This is the single biggest challenge facing the country as it tries to reverse its falling birthrate. Young people complain about the financial burden of having children and their own economic uncertainty, and push back on traditional ideas about the woman’s role as a caretaker at home. Many have expressed a desire to focus on their careers, while others have embraced the “double income, no kids” lifestyle.

Despite this hurdle, officials are trying to push up one of the lowest fertility rates in the world. While experts say it would be nearly impossible for the Chinese population to start growing again, the country could keep its birthrate steady. Making assisted reproductive technologies accessible to more people would help, just as it has helped in wealthier countries such as Denmark, said Ayo Wahlberg, an anthropologist at the University of Copenhagen.

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The government recently promised to build at least one facility offering IVF for every 2.3 million to 3 million people by 2025. It currently has 539 medical institutions and 27 sperm banks that have been approved to carry out assisted reproductive technology. Each year these facilities provide more than 1 million cycles of IVF and other assisted fertility services. Around 300,000 babies are conceived.

Experts say these efforts are meaningful ways to help couples who want to have children. If the country can scale up the services in an affordable way, it could even be a model for other countries facing similar challenges with infertility. But whether it will do much to change its demographic trajectory is another question.

“The problem is that it is putting a Band-Aid on a gushing wound,” said Wahlberg, the author of a book on fertility in China.

For couples including Wang Fang and her husband, IVF changed their lives. Wang went through two rounds of IVF in 2016 before she gave birth to twins in 2017. Her husband’s first marriage ended in divorce because they were unable to have a child.

Wang, a factory worker, and her husband, an electrician, quit their jobs during the pregnancy to prepare for the birth.

When the first round of IVF failed, the couple felt broken. They learnt that they might need a sperm donor, something that Wang has kept a secret from the family. Her parents think the couple’s fertility issues were due to her.

“In our hometown, if you don’t have children, you would not be able to hold your head high,” Wang said. The second time they did IVF, the 14-day waiting period to determine if it was successful “felt like a half a century,” she said.

As soon as they learnt the outcome, they called everyone. Relatives offered to pitch in with their savings to help cover the costs, which exceeded $US22,000 ($31,000), a huge sum for the couple, whose monthly household income was less than $US1200 when Wang and her husband were working.

“IVF is not a one-time deal, and we ran out of our money after several big items, so we had to borrow money to continue,” Wang said. If even some of those costs had been covered by medical insurance, as the government has said it will now start doing, “it would certainly have helped us and relieved some pressure.”

Each round of IVF can cost $US5000 to $US12,000 and many couples need to do it as many as four or five times; each round has a success rate of roughly 30 per cent. Under the new government measures, medical insurance would likely cover about half the cost of a round of IVF, said Lin at Beijing Perfect Family Hospital.

The policy has not been put into effect, its details are unclear and a deadly outbreak of COVID could delay things. Still, Lin is optimistic that some version of the policy will be put into place in the coming months.

But he’s also realistic about its impact. “It is certainly hard to expect much growth in our industry when the overall fertility rate and the willingness to have children are shrinking,” Lin said.

China has a complicated relationship with fertility. For three decades, officials restricted families to one child — sometimes through brutal measures.

Today, infertility affects 18 per cent of couples, compared with a global average of around 15 per cent. Researchers cite several factors, including the fact that Chinese couples often wait until later to have children and the common use of abortions, which experts have said could affect fertility.

Su Yue, 32, never had a strong desire to have a baby, but her husband and in-laws did. After the couple tried for several years, her mother-in-law gave them money to start IVF treatment. They were successful last year.

Su loves her son, whom she refers to affectionately as “Cookie”. But she said giving birth had cost her job. She had been breastfeeding while working remotely, but then her boss required her to come into the office. As a career-minded millennial, she laments having to resign.

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“The most stressful thing about IVF is that I lost my job,” Su said.

Since her transplant, which was successful, in late November, Guo has been taking it easy back at home in Zhangjiakou. The hot pot restaurant that she and her husband own has been busy during the current Lunar New Year period. She still helps out, and she has found time to knit two mattress quilts for the baby.

Mostly, though, she tries to rest in bed, Guo said. “I feel sick and dizzy all the time”.