China's fertility rate is plummeting, causing concerns among parents and experts. Tiffany Tan explores why and what it means for the aging country.

Linlin injected her upper arm with a fertility hormone every morning for two weeks.

The shots were to help her produce as many eggs as possible, to prepare her body for in vitro fertilization.

The 34-year-old nurse from northern China, who refuses to give her full name for privacy reasons, has wanted a baby since 2011. She had an ectopic pregnancy the same year and has been unable to conceive since.

"My body can't take it anymore, and there has also been a lot of psychological pressure," Linlin says in a phone interview.

"I'm worried I'm going to have another abnormal pregnancy."

After marking their ninth wedding anniversary still childless, Linlin and her husband decided to try IVF - a medical procedure in which mature eggs are removed from her body, fertilized with her husband's sperm and inserted into her uterus for normal development.

The couple is expecting to spend around 40,000 yuan ($6,400) on their first try, while knowing that some families have shelled out five times as much with no baby to show for it.

According to the China Population Association, at the end of 2012, 12.5 percent of mainland Chinese of childbearing age - or 40 million people - had been diagnosed with infertility. (Infertility is clinically defined as failure to conceive after at least 12 months of unprotected sexual intercourse.)

Two decades earlier, China's infertility rate was only 3 percent. What has caused the spike in numbers?

It's the decision to delay marriage or parenthood, especially among career-driven urbanites, say reproductive specialists and population researchers. A woman's fertility begins to decline in her early 30s and drops sharply after 35.

Although the average age of first marriage in China is 25 for men and 23 for women, in big cities such as Shanghai, it is 34 for men and 31.6 for women. The data, released by the Shanghai Civil Affairs Bureau in February, show an increase of 1.3 years for both sexes within just one year.

Other major factors experts cite are more sedentary lifestyles, which lower the quality of egg and sperm cells. There is also the rise in sexually transmitted diseases, which can damage men's and women's reproductive systems.

Doctors are similarly worried about the effects of induced abortions, which have become widespread in China as a method of family planning. Data released by the National Health and Family Planning Commission last year show that some 13 million abortions are conducted in China every year - or 25 abortions per minute.

"Don't get an abortion again and again," says Zhai Guirong, director of the obstetrics and gynecology department at Beijing Obstetrics and Gynecology Hospital.

"This can thin out the uterus lining and block the fallopian tubes."

A study of 1,236 childless women by the Chongqing Family Planning Research Institute found that almost 60 percent suffered infertility as a result of induced abortions.

For the millions of Chinese couples unable to bear children, another option is adoption.

Between 2008 and 2011, the period for which the most recent data is available, up to 90 percent of Chinese adoptees went to local families. The year 2009 saw a high of 39,801 domestic adoptions, the Ministry of Civil Affairs reports.

Xueli, a housewife in Hebei province, considered adopting when she could not get pregnant after three years of marriage. She had already tried traditional Chinese medicine treatments and had visited Buddhist temples to pray for a child.

"My in-laws would always talk about wanting a grandchild," says the 29-year-old, who refuses to publish her real name to protect her family's privacy.

"That stressed me out and hurt my feelings."

But Xueli never went down the adoption path since IVF blessed her family with twin boys last year. She has quit her sales job and now spends her days playing with her sons and watching them nap in the afternoon.

The growing reproduction problems of an aging Chinese society alarm some social scientists. Official data put China's birth rate at 1.5 births per woman - less than the 2.1 needed for a population to replace itself.

"The family unit won't last, and the country won't be able to sustainably develop," Yi Fuxian, a doctor-turned-demographer, says.

"Youthful vigor will decline, and there will be a labor shortage, while the proportion of the elderly who are dependent on social security will continue to grow.

"This is a threat to China's economic development," says Yi, author of The Empty Nest of a Big Country: Reflections on China's Family Planning Policy.

"China needs to maintain a birth rate of 2.3."

Other experts, meanwhile, think China's declining birth rate is a normal phenomenon of the 21st century.

"Low fertility is common in a fast-developing country like China," says Ting Kwok-fai, a sociology professor and director of the Center for Chinese Family Studies at the Chinese University of Hong Kong.

"Some people say the family is in crisis. But I would say that this simply means the family has changed."

What China needs to work on, Ting says, is an appropriate response, such as improving the social security system and elderly care institutions.

As Linlin prepares for her eggs to be harvested, she can't help but think back to her marriage's early years.

She discovered she was pregnant one day, when she was in her mid-20s and only a few years out of nursing school.

She and her husband didn't feel financially secure enough to start a family, so they terminated the pregnancy.

Contact the writer at tiffany@chinadaily.com.cn

Xu Lin, Sun Ye, Wang Jingjing and Wang Peng contributed to this story.

Wuhan Songziniao Infertility Hospital establishes the "bridal chamber" for couples expecting a child. Special facilities and decorations are installed to help fertilization. Sun Xinming / for China Daily

(China Daily 04/27/2014 page3)