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| It was a cold and overcast morning in November, but one full of promise for Guo Meiyan and her husband: They would finally get a chance to start a family. |
| 那是去年11月一个寒冷阴沉的早晨，但对郭美艳和丈夫来说却充满了希望：他们终于有了生孩子的可能。 |
| As Ms. Guo, 39, was wheeled on a gurney into a hospital room where a doctor transferred her eggs, which had been harvested and fertilized, back into her uterus, she also felt a sense of dread. |
| 躺在轮床上的郭女士被推进医院的一个房间，医生把之前从她身上取出的卵子进行了体外受精后，移植回她的子宫。此刻，39岁的她也有一种恐惧感。 |
| “If the transplant is not successful, all the money we spent will be wasted, all the pain I endured will be wasted, and we will have to start over again,” said Ms. Guo, who had traveled 125 miles to Beijing from the northern city of Zhangjiakou. She and her husband had been living in hotels to be near the hospital for a month during the final stage of the in vitro fertilization process. |
| “如果（手术）不成功的花，钱也白花了，罪也白受了，又得从头来重做一次，”郭女士说，她是从200公里以外的张家口来北京这家医院的。她和丈夫已在附近的旅馆里住了一个月，以便在对卵子进行体外受精过程的最后阶段留在医院附近。 |
| They are among hundreds of thousands of Chinese couples who turn to assisted reproductive technology every year after exhausting other options to get pregnant. They travel from all corners of the country to big cities like Beijing in the hopes of beating the odds of infertility. Many wait in long lines outside hospitals before sunrise, just for the possibility of a consultation. |
| 每年有数十万对中国夫妇跟他们一样，在用尽各种方法仍无法怀孕后，转而求助于辅助生殖技术。这些不孕夫妇抱着战胜不孕症的希望，从全国各地来到北京这样的大城市。只是为了挂上就诊号，许多人在天不亮时就在医院外排起了长队。 |
| Now, the Chinese government wants to make the technology, which it made legal in 2001, more accessible. It has promised to cover some of the cost — typically several thousand dollars for each round — under national medical insurance. It is one of more than a dozen policy measures that Chinese officials are throwing at what they see as a very big problem — a fertility rate so low that China’s population has started to shrink. |
| 现在，中国政府想让更多的人用上辅助生殖技术，该技术已在2001年合法化。政府已承诺将辅助生殖技术的部分费用纳入国家医疗保险覆盖范围，一个周期的体外受精费用通常是几万元人民币。这是中国官员为解决一个在他们看来非常大的问题——中国的生育率已经低到导致人口开始减少的程度——所采取的十多项政策措施之一。 |
| China has arrived at this turning point sooner than other countries at its stage of economic development, leading to what some demographers refer to as the curse of “getting old before getting rich.” As fewer babies are born each year and China’s oldest people live longer, the government is being forced to tackle a series of connected challenges — a shrinking labor force, a fledgling pension system and a generation of young people who aren’t interested in having babies. |
| 从经济发展的角度来看，中国比其他国家更早地达到了这个人口转折点的时间，导致一些人口学家称为“未富先老”的祸端。随着中国每年出生的婴儿越来越少，而最年长人口的寿命越来越长，政府不得不应对一系列相互关联的挑战：劳动力萎缩、刚刚起步的养老金制度，以及对生育不感兴趣的一代年轻人。 |
| Subsidizing fertility services like I.V.F., a technology that fertilizes eggs with sperm in a lab and transplants an embryo into the womb, is “a big deal,” said Lin Haiwei, the chief executive at Beijing Perfect Family Hospital, where Ms. Guo had her procedure. Patients go to great lengths to pay for fertility services. Some of them pool loans from relatives. Farmers time their appointments with the autumn harvest when they have money to pay. |
| 北京家圆医院首席执行官林海伟说，为体外受精等生殖技术服务提供补贴“分量是很大的”。体外受精指的是在实验室里使卵子受精，形成胚胎后移植到子宫。郭女士就是在这家医院做的体外受精。不孕症患者为支付辅助生殖服务的费用竭尽全力。有些人从亲戚那里借钱。农民夫妇把就诊时间安排在秋收的时候，这样他们才有钱支付费用。 |
| But even as there is a clear demand for fertility services, Mr. Lin said, the number of patients visiting the hospital is lower each year. “The big picture is that people are less willing to have children,” he said. |
| 林海伟说，尽管对辅助生殖服务有明显需求，但来医院就诊的人数却逐年减少。“大背景是大家的生育意愿在降低，”他说。 |
| This is the single biggest challenge facing China 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 a lifestyle known as “double income, no kids.” |
| 这是中国试图扭转出生率下降趋势所面临的最大挑战。年轻人抱怨生养孩子的经济负担和自身经济未来的不确定性，并对女性在家庭中的作用主要是照顾孩子的传统观念心存反感。许多人表示，希望将注意力放在自己的事业上，一些人接受了“丁克”（双收入，无孩子）的生活方式。 |
| 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 China’s 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 like Denmark, said Ayo Wahlberg, an anthropologist at the University of Copenhagen. |
| 尽管存在这种障碍，但官员们仍在努力提高世界上最低的生育率之一。虽然专家说，让中国人口重新开始增长几乎不可能，但还是可以将出生率保持在稳定水平。哥本哈根大学的人类学家阿尤·瓦尔伯格说，让更多的人用上辅助生殖技术将有所帮助，就像在丹麦等较富裕国家那样。 |
| China recently promised to build at least one facility offering I.V.F. for every 2.3 million to three 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 a million cycles of I.V.F. and other assisted fertility services. Around 300,000 babies are conceived. |
| 中国最近承诺到2025年时，将为每230万至300万人口建立至少一个提供体外受精服务的辅助生殖设施。目前国内有539家提供这种服务的医疗机构和27家获准开展辅助生殖业务的精子库。这些机构每年提供的人类辅助生殖各项技术类别总周期数超过100万，出生婴儿数超过30万。 |
| Experts say these efforts are meaningful ways to help couples who want to have children. If China can scale up the services in an affordable way, it could even be a model for other countries that are facing similar challenges with infertility. But whether it will do much to change China’s demographic trajectory is another question. |
| 专家表示，这些努力为想生孩子的夫妇提供了有意义的帮助。如果中国能扩大辅助生殖服务的规模，让更多的人负担得起的话，甚至有可能成为其他面临类似不孕不育挑战的国家的榜样。但这项技术是否将在扭转中国人口趋势上起很大作用，则是另一个问题。 |
| “The problem is that it is putting a Band-Aid on a gushing wound,” said Mr. Wahlberg, who is the author of a book on fertility in China. |
| “辅助生殖技术为中国的生育率问题帮不上大忙，”瓦尔伯格说，他著有一本关于中国生育问题的书。 |
| For couples like Wang Fang and her husband, I.V.F. changed their lives. Ms. Wang went through two rounds of I.V.F. 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. |
| 辅助生殖技术改变了像王芳和她丈夫这样的夫妇的生活。王女士在2016年做了两个周期的体外受精后，于2017年生下一对双胞胎。她丈夫的第一次婚姻以离婚告终，因为他们无法生育。 |
| Both Ms. Wang, a factory worker, and her husband, an electrician, quit their jobs during the pregnancy to prepare for the birth. |
| 王女士曾在一家工厂当工人，丈夫是电工。他们在她怀孕期间辞掉了工作，为生孩子做准备。 |
| When the first round of I.V.F. failed, the couple felt broken. They learned that they might need a sperm donor, something that Ms. Wang has kept a secret from the family. Her parents think the couple’s fertility issues were due to her. |
| 第一个周期的体外受精失败后，这对夫妇感到精疲力竭。医生告诉他们，他们可能需要使用他人捐献的精子。王女士一直对家人保密这件事。她的父母至今认为她和丈夫的生育问题出在她身上。 |
| “In our hometown, if you don’t have children, you would not be able to hold your head high,” Ms. Wang said. The second time they did I.V.F., the 14-day waiting period to determine if it was successful “felt like a half a century,” she said. |
| “如果没有孩子，在我们老家是抬不起头的，”王女士说。他们做了第二个周期的体外受精，等待确定是否成功的那14天“感觉像过了半个世纪一样”，她说。 |
| As soon as they learned the outcome, they called everyone. Relatives offered to pitch in with their savings to help cover the costs, which exceeded $22,000, a huge sum for the couple, whose monthly household income was less than $1,200 when Ms. Wang and her husband were working. |
| 得知成功后，他们马上给所有的人打了电话。亲戚们提出凑钱帮他们支付逾15万元的费用。王女士和丈夫工作时的家庭月收入不到8500元，15万元对他们来说是一笔巨款。 |
| “I.V.F. 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,” Ms. 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.” |
| “做试管婴儿不是一锤子买卖，出了几次大项后钱就没了，还要再去借钱继续之后的手术，”王女士说。如果医保能覆盖这些费用的一部分的话，就像政府现在保证将开始做的那样，“肯定能帮助我们缓解一些压力”。 |
| Each round of I.V.F. can cost $5,000 to $12,000, and many couples need to do it as many as four or five times; each round has a success rate of roughly 30 percent. Under the new government measures, medical insurance would likely cover about half the cost of a round of I.V.F., said Mr. Lin at Beijing Perfect Family Hospital. |
| 一个周期的人工受精费用从3.5万到8.5万元不等，许多夫妇需要做四五个周期的体外受精；每个周期的成功率大约为 30%。北京家圆医院的林海伟说，按照政府的新规定，医保可能会覆盖一个周期的体外受精费用的一半左右。 |
| The policy has not been put into effect, its details are unclear and a deadly outbreak of Covid could delay things. Still, Mr. Lin is optimistic that some version of the policy will be put into place in the coming months. |
| 这项政策尚未生效，其细节也不清楚。国内新冠病毒疫情严重可能会导致事情推迟。尽管如此，林海伟仍对这项新政策的某个版本将在未来几个月内实施持乐观态度。 |
| 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,” Mr. Lin said. |
| 但他对政策能产生的影响也很现实。“在社会总体生育率和生育意愿萎缩的情况下，我们肯定很难对我们行业的增长抱有很大预期，”林海伟说。 |
| China has a complicated relationship with fertility. For three decades, officials restricted families to one child — sometimes through brutal measures. |
| 中国与生育问题的关系很复杂。官员们曾在三十年多年里限制家庭只生一个孩子，有时甚至为此采取残酷的措施。 |
| Today, infertility affects 18 percent of couples in China, compared with a global average of around 15 percent. 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. |
| 如今，中国有18%的夫妇受不孕不育困扰，而全球的平均比例约为15%。研究人员给出的几个因素包括，中国夫妇结婚后常常要等几年才要孩子，以及堕胎很常见，专家表示，堕胎可能会影响生育能力。 |
| 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 I.V.F. treatment. They were successful last year. |
| 现年32岁的苏玥（音）从没有过想要孩子的强烈愿望，但她丈夫和公婆却希望他们这样做。夫妻俩试了几年没成功后，婆婆给了他们钱，让他们开始接受体外受精治疗，去年生下一个儿子。 |
| Ms. Su loves her son, whom she refers to affectionately as “Cookie.” But she said giving birth had cost her 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. |
| 苏女士非常爱儿子，她亲昵地称他“饼干”。但她说生孩子让她失去了工作。在用母乳喂儿子的那段时间里，她一直远程工作，但后来老板要求她回办公室上班，她不得不辞了职。她属于有事业心的千禧一代，对辞职感到痛惜。 |
| “The most stressful thing about I.V.F. is that I lost my job,” Ms. Su said. |
| “做试管婴儿给我最大的压力，就是我丢了工作，”苏女士说。 |
| Since her transplant, which was successful, in late November, Ms. 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. |
| 去年11月底受精卵移植成功后，郭女士一直在张家口的家中从容地过着日子。今年春节期间，她和丈夫开的火锅店生意兴旺。她有时仍去帮帮忙，还抽空给宝宝织了两条被子。 |
| Mostly, though, she tries to rest in bed, Ms. Guo said. “I feel sick and dizzy all the time.” |
| 不过郭女士说，她大多数时间在卧床休息。“我总是感觉恶心、头晕。” |
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