Key tests for planning pregnancy and how to access your reproductive health care for fertility success

As a modern city, Hong Kong is a place with no time for love. According to the Census and Statistics Department (C&SD), an upward trend in late marriage has been observed over the past few decades, probably due to the city’s high cost of living, and citizens’ pursuit of better educational and occupational opportunities.

While holding over having a baby, some may start to ask: is it too late for healthy pregnancy?

“If couples are planning to get married, or ready to enter into the new stage of having a baby especially in their late 30s, it’s always good to take both premarital check-up and subfertility workup.” says Dr Grace Kong, a specialist in obstetrics & gynaecology based in Hong Kong.

“Premarital check-up helps couples gain a better understanding of their own health. Diseases can be detected at an early or asymptomatic stage, especially those that may be contagious or inherited, and thus treatment can be started earlier to ensure their future babies are healthy,” she explains. “Screening for some common concerns such as thalassemia, rubella, hepatitis B and HIV is available with a wide range of medical laboratory tests.”

On the other hand, subfertility workup (or infertility evaluation) provides investigations on underlying causes for couples who are worrying or have already suffered from subfertility problems. “Generally speaking, a couple is considered to be sub-fertile when they fail to conceive after one year of regular, unprotected sexual intercourse,” says Dr Kong.

As a consequence of delayed marriage, it is increasingly common for couples to face subfertility. According to statistics, 1 in every 6 couples are affected nowadays, and the subfertility rate rises with female age, particularly after the age of 35.

“Some couples may argue about who is more infertile, however, studies already prove that men and women are equally likely to have fertility problems, with female infertility accounting for 30% of the cases and men’s problems for another 30%, and the remaining 40% is either a joint problem or an unexplained cause,” Dr Kong notes.

For men, subfertility cases are mostly related to sperm production, sperm function or transportation in the genital tract. History of genital surgeries, mumps infection, varicocele or unhealthy lifestyle such as smoking and drinking, can lead to low sperm production, abnormal sperm function or blockage that prevent any sperm delivery.

Factors affecting women’s fecundity can further be classified into ovulatory and structural factors. Hormone plays an important role before and during pregnancy. When hormonal regulation is disrupted, irregular periods or even amenorrhea may occur. This is considered as an ovulatory factor. Meanwhile, if women experience pain during menstruation or intercourse, or with a history of pelvic infection or pelvic surgeries, fallopian tube blockage may be suspected. Consequently, fertilization may not happen as egg and sperm cannot meet inside the tube.

Despite being sub-fertile, it is still possible to conceive naturally. If any problems are found, you need to have further medical tests, and the sooner the better. “For men, semen analysis would be the single effective way to check sperm volume, acidity, density, motility and morphology,” says Dr Kong.

As for women, checking hormones like mid-luteal progesterone would be useful to see if ovulation does occur. If ovulation does not happen as expected, doctors may suggest further evaluation to identify the causes behind. “Otherwise, structural abnormalities found in a woman’s reproductive organs, such as uterus and ovaries, may also pose a risk to fertility,” says Dr Kong. “Ultrasound can be used to examine if there are any abnormalities in the organs. A more in-depth assessment, like HSG or HyCoSy test, can be performed to check patency of the fallopian tubes.”

If couples have any medical history that may affect pregnancy, they should consult a gynaecologist as soon as possible.