Assisted Reproduction: Japan vs. China—Why China Is More Popular?

At a private fertility clinic in Tokyo's Shibuya district, 38-year-old American lawyer David stared at the price list, which showed “single IVF cycle costs around ¥1.5 million (approximately ¥75,000 RMB),” and sighed softly. Meanwhile, at an assisted reproduction center in a top-tier Shanghai hospital, Lucy, an Australian teacher who had just completed her initial examination, told her interpreter: “I heard that after third-generation IVF was included in medical insurance here, the total cost can be kept under 100,000 RMB, and you can even use the international medical department's fast-track service.”

These two scenes reflect a subtle shift in the global assisted reproductive market: Japan, once renowned for its “technological sophistication” and “service privacy,” now faces a strong rise in China's assisted reproductive industry. According to 2024 data from The Lancet Global Health, China has ranked second globally in assisted reproductive cycles for three consecutive years (exceeding 1.5 million annually), with foreign patients' share surging from 3% in 2019 to 8% in 2024. Meanwhile, Japan's cycles have remained stable at around 400,000, with slow growth in foreign patients.

I. From “Technology Worship” to “Demand Alignment”: Policy Relaxation and Accessibility Emerge as Key Variables

Japan's ART industry advantage stems from technological accumulation. As one of the world's earliest countries to legalize in vitro fertilization (IVF) clinical applications (1983), Japan maintains refined medical standards in embryo culture, blastocyst transfer, and genetic screening (e.g., PGT-M for single-gene disorders). For instance, the embryo laboratory at Kato Women's Hospital in Tokyo set an industry record with a “78% blastocyst formation rate,” and its “mild stimulation protocol” for older women is regarded by Western academia as a model of “gentle treatment.”

However, Japan's “technological edge” has always been constrained by strict ethical and policy frameworks. Under Japan's Assisted Reproductive Technology Law, the upper age limit for women undergoing IVF treatment is 45 (some clinics extend this to 48), and they must provide either a “marriage certificate” or a “partner's informed consent form.” While egg freezing for single women became legal in 2023, it is strictly limited to “future conception with a spouse,” prohibiting non-marital births. More critically, Japan's national health insurance provides virtually no coverage for ART costs (only ovulation-inducing drugs for some low-income groups qualify for subsidies), resulting in out-of-pocket expenses for a single IVF cycle reaching ¥1-2 million (approximately ¥50,000-100,000 RMB).

In contrast, China's policy adjustments exhibit a more “birth-friendly” orientation. Following the 2021 “three-child policy,” China's National Health Commission swiftly advanced ART coverage under medical insurance: Starting in 2023, 21 provinces, including Beijing, Guangdong, and Zhejiang, included 16 ART procedures (such as follicle monitoring, embryo culture, and egg retrieval surgery) in insurance reimbursement. This reduced the base cost of a single IVF cycle in Beijing (excluding medication) from ¥30,000–50,000 to ¥10,000–20,000. In 2024, some provinces further piloted “advanced maternal age subsidies” (e.g., Shanghai provides ¥10,000 special subsidies for IVF treatments for women over 40). While easing restrictions, China has not relaxed ethical oversight—the 2023 revision of the “Administrative Measures for Human Assisted Reproductive Technology” explicitly prohibits surrogacy and sex selection. However, restrictions on egg freezing for single women (requiring medical indications) are more flexible than Japan's, objectively accommodating diverse reproductive needs.

II. From “Small and Specialized” to “Large and Comprehensive”: Universal Accessibility and Availability of Medical Resources

Japan's assisted reproductive institutions are renowned for being “small and specialized”: only about 500 licensed fertility centers nationwide, with 80% concentrated in major cities like Tokyo and Osaka. Most are private clinics (such as Eikyo Hospital and Kato Clinic), handling a limited number of patients. Foreign patients must book appointments 3-6 months in advance, with initial consultations typically spanning 2-3 days (due to fixed clinic hours), and egg retrieval procedures requiring synchronization with individual doctors' schedules. While this appointment-based model ensures service quality, it struggles to meet international patients' demand for efficiency.

China's assisted reproductive industry exhibits “scaled and tiered” characteristics: According to National Health Commission data, as of June 2024, 602 medical institutions nationwide were approved to perform ART (with tertiary hospitals accounting for 45%), covering all provincial-level administrative regions. Leading centers (such as Peking University Third Hospital and CITIC Xiangya Reproductive and Genetic Hospital) handle over 10,000 cycles annually, with medical teams averaging over 10 years of clinical experience (some specialists exceeding 20 years). These facilities typically offer multilingual patient navigation and dedicated international medical departments. More crucially, China's centralized healthcare system enables efficient resource allocation: most centers offer one-stop services covering the entire process—initial consultation, examinations, ovarian stimulation, egg retrieval, and embryo transfer. International patients can book appointments online via hospital websites or international departments. Test results are typically available within 24 hours, with stimulation cycles averaging 10–12 days (compared to 12–14 days in Japan), compressing the overall treatment cycle to 2–3 weeks.

III. From “Technology Worship” to “Emotional Resonance”: The Hidden Competitive Edge of Cultural Adaptability

In Japan, assisted reproductive technology is often viewed as a “last resort.” Influenced by traditional notions of “family continuity,” societal discourse on “technology-assisted reproduction” remains biased. Some clinics subtly inquire whether patients face marriage pressure due to infertility, or even suggest “trying conventional treatments first.” This atmosphere creates pressure for many international patients—particularly single women and LGBTQ+ individuals.

China's societal inclusivity, however, strikes a balance between tradition and modernity. On one hand, the traditional notion that “failing to produce an heir is the greatest filial disobedience” still holds sway. Yet the younger generation shows significantly greater acceptance of “reproductive autonomy.” The 2024 China Assisted Reproductive Industry White Paper reveals that among patients aged 25-35, 37% chose IVF for “proactive family planning”—up from just 12% in 2019. On the other hand, positive policy and public discourse guiding “diverse fertility needs” (such as CCTV's coverage of “single women freezing eggs” and social media discussions on “including assisted reproduction in medical insurance”) have made it easier for foreign patients to gain psychological acceptance. In the waiting area of an international fertility center in Shanghai, Sophie and Louise, a same-sex couple from France, shared: “The medical staff here don't look at us strangely. They directly ask, ‘Whose sperm/eggs would you like to use?’ This respect makes us feel very at ease.”

IV. Conclusion: Where “Technology” Meets “Demand,” China Is Defining a New Paradigm for Assisted Reproduction

Japan's assisted reproductive industry operates like a precision-engineered “medical instrument,” pursuing perfection in technical details. China's sector, however, functions more as a “full-scenario solution machine”—not only providing internationally aligned technologies but also addressing global families' deep-seated demand for “affordable, efficient, and dignified” fertility services through policy liberalization, resource decentralization, and cultural inclusivity.

For international patients, choosing China may not stem from “Japan's shortcomings,” but rather because “China better understands their needs”: When a 42-year-old German working woman needn't worry about “exceeding age limits,” when a New Zealand same-sex couple needn't fret over “legal status,” when a Southeast Asian single mother needn't be deterred by “sky-high costs”—the rise of China's assisted reproductive industry is fundamentally a “demand-centered” medical revolution.

As stated by an expert from the World Health Organization's Assisted Reproductive Technology Assessment Group: “The future global center of assisted reproduction may not lie in the most technologically advanced nations, but in those that best understand that ‘fertility is a fundamental human right.’ China is on this path.”

Document dated 2025-10-13 10:42 Modify