"China News Weekly" reporter/Niu He Zhouyou
Published in the 1126th issue of "China News Weekly" magazine on January 22, 2024
One day in early 2024, at the Reproductive Medicine Center of Peking University Third Hospital (hereinafter referred to as Peking University Third Hospital), 30-year-old Liu Lin and her husband were sitting on the waiting seats outside the outpatient clinic, with a slightly tired look on their faces.
Six months ago, Liu Lin started to try in vitro fertilization at Peking University Third Hospital. That day was the day she went to the hospital to check the embryo culture results.
Liu Lin told China News Weekly that she had been pregnant naturally, but the fetus in her belly was diagnosed with congenital deafness and required cochlear implants. Considering financial pressure and future health problems of the child, she and her husband gave up the birth.
Later, Liu Lin discovered through genetic screening that she and her husband were both carriers of the deafness gene.
The doctor told her that in her case, she could consider trying "third-generation in vitro fertilization" to have a healthy child.
Since the world's first test-tube baby was born in the UK in 1978, people have increasingly explored this technology.
More than 10 million babies have been born worldwide due to IVF technology.
At present, China is the country that carries out the most assisted reproduction in the world.
In June 2022, data released by the National Health Commission showed that the number of babies born through assisted reproductive technology in China every year exceeded 300,000.
Huang Hefeng, academician of the Chinese Academy of Sciences and director of the Institute of Reproduction and Development of Fudan University, said in an interview with China News Weekly that major domestic assisted reproductive centers can basically achieve a pregnancy rate of more than 40%, and the pregnancy rate of some reproductive centers can reach 50%. %.
But if people want to be healthy throughout their life cycle, human intervention should be reduced as much as possible from the source of life.
For infertility treatment, in vitro fertilization must be the last step.
On January 10, an article published in Advances in Human Reproduction led by the International Federation of Fertility Societies explained for the first time the main differences in reproductive health care between countries in the context of slowing global population growth.
The article pointed out that if the impact of immigration is ignored, the population of many countries is expected to decline by more than 50% from 2017 to the end of this century.
The article calls for policies to reduce the risk factors for infertility and develop simpler, lower-cost assisted reproductive technologies.
Only a small number of patients need
Li Jia, 35, who lives in Beijing, has studied and worked abroad all year round.
She returned to China in early 2023 and began the life of "making babies".
From 2018 to 2019, she had two artificial inseminations abroad, both of which ended in failure.
Li Jia told China News Weekly that after returning to China, she went to Peking University Third Hospital for a check-up and found that there was water on one side of her fallopian tube.
In early April 2023, she registered in the hospital for the first time. At the end of July, the doctor formulated a treatment plan for her.
Assisted reproduction mainly includes artificial insemination, in vitro fertilization-embryo transfer technology and its derivative technologies.
In vitro fertilization-embryo transfer technology, commonly known as in vitro fertilization, is the core technology of assisted reproduction.
Huang Hefeng said that "the development of in vitro fertilization is not without limitations." It is suitable for those with clear indications, including women with fallopian tube obstruction, fallopian tube ligation, ovarian insufficiency, severe oligoasthenozoospermia in their partners, and endometriosis. Women with confirmed infertility such as uterine disease, and people at risk of single-gene genetic diseases.
At present, about 1.3 million couples in China use assisted reproductive technologies such as in vitro fertilization every year, and about 3% of newborns born each year are born through assisted reproductive technologies such as in vitro fertilization.
Huang Guoning, chairman of the Reproductive Medicine Branch of the Chinese Medical Association and head of the Reproductive Medicine Center of Chongqing Maternal and Child Health Hospital, said that taking his hospital as an example, there are about 450,000 infertility clinic visits every year, including egg retrieval for in vitro fertilization. There were about 11,000 surgeries, accounting for about 2.4%.
Infertility does not necessarily mean IVF is necessary.
In October 2021, the "Core Information on Health Education for Infertility Prevention and Treatment" issued by the National Health Commission suggested that 80% to 90% of infertility patients can be cured through comprehensive means such as lifestyle adjustments, surgical treatment, and psychological counseling. To achieve pregnancy, only a small number of patients require assisted reproductive technology treatment.
In March 1988, the first test-tube baby in mainland China was born at Peking University Third Hospital. Zhang Lizhu, a doctor at the hospital, was the cultivator of this new life.
Since the development of in vitro fertilization, its core technical means have been updated to the fourth generation, but the first three generations of technology are currently mainly used.
When a patient sees a doctor, the doctor will generally choose an appropriate IVF program based on the patient’s indications.
The first three generations of IVF technologies are conventional in vitro fertilization and embryo transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), and preimplantation genetic testing (PGD) (hereinafter referred to as "first generation" and "second generation" respectively). "generation" "three generations").
Duan Tao, the former director of Shanghai No. 1 Maternal and Infant Health Hospital and the reproductive strategic consultant of Jinxin, a private assisted reproductive institution, told China News Weekly that among the three types of in vitro fertilization technologies, patients choose more of the first two and "three generations". "The proportion of patients is very small.
Because not every assisted reproductive institution can provide "three generations".
Most of the female patients Duan Tao has treated are over 30 years old and have relatively high personal income, educational background, and family economic level.
Yang Xiaokui, director of the Reproductive Medicine Department of Beijing Obstetrics and Gynecology Hospital, told China News Weekly that the assisted reproductive patients he receives are generally older, with most of them over 35 years old. In 2023, the number of patients over 40 years old will also gradually increase.
Yang Xiaokui initially estimated that at the end of last year, the number of assisted reproductive patients in her clinic increased by about 20% compared with the same period in previous years.
Data released by the Reproductive Medicine Branch of the Chinese Medical Association shows that from 2017 to 2021, about 70% of infertile women in China who received assisted reproductive treatment were under the age of 35.
In Huang Guoning's view, infertile couples who go to the hospital for medical treatment basically have a strong desire to have children.
According to the definition of the World Health Organization, infertility is a male or female reproductive system disease that refers to the failure to achieve pregnancy without taking any contraceptive measures and having normal sexual life for more than one year.
The latest national reproductive health epidemiological survey analysis results by the team of Qiao Jie, academician of the Chinese Academy of Engineering, expert in obstetrics, gynecology and reproductive medicine, and director of Peking University Health Science Center, show that from 2007 to 2020, the domestic infertility incidence rate has increased from 12% to 18% .
In vitro fertilization is often misunderstood by the public.
Many women who have difficulty conceiving will regard it as a shortcut to fertility, but in fact, it is like a "black box" with unpredictable results.
Usually, for in vitro fertilization, patients have to go through multiple stages such as examination, ovulation induction, in vitro fertilization, checking embryo development, embryo transfer, and checking whether pregnancy is successful.
In early August 2023, Li Jia officially entered the ovulation induction stage.
In order for the follicles to mature and be discharged, ovulation induction injections are required for about 7 to 15 days at this stage. During this period, the follicle development needs to be monitored continuously in the hospital.
Afterwards, Li Jia retrieved 7 eggs in the hospital and cultured 4 embryos.
Because the quality of the embryos was poor, Li Jia could only wait for the embryos to develop into blastocysts before transplanting them. However, before the embryos could be transplanted, the cultured blastocysts were "annihilated."
Lou Jiaoying, director of the Reproductive Center of Dongfang Hospital of Beijing University of Chinese Medicine, said in an interview with China News Weekly that judging from the current outpatient visits at Dongfang Hospital, there are many patients with repeated miscarriages or failed in vitro fertilization.
Having too many artificial abortions can easily lead to fallopian tube obstruction or endometrial lesions.
Fang Cong, director and chief physician of the Reproductive Center of the Sixth Affiliated Hospital of Sun Yat-sen University, told China News Weekly that common failure factors for IVF are ovarian function decline due to older age, reduced egg quality, and severe endometrial damage caused by other reasons. wait.
For example, some women have had multiple abortions when they were young. The endometrium has become very thin and the "soil" is very poor. Even if there are good embryos, it is difficult for them to implant smoothly.
Some women may have repeated implantation failures due to autoimmune problems. In this case, they need to take immune-modulating drugs to increase the probability of "seed implantation."
Data released by the Reproductive Medicine Branch of the Chinese Medical Association shows that the average clinical pregnancy rate of domestic IVF treatment in 2021 is about 50%, of which the clinical pregnancy rate of patients younger than 35 years old is 50% to 60%, and the clinical pregnancy rate of patients older than 35 years old is about 50%. is about 40%.
"Age is the main physiological factor that affects female fertility." Huang Guoning said that compared with the age of 20 to 29, the fertility of women aged 35 to 39 is reduced by 25%, and the fertility of women aged 40 to 45 is reduced by 95%.
This phenomenon is not only related to the gradual decrease in the number of eggs, but also affected by egg aging.
The number of ovulations a woman can ovulate in her lifetime is limited. Pathological ovarian function decline may occur at any age, but the older she gets, the more obvious this decline becomes.
Can costs still be reduced?
"Including the cost of the two previous artificial inseminations, so far, it has cost about 100,000 yuan, and there is no result." Li Jia said that since 2023, the treatment of in vitro fertilization has cost more than 30,000 yuan.
The cost of a single IVF cycle includes medications, surgery, anesthesia, blood tests, egg and sperm processing, embryo storage, embryo transfer, and more.
Huang Hefeng said that from the 1980s to the present, the average cost of a cycle of "test tube baby" has not changed much, about 20,000 to 30,000 yuan per cycle.
Starting from February 1, 2024, Gansu will include 12 therapeutic assisted reproductive medical services such as egg retrieval and embryo transfer into medical insurance.
When insured persons enjoy assisted reproductive medical insurance benefits, there is no deductible. According to Category B items, the individual pays first, and then is reimbursed at a rate of 60%. The basic medical insurance for employees and urban and rural residents implements the same reimbursement rate, and does not crowd out individual outpatient services. , the outpatient mutual aid fund limit is not included in the maximum annual fund payment limit.
Starting from November 1, 2023, Guangxi will include some therapeutic assisted reproductive medical services such as egg retrieval, embryo culture, and embryo transfer into medical insurance payment.
On October 30, 2023, a research report released by Northeast Securities mentioned that the assisted reproductive projects included in Guangxi Medical Insurance are mainly "first generation" and "second generation", and "third generation" only includes tissue and cell biopsy.
Assuming that the patient is reimbursed through the employee medical insurance, the minimum reimbursement for one "generation" is 6,230 yuan and the maximum reimbursement is 8,586 yuan.
Calculated based on the expenditure of 30,000 to 40,000 yuan for a single IVF cycle, the actual medical insurance fund payment ratio is about 25%.
From 2022 to 2023, Beijing and Liaoning have successively issued notices stating that assisted reproductive medical services will be included in medical insurance.
In July 2023, Beijing will include 16 therapeutic assisted reproductive technology projects, including ovulation induction examinations, intrauterine artificial insemination, etc., into the scope of basic medical insurance reimbursement.
Currently, there are 16 reproductive centers in Beijing that include some assisted reproductive projects in medical insurance payments.
In August 2023, the Liaoning Provincial Medical Insurance Bureau responded that the 18 assisted reproductive projects originally planned to be implemented in the province on July 1 were forward-looking adjustments, and further research and demonstration of supporting treatment policies were needed.
At present, Beijing is the place with the largest coverage of assisted reproduction in medical insurance in the country, and there is no limit on the number of reimbursements.
"China News Weekly" noted that Guangxi's relevant policies have many restrictions on assisted reproduction-related projects included in medical insurance, including being limited to outpatient clinics, and each person can only be reimbursed a maximum of two times, basically covering two times for each insured person. Treatment costs for an assisted reproductive transplant cycle.
Duan Tao said that now all regions are carefully looking at the policies introduced by Beijing, and other places are also studying, but there are still only a few provinces that include assisted reproduction in medical insurance.
In his view, the inclusion of policies in medical insurance to encourage support is more significant than actually promoting an increase in the desire to have children.
Li Yang, head of the Reproductive Health Department of Meizhongyihe Group, recalled that since Beijing included some assisted reproduction projects in the scope of reimbursement, from July to August 2023, the number of outpatient consultations at Beijing Meizhongyihe North Third Ring Women's and Children's Hospital increased. There was a short-term small peak, and then it gradually fell back.
When it was first included in medical insurance, many people went to outpatient clinics for consultation, but 30% to 40% did not ultimately choose assisted reproduction.
Yang Xiaokui told China News Weekly that after Beijing included assisted reproduction in medical insurance, the outpatient volume of her department increased by 20 to 30 percent.
At that time, the hospital specially added night and weekend outpatient clinics for this purpose.
Now, the monthly outpatient volume of her department has not dropped significantly, and has basically remained at eight to nine thousand patients per month.
Duan Tao analyzed that whether the inclusion of medical insurance will be rolled out on a large scale depends on how big the medical insurance "plate" is in each place.
At present, more and more contents are included in medical insurance, but the "plate" of medical insurance has basically not increased.
At the same time, major hospitals are promoting cost control. When assisted reproduction is included in medical insurance in more and more places, it is still unclear whether it will be further included in the scope of medical insurance cost control.
Duan Tao analyzed that judging whether a technology can reach the public mainly depends on three "A"s, namely available, accessible, and affordable.
The inclusion of assisted reproductive technology in medical insurance only solves the problem of affordability.
Although the country now encourages the use of medical insurance across regions, in reality, there are still many details that cannot be implemented.
IVF usually takes several months to complete a cycle.
Many prefecture-level cities may have only one institution that can carry out assisted reproduction, and some may not even have one. This means that if local people want to do assisted reproduction, they have to go out of town, which inadvertently increases time, transportation and other costs.
Yu Baorong, a professor at the School of Insurance at the University of International Business and Economics, told China News Weekly that the past principle of China’s medical insurance has always been “low-level and wide coverage”, which is positioned to cover basic basics and diseases related to health conditions, while infertility It was not previously considered a medical condition.
Whether assisted reproductive technology is included in the scope of medical insurance payment depends on policymakers and other parties’ understanding of assisted reproductive technology and the positioning of China’s social medical insurance system.
Many countries around the world are trying to provide various types of public financial support, such as medical insurance, subsidies, tax incentives, etc., to ease the financial burden of patients who choose assisted reproduction.
Public information shows that in 2004, Japan introduced subsidies for assisted reproductive treatment, and then gradually eliminated the income restrictions for subsidy recipients, expanded the scope of subsidy recipients, and increased the subsidy amount to reduce the financial burden on patients.
After Japan incorporates assisted reproduction into medical insurance in 2022, all public and private assisted reproductive medical institutions will apply subsidies for in vitro fertilization treatment, and reimbursement costs will be shared by government financial subsidies and insurance premiums paid by employers and employees.
According to Yu Baorong, many countries have included assisted reproductive technology in medical insurance.
Compared with China, the cost of IVF in the United States is higher.
In August 2022, a study by Duke University in the United States mentioned that the cost of in vitro fertilization is the main obstacle that prevents infertile people from obtaining assisted reproductive services.
In the United States, the average cost per cycle of IVF is $12,400.
In the most expensive areas of the United States, IVF costs more than $60,000 per successful birth.
The United States is also trying to reduce the financial burden of assisted reproduction.
Currently, assisted reproductive treatments in the United States are covered by commercial insurance and are mainly borne by enterprises.
As of August 2022, 20 states in the United States have "insurance laws", that is, state laws, requiring insurance companies to provide insurance for the diagnosis and treatment of infertility, and 13 of them authorize third parties to provide insurance for in vitro fertilization.
From 1997 to 1999, Huang Guoning went to Chicago and New York in the United States to learn embryo freezing, "second generation" and "third generation" test tube baby technology.
At that time, he noticed that if newlyweds in Chicago in the United States were diagnosed with infertility after marriage and needed in vitro fertilization, they could get free in vitro fertilization treatment as long as they purchased commercial fertility insurance.
Huang Guoning said that at present, even if IVF technology is included in medical insurance, only part of the project expenses can be reimbursed.
He suggested that other channels could be considered to help reduce the burden on patients, such as charity donations, maternity insurance, etc.
The difference in goals between IVF and other disease treatments is that other disease treatments consider the extent of disease recovery, while IVF either fails or succeeds.
During treatment, doctors will choose the treatment plan that is most suitable for the patient, but they cannot lower the technical level of IVF for the sake of lower prices.
A track with predictable growth potential
In June 2023, David Adamson, chairman of the International Artificial Reproduction Technology Monitoring Committee, disclosed the preliminary monitoring results of global in vitro fertilization in 2019 at the European Conference on Human Reproduction and Embryology held at that time.
Data show that the total number of assisted reproductive diagnosis and treatment cycles in 81 countries in that year was nearly 3.5 million, of which the number of IVF cycles reached 750,000.
Adamson said that from 1978 to 2023, at least 12 million test-tube babies have been born worldwide.
Currently, the number of assisted reproductive cycles globally is growing at approximately 6.7% per year.
In China, driven by the large base of infertility patients and breakthroughs in assisted reproductive technology, the assisted reproductive market has grown rapidly.
According to reports, since 2015, many investment companies such as Sequoia Capital and Hillhouse Capital have entered the assisted reproductive field.
According to data from the Sullivan and Leopard Research Institute, China's assisted reproductive market has grown rapidly from 18.58 billion yuan in 2015 to 43.41 billion yuan in 2020.
It is expected that from 2020 to 2025, the domestic assisted reproductive services market will grow at a compound growth rate of 14.5% per year to 85.43 billion yuan.
In China, the assisted reproductive services market is mainly composed of public medical institutions. In addition, there are a few private medical institutions.
According to the National Health Commission, as of December 31, 2022, there were a total of 559 domestic institutions approved to carry out in vitro fertilization.
Duan Tao believes that in the field of assisted reproduction, the "rush" phase has passed. In the future, this will be a track for sustained and stable growth. Because this growth is restricted by factors such as license application, fertility wishes, and policies, this growth is not explosive. Frenetic growth, room for growth can be expected.
A license is the ticket for medical institutions to enter the assisted reproductive market.
Duan Tao analyzed that in China, it is not easy to get an IVF license. Even if you get a license, you usually have to conduct a pilot trial of artificial insemination first and pass the assessment of the relevant departments before you can officially do IVF. This process It probably takes 2 to 3 years.
If you want to apply for “third generation” IVF, you also need a prenatal diagnosis license and technical support.
Even if these steps are completed, it will take at least several years to gain the trust of local patients.
As of the end of 2022, there are 18 assisted reproductive institutions in Beijing.
According to Li Yang, since 2016, Beijing has not approved any new licenses in the past seven years.
In comparison, it will be easier for prefecture-level cities to obtain licenses.
"China News Weekly" inquired about the list of assisted reproduction institutions and found that currently, Guangdong, Jiangsu, Shandong, and Henan have 56, 35, 34, and 33 medical institutions with assisted reproduction licenses respectively, while Gansu, Qinghai, and Ningxia only have 4 medical institutions respectively. 1, 2, and 2 institutions obtained licenses.
"Applying for a license is very strict." Duan Tao said that many medical institutions want to apply for a license, and some institutions have applied for 5 or even 10 years but have not been approved.
Anything that expands rapidly requires supervision and restraint.
In February 2001, the former Ministry of Health promulgated the "Administrative Measures for Human Assisted Reproductive Technology" and the "Administrative Measures for Human Sperm Banks"; in May of the same year, the former Ministry of Health issued the "Technical Specifications for Human Assisted Reproduction" and "Technical Specifications for Human Sperm Banks" According to the "Ethical Principles for the Implementation of Human Assisted Reproductive Technology" and other regulations, assisted reproduction is included in the scope of national supervision.
Since then, the country has promulgated a number of administrative regulations and departmental rules to regulate the development of assisted reproductive technology.
The "Administrative Measures for Human Assisted Reproductive Technology" stipulates that the human assisted reproductive technology approval certificate shall be verified every two years, and the verification shall be handled by the original approval authority.
Those that pass the verification can continue to carry out human assisted reproductive technology; those that fail the verification will have their approval certificates withdrawn.
Fang Cong said that Guangdong Province has a verification organized by the Health Commission every two years to supervise the compliance of each reproductive center in carrying out this technology. It also pays attention to the technology application of each center, such as the success rate. Is it stable?
Under the premise of strengthening management, the average success rate of IVF in reproductive centers across the country has been relatively stable in recent years, and this rate is slightly higher than that in Europe and the United States.
In Fang Cong’s impression, in the early years, the former Ministry of Health organized experts from across the country to conduct verification of assisted reproductive centers in various provinces every year. As the number of reproductive centers increased, the verification work was gradually borne by each province.
If it is a newly established reproductive center or a new assisted reproductive technology project is launched, such as "third generation", experts from outside the province must still be invited to come for verification.
Fang Cong said that reproductive centers that fail to pass the verification will generally be required to suspend operations for rectification and then re-verify. In serious cases, their qualifications to carry out assisted reproductive technology will be revoked.
Most of the cases that fail the verification are due to irregularities in treatment.
In July 2023, the official website of the Beijing Municipal Health Commission issued approval notices from multiple hospitals on the verification results of human assisted reproductive technology, involving ten hospitals including Peking University First People's Hospital, Peking Union Medical College Hospital, Beijing Chaoyang Hospital, and Peking University Third Hospital. There are many hospitals that can carry out assisted reproduction.
The relevant notice mentioned that that year, the Beijing Municipal Health Commission organized experts to conduct on-site verification and review of artificial insemination, "first-generation" and "second-generation" technologies officially operated by the above-mentioned hospitals.
The approval notice shows that the above-mentioned hospitals have passed the above technical calibration, but the hospital "must make serious rectifications in accordance with relevant national regulations on the issues raised by the expert group during the calibration inspection, and submit rectifications to the Beijing Municipal Health Commission within 3 months report, strengthen standardized management, and ensure medical quality and medical safety."
The gray area and excess of assisted reproduction
Although regulations are tightening, there are always hidden gray areas behind the huge market for assisted reproduction.
In the bathroom of a tertiary hospital in a northern city, there are several small advertisements for "surrogate egg donation". Some advertisements clearly read "Full tertiary hospital operation, gender selection, self-pregnancy with egg donation, international assistance available." Pregnancy" and other content.
"China News Weekly" called multiple numbers on the advertisement as a person trying to conceive. The other party said that his company has an independent assisted reproduction laboratory. In addition to going to the hospital to check various physical indicators, other projects such as egg retrieval and embryo transfer are available. conducted in its laboratory.
These companies can provide egg donation, sperm donation, "third generation", gender screening and other services, but they are not included in the list of institutions approved by the state to carry out assisted reproductive technology.
The reporter contacted the staff of a gray assisted reproductive institution.
She said that the company she works for mainly carries out "second generation" and "third generation". If you want to do IVF in the company where you work, you need to sign a contract first, and then a dedicated assistant will take the patient through each link.
The staff member said that the company has cooperated with the chief physicians of many tertiary hospitals in the city for many years. A doctor from a tertiary hospital will be responsible for each patient. It costs 150,000 yuan to identify the gender of the "three generations". "Three generations" are 30,000 yuan cheaper.
The company does not limit the number of IVF attempts until success is achieved.
After one failure, you only need to pay the embryo transfer fee of more than 10,000 yuan.
The staff member also said that there are many companies similar to hers in other cities.
Patients who come to her company for in vitro fertilization basically undergo gender identification.
However, in China, it is expressly prohibited to determine the gender of the fetus in the body for non-medical reasons.
Sun Yingpu, chief scientist of the First Affiliated Hospital of Zhengzhou University and director of the Henan Provincial Key Laboratory of Reproduction and Genetics, pointed out to China News Weekly that technically speaking, many medical measures including B-ultrasound and prenatal diagnosis can diagnose gender, but the country has long Gender selection is expressly prohibited.
Only in special circumstances, such as if there is a chromosomal genetic disease and only offspring of a specific gender will not inherit the disease from their parents, gender screening can be performed.
One afternoon in December 2023, "China News Weekly" came to an office of the aforementioned gray assisted reproductive institution.
The aforementioned staff explained that the company has registered a new enterprise, and the name of the newly registered enterprise will be displayed when signing the contract.
The staff member said that the office space is mainly used for receiving customers and signing contracts.
The egg retrieval surgery, embryo transfer and other steps involved in the IVF process need to be completed in the company's laboratory.
"The laboratory cannot be entered at will. Patients can only go to the laboratory when they need to perform relevant surgical operations. Moreover, when the patient takes the car to the laboratory, the windows of the car will be sealed throughout to prevent the destination from being seen. Arriving at the destination Afterwards, the patient's communication equipment will be confiscated to prevent them from sending their location outside, filming the scene, etc.," the staff member said.
The staff member would not disclose the location of the company's laboratory, mentioning only that it was in the suburbs.
A staff member of another company that provides assisted reproductive services told China News Weekly that her company only does gender selection for the “third generation.”
Because her company is a gray institution, when reporters expressed concerns about whether the treatment could be carried out smoothly, she emphasized that the company has been conducting relevant business for more than ten years.
These gray institutions will not consider whether people who want to do IVF meet clinical indications.
The staff of the aforementioned gray assisted reproductive institution said that as long as you want to do IVF, you can do it, and it is also divided into a variety of package models.
For example, "ovum donation + test tube baby + gender identification" and "ovum donation + surrogacy + gender identification", the price of the former is 180,000 yuan, while the price of the latter varies between hundreds of thousands of yuan to millions of yuan.
Even licensed assisted reproductive institutions still use excessive assisted reproduction.
Tang Si, 41 years old, has undergone in vitro fertilization for the second time in a private hospital.
She told China News Weekly that many non-public assisted reproductive institutions will provide gender identification services. On the identification certificate, patients can directly see the gender identification results of cultured blastocysts, that is, sex chromosomes XX or XY.
In the 1970s, the WHO defined the time interval for infertility as two years; in the 1990s, this period was changed to one year.
In Duan Tao's view, this has greatly increased the number of infertile people.
On the other hand, IVF technology originally had strict clinical indications. Now that major reproductive centers value the number of cycles of assisted reproduction, the control of indications may not be so strict, resulting in some cases that do not meet the medical indications or Patients with less strong indications can also undergo in vitro fertilization.
Duan Tao further explained that some assisted reproductive institutions did not conduct more detailed examinations on patients, nor did they try to regulate sperm quality, induce ovulation, perform laparoscopic surgery, etc. to allow them to conceive naturally, so they jumped directly to the step of in vitro fertilization. .
When asked how to communicate with doctors, Tang Si said frankly that hospitals will ask patients whether they suffer from infertility, and most patients will give a positive answer.
Sometimes it is difficult to detect the cause of infertility. It may be that all indicators of both parties are normal, but they have been unable to conceive after years of intercourse.
Tang Si once told the doctor in charge of her in vitro fertilization that she and her husband’s first child was already over ten years old, but the second child had not been successful.
But the doctor didn't ask any more questions.
Duan Tao analyzed that for a normal and healthy couple, the probability of getting pregnant naturally every month is 20% to 25%.
Some patients try to prepare for pregnancy naturally for 3 to 6 months, but when they fail, they lose patience and discuss with the doctor whether they can directly undergo in vitro fertilization. In this case, the couple often does not have major reproductive problems.
Doctors may eventually obey the patient's wishes at the patient's request. As a result, the bottom line of indications for in vitro fertilization has been exceeded step by step.
(Liu Lin, Li Jia and Tang Si are pseudonyms in the article)
"China News Weekly" Issue 3, 2024
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