Even as a child, Hong Kong YouTuber Sona Tina Ng envisioned her ideal future. She would get married, have two or three children and experience the joy of motherhood within a loving family.
This life began to take shape for Ng when she discovered she was pregnant in early 2019, just months after marrying her long-term partner. The couple were filled with joy as they prepared for the arrival of their first child.
Hong Kong YouTuber Sona Tina Ng. Photo: Kyle Lam/HKFP.
They celebrated by purchasing numerous pig plush toys, anticipating a baby born in the Year of the Pig. They also brainstormed a name for their little one.
During the eighth week of Ng’s pregnancy, she noticed light bleeding that lasted for several days, accompanied by abdominal pain. Before she could reach the emergency room, she began to bleed heavily in the bathroom at home. In that moment, she pushed out a mass, marking the heartbreaking loss of her first pregnancy.
Ng was devastated. Everything in her life had been going according to plan until that moment. When she spoke with her private obstetrician about the situation, the doctor reassured her that miscarriages are not uncommon. At just 28 years old, the doctor advised her to take time to rest and encouraged her to try again in the future.
“My husband and I didn’t dwell on any potential issues with my first pregnancy. We decided to try for another baby later that year, and we were successful again,” Ng said in an interview with HKFP in November.
Children running around in a playground in Hong Kong. Photo: Kyle Lam/HKFP.
Around five weeks into her second pregnancy, Ng noticed light bleeding once again. The hospital was unable to offer much assistance, as she was still in the very early stages of gestation. She returned home and shortly afterwards suffered her second miscarriage.
Ng’s second pregnancy loss prompted her to seek information online, where she learned about recurrent miscarriages. Concerned, she asked her obstetrician if checkups were necessary to identify the cause. But her doctor reassured her that such tests were not needed, explaining that only after three or more failed pregnancies would her condition be classified as recurrent miscarriage.
Disappointment, shame and guilt
Repeated miscarriages, which affect one in every 100 couples in Hong Kong, not only inflict physical pain on women like Ng. They also leave lasting feelings of disappointment – and often of shame and guilt.
Amanda had expected her second pregnancy to be smooth like her first. But between 2020 and 2022, she suffered two painful miscarriages. While many women joyfully announce their pregnancy, Amanda said her previously miscarriages instilled a deep fear that her baby might be “gone suddenly.” She chose not to tell others about her pregnancy until her bump became noticeable.
A baby shop in Hong Kong. File photo: Kyle Lam/HKFP.
For six months, Amanda was constantly unhappy no matter what she did. “It was like there was a hole in my heart, and that hole could not be filled.”
She was also extremely stressed during prenatal checkups for fear of again being told there was no heartbeat.
“Every day it felt like I was carrying a bomb, and I had no idea if it would explode suddenly,” Amanda recalled, speaking under a pseudonym.
Desire to know
Amanda was, however, determined to give her firstborn a sibling and was desperate for answers. After her first miscarriage, doctors had performed an autopsy on her foetus and found no genetic abnormalities. She began to suspect it was her own health that caused the miscarriage.
She spent hundreds of thousands of Hong Kong dollars seeking advice and treatment from medical experts including immunologists and embryologists. She eventually found she had a blood blotting condition that required daily injections of either Heparin or Clexane during pregnancy.
Professor Li Tin-chiu. Photo: Kyle Lam/HKFP.
Li Tin-chiu, who established Hong Kong’s first dedicated clinic for treating recurrent miscarriage in 2014, told HKFP that patients are increasingly proactive in seeking answers for their repeated pregnancy losses.
While some doctors may tell them that each pregnancy has a 10 to 15 percent chance of ending in miscarriage and suggest they “just try again,” fewer patients are willing to accept such responses. This shift in expectations was important, said Li, who currently practises at the Union Reproductive Medicine Centre under Union Hospital.
This trend coincides with a gradual change in the definition of recurrent miscarriage globally. In the US, it is classified as two or more consecutive pregnancy losses, while in the UK the threshold is set at three or more. More countries now recognise that women who experience two consecutive pregnancy losses may be facing underlying recurrent causes, he said.
Jacqueline Chung, deputy director of the Assisted Reproductive Unit in The Chinese University of Hong Kong (CUHK), Prince of Wales Hospital, told HKFP in November that there is no consensus in Hong Kong’s medical sector as to which threshold should be adopted.
She generally recommends that patients who have experienced two or more miscarriages undergo tests and checkups to determine the underlying causes. Around half of these cases remain unexplained.
Dr. Jacqueline Chung. Photo: Kyle Lam/HKFP.
With over 30 years of experience in reproductive medicine, Li said he is “very sensitive” to the needs of his patients. Although some may be turned away from public hospitals and clinics for not meeting the UK threshold for recurrent miscarriage, he is committed to providing specialised care and treatment to help them prevent further losses.
“These women often ask, ‘Do you want me to go through another miscarriage?’ They simply want to understand the causes so they can avoid a third loss,” he said, adding obstetricians should “take more initiative” to tell patients who have suffered a miscarriage to do relevant tests and checks.
Causes and treatment
According to Chung, there are six known causes of recurrent miscarriage, including uterine abnormalities, cervical weakness, and chromosomal abnormalities. Conditions such as abnormal thyroid function, autoimmune diseases, and thrombophilia – which can lead to blood clots and bring abnormal blood flow to the uterus – can also increase the risk of miscarriages.
A uterus model. Photo: Kyle Lam/HKFP.
Blood tests, magnetic resonances imaging, three-dimensional vaginal ultrasounds, chromosomal analysis, and other assessments may be conducted to investigate the causes of miscarriage.
High cost
Amanda, now a mother of two in her late 30s, explained that she did not seek specialist help within the public healthcare system because they might not consider tests and checkups necessary in her situation.
“I’m not sure if two or three miscarriages would justify additional services in public hospitals. In my case, they might view it as just an occasional occurrence,” she said.
While some patients can seek help from medical professionals in private practice, women with fewer financial resources face significant barriers to accessing care and treatment.
Chung said the tests could be very expensive, with some basic genetic testing costing more than HK$6,000. In Amanda’s case, she spent around HK$5,000 a month on anti-blood clotting medication during the entire period of her gestation.
A leaflet explaining ChromoSeq, a genetic test developed and validated by The Chinese University of Hong Kong. Photo: Kyle Lam/HKFP.
To ease the financial burden, CUHK collaborated with The Family Planning Association of Hong Kong to launch the Jockey Club Genetic Carrier Screening Programme for High-Risk Couples in May last year.
The programme, which only lasts for three years, targets couples who have experienced two or more miscarriages or have faced repeated foetal malformations or disabilities during pregnancy. It also caters for individuals with a strong family history of intellectual disabilities, miscarriages, malformations, or other high-risk factors for genetic disorders.
So far, about 700 couples have received free genetic counselling and genetic screening tests through the programme, according to Chung of CUHK, one of the experts involved.
The Hong Kong government has introduced various incentives in recent years to boost the city’s declining birth-rate, including a one-time HK$20,000 “baby bonus” implemented last year. Starting from this year, expenses on assisted reproductive services may enjoy a tax deduction under salaries tax and personal assessment, subject to a ceiling of HK$100,000 a year.
The government also pledged to increase the assisted reproductive service quota for in-vitro fertilisation (IVF) treatment at public hospitals and clinics from 1,100 per year to 1,800, over the span of five years.
An embryologist at Prince of Wales Hospital observes an embryo on a computer. Photo: Kyle Lam/HKFP.
Ng, who also spent hundreds of thousands of dollars on her efforts to give birth, suggested that it consider providing subsidies or loans to help couples access private reproductive healthcare services.
“People are marrying later these days. By the time they discover any reproductive issues, they may already be in their 40s. If they have to wait in line for public healthcare services, their chances of having a baby diminish, and the associated risks increase,” she said.
No mechanism for counselling
Celia Chan, a social work scholar at the University of Melbourne, told HKFP that women with recurrent miscarriages tend to experience more severe emotional distress because they often had high hopes of having children.
Such losses can result in “deep-level trauma,” with each miscarriage intensifying the grief. Women may feel increasingly distanced from their desired role as mothers with every miscarriage.
A baby shop in Hong Kong. File photo: Kyle Lam/HKFP.
“Women may question whether they had done anything that caused the miscarriage. There is often a lot of guilt, shame and embarrassment,” Chan said.
Those who have suffered multiple miscarriages may find themselves surrounded by friends with children, which can lead them to withdraw from social interactions. Others may encounter “secondary trauma” when doctors emphasise how common miscarriages are or suggest that they simply try again.
Although public hospitals have guidelines for medical staff on addressing the emotional distress caused by miscarriage, there is no formal mechanism requiring them to refer cases to counsellors or social workers. This practice often relies on the discretion of individual frontline medical personnel, such as midwives, she said.
Before her move to Australia earlier this year, Chan led the pilot project Jockey Club Perinatal Bereavement Care at the University of Hong Kong, which aimed to provide mental health support to couples grief-stricken over the loss of a pregnancy.
The three-year project was a collaboration with Hong Kong Young Women’s Christian Association Family Wellness Centre and Caritas-Hong Kong Grace Port-Caritas Miscarriage Support Centre. They are in the process of securing a new round of funding.
A baby loss memorial sculpture. Photo: Kelly Ho/HKFP.
“Medically or statistically speaking, miscarriage may be common. But to the couple or the women, it is not natural, it is a major setback in their lives,” Chan said.
Chan said she hoped more medics could show empathy for couples grieving over their loss.
Pain was ‘worth it’
Following her second miscarriage, YouTuber Ng chose to consult another obstetrician who diagnosed blood clotting issues. Despite identifying the cause of her previous pregnancy losses, Ng’s third attempt to have a baby ended in another miscarriage.
Her doctor recommended trying IVF to better control the timing of her pregnancy and to prepare for the administration of anti-blood clotting medication in advance.
Wary of getting her hopes up, Ng did not expect her first IVF implantation to succeed. But the process went smoothly and she fell pregnant again in late 2020.
Hong Kong YouTuber Sona Tina Ng. Photo: Kyle Lam/HKFP.
The YouTuber, who began sharing videos on travel, beauty, and fashion in 2015, also started documenting her pregnancy journey, including the challenging task of self-administering anti-blood clotting medication into her belly every day.
“It was really painful. I ended up with so many bruises from injecting in the wrong spots. As my belly grew larger, it became increasingly difficult to administer the injections, especially as I could feel the baby moving inside,” Ng recalled.
But all the pain was “worth it” when Ng finally welcomed her first-born in 2021.
After struggling through three miscarriages and finally welcoming her daughter, she strove to complete her ideal family with a second child. She became pregnant twice with the two remaining embryos from her first IVF treatment, but they both ended in miscarriage.
She eventually decided to start a new round of IVF treatment earlier this year. After countering hurdles in collecting eggs from her ovaries, Ng was successfully impregnated again in June. When she announced her pregnancy on social media last month, the comments section was flooded with congratulatory messages.
A card gifted to Professor Li Tin-chiu. Photo: Kyle Lam/HKFP.
Reproductive medicine expert Li said he believed 80 per cent of women could find ways to become pregnant. What was important was identifying the issues and following up with the right treatment, he said.
“Having worked on recurrent miscarriage cases for over 30 years, I have an admiration for women. They are very brave,” he said.
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