The three-child policy has been relaxed for one year, and China's population birth rate is still on a downward trend. Data from the National Bureau of Statistics shows that the national birth population in 2021 was 10.62 million, and the birth rate of population further dropped to 7.52 per thousand.
However, various signs of indicate that the domestic assisted reproductive industry has not declined like obstetrics. The age of patients is obvious. Under the suggestion of the optimal age under 40, the post-80s generation has begun to become the main force of this demand, accompanied by strong fertility anxiety.
2022 COVID-19 pandemic is everywhere, and travel is often inconvenient, but the belief that infertility patients with infertility hopes to have a child has almost not shaken. On the Internet, assisted reproductive doctors from senior high schools in big cities have issued a document asking patients to check locally through Internet hospitals to reduce the time and number of times they go to and from big cities.
Director of the Department of Assisted Reproductive of Women and Infants in Shanghai Teng Xiaoming mentioned to Badian Jianwen that in April and May, when the epidemic in Shanghai was the worst, they still completed 40-50 monthly egg retrieval operations - "The patients' demand is particularly urgent, and they have worked hard to complete all required procedures in accordance with the epidemic prevention and control requirements."
However, in the impression of many practitioners, although the number of assisted reproductive surgery is stable, it has not yet seen a large-scale growth. The gap shows that there are two ice and fire, which coexist with the decline in fertility anxiety and the desire to give birth. Just as a senior obstetrician and gynecologist teases young people’s fertility philosophy: either not having a child or hoping to get pregnant immediately.
Regarding the development trend of assisted reproduction, Professor of Shanghai First Maternity and Infant Health Hospital Duan Tao analyzed to Badian Health News: "Although the willingness to give birth is declining, assisted reproduction will be a slowly rising L-shaped curve. Because although young people have a low desire to give birth, they want to give birth when they get older, Assisted reproduction will come to mind. ”
New reproductive anxiety: Can't wait for anything else, I want to test the test tube
In the waiting hall of the assisted reproductive clinic, from young couples with hyaluronic acid faces to middle-aged couples with receding hairlines, the anxiety on each face is visible. Behind the pressure of
is the cruel reality. Whether it is work or childbirth, 30 years old, 35 years old, 38 years old... every threshold for the development of a career is also the threshold for childbirth. The timetable is imprinted in everyone's heart, and IVF is the most efficient choice among the current treatment methods for infertility.
According to the "China Maternal and Child Health Development Report (2019)", the total number of assisted reproductive cycles in China each year exceeds 1 million, and the number of babies born exceeds 300,000. Based on the estimated 10.62 million births in 2021, nearly 3% of babies nationwide were born due to assisted reproductive technology.
And among the various technologies related to assisted reproduction, IVF has the highest attention and usage rate. The 2021 Lancet mentioned that the clinical pregnancy rate of IVF in China (30%) and live birth rate (28.8%) are similar to the data reported in Europe and the United States, and are much higher than other assisted reproductive methods such as artificial insemination .
social sharing platform Xiaohongshu, the number of views on the topic "The Road to Test Tube" reached 42.241 million, and the number of views on the topic "Exembracing Eggs" reached 4.366 million. Among the topics on Weibo , there are dozens of related test tubes. The topic with the highest data is related to going abroad for test tubes, with a discussion volume of 120,000 and a reading volume of 750 million. Especially in first- and second-tier cities, assisted reproduction and IVF have long discussed "sinking" from online discussions to real life - relatives and friends of relatives, friends of friends, and there are always a few people I know who turn to assisted reproductive technology. On the eve of the Mid-Autumn Festival, in the context of new crown local cases spread across 24 provinces, there are still many patients with CT scans in the reproductive center of a well-known public tertiary hospital in Beijing who are still holding CT scans in other hospitals.
In another well-known public tertiary reproductive center, before 10 a.m., the doctors who got up early to grab the number were waiting nervously with their numbers; at noon, they started queuing after the examination and fed back the examination results to the doctor. There were at least 7 or 8 people waiting at the entrance of the chief physician's clinic.
exhausted all the methods, including traditional Chinese medicine, Western medicine, surgery, artificial insemination, and finally IVF, and constantly failed and tried again. Such stories continue to be staged with anxiety and obsession with not seeking.
In Shanghai, a head nurse told Badian Jianwen: The patient here has a much anxiety level than the department she was in before.
1Bao Shihua, director of the Department of Reproductive Immunology of Women and Infants, mentioned that a large number of patients here have insomnia and anxiety. What they need most is not only assisted reproduction, but also psychological counseling.
Teng Xiaoming introduced that within the assisted reproductive department of a woman and baby, a comprehensive psychological clinic focusing on relieving anxiety will be opened soon.
A woman who had just experienced the first egg retrieval and transplantation. After failing, she took a month off and then returned to the hospital to monitor the transplant time and tried to transplant again. "I am 36 years old, I'm in a hurry."
Xiaoting and her husband have been married for three years and have not contraceptive, but have never been pregnant. She planned to try IVF last year, but she found that she was pregnant while monitoring ovulation, so the IVF was put on hold.
However, that unexpected pregnancy did not bring the child, and Xiaoting's fetus stopped soon. In May this year, although the doctor repeatedly advised her to take care of her body, Xiaoting decided to go directly to the second generation of test tubes, "can't wait."
Jin Li's experience is a bit similar to Xiaoting. In the first five years after marriage, neither she nor her husband wanted children, and felt that the world of the two was more free, and even considered DINK . Both were born in 1984. When they were 34 years old, they suddenly felt that they still wanted a child.
Jin Li has suffered from primary amenorrhea since childhood and needs to take sex hormones to maintain her menstrual cycle. There are difficulties in natural conception , so she decided to seek assisted reproduction.
In that public tertiary hospital with the national comprehensive ranking, the doctor suggested that Jin Li try ovulation first and then be guided by the doctor to have sex and artificial insemination. If all fail, then try IVF. This is a standard treatment process that complies with clinical guidelines and national norms, but she refused.
Jin Li and her husband have been separated from each other for a long time, and there are almost no conditions to frequently travel to and from the hospital. Moreover, "After ovulation induction, after induction, sexual intercourse and artificial insemination, I still have to go to IVF. Why don't IVF directly?"
In her opinion, the long waiting and attempts of objective conditions are more like a detour: "IVF technology is very mature, when should I do examinations and egg retrieval, For transplantation, doctors will tell you that when the quality of eggs and sperm is OK, the success rate is also higher, which is a more controllable and time-saving solution. "
Age anxiety and medical indications that have not changed for 15 years
Fertility problem is related to their time cost, workplace development, etc., and has similar ideas to Jin Li. He hopes to get a child as soon as possible with assisted reproduction, especially IVF technology.
Some of the patients born in the 1980s and 1990s are due to workplace pressure. A woman born in 1994 and married for four years, who just resigned and was at home this year, was considering whether to take the opportunity to try IVF. She mentioned: "If you can't get pregnant this year, time will be wasted, and going to work will also affect your work."
"In fact, every time you go to the hospital, the process of visiting the hospital is very short, and time is spent in line," said Xiaoting, a born-80s generation, said, "You can't take leave too frequently at work, and the unit was a bit taboo.I plan to try twice first, even if I fail, I will freeze several fertilized eggs. Whenever I want to transplant, I will thaw again. "
In China, patients who seek help with assisted reproduction show a clear trend of aging. Data from Tianjin United Family Hospital Assisted Reproduction Medicine Center shows that the average age of patients in the center in 2019 was 34.3 years old, and rose to 36.2 years old in 2021. From January to August 2022, the average age of patients is 37.2 years old. This age is about to break through the optimal years of assisted reproduction. In the 2019 Assisted Reproduction released by the Reproductive Medicine Branch of the Chinese Medical Association in 2022 In the technical data report, infertile women over 35 years old account for nearly 30% of the total number of infertile people.
Higher age has aggravated the fertility anxiety of the post-80s generation, and also brought new assisted reproductive needs. For example, while you are young, you can store several more embryos in one test tube, and directly transplant them when you want to have a second or third child in the future; or give birth to twins through test tubes, and make the most efficient use of one pregnancy period.
Even some respondents mentioned some alternative needs, "such as unmarried women want to freeze eggs, or want to donate sperm and through for assisted reproduction."
However, under the national conditions of China, the former's wishes are destined to take a detour, while the latter group of people are not connected.
Zhao Panlin, deputy director of the Meizhong Yihe Reproductive Center, said that test-tube fertilization is a treatment for infertility and should not be It is a pregnancy method that can be chosen at will. IVF without indications does not comply with medical standards and principles.
Teng Xiaoming said that in his reproductive center, if it is not organic, it is recommended that couples visiting the doctor try to promote pregnancy first. The only exception is patients over 38 years old, because at this time, age has become an independent risk factor.
Then, assisted reproduction, especially IVF Has the surgery been abused?
A respondent mentioned to Badianjian Wen that infertility in China involves more than 40 million people, and about 15% of these people need to undergo assisted reproductive treatment. The annual cycle of IVF in China is currently about 1 million, and the number of IVF born is about 300,000. Judging from the data, not many, or even not enough.
On the other hand, patients strongly hope to choose The situation of IVF is not uncommon in reproductive centers. The attending doctor of , a prefecture-level city in East China, told Badian Health News that this is not unrelated to the short-term and high success rate of this technology. Artificial insemination often requires half a year to try, with a success rate of about 15%, while IVF only takes 2 months at the fastest, with a success rate of about 50%-60%.
However, the new technology is very cautious when encountering fertility problems. The domestic trial scope of IVF is strictly limited, based on 200 The 7-year "Technical Specifications, Basic Standards and Ethical Principles" lists in detail six major indications applicable to women's gamete transport disorders, ovulation disorders, and men's oligospermia and insufficiency.
In the next 15 years, there has been no revision or change in the medical indication regulations on IVF.
With the decline in birth rate and other contemporary problems, some senior experts believe that there is reasonable room for revision for medical indication regulations.
Duan Tao told Badian Health News that initially emphasized that assisted reproduction should follow medical indications because the technology is not mature enough, which has caused various complications such as ovarian hyperstimulation syndrome, and even caused death.
"Assisted reproduction has developed to this day, the technology has matured a lot. Some countries no longer emphasize medical indications. Patients have requirements, and hospitals can do it after evaluation, which also proves that there will not be too many safety issues. "He said, "There are differences between national conditions. For example, unmarried women who have no medical indications want to freeze eggs or want to assisted reproduction through sperm donation, which is not allowed in our country."
To this day, the reproductive anxiety of post-80s and 90s is not only a medical problem, but also a tendency to underground aided reproduction. Adult men and women who do not meet the requirements of assisted reproduction but have a strong desire to become parents. If the formal domestic assisted reproduction institutions do not accept it, they may turn around and go to an underground clinic, and the safety of the surgery is not guaranteed, which has become a common hidden danger in China.
Assisted reproductive industry under the influence of multiple factors
Where is the reality that the desire to give birth is reduced and the anxiety of fertility is increased, what will the assisted reproductive industry go?
In China, infertility has long been a neglected health issue, and for assisted reproductive institutions, it has been until 2015 Before, strict control and management have always been the main theme. In the "Technical Specifications, Basic Standards and Ethical Principles" promulgated in 2007, it clearly stipulates that "the in vitro fertilization, embryo transfer and its derivative technologies implemented by any reproductive institution every year shall not exceed 1,000 egg retrieval cycles." To this day, the egg retrieval cycle has exceeded 1,000 cases in large cities in China.
Relaxation of population policies and postponed fertility Age has changed all this.
In January 2016, the full second child was implemented, expanding the target population of assisted reproduction from families without children and primary infertility to elderly couples who want to have a second child. The expanded applicable population triggered a rapid increase in data. In that year, the number of assisted reproduction cycles in China exceeded 1 million for the first time, and in 2017, the data reached 1.15 million.
The full opening of the third child in 2021 has not achieved the effect of opening the second child. Although there is no exact data yet, many doctors from assisted reproductive departments told Bajiu that there is no significant change in the number of patients.
Among the current patients who come to the hospital, "one child is the main one, two child is a lot, and occasionally there are three childs", one assisted reproductive The department director told Bajiu Jianwen. In the assisted reproductive department where the doctor is located, the patient began to have repeat customers, that is, the first child had assisted reproduction and came to pursue the second child. In the past, parents of the first generation of only children who came for surgery due to their own loss have almost no more.
. On the other hand, because there is no restriction in the patient's movement, infertility is a disease with a particularly large medical radius, which also leads to polarization in the clinic. The number of assisted reproductive clinics (licensings) released by the National Health Commission of has increased from 358 to 536, but the number of overcrowded clinics in major cities is still prominent, such as Beijing Medical College Third Hospital , Shanghai Ninth Hospital , CITIC Xiangya and other institutions have annual cycles of over 10,000. On the whole country, many private hospitals that have obtained licenses can only do a few hundred cycles a year and receive customers It is still a problem.
. The discussion on the inclusion of assisted reproduction into medical insurance was triggered by a trial notice from the Beijing Medical Insurance Bureau in February this year, but in April, it was reported that " was suspended from the execution of ".
A practitioner told Badian Jianwen: "From the price of assisted reproduction, it is difficult to enter medical insurance. At present, the cycle cost of first-generation and second-generation IVF is about 20,000 to 30,000 yuan per public and 50,000 yuan in private. The cycle cost of third-generation IVF technology with a family history of genetic diseases is about 130,000 to 200,000 yuan per cycle.
Therefore, the population of childbearing age has decreased, and the willingness to give birth has decreased, and it is difficult to support the payment in the short term. Regarding the future of assisted reproduction, an investment person bluntly said that he was not optimistic, and even suspected that this was just a "hype prosperity."
However, some industry insiders expressed different opinions. Director Mou Wanhong of the Assisted Reproductive Medicine Center of Tianjin United Family Hospital said that as the childbearing age increases year by year, the rate of infertility of is increasing year by year, and the demand for assisted reproductive assisted fertility technology will remain stable or even increase in recent years.
In Northern Europe, about 5% of children are born from assisted reproduction, while in China, this proportion is currently about 3%.A research report by Toubao shows that in 2022, the penetration rate of assisted reproduction in the United States will reach 32.5%, while the penetration rate of assisted reproduction in China during the same period is only 8.7%.
Duan Tao mentioned to Badianjian that the decline in fertility rate in China is accompanied by an increase in the age of reproductive women, which often means an increase in the incidence of infertility, which means an increase in the permeability of assisted reproductive. He predicts that assisted reproduction will appear as a "slowly rising L-shaped curve" in the future.
Xiaoting and Jin Li are pseudonyms in the article. Ge Shurun also contributed to this article.
Li Shanshan, Tian Wei | Writing
Ji Minhua丨Editor
This article was first published on the WeChat public account "Bao Dian Wen"
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