When Connie Wat Hong-ying and her husband Philip Cheng told their families six years ago that they wanted to adopt, her parents and in-laws baulked. Both sides wanted the couple to have children who would maintain the family bloodline.

'I was just 30 then, and they said I should try to conceive for longer,' Wat says. 'We kept explaining that we really wanted to be parents, and adopting a baby could make our wish come true.'

Wat and her husband had been advised to seek fertility treatment but both had ethical concerns, and went ahead with their plan.

For all the doubts expressed about adopting, the family elders' objections quickly faded when Wat brought home a 14-month-old baby named Abby in 2007.

'They fell in love with her at first sight. They are the ones who spoil her the most now,' says Wat.

A new member joined their family three years ago when Wat finally conceived and gave birth to a girl named Elly. 'I am glad Abby has a companion. They play with each other all the time now.'

Figures from the Council on Human Reproductive Technology show that the number of fertility treatments in Hong Kong nearly doubled from 4,693 in 2009 to 7,749 in 2010 (including donor insemination, artificial insemination by husbands and other reproductive technology procedures).

Although the figures on fertility treatments do not directly correlate to the number of people seeking treatment (one person may try several times, using different methods), the sharp rise suggests there is a significant pool of people eager to have children.

Yet the increase in local adoptions is low by comparison: there were 96 cases last year, compared with 83 in 2008.

Wat, the supervisor of adoption services with Mother's Choice charity, says the slow rate of adoption shows most Hong Kong people cling to traditional concepts of having biological offspring.

'They think a child with their own blood is better than one without,' she says.

Adopting is a big step, of course. 'Parents must be 100 per cent certain that they are ready for adoption and not have any doubts about raising a child with no blood links,' Wat says.

Few were better prepared for adoption than Wat, who had worked in adoption services for five years before she was introduced to Abby.

'Adoption is a lifelong commitment. It's more than simply bringing a child home. The child comes with a past that parents and child have to live with for the rest of their lives,' she says.

'Many adoptive children, especially the older ones, lack a sense of security. Some of them might have switched abodes and foster parents a couple of times before they finally got adopted.

'Even those who are adopted straight from the institution can lack trust in people. The carers cannot fulfil all the babies' needs, and their craving for physical touch is sometimes not satisfied.'

That's why organisations providing adoption services, such as International Social Service and Mother's Choice, encourage adoptive parents to go out of their way to help their children shake off the sense of alienation that comes with abandonment.

Abby's response was typical. Although just over a year old at the time, she was visibly anxious and stressed when she first came to live with Wat and her husband.

'She lived in a foster home for a year before meeting us and clung to her foster mother [at the introductory session],' Wat says. 'She became frightened that her foster mother was no longer around. She refused to eat and would cry whenever I put her down. It took three months for her to like us.'

All adoptions by local families were conducted through the Social Welfare Department until 2010. Then the government authorised three organisations - Po Leung Kuk, International Social Service and Mother's Choice, which previously only handled overseas adoptions - to vet applications and match children with prospective parents.

The process can take between a few months to several years. All applicants must pass rigorous vetting to ensure the child can enjoy a decent standard of living in the adoptive family, says Anita Ng Yuen-han, ISS' director in Hong Kong.

For instance, couples must have been married for at least three years.

'Their marriage must be stable and the parents must earn decent salaries,' says Ng. 'Adoptive parents come from all walks of life. Some young couples turn to us after they fail to conceive a baby through artificial insemination. Others have concentrated on career achievements and by the time they want to have children, they have missed [their chance].'

Applicants may specify the age range and gender of the child, but other than that, they do not have a say over who they adopt, Ng says.

'We don't want any child to face any rejection,' she says. 'But we make sure prospective parents get all the information about the child - [the agency would spell out any medical problems so the applicants can make an informed decision, for example] - and accept it before we arrange for them to meet.

'But those who consider adoption are always kind people. They always fall in love with the children at the first meeting.'

Wat says all adoptees have a portfolio about their origins that enables them to learn about their past when they grow up.

'The portfolio constructs the whole story of why the child is here, with pictures of his place of birth, how he wound up in an institution or foster family, his favourite nurse in the institution and so on,' she says. 'It also records all the milestones in his life, like the day he first met his adoptive parents right up until the day he leaves the institution. Everyone should know about their origin, as it forms a part of their identity.'

With adoptions from abroad, agencies such as ISS, which has organised inter-country adoption for 50 years, require prospective parents to undergo training before the process can proceed.

'Parents should exercise extra patience with children who might suffer from developmental delay because of institutionalisation after birth. Living for a long time in a group with strict schedules also makes it difficult for them to adapt to home life,' says Ng.

'One of the important parts of training is teaching parents how to tell the children that they were adopted. They must tell them as soon as possible. If they are told by a third party, instead of their adoptive parents, or find out after they grow up, the news will come as a shock.'

With Abby, Wat has taken a matter of fact approach. She made it clear early on that she was adopted and her daughter took the news in her stride. 'Everybody, including our friends and relatives, knows about the adoption, so they no longer see it as an issue. It's just the story of where she came from. We have a picture of her biological parents, which Abby treasures.

'She tells me she sometimes misses them, and I've promised that we will try to find them later. I wrote a letter to her biological parents through the Social Welfare Department, but they no longer live at the correspondence address. I told her that to prepare her for never seeing them again.'

Anyone wishing to reunite with their biological parents or children after they grow up must get the consent of the other party before they get into contact.

Jacob Weisman, 19, who was adopted by an American couple from an orphanage in Mong Kok when he was two months old, is curious about his origins.

Now in Hong Kong on an internship with an entertainment website, the Berkeley economics and law student is glad to be able to return to his birthplace.

'I thought about looking for my biological mother. I don't know her, but it's part of my history. It will be interesting to know what happens with her,' he says.

Weisman had asked his adoptive parents about what led to his adoption and doesn't blame his biological mother for deciding to give him up.

'She was really young then,' he says. 'She and her boyfriend were not ready for marriage and the boyfriend's family did not want to have a kid unless they were married. She knew she couldn't take care of a baby by herself, so she put me up for adoption. In her situation, it was possibly the best option for her.'

In any case, his adoption not only led to a new life in the US, it gave him three siblings. One of them, Caitlin, came from the same orphanage. Also on an internship in Hong Kong, 22-year-old Caitlin was adopted when she was just three months old.

'Although we were too young to remember anything then, we know we always knew each other. We are not biologically related, but seem to look more and more similar as we grow up,' Jacob says.

Caitlin and Jacob studied at the Chinese International School and lived in Hong Kong until 2006, when the entire Weisman family moved back to the US. Their mother, a social worker, gave birth to a daughter and son after adoption.

An architecture student at the Rhode Island School of Design, Caitlin says she loves having a big family. 'We play basketball and cards. We get enough people to have two teams, one of boys and the other of girls. My younger brother and sister have red hair but they think they are Chinese because of us.'

Jacob says because he and Caitlin are about the same age, they are close to each other.

'It's not because we are adopted. My elder sister takes care of me. We didn't really talk when we were younger. But as we grow older, we talk about everything - like love troubles and studies.

'She lives on the east coast and I live on the west coast [of the US], but we see each other all the time during the holidays,' Jacob says.

'The way we see [our adoptive parents] is not that we are grateful to them because they take care of us. We just see them as our parents. They treat us the same [as their biological children].'