Shanghai’s amended family planning policy takes effect from today and some couples who meet the new requirement have already started planning to have a second baby.

Some women now eligible to have a second child are in their late 30s to early 40s and may need to resort to in-vitro fertilization (IVF), where a woman’s eggs are fertilized by sperm outside the womb.

Though there hasn’t yet been a big rush for such treatments from Shanghai residents, but people from other provinces have been making inquiries, according to doctor Sun Xiaoxi, vice president of Shanghai Ji’ai Genetics & IVF Institute. Sun says the institute is expecting more inquiries and more clients later.

Second children born to eligible couples from today will be legal under the amended policy, which may result in about 20,000 to 30,000 more babies born each year, according to the Shanghai Health and Family Planning Commission.

Shanghai doesn’t set age requirements for having a second child like Beijing and Tianjin. Mothers in those cities either have to be at least 28 years old or wait four years after the first one is born to have a second.

On average, Shanghai women are 27 years old when they marry and almost 29 when they have their first child. The average interval between two children for couples with both spouses from a one-child family is 3.8 years, which makes setting age restrictions unnecessary, says Zhang Meixing of the Shanghai Health and Family Planning Commission.

Though that may be good news for population control, it’s not that good for those who plan to have a second baby.

“Most of the women in their child-bearing period can have their second child naturally if they get their first baby in the natural way, but undeniably, it’s more difficult for women to get pregnant after turning 35,” Sun says.

Usually there is no need for IVF treatment in order to conceive a second child, according to Sun. But for women over 35 years old, he suggests both spouses have a physical examination before preparing for pregnancy.

If their reproductive and overall health are both good, they can try conceiving naturally. If not, they may need IVF treatment. For those who used IVF treatment for their first child, they very well may need it again to have another.

About 10 to 15 percent of Chinese young and middle-aged couples were infertile in 2010, rising from 8 to 10 percent a decade ago. The increase was attributed to a rise in unhealthy lifestyles, pollution and infections.

Fallopian tube problems, ovulation failure and uterine endometriosis are the most common causes of female infertility in Shanghai, according to Sun. Azoospermia, which is the absence of motile sperm, and oligozoospermia, low sperm count are the major problems among infertile men.

With the first “test-tube baby” clinic approved by the then Ministry of Health (currently National Health and Family Planning Commission) in 2005, IVF treatment has helped thousands of couples fulfill their dream of being parents in China.

But the amended family planning policy may pose a big challenge to IVF doctors in Shanghai since they may receive more older clients.

“The success rate of IVF drops with age,” Sun says. “Though the technology enables an average success rate of 40 to 45 percent, it drops to only 20 percent for a 40-year-old woman.”

Shanghai Ji’ai Genetics & IVF Institute’s clients average about 32 years old when having their first baby. Considering the average interval of 3.8 years between the first and second child in the city, many of these clients will be over 35 if they decide to have a second child.

Of course, there still is a chance they can have a second baby, but some women will need more care and they will need to carefully consider the possible risks, according to Sun, who successfully helped a woman aged 38 have her second child last year.

The woman from Zhejiang Province had her first child through IVF treatment about seven years ago when she was 31. Though both spouses were an only child, they didn’t plan to have a second baby due to financial reasons. But they returned last year eager to have a second child because their financial situation has improved.

IVF treatment in Shanghai costs about 30,000 yuan (US$4,918) on average. This includes a series of checks, medication and surgery. About 10 eggs will be taken and fertilized with sperm in the lab. About six fertilized eggs will then be selected as candidates to implant in the uterus.

According to the amended “Human Assisted Reproductive Technology Regulation,” released by the former Ministry of Health in 2003, triplets and more are banned through assisted reproductive technology. An agreement on embryo reduction must be signed by couples before eggs are fertilized by a lab.

Considering reduction surgery can potentially harm the mother and other embryos, IVF institutes and centers in Shanghai generally only implant two fertilized eggs into the uterus at one time. This process will be completed up to two more times for an additional fee. The cumulative success rate is 80 percent for the implantation of up to six embryos.

If both embryos survive, couples can choose to keep both or abort one. About one-fourth of IVF babies are twins, while the natural chance of having twins is only one in 88 pregnancies.

“Most couples will keep both, as they consider twins a double-gift,” says Sun, who cautions they will face a much higher risk of premature and low-birth-weight babies.

Some experts urge single embryo transfers rather than two. With current technology, the success rate is about 30 percent for a single embryo transfer, according to Teng Xiaoming, director of Shanghai No. 1 Maternity and Child Health Hospital’s IVF center.

“That’s only 10 to 20 percent lower than a multi-embryo transfer, with much lower risks for both mothers and babies,” he says.

One-child families in Shanghai receive bonuses

1. Bonus for parents of the only child:

Each parent will get a 30-yuan bonus each month.

2. Subsidy for rural family planning:

Each parent will get an annual subsidy of 1,200 yuan.

3. One-time bonus upon retirement:

Each parent of an only child will receive 5,000 yuan upon retirement. A married couple with no children will each get 10,000 yuan when retiring.

4. Special family planning subsidy:

Each parent with an only child who is disabled will receive no less than 150 yuan every month upon turning 49 years of age. Each parent with an only child who dies will receive no less than 500 yuan every month.

Helping young siblings coexist

Two children in one family is becoming more common in Shanghai. Amendments to the one-child policy now allow couples to have a second child if either parent is an only child. Treating two children fairly and helping them coexist with each other is now a big task for many of these families. How to make it work can be really challenging.

(Zhang Qian)

Jayden Fei, 6; Ann Fei, 3

Six-year-old Jayden Fei gradually found his 3-year-old sister Ann to be both a competitor and partner rather than a pet.

He misses the days when Ann just wanted milks and hugs. But he also likes running around and playing with her. However, quarrels and fights are inevitable.

Jayden will say, “It is not my fault” whenever an adult steps in to stop a fight. Yet, he often ends up being disciplined.

“It is natural that the elder generation like my parents will favor the younger child in quarrels,” says Fei Xiaoping, the father, a 33-year-old bank manager. “They believe the elder one should be responsible to tolerate and take care of the other.

“But in most cases, it is Jayden who starts the fight to claim his proprietary rights,” he says.

Though they cannot talk their parents out of their values, Fei and his wife try to be as fair as possible with the children. That will include giving them equal gifts, food and time to play.

“Despite the quarrels, they love spending time together. And my wife and I reached an agreement that they will be punished equally when quarrels and fights happen,” Fei says. “Neither of them will get the toy if they fight for it.”

Lily Chen, 2; Tony Chen, 4 months

Two-year-old Lily Chen lives with her father’s parents while her 4-month-old brother lives with her parents and her grandparents on her mother’s side.

Both sides will communicate with a video-chat app a few times a week. But Lily will turn around when seeing her grandparents hug her little brother on screen since she hardly got hugs from them before because she is a girl.

“She will be low for quite a while after the video-chat and turn to me for a hug,” says Lily’s paternal grandmother.

Laura Le, 4; Kevin Le, 18 months

Choosing a new bed, new sheets and new decorations for her own room, 3-year-old Laura Le happily moved out of her parents’ room when her little brother was born 18 months ago.

She talked to her little brother often before he was born, and was thrilled to see him the other day when she came home from kindergarten.

“Laura is very understanding about Kevin staying in our bedroom, while she as a big sister sleeps with her grandparents,” says Le Gang, the father, a 36-year-old private business owner. “We make it up to her on trips, allowing her to sleep with us while her little brother stays with the grandparents.”

Le and his wife try to play with both so neither will feel ignored.

Laura also gets upset to see Kevin touching her toys and piano. She doesn’t hurt him, but she will push him gently and take the toys away.

“They will have brushes, and I won’t prevent them from happening,” Le says. “Each one is a chance for them to learn how to cope with each other.”