WITH two fertilized eggs implanted into her uterus just four days ago, Jenny Tao and her husband, both from southwest China’s Chongqing city, are filled with excitement and nervousness.

Tao has another appointment scheduled at the reproductive center of Renji Hospital in Shanghai 20 days after implantation to see whether the eggs have turned into growing embryos. If all goes according to plan, she will give birth again in just under nine months — possibly to twins.

After her husband was diagnosed with insufficient and weak sperm, 33-year-old Tao had her first child through in-vitro fertilization (IVF) seven years ago in Shanghai.

The couple later planned to have a second child through the same process as amendments to China’s family planning policy allowed women to give birth a second time provided that they or their partner are only children themselves.

“The success rate for Tao is very optimistic, about 50 to 60 percent, as her embryos have been preserved well at the center, and she is still within a good child-bearing age,” says Dr Zhao Xiaoming of Tao’s chances of carrying her pregnancy to term. Zhao is chief physician at the Reproductive Medicine Department of Renji Hospital, an institution affiliated to Shanghai Jiao Tong University School of Medicine.

With Shanghai’s first successful birth of “test-tube baby” in 1998, assisted reproductive treatments have helped thousands of Chinese couples fulfill their dreams of becoming parents.

Now, many like Tao are again seeking medically-assisted pregnancies as authorities loosen family planning policies.

To accommodate an increase in the number of infertile couples looking for reproductive treatments, authorities in Shanghai are planning to open new reproductive centers, while existing facilities are also expanding.

Unfortunately, availability of donated sperm and eggs has lagged the rising demand for IVF and related services.

Among Chinese couples between the ages of 20 and 45, experts estimate that about 10-15 percent suffer from fertility, up from 8-10 percent a decade earlier.

Fallopian tube problems, ovulation failure and uterine endometriosis are the most common causes of female infertility in Shanghai, according to Sun Xiaoxi, vice president of the Shanghai Ji’ai Genetics & IVF Institute.

An absence of motile sperm and low sperm counts (conditions known as azoospermia and oligozoospermia respectively) are the biggest fertility problems among the city’s men.

Considering that there were 4.18 million married women of prime child-bearing age in Shanghai as of 2012, meaning some 400,000 local families may face difficulty conceiving. Among them, as many as 80,000 may need to resort to assisted reproductive treatment.

Of course, demand becomes even greater considering the number of infertile couples from outlying cities and provinces who come to Shanghai for treatment.

Based on statistics from 2012 and 2013, some 58 percent of patients at Shanghai’s nine certified reproductive centers were non-local residents. In 2014 alone, an estimated 30,000 couples in total received assisted reproductive treatments in the city.

After handling some 5,300 cases last year, the reproductive center at Renji Hospital expects to see a 20-percent increase in cases in 2015 based on the number of patients it has already seen this year.

Several certified centers in Shanghai have been expanding to cope with rising patient numbers. At the same time, the Shanghai Human Assisted Reproductive Technology Setting Plan aims to coordinate the efforts of 17 reproductive medical organizations and one sperm bank by 2018.

The success rate of IVF treatments in Shanghai has been increasing steadily over recent years, thanks largely to breakthroughs in equipment and testing. The success rate at Renji Hospital alone, for instance, has been hovering around 49 percent since 2013.

Egg quality matters

Some factors though are impossible to change, say doctors. Conditions with patients themselves, particularly their ages, will greatly influence their odds of giving birth, even with the most sophisticated treatment.

“Egg quality and the uterine environment naturally deteriorate when women surpass 35 years old,” according to Zhao, who says success odds may drop to about 20 percent for women over 40, and below 5 percent for those over 45.

Zhao cites one patient, a woman in her late 30s, who spent five years receiving treatment from doctors before finally giving birth. With this patient, Zhao explains, several unsuccessful attempts to get pregnant has been made at hospitals outside of Shanghai.

While local facilities have largely been able to cope with heavier patient volumes, the same cannot be said for city’s sole sperm bank.

The Shanghai Human Sperm Bank at Renji Hospital — one of the few facilities of its kind in China with more than 10,000 total samples ­— is facing a widening supply and demand gap, according to its director, Luo Chengzu.

Luo attributes the gap to a shortfall in qualified donors. Currently, university students make up some 60 to 70 percent of the bank’s donor candidates. Yet, only 30 percent of all candidates satisfy the qualifications to become a donor.

In addition to passing a series of lab tests, donors must also avoid unhealthy habits such as smoking, drinking alcohol and sleeping irregular hours — all of which, doctors say, can lower sperm quality.

In addition to these hurdles, cultural stigmas surrounding sperm donation also keep men away.

“I didn’t want people to know that I donated sperm,” says a salesman surnamed Li who made a donation when he was a student and needed money.

“Others might make presumptions about me,” adds Li, who believes that such donations are widely seen by the public as “strange.”

In light of current supply bottlenecks, the Shanghai Human Sperm Bank is only able to satisfy the most pressing demands at any given moment.

Yet, things become even more complicated when infertile couples need an egg. Although authorities at Renji Hospital announced plans to build the country’s first egg bank back in 2010, the implementation of such plans have been stalled by a lack of approval from the National Health and Family Planning Commission.

“We are fully ready technically, but not in terms of policy,” says Zhao.

At present, the city’s reproductive facilities collect, freeze and implant eggs on a limited scale.

In most cases, fertile women in relationships with infertile men are willing to donate their eggs when they receive treatment themselves. Such practices do not violate current laws, which forbid hospitals from actively recruiting egg donors.

“About 10 eggs on average can be harvested from a woman after the promotion of ovulation, but very few people are willing to donate (to others),” says Zhao. “They would rather save (the eggs) for their own use in the future.”

Currently, middle-aged couples who have experienced the death of their child represent a considerable portion of those requiring eggs.

“It is sad, but this is the reality,” says Zhao, who expresses strong reservations about trying IVF treatment on middle-aged women.

“It is not just about the low success rate for such treatments, but also the burdens put on the aged woman’s body during pregnancy,” explains Zhao.

In one recent instance, Zhao says she declined treatment to a couple in their 60s, even though the woman claimed that she was willing to risk her life for another child.

Nine certified assisted
reproductive organizations
in Shanghai

International Peace Maternity & Child Health Hospital of the China Welfare Institute

Shanghai Ji’ai Genetics & IVF Institute

Shanghai First Maternity and Infant Hospital

Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine

Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine

Shanghai No. 9 People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine

Shanghai Tongji Hospital

Shanghai Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine

Shanghai No. 6 People’s Hospital