It was a cold and cloudy November morning, but one full of promise for Guo Meiyan and her husband: they would finally have a chance to start a family.
When Mrs. Guo, 39, was wheeled on a stretcher to a hospital room where a doctor transferred her eggs, which had been harvested and fertilized, back into her womb, she also felt a sense of fear.
“If the transplant fails, all the money we spent will be wasted, all the pain I endured will be wasted, and we will have to start over,” said Ms. Guo, who had traveled 200 kilometers to Beijing from the northern city of Zhangjiakou. She and her husband lived in hotels for a month to be near the hospital during the final stages of the in vitro fertilization process.
They are among the hundreds of thousands of Chinese couples who turn to assisted reproductive technology every year after exhausting all other options to conceive. They travel from all corners of the country to major cities like Beijing in the hopes of beating the odds of infertility. Many wait in long queues outside hospitals before dawn just for the possibility of a consultation.
Now the Chinese government wants to make the technology it legalized in 2001 more accessible. It has promised to cover some of the costs — usually several thousand dollars for each round — under national health insurance. It is one of more than a dozen policies that Chinese officials are deploying against what they see as a very big problem: a fertility rate so low that China’s population has begun to shrink.
China has reached this turning point earlier than other countries in the stage of economic development, leading to what some demographers call the curse of “grow old before you get rich.” As fewer babies are born each year and China’s oldest people live longer, the government is forced to address a series of interlinked challenges: a shrinking workforce, a nascent retirement system and a generation of young people uninterested in having babies .
Subsidizing fertility services such as IVF, a technology that fertilizes eggs with sperm in a lab and transplants an embryo into the uterus, is “a big deal,” said Lin Haiwei, the director of Beijing Perfect Family Hospital, where Ms. Guo hair had procedure. Patients go to great lengths to pay for fertility services. Some of them pool loans from relatives. Farmers schedule their appointments for the fall harvest when they have money to pay.
But while there is a clear demand for fertility services, Mr Lin said, the number of patients visiting the hospital is lower every year. “The big picture is that people are less willing to have children,” he said.
This is China’s biggest challenge as it tries to reverse its declining birth rate. Young people complain about the financial burden of having children and their own economic insecurity, and push back on traditional ideas about women’s role as caretakers in the home. Many have expressed a desire to focus on their careers, while others have embraced a lifestyle known as “double income, no kids.”
Despite this hurdle, officials are trying to push up one of the lowest fertility rates in the world. While experts say it’s nearly impossible for China’s population to grow again, the country could keep its birth rate stable. Making assisted reproductive technologies accessible to more people would help, just as it has helped in wealthier countries like Denmark, said Ayo Wahlberg, an anthropologist at the University of Copenhagen.
China recently pledged to build at least one facility offering IVF for every 2.3 million to three million people by 2025. It currently has 539 medical institutions and 27 sperm banks approved to perform assisted reproductive technology. Each year, these facilities provide more than a million cycles of IVF and other assisted fertility services. About 300,000 babies are conceived.
Experts say these efforts are meaningful ways to help couples who want kids. If China can affordably scale up services, it could even be a model for other countries facing similar infertility challenges. But whether it will do much to change China’s demographic trajectory is another question.
“The problem is that it puts a Band-Aid on a running wound,” says Wahlberg, author of a book on fertility in China.
For couples like Wang Fang and her husband, IVF changed their lives. Ms Wang underwent two rounds of IVF in 2016 before giving birth to twins in 2017. Her husband’s first marriage ended in divorce because they could not have a child.
Both Ms. Wang, a factory worker, and her husband, an electrician, quit their jobs during pregnancy to prepare for childbirth.
When the first round of IVF failed, the couple felt broken. They found out that they may need a sperm donor, something Ms. Wang has kept secret from the family. Her parents believe the couple’s fertility problems were due to her.
“In our hometown, if you don’t have kids, you wouldn’t be able to hold your head high,” said Ms. Cheek. The second time they did IVF, the 14-day wait to determine if it was successful felt “like half a century,” she said.
As soon as they heard the outcome, they called everyone. Relatives offered to contribute with their savings to help cover expenses, which exceeded $22,000, a huge sum for the couple, whose monthly family income was less than $1,200 when Ms. Wang and her husband were at work.
“IVF is not a one-time deal and we ran out of money after several major items, so we had to borrow money to continue,” said Ms. Wang. If even a portion of those costs were covered by health insurance, as the government has said it will now do, “that would certainly have helped us and taken some of the pressure off.”
Each round of IVF can cost $5,000 to $12,000, and many couples have to do it as many as four or five times; each round has a success rate of about 30 percent. Under the new government measures, medical insurance would likely cover about half the cost of IVF treatment, said Mr. Lin at Beijing Perfect Family Hospital.
The policy has not been implemented, the details are unclear and a deadly Covid outbreak could slow things down. Still, Mr. Lin is optimistic that a version of the policy will be introduced in the coming months.
But he is also realistic about its impact. “It is certainly hard to expect much growth in our industry when the overall fertility rate and willingness to have children declines,” said Mr. Lin.
China has a complicated relationship with fertility. For three decades, officials limited families to one child — sometimes through brutal measures.
Today, infertility affects 18 percent of couples in China, compared to a global average of about 15 percent. Researchers cite several factors, including the fact that Chinese couples often wait until later to have children and the widespread use of abortions, which experts have said can impair fertility.
Su Yue, 32, has never had a strong desire to have a baby, but her husband and in-laws have. After the couple tried for several years, her mother-in-law gave them money to begin IVF treatment. Last year they were successful.
Mrs. Su loves her son, whom she affectionately calls “Cookie.” But she said the delivery cost her her job. She had been breastfeeding while working remotely, but then her boss demanded that she come to the office. As a career-focused millennial, she laments having to step down.
“The most stressful thing about IVF is that I lost my job,” Ms Su said.
Since her successful transplant at the end of November, Ms. Guo has been taking it easy at home in Zhangjiakou. The hot pot restaurant she and her husband own has been busy during the current Lunar New Year period. She is still helping and she has found time to knit two mattress covers for the baby.
But mostly she tries to rest in bed, Ms. Guo said. “I feel sick and dizzy all the time.”
