Public Perception on Infertility and IVF - A Hong Kong Study

Dr. Milton Leong MDCM DSc(McGill)

Director, IVF CenterHong Kong Sanatorium & Hospital

Global Chinese Conference 15 Dec 2002

Infertility

1/6 couples trying for pregnancy Medical,social and psychological

problems studied

Very few perception studies

Perception study in Infertility

Bertarelli Foundation Survey 2000 1st published population perception

survey Polled 6 European Countries, USA and

Australia 1998/1999 Telephone survey: random selection

households 7036 polled, no mention of % completion

Perception Survey in Infertility

6 questions Asked You/your friend to avoid

rejection 52 % claimed personally know

somebody who had infertility

Perception Study in Infertility

Is Infertility a disease? Mean 38% Australia, UK, USA 20% Germany, Italy 55%

Heard of IVF? 77% (Germany) to 99% (Sweden)

Perception study in infertility

Should IVF be reimbursed? Told respondent cost 3x IVF equals

hip replacement 60-80% said to reimburse

Perception Study in Infertility

Although 97% of respondents heard of IVF and approved of IVF, only 16% answered correctly that IVF success is similar to that of natural pregnancy.

Most people guessed the success rate, and no correlation can be established

YWCA Perception Study 2002

Aims: Infertility problem vs no problem psycho-social states medical aspects - treatment

profiles

Bertarelli vs. Hong Kong Survey

Bertarelli

52% know infertility 16% know success

rate 89% know IVF 38% said infertility =

disease

Hong Kong

50% know infertility 20%know success

rate 46% know IVF 50% said

infertility=disease

YWCA Perception Study 2002

Methodology: Telephone survey Randomly called numbers No demographic questions to

maximise response Respondents answer 7,15, or16

questions

YWCA Perception Study 2002

Randomly dialed Numbers Carried out July to October Successfully Connected:147897 Valid Data: 7028 Success Rate: 5%

YWCA Perception Study 2002

0 20 40 60 80 100

infertile

no problem

INFERTILE PATIENTS

Suffering Period

Suffering Period

5 Years or more4 Years3 Years2 Years1 Year

Per

cent

40

30

20

10

0

Recvd. Treatment

Recvd. Treatment

YesNo

Per

cent

100

80

60

40

20

0

INFERTILE Treatment Vs Time

Suffering Period

5 Years or more

4 Years

3 Years

2 Years

1 Year

% W

ithin

Gro

up

100

90

80

70

60

50

40

30

20

10

0

Recvd. Treatment

Yes

No

as suffering time increased, more infertility subjects received treatment,

however, when they suffered more than 5 years, the subjects received treatment decreased N = 1173

Chi-square test P<0.05

Accepted ART? N = 265

ART Accepted?

ART Accepted?

NoYes

Pe

rce

nt

60

50

40

30

20

10

0

Why Reject IVF

anti-religiousbelief

IVF=abnormalbabies

Ashame ofbeing known toneed ivf

Too expensive45.7%

24%22.5%

7.8%

Chi-Square Compare Subjects with and Without Infertility (p <

0.05)

Infertility Y/N

NoYes

% W

ithin

Gro

up

100

90

80

70

60

50

40

30

20

10

0

Know IVF Ctr? Comb.

No

Yes

More subjects reported no Infertility problem knew IVFC

The expected Success Rate of IVFC was different between subjects with and without Infertility

Infertility Y/N

NoYes%

With

in G

rou

p

100

90

80

70

60

50

40

30

20

10

0

Success Rate Comb.

50%

40%

30%

20%

10%

Chi-Square Compare Subjects with and Without Infertility (p <

0.05)

Infertility Y/N

NoYes

% W

ithin

Gro

up

100

90

80

70

60

50

40

30

20

10

0

Disease?

No

Yes

More Infertile Subjects reported that they believed infertility is a disease.

Chi-Square Compare Subjects with and Without Infertility

(p = NS)

Infertility Y/N

NoYes

% W

ithin

Gro

up

100

90

80

70

60

50

40

30

20

10

0

Know Reasons? Comb.

No

Yes

Investigations on Treated Subjects

Check - Hormone

Check - Hormone

NoYesP

erc

en

t

70

60

50

40

30

20

10

0

Check - USound

Check - USound

NoYes

Pe

rce

nt

60

50

40

30

20

10

0

Investigations done Treated subjects

Check - Semen

Check - Semen

NoYes

Pe

rce

nt

60

50

40

30

20

10

0

Check - FTube

Check - FTube

NoYes

Per

cent

60

50

40

30

20

10

0

Basic Investigations Made

0

20

40

60

80

100

SA HSG

HKG

USA

Treatment Method offered

0

10

20

30

40

50

60

OI IUI IVF GIFT ICSI

% Treatmentoffered

Summary of Results

16% of polled has infertility problem 45% view infertility as disease. For

infertile couples 52% consider it a disease

35% only has heard of IVF centers 50% know the reason for their infertility 30% know IVF success rate (20-40%)

Summary of Results

1173/7208 polled claimed to be infertile only 265 (34%) have received or under

treatment 50.6% had ovulation induction 34% had intra-uterine insemination 24% had IVF/related treatment

Summary of Results

Diagnosis procedures reported Ovulation/hormone, laparoscopy 35% SA, HSG only 45% Ultrasound only test >50% (58%) 42% answered that none of the above

tests were done

Summary of Results

Although 50% of respondents who are under treatment accepts IVF

Only 30% actually received IVF treatment

This is 6.5% of respondents who has infertility

Of those rejecting IVF, 45.7% worry IVF begets abnormal babies. 22.5% think too expensive

CONCLUSIONS

There is misconception about IVF mainly in the availability, success rate, and the technology itself

There is a problem of education, so that appropriate tests were not done

Funding is not enough, especially third party payment

CONCLUSIONS

Patients are not seeking treat-ment. Social factors and other psychological reasons may be present.

May also be that right treatment is not readily offered, so treat-ment abandoned after a while

Cost Hip Replacement Vs IVF

Hip Replacement OT charge:$40000 Hospital Bed:

$20000 Surgical Fee:$30000 Drugs etc: $5000 Total: $95000

IVF OT charge: $12000 Hospital bed:$3000 Surgical Fee:$15000 Lab Fee:$ 15000 Drugs etc:$15000 Total: $$60000