Couples are heading abroad to improve their chances of starting a family

The easing of China's family planning policy was a boon for Zhang Yinhe and his wife Xu Mengsha, who had decided to freeze an embryo for use during in vitro fertilization in the hope of having a second child someday.

However, in China most IVF procedures are restricted to infertile couples, and reproductive clinics have been overwhelmed with hopeful couples since the family planning policy was scrapped two years ago, which meant Zhang and Xu faced a long wait before they could have the procedure.

Instead of waiting, the Beijing residents flew to Thailand, where they joined a wave of Chinese heading to Southeast Asia, the United States and other countries in a test-tube baby boom.

"There is an old saying in China: 'A son and daughter complete the family,'" said Zhang, a 31-year-old airline pilot. He was speaking after a consultation at Bangkok's Piyavate Hospital, where the walls are festooned with posters in Mandarin about IVF, as other Chinese patients waited their turn.

Definitive numbers on China's share of the assisted-reproduction tourism sector are unclear, but spending is estimated to have hit $1.4 billion last year, a rise of 22 percent from 2016, according to the Qianzhan Industry Research Institute.

Rapid growth is expected in the future.

Overseas clinics are adding Mandarin-speaking staff and Chinese-language websites, and increasingly focusing their marketing on Chinese nationals seeking a second or even third child.

Chinese figures estimate that 90 million women became eligible for another child when the previous family planning policy was relaxed, and more second children were delivered last year than firstborns.

However, Chinese couples are increasingly having children later in life, when the parents are past their reproductive primes and may require help from science.

Around 12 percent of the childbearing population is unable to conceive naturally, according to studies in China, yet there are only about 400 licensed IVF clinics in the country and waiting lists can reach 12 months.

Restrictions

IVF involves combining eggs and sperm in a lab and implanting any viable embryos that result into the womb.

The family planning policy caused birth rates to plummet, leading the government to relax the policy in the hope of ensuring that a future workforce would be able to support the country's rapidly aging population.

Despite that, China still bans or restricts fertility options such as egg donations, surrogate motherhood, gender selection and the freezing of embryos for later use, partly because of fears that opening the floodgates could spark a population explosion.

Health officials estimate that only around 500,000 IVF procedures took place in China in 2016, far short of what fertility specialists believe is required.

"There is big demand in China, but we can't handle it here," said Ri-Cheng Chian, director of reproductive medicine at Shanghai's 10th People's Hospital.

That discrepancy has seen hopeful couples booking tickets to Thailand, Malaysia, Cambodia and Russia.

IVF treatment costs about 30,000 yuan ($4,400) in China, but the cost can be several times higher overseas, where many Chinese feel they will find higher-quality care.

Zhang, the pilot, is keen on IVF because the procedure can screen for genetic defects, a practice that is restricted in China.

"It's a lot of money for a Chinese family, but compared with the health of my next generation, I am happy to spend it," he said.

Chartree Saenghiranwatana, a fertility specialist at Piyavate Hospital, said the clinic has been "getting increasing demand from Chinese patients in the past year or two", and is recruiting Mandarin-speaking doctors and nurses.

Some Thai clinics say up to 80 percent of their customers are Chinese.

Baby bump

"A new industrial chain is forming for reproduction in Southeast Asia," said Wei Siang Yu, the Singaporean founder and chairman of Borderless Health Group.

The group has created a platform for video-conferences on which Chinese patients can consult fertility experts around the world, aided by Mandarin-speaking interpreters.

It is also establishing sperm and egg banks primarily for Chinese clients in several countries, including Thailand, Australia and the US, complete with a phone app that allows potential parents to monitor their "fertility assets" almost like a bank account.

Two years ago, Chinese patients were sixth or seventh in the ranks of foreigners traveling to Thailand for medical tourism, but they will be the largest group this year, according to Yu.

In addition to infertility or the desire for a larger family, the Chinese preference for male heirs sends some couples overseas in search of clinics that will perform gender screening-even though the procedure is technically illegal in most countries-and LGBT couples in China are also packing their bags.

Li Na, from Central China, has undergone expensive IVF procedures in Shanghai, Hong Kong and the US.

The procedures all failed, but Li and her husband hit the jackpot in Thailand where they had twin girls via a surrogate mother in addition to a boy through IVF.

Li, 41, has channeled the experience into a side career as a consultant to couples seeking the same joy she felt.

"I couldn't stop crying when I flew down to Thailand to pick them (the twins) up," she said. "It was hard to believe they were mine."