At 8:30 in the morning, a line weaves through the lobby and out the front door of the Shanghai Ji Ai Genetics and IVF Institute. Next to the lobby, people crowd into a waiting room, which looks and sounds as much like a train station as it does a medical office. There's an electronic board on the wall, but instead of destinations and times, it flashes names of patients, telling them which room to go to and which doctor to see.
Weipeng Zhao, 71, heads this center. Two decades ago, he was a well-known surgeon in China and in the prime of his career when he was sent to the National Institutes of Health on a scientific exchange. He later landed at the Genetics and IVF Institute, or GIVF, a privately owned clinic in Fairfax, Va., just outside Washington, D.C.
He remembers talking about China's economic growth with the company's founder, Joseph Schulman, some 15 years ago.
"He said, 'Why we don't go to China?' " Zhao recalls. "I said, 'Yes, you have to go. This is [an] opportunity.' "
At the time, in vitro fertilization was being done in China in government-run hospitals, but the numbers were small and equipment was scarce. Chinese officials were eager to have American help in setting up IVF clinics — ones that would be stocked with Western technology.
Given the extreme measures China had taken to slow its population growth, this came as a surprise to many. Zhao remembers that there was disbelief among some people, who thought of China as a "family planning country," not as a place to go for infertility treatment.
China's introduction of strict population control policies in 1978 led to forced abortions and sterilizations. Over the years, many families have paid substantial fines for violating the policies.
Still, by the mid-1990s, there was government support for IVF, the idea being that every family should be able to have one child. And thus, an industry was born.
Looking back, Zhao recalls a journey that was "imbued with resistance ... and invasion of corruption from all sides." Doing business in China was complicated, approvals were hard to come by, and parts of the original plan failed. But a partnership with a prominent Chinese hospital in Shanghai took root.
And today, Shanghai Ji Ai, whose name means "collecting love," is in its 13th year, and the center is busier and more profitable than ever.
Chen Hua, an obstetrician-gynecologist, sees about 40 patients a day.
"We have many families in China who don't even have one child," Chen says. "So they need a child even more."
Experts in China and the U.S. don't think the infertility rate in China is unusually high. They also don't think the growth of in vitro fertilization is fueled by couples looking to skirt the one-child policy, not to say that doesn't happen in some cases.
Anywhere in the world, it's estimated that approximately 10 to 15 percent of couples suffer from infertility. With a population of 1.3 billion, China's need for infertility treatment is huge.
Wang Zhongqing, 34, has tried for several years to get pregnant. She has gone to three different hospitals but was told her case was too complicated.
"Not having a child, you feel the pressure," she says, adding that family pressure is the greatest of all. "They're always pushing, 'Go get looked at! How come you haven't gone yet?' They're so anxious."
At Ji Ai, the cost of a typical IVF cycle — that's one attempt at getting pregnant — runs about $4,500. With rising incomes in China, it's something a growing number of people can afford, and it's almost a given that parents help out.
A Great Demand In Shanghai
One floor up from the consultation rooms is the embryology lab. It was set up by Andrew Dorfmann, who directs GIVF's embryology lab back home in Fairfax. Many of the Chinese technicians have trained in his lab in the U.S., and Dorfmann comes to Shanghai a couple of times a year to make sure they're on track.
The two labs are largely identical. They perform most of the same procedures, though one procedure they don't do in Shanghai is sex selection. Perhaps the biggest difference is volume. Demand for IVF in Shanghai is so great that the lab there handles about six times the volume as the lab in Fairfax.
"The pace here is so high, and the number of patients they're seeing, the throughput is high," Dorfmann says.
When the Chinese staff go to Virginia, they're amazed at how spacious and uncrowded the facilities are.
"Last time I went to America, there were at most two patients sitting on sofas. Only when one left did the next one go in. They weren't all standing in a line," remembers Han Jinlan, an OB-GYN.
In Shanghai, on the other hand, the lines keep getting longer and longer.
"In 1998, we had sofas for everyone. Then we switched to chairs. Then to stools. Now we have people sitting in the stairwell," she laments.
The productivity in Shanghai has resulted in big paydays for the staff, who get monthly bonuses based on the revenue their departments bring in. This pay-for-performance would have been unthinkable in Weipeng Zhao's time as a surgeon in China. Today, it's part of his strategy for keeping Ji Ai competitive as IVF centers pop up all around.
Surrounding Ji Ai are 10 IVF centers, in Shanghai alone. There are now several hundred government-licensed clinics throughout China, some of them with newer, more spacious facilities, and even VIP services for China's growing upper class.
"The patients always criticize us, 'Hah, you are joint-venture medical center, but you don't have the VIP service,' " he says. "Yes, we don't have yet. We don't have the space!"
Real estate is hard to come by in downtown Shanghai, but Zhao says somehow they will figure out a way to keep growing.
ROBERT SIEGEL, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MELISSA BLOCK, Host:
Unidentified Woman #1: (Foreign language spoken)
ANDREA HSU: There's an electronic board on the wall, but instead of destinations and times, it flashes the names of patients, telling them which room to go to and which doctor to see.
WEIPENG ZHAO: In the morning time and the afternoon time, every day is very crowded.
HSU: He remembers talking to the company's founder, Joe Schulman, about China's economic growth.
ZHAO: He said, why we don't go to China? I say, yes, you have to go. This is opportunity.
HSU: Given the extreme measures China had taken to slow its population growth, this came as a surprise to many.
ZHAO: Because they're saying this is a family planning country. You want doing the infertility treatment? No.
HSU: Still, by the mid '90s, there was government support for IVF, the idea being every family should have one child. And thus, an industry was born.
CHEN HUA: (Foreign language spoken)
HSU: Chen Hua is an obstetrician-gynecologist here. She sees about 40 patients a day.
HUA: (Through Translator) We have many families in China who are childless, so they need a child even more.
HSU: Thirty-four-year old Wang Zhongqing has tried for several years to get pregnant. She's gone to three different hospitals but was told her case was too complicated. She desperately hopes she'll get help here.
WANG ZHONGQING: (Through Translator) Not having a child, you feel the pressure. My classmates' children are so big already, 8 or 9 years old.
HSU: And pressure from family is the greatest of all.
ZHONGQING: (Through Translator) They're always pushing: Go get looked at. How come you haven't gone yet? They're so anxious.
HSU: Unidentified Woman #4: Okay. We're finished.
HSU: One floor up, lab technicians finish the first of 15 egg retrievals they'll do this morning. Within minutes, they're on to the next patient.
ANDY DORFMANN: It's actually a terrific lab back here.
HSU: Andy Dorfmann is director of the embryology lab back home in Virginia. Many of the Chinese techs have trained in his lab, and he comes to Shanghai a couple times a year to make sure they're on track.
DORFMANN: Unidentified Woman #5: Three.
DORFMANN: Three, OK.
HSU: The Shanghai lab is largely the same setup as the one in the U.S. but with six times the volume. So the embryologists are extremely careful about double-checking names.
DORFMANN: The pace here is so high, and the number of patients that they're seeing, the throughput is so high.
HSU: When the Chinese staff go to Virginia, they can hardly believe what they see. Han Jinlan is an OB-GYN. She ran the day-to-day operations at JIAI until last year.
HAN JINLAN: (Through Translator) Last time I went to America, there were at most two patients sitting on the sofas. Only when one left did the next one go in. They weren't all standing in a line.
HSU: In Shanghai, on the other hand, the lines keep getting longer and longer.
JINLAN: This pay-for-performance would have been unthinkable in Weipeng Zhao's time as a surgeon in China. Today, it's part of his strategy for keeping JIAI competitive, as IVF centers pop up all around.
ZHAO: Last month, I showed our board member the one Shanghai map. We are in the Shanghai downtown area. Surrounding us, 10.
HSU: Ten more IVF clinics in Shanghai alone. Throughout China, there are now several hundred government-licensed clinics. Some of them with newer, more spacious facilities.
ZHAO: The patient always criticize us: Hah, you are joint venture medical center, but you don't have the VIP service. Yes, we don't have yet. We don't have the space.
HSU: Andrea Hsu, NPR News.
BLOCK: And our series continues online with The Baby Project. Nine women from across the United States are blogging about their final weeks of pregnancy, and later this summer about their first few weeks of parenthood. You can meet them at npr.org. Transcript provided by NPR, Copyright NPR.