Case studies / Healthcare
Paid search · Cross-border healthcareTwo countries, three languages, and one budget we deliberately underspent.
A Hong Kong IVF clinic ran two campaigns with nothing in common: local patients searching in Traditional Chinese and Mandarin, and American patients who had already been through failed treatment at home and were willing to board a plane. The Google Ads account was suspended when we arrived.
A Hong Kong fertility clinic serving two very different patient markets.
The clinic provides IVF and reproductive immunology treatment in Hong Kong, serving local patients seeking fertility care nearby and U.S. patients who had experienced repeated failed IVF cycles and were considering traveling abroad for specialized treatment.
The challenge was reaching both audiences effectively through one marketing strategy, across three languages, different search behaviors, and patient needs that were worlds apart.
One clinic. Two audiences with nothing in common.
A patient in Kowloon looking for a local IVF clinic and a patient in California who has already been through three failed cycles are not variations of the same buyer. They searched differently, in different languages, for different reasons, and no single campaign reached both. So we didn't build one.
A local clinic, in the patient's own language.
Traditional Chinese and Mandarin campaigns for patients in Hong Kong searching for IVF treatment nearby. Competing against every local clinic, on familiar terms, where the decision was which clinic rather than whether to travel.
- Language Traditional Chinese, Mandarin
- Search volume Steady
- Competition Every local clinic
- Monthly budget $3,000
Patients who already tried, at home, and it didn't work.
English campaigns reaching people who had been through repeated failed cycles and been told their infertility was unexplained. They weren't shopping for IVF: they were looking for someone who would investigate further. A small audience, and buying past it added noise, not patients.
- Language English
- Search volume Narrow and specific
- Decision Whether to fly
- Budget allocated $5,000, underspent
A decade of advertising, switched off overnight.
The clinic had run Google Ads successfully for more than ten years. Then the account was suspended for policy violations and every campaign stopped at once.
That's how we were introduced. Not a performance problem: a complete loss of paid visibility in a category where the alternative acquisition channels are slow and patients are searching right now.
Underneath the suspension, four things needed solving.
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Healthcare advertising policy is unforgiving
IVF and reproductive medicine sit in one of Google's most restricted advertising categories. Ten years of account history meant ten years of accumulated policy exposure, and reinstatement required identifying and correcting every violation rather than appealing the outcome.
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Two markets were being served by one structure
Hong Kong and American patients arrived with different questions, in different languages, at different stages of a decision. Run together, the account optimises toward whichever produces cheaper clicks, not whichever produces patients.
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Three languages, and one of them isn't a translation
Traditional Chinese for Hong Kong, Mandarin, and English for the US. Translating English keywords into Chinese produces terms nobody searches, so the campaigns had to be built in each language rather than converted into it.
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The American audience was tiny and had to stay that way
Patients who had been through failed treatment and would consider travelling internationally were a small, specific group. The temptation with a $5,000 monthly budget is to broaden until it's spent, which fills the calendar with enquiries who were never going to board a plane.
Five steps, and the first one had to work.
Nothing else was possible until the account was serving again.
Get the account reinstated
A full audit of the suspended account to identify the policy violations behind the suspension, corrections at account and campaign level to meet Google's healthcare advertising requirements, then a reinstatement request supported by the documented fixes.
Paid visibility restored after a complete outage.
Separate the two markets completely
Hong Kong and United States campaigns rebuilt as independent structures with their own budgets, their own keywords, and their own bidding. Nothing shared, so neither market could quietly absorb the other's spend or distort its performance data.
Each market could be judged, and funded, on its own results.
Build in each language, don't translate into it
Traditional Chinese and Mandarin campaigns built around the terms patients in Hong Kong actually used, rather than translations of English keywords. Ad copy written for each language rather than converted, because a translated IVF ad reads exactly like a translated IVF ad.
A 5.21% click-through rate across campaigns.
Target the American searcher who already knows what they want
English campaigns built narrowly around patients who had been through failed treatment and were investigating further, people searching with a specific problem rather than browsing IVF options. Tight keywords, no broadening for volume.
A small, high-intent audience, deliberately kept small.
Optimise toward enquiries, not clicks
Conversion tracking rebuilt around meaningful patient actions: appointment bookings, phone calls, and treatment enquiries, with bidding, keyword pruning, and ad copy iterated against those outcomes. Analytics wired properly so the two markets could be compared rather than blended.
42 qualified leads a month, and 270% more within segment on the same budget.
We didn't spend the American budget.
The US campaigns had $5,000 a month available. Most months we spent well under it, and we told the client why rather than finding somewhere to put it.
The audience for cross-border IVF treatment is not large. It is people who have been through several failed cycles, who have been told their infertility is unexplained, and who will consider travelling to Hong Kong for a different opinion. A specific and finite group.
You can always spend more. Broaden the keywords, loosen the match types, add general IVF terms, and the budget clears every month. What arrives is enquiries from people who were never going to get on a plane: and a clinic spending consultation time discovering that one call at a time.
An agency paid a percentage of ad spend has no reason to underspend a budget. We think that's the strongest argument for not being paid that way.
Hong Kong was the opposite situation and was funded accordingly: a real local market with steady search volume, running at $3,000 a month against every other clinic in the city.
- Hong Kong budget $3,000 / mo
- US budget available $5,000 / mo
- US budget used Deliberately under
- Qualified leads 42 / mo
Three things that hold beyond fertility.
Never run two markets in one structure
Blended, the account optimises toward whichever market produces cheaper clicks, which is usually the one producing fewer customers. Separate budgets are the only way to know which is actually working.
Build campaigns in the language, not into it
Translated keywords produce terms nobody searches, and translated ad copy reads translated. In any non-English market, the campaign has to start in that language.
An unspent budget is sometimes the right answer
If your qualified audience is finite, spending past it buys noise. Ask your agency what they would do with a budget they cannot spend efficiently, the answer tells you a great deal.
What went into it.
Six of our services, on one account.
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