BEIJING • It is a paradox in China. Just when the country relaxes its one-child policy as the population ages, many couples find it hard to conceive because of factors such as lower sperm counts, later pregnancies and other health barriers.
Take, for example, the case of a man who wanted to be known only as Mr Zhang, a visitor from northern China to the Beijing Perfect Family Hospital.
The 38-year-old construction businessman worked hard to build a career with his wife, who is 35. But when they were ready to have kids, it was a struggle.
So they became one more couple among millions of Chinese to turn to an assisted reproductive-health market that could be worth about US$15 billion (S$20.5 billion).
Businesses from China to Australia and even California are lining up to help - and profit from - the demand.
Mr Zhang said his package for IVF, or in-vitro fertilisation, cost US$14,700 each round.
"All the years of smoking, drinking and business dinners take a toll. It's difficult for me and my wife to conceive naturally and we need help."
China's market for IVF alone was worth US$670 million last year and is expected to surge to US$1.5 billion in 2022, said BIS Research.
Average sperm count (number of sperm per millilitre) dropped from 100 million in the early 1970s to as low as 20 million in 2012 in China, said Mr Huang Yanzhong, senior fellow for global health at the Council on Foreign Relations.
The higher stress levels accompanying economic growth, pollution, late marriage and childbirth, smoking and alcohol use could be contributing factors, he added.
Global Business Virtus Health, an Australian company that offers fertility treatments, has Chinese firms approaching it regularly for partnerships, but getting a Chinese licence is difficult.
Hence, it works with medical tourism agencies in China that help patients get to its Australia and Singapore clinics.
Over in the United States, Mr Mark Surrey, co-founder of the Southern California Reproductive Centre, said 20 per cent of patients came from China over the past year.
"There are increasing numbers of people in China who have the socioeconomic means to choose what kind of reproductive technology they would like," he noted.
Among other services, the centre's California-based clinics offer tests to determine the gender of the embryo. Such services can be particularly attractive to patients from China, where gender selection is banned.
At home, China's public facilities are overburdened, said Ms Roberta Lipson, chief executive of United Family Healthcare, partly owned by China's Shanghai Fosun Pharmaceutical Group.
Her company has been conducting IVF and fertility services in Tianjin for more than two years, with expertise from around China, Britain and Australia.
Chinese patients face a number of hurdles at home. Single women are not allowed to freeze their eggs, a restriction that has led to many considering trips abroad.
"Regulations make it difficult to enter the market," said Mr Masoud Afnan, director of fertility services at Tianjin United Family Hospital.
Clinics "need a full IVF clinic, with the required number of staff, to do IUI for two years. This is an expensive option to just do IUI", noted Mr Afnan, referring to intrauterine insemination, a process that places sperm in the uterus.
As of last year, the country had 451 sperm banks and medical institutions licensed to provide reproductive care, the National Health and Family Planning Commission estimates.
But that is outpaced by demand in a country of 1.4 billion people.
Overseas players such as IHH Healthcare, which is listed in Malaysia and Singapore, and Thailand's Bumrungrad Hospital and Bangkok Dusit Medical Services are among those likely to benefit from increased demand from Chinese patients, said Ms Laura Nelson Carney, an analyst with Sanford C. Bernstein.
Mr Zhang said he knows many others with similar troubles.
"Our friends can talk about it openly," he said. "Many of them use IVF too."
The process requires multiple visits to Beijing. Mr Zhang and his wife visited last November for the extraction of eggs and sperm and again in March for preparations.
Still, he will likely consider having two children - if the first attempt does not result in twins.