INFERTILITY is increasingly a problem for young Chinese couples, according to a recent report. Delayed marriage and child-bearing, pollution, heavy smoking and drinking and unhealthy living are factors. Zhang Qian reports.

Lisa Wang (not her real name) and her husband are anxiously waiting to hear from a certified reproductive medicine center. She has been taking medication to promote ovulation and regularly goes to the hospital for a check on her ovaries.

If all goes well, the eggs will be harvested, placed in a "test tube" with her husband's sperm; the eggs will be fertilized and one or two will be implanted in her uterus. Nine months later, out comes a baby through in vitro fertilization - a "test-tube baby."

The 32-year-old woman has been married for five years, but diligent efforts have not resulted in pregnancy. Doctors say one fallopian tube is blocked and ovarian follicles (sacs containing eggs) are not of good quality. She could either undergo surgery to remove the obstruction and try again to get pregnant - go for an in vitro fertilization, more expensive, but more efficient.

The cost of a first go at having a test-tube baby costs between 25,000 yuan (US$3,661) and 30,000 yuan; successive tries at the same hospital cost 2,000 yuan to 3,000 yuan.

If she's lucky, she might have twins.

"I am already 32 years old. I don't want to waste even more time waiting," says Wang, "It's so sad to see other parents playing with their kids."

Wang knows the procedure may not be successful, test-tube babies are not guaranteed, but she decided to give it a try.

An old Chinese saying goes that there are three ways to be unfilial - the worst is not to produce offspring, sons to carry on the family name. Continuing the family blood line is a powerful incentive for Chinese. Most people believe that only by having a child can they complete their lives,

But infertility is a problem for an increasing number of people nowadays. Usually a woman with a regular sex life becomes pregnant within a year, says Dr Feng Yun, director of the Reproductive Medicine Center of Ruijin Hospital. If that doesn't happen, it's likely to mean a fertility problem for the woman, or the man.

Both partners should be tested, the doctor says, noting that men are reluctant to be tested as they believe it reflects on their masculinity.

The infertility rate is about 10-15 percent among Chinese couples of child-bearing age (20-45 years), according to the 2009 China Infertility Status Report released in October. It is conducted by the Chinese Women and Children's Development Center and the China Population Association.

The rate is four times that of 20 years ago (2-5 percent), according to Dr Xu Runsan, director of Gynecology of the China-Japan Friendship Hospital. And the rate is higher in big cities like Shanghai and Beijing, Xu told a local newspaper.

Around 80,000-10,000 couples in Shanghai are infertile, according to Dr Feng of Ruijin Hospital.

Postponing marriage and child-bearing because of work and living pressure is an important cause of infertility, she says.

"Age plays the most important role in child-bearing, especially for women," says Dr Feng. "The functions of every organ decline with age, and that's true of the reproductive system too."

The 15th year after menstruation begins is usually the end of prime child-bearing years as the reproductive system declines quickly from that time, she says. That's usually around 30 years of age.

The peak years are from 23 to 28, she says.

Women over 30 are more likely to have a declining number and quality of eggs and the uterus is also not at its best. Even if they do get pregnant, these women run a higher risk of miscarriage than younger women.

The biological clock is ticking.

But many young women postpone child-bearing for the first few years of marriage, saying they want to pursue their career. By the time they have achieved success in work, they have missed the optimum child-bearing age. Some find themselves infertile.

That is the case with Wang and her husband. They decided not to have a child for the first few years of marriage, and two years ago they decided to try for a baby. They were unsuccessful.

The report also indicates that the infertility affects people at increasingly younger ages, from 25 to 30 years.

Dr Feng says reasons include environmental pollution, psychological stress, unhealthy lifestyle and sexual activity at too early an age.

Ailments and inflammation of the reproductive system can contribute to infertility. Sexually transmitted infections (chlamydia, gonorrhea, pelvic inflammatory disease) can cause or contribute to infertility.

Apart from the age problem, inflammation in the reproductive system contributes to a great many infertility cases, as it may block fallopian tubes or damage the uterus. Too many abortions (medical or surgical), and improperly performed abortions can cause problems that may lead to infertility, says Dr Feng.

Clinical depression, eating cold foods during menstruation and prolonged exposure to some kinds of radiation, or high radiation, contribute to infertility.

Though older men can definitely father children, there has been a sharp increase these days in cases of low sperm count and poor sperm viability.

The infertility report says the sperm count per milliliter of semen has dropped from 100 million 30 years ago to 60 million to 20 million today.

Air pollution, radiation, smoking, drinking, less physical exercise and venereal diseases can directly cause decreased sperm count and lower viability, say Dr Feng.

She recently saw an infertile patient couple, both in their prime years, but the man was a heavy smoker and drinker and suffered problems of sperm count and viability.

Dr Feng told the man to stop heavy smoking and drinking and get healthy. He was annoyed and immediately said no.

He said drinking and smoking are part of his business, the way he makes a living. If he can't smoke and drink with customers, he would lose his job, he said.

His wife began to cry. Seeing her distress, he said he would quit smoking and drinking for one month.

"I didn't know what to tell him," says Dr Feng. "It's even hard for a healthy couple to get pregnant in one month. How can we expect successful assisted reproduction in one month of not drinking for a man who has inactive sperm?"

Medical treatment, artificial insemination and in vitro fertilization are commonly used to treat infertility.

The successful pregnancy rate is about 10-15 percent for ordinary medical treatment, 15-20 percent for artificial insemination and 40-50 percent for in vitro fertilization, according to the report in infertility in China.

Nothing is 100 percent successful.

A high rate of multiple-developing embryos contributes to a relatively high rate of miscarriage, premature labor and sub-healthy babies, as the uterus (of a previously infertile woman) usually cannot support two or more babies. The health of the mother can be endangered.

National standards state that no more than three fertilized embryos be implanted. Dr Feng says she implants two for most people, but only one for a young mother.

In vitro fertilization can help many infertile couples, even those who are middle aged. But Dr Feng recommends that people seek help early.

"It's likely that when people decide on a test-tube baby, other methods have failed and the uterus is already old and not good for the baby," she says. Test-Tube Baby (in vitro fertilization)

IVF is a process by which egg cells are fertilized by sperm outside the uterus, and then implanted.

It is a major treatment when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulation, removing eggs from ovaries and letting sperm fertilize them in a fluid medium.

The fertilized egg (zygote) is then transferred to the uterus.



Artificial Insemination

The procedure places sperm in the female reproductive tract by means other than sexual intercourse. Freshly ejaculated sperm, or sperm that has been frozen and thawed, is placed high in the vagina or into the uterus.

It was originally developed to help couples in cases where there were "male factor" problems preventing conception.



Reproductive Health Centers In Shanghai

Reproductive Medicine Center of Ruijin Hospital

(197 Ruijin No. 2 Rd, 6437-0045)

Heredity and Infertility Center of Ji'ai Hospital

(588 Fangxie Rd, 6345-5468)

Shanghai First Maternity Infant Hospital

(536 Changle Rd, 5403-5206)

International Peace Maternity and Child Health Hospital

(910 Hengshan Rd, 6407-0434)

Reproductive Medicine Center of Renji Hospital

(145 Shandong Rd, 5875-2345)

Reproductive Medicine Center of Shanghai No. 9 People's Hospital

(639 Zhizaoju Rd, 2327-1699)

Reproductive Medicine Center of Changhai Hospital

(168 Changhai Rd, 2507-1114)