situation, and timeline.

5. Prepare mentally. IVF at an older age may require multiple cycles to succeed. Maintain patience and confidence, and work closely with your medical team.

Declining ovarian function in older women is an irreversible physiological process. If you have fertility aspirations, it is advisable to seek professional reproductive medicine support as early as possible. Through comprehensive evaluation of AMH and other indicators, and the development of personalized treatment plans, your chances of success can be improved. If you are facing the challenges of pregnancy at an older age or declining ovarian function, please feel free to contact us. We will provide professional consultation and assessment recommendations tailored to your specific circumstances.