Special Report | China Leads in Assisted Reproductive Technology, Yet Infertile Families Still Face Difficult Obstacles (AI Translation)
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文｜财新周刊 许雯 赵今朝
By Caixin Weekly’s Xu Wen and Zhao Jinzhao
文｜财新周刊 许雯 赵今朝
By Xu Wen and Zhao Jinzhao for Caixin Weekly
一排排队列整齐的白色液氮罐中，近80万枚微小而透明的人类胚胎正在-196℃的液态氮中沉睡。
In rows of neatly arranged white liquid nitrogen tanks, nearly 800,000 tiny, transparent human embryos lie in slumber, preserved in liquid nitrogen at minus 196 degrees Celsius.
这是坐落于湖南长沙的中信湘雅生殖与遗传专科医院（下称“中信湘雅”）胚胎库。自1980年建院至今，已有超过23万个“试管宝宝”在这家医院出生。
This is the embryo storage facility at CITIC-Xiangya Reproductive & Genetic Hospital (hereinafter "CITIC-Xiangya"), located in Changsha, Hunan Province. Since its establishment in 1980, more than 230,000 "test-tube babies" have been born at this hospital.
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- The average age for first-time parents in China has increased, and lifestyle changes have led to a rise in infertility rates, from 3% two decades ago to 18% in 2020.
- Despite advanced assisted reproductive technologies (ART) in China, only about 1.3 million ART cycles are performed annually for an estimated 8.1 million women needing treatment, partly due to high costs and societal stigma.
- While 27 Chinese provinces have included ART services in medical insurance, significant costs remain uncovered, and single women face legal restrictions on accessing ART services like egg freezing, often seeking solutions abroad.
[para. 1] The article examines the state of assisted reproductive technology (ART) in China, centered on the leading embryo bank at the CITIC-Xiangya Reproductive and Genetic Hospital in Changsha, which houses nearly 800,000 frozen embryos. Since its establishment in 1980, the hospital has facilitated the birth of over 230,000 "test-tube babies,” illustrating the significant growth of ART in China—from initial efforts with a low success rate to becoming a global leader, with China now accounting for about 3% of its annual newborns as test-tube babies (roughly 300,000 out of 9 million)[para. 1].
[para. 2] The demand for ART services has expanded as infertility rates in China rose from 3% in the 1980s and 1990s to 18% by 2020, implying 54 million infertile women out of 300 million women of childbearing age; approximately 8.1 million require ART. However, only 1.3 million cycles are performed annually, revealing a substantial unmet demand[para. 2].
[para. 3] ART’s social value is being increasingly acknowledged, both as a tool to fulfill the wishes of infertile households and as a potential lever to address declining birth rates and optimize population structure amidst China’s demographic challenges. Since 2024, ART has been progressively included in medical insurance (医保), with 27 provinces and regions (including Beijing, Shanghai, Zhejiang, and Xinjiang) covering ART services by October 31, 2024, although the long-term effects are still uncertain[para. 3].
[para. 4] Despite a rising incidence of infertility, ART clinic patient numbers are stagnant or declining, attributed to both expanded clinic capacity (622 facilities as of 2024, up from 517 in 2019) and a plateau or drop in national fertility intentions. The demographic profile of ART patients is also shifting older, as societal changes mean more people are marrying and having children later. Surveys show intended fertility dropped from 1.76 in 2017 to 1.64 in 2021, with "post-90s" and "00s" women averaging only 1.54 and 1.48 intended children, respectively[para. 4].
[para. 5] Misconceptions and stigma around ART persist. Many couples, out of misunderstanding or social anxiety, delay seeking medical help, sometimes trying folk remedies or enduring long cycles of ineffective treatments. Only 46.5% of infertile couples in China seek medical care (below the global average of 56%), and the average time from diagnosis to ART treatment is two to three years. Clinical pregnancy rates for in vitro fertilization (IVF) in China are about 40–50%, matching global benchmarks. Proper diagnosis and treatment could result in pregnancy for 80–90% of infertile women using varied methods, but ART is required in less than 20% of cases[para. 5].
[para. 6] Cost is a crucial barrier. ART is expensive—each IVF cycle in China costs 30,000–50,000 RMB, with second- and third-generation treatments ranging from 50,000 to 100,000 RMB. While medical insurance now covers many core ART procedures in several regions, many drugs, genetic testing, and storage fees remain out-of-pocket, and insurance impact on actual ART uptake is modest, as shown by modest increases in patient visits after policy implementation[para. 6].
[para. 7] Geographic disparities further complicate access, with advanced facilities clustered in eastern/seaside cities, and western provinces like Tibet, Qinghai, and Ningxia much less served. This leads many patients to travel great distances for ART. In some provinces, the number of ART cycles per institution falls far short of need, while donor egg supply is highly insufficient and strictly regulated, sometimes leading to illegal markets[para. 7].
[para. 8] The growing demand for more diverse reproductive options—including single women seeking ART or oocyte freezing—remains largely unmet due to regulatory restrictions; only married couples suffering infertility or certain diseases can access egg freezing legally. Internationally, countries like France provide full coverage for ART, including for single women, helping sustain higher fertility rates despite later marriage ages and more non-marital births. In China, many single women either go abroad or turn to clandestine domestic solutions[para. 8].
[para. 9] Delayed childbearing and lifestyle changes contribute to wider declines in fertility, with average initial marriage ages increasing by nearly four years over the last decade. Fertility preservation awareness is rising, but legal and professional consensus on supporting widespread egg freezing for social (non-medical) reasons remains divided due to concerns about over-promising outcomes and possible misuse. Experts emphasize that optimal childbearing age remains crucial, as delayed parenthood brings increased risks[para. 9].
[para. 10] In summary, while China’s ART capability has reached international standards and service capacity is at a record high, significant barriers remain—including costs, regional inequalities, regulatory rigidity, social stigma, and shifting fertility preferences. Addressing these requires systemic changes in healthcare access, insurance, legal approaches to ART access for single women, and broader societal support for comprehensive fertility planning and protection[para. 10].
- Merck China Medical and Health Assisted Reproduction Division
- Merck China Medical and Health Assisted Reproduction Division is involved in the field of assisted reproductive technology. Wu Jin, the head of the division, highlighted that patients typically take two to three years after an initial infertility diagnosis to seek treatment at an assisted reproduction facility, citing data from Peking University Third Hospital.
- Kingseg Pharmaceutical
- Kingseg Pharmaceutical, a Chinese company, was mentioned in the article in the context of couples facing infertility. According to the article, Kingseg Pharmaceutical noted that many couples dealing with infertility often feel shame and frustration. This, to some extent, leads to their resistance towards assisted reproductive technologies.
- 1980：
- Establishment of CITIC-Xiangya Reproductive & Genetic Hospital in Changsha, Hunan Province.
- 1980s：
- CITIC Xiangya Hospital, Peking University Third Hospital, and Peking Union Medical College Hospital began eight years of collaborative technical research on assisted reproductive technology.
- 1988：
- Mainland China’s first successful test-tube baby was born at Peking University Third Hospital.
- 1990s：
- Infertility rate in China was 3%.
- 2001：
- Chinese government issued regulations and standards to regulate assisted reproduction, accelerating the development of the industry.
- 2003：
- The 'Specifications for Human Assisted Reproductive Technology' were revised by the former National Health and Family Planning Commission, prohibiting provision of such technology to single women.
- 2004：
- Japan launched a national assisted reproductive treatment subsidy program.
- 2006：
- The 'Implementation Rules for the Verification of Human Assisted Reproductive Technologies and Human Sperm Banks' issued by the former National Health and Family Planning Commission, restricting egg donation policy.
- 2007：
- Infertility rate in China reached 12%.
- Between 2007 and 2012：
- China added an average of 50 assisted reproduction centers annually.
- 2010：
- Average age at first birth among women was 25-28 years old (used for later comparison).
- 2015：
- Approval authority for reproductive centers delegated from national to provincial authorities, leading to another surge in the number of institutions.
- 2015：
- Reproductive Medicine Branch of the Chinese Medical Association launched 'Reproductive Health in Remote Areas' public welfare program.
- 2017：
- Average intended number of children among women of childbearing age in China was 1.76.
- 2019：
- CITIC-Xiangya's annual treatment cycles peaked at over 50,000.
- 2019：
- The number of assisted reproductive institutions nationwide was 517.
- 2019：
- Average intended number of children among women of childbearing age in China was 1.73.
- 2019：
- Ningxia increased its number of assisted reproductive institutions from two in 2019 to three by June 2024; other northwestern provinces saw no increase since 2019.
- September 2019：
- China’s National Health Commission responded to a proposal about establishing a public egg donation system and began related research.
- 2020：
- Infertility rate in China climbed to 18%.
- 2020：
- Subsidizing ART at 20%, 50%, and 80% of treatment costs per cycle could increase the number of newborns by 116,000, 233,000, and 345,000 respectively, according to calculations in the 'China Assisted Reproductive Technology Research Report 2023.'
- 2021：
- National Health Commission survey found average intended number of children among women dropped to 1.64. For those born in the 1990s and 2000s, figures were 1.54 and 1.48.
- 2021：
- Qiao Jie's study found infertility rates in China rose from 12% in 2007 to 18% in 2020.
- 2021：
- National Health Commission responded to a proposal on egg freezing for single women, reiterating restrictions.
- 2022：
- Average monthly outpatient visits at Peking University Third Hospital reproductive center were about 29,000.
- April 2022：
- Japan included assisted reproductive technology under national health insurance, reimbursing up to 70% of costs.
- 2023：
- 43 new assisted reproductive institutions added in China.
- 2023：
- Monthly outpatient visits at Peking University Third Hospital reproductive center in early 2023 were about 33,000.
- May 2023：
- Monthly outpatient visits at Peking University Third Hospital reproductive center before insurance coverage implementation were 42,000–43,000.
- June 2023：
- Monthly outpatient visits at Peking University Third Hospital reproductive center were 42,000–43,000.
- July 1, 2023：
- Beijing implemented new medical insurance reimbursement policy for ART.
- July 2023：
- Monthly outpatient visits at Peking University Third Hospital reproductive center increased to 48,000–49,000 after insurance policy implementation.
- August 2023：
- Monthly outpatient visits at Peking University Third Hospital reproductive center were 48,000–49,000.
- 2023：
- Shanxi Province: Of its 12 assisted reproductive institutions, only one handled over 10,000 cycles, two over 1,000, four over 500, and three fewer than 100.
- 2024：
- Estimated average age of childbearing among Chinese women will be 29.15 years (UN projection).
- 2024：
- Number of assisted reproductive institutions in China increased to 622.
- By June 2024：
- Guangdong had 61 institutions capable of providing ART; Xizang had one; Qinghai, Ningxia, and Gansu had two, three, and four respectively.
- October 2024：
- Guangdong Province increased the government-guided price for embryo storage fees from RMB 100 to RMB 150 per tube per month.
- October 2024：
- After Guangdong Province included egg retrieval and seven other ART treatments under medical insurance, calculations specify reimbursements for different ART procedures.
- As of October 31, 2024：
- 27 provincial-level regions in China, including Beijing, Guangxi, Gansu, Inner Mongolia, Shanghai, Zhejiang, Jiangxi, Shandong, Qinghai, Xinjiang, and the Xinjiang Production and Construction Corps, have incorporated assisted reproductive services into their health insurance coverage.
- December 2, 2024：
- National Healthcare Security Administration announced a program to enable transfer and shared use of individual medical insurance accounts across provinces within one to two years.
- 2025：
- Professor Lu Guangxiu, age 85, conducted a medical outreach trip focused on reproductive health in Xizang.
- Beginning of 2025：
- China accelerated efforts to include ART in its national health insurance program.
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