Repronews #48: 20,000 babies born under Taiwan IVF subsidy program

Over 6% of Taiwanese babies born via IVF; rise of FemTech; state ballot measures; most US women still want children; fertility's economic impact; genetics of ancient Rome; space humans

Photo: Nuwa Fertility Center (Taiwan).

Welcome to the latest issue of Repronews! Highlights from this week’s edition:

• Repro/genetics

  • 20,000 babies born in Taiwan under subsidized IVF program over past three years, 6% of babies in Taiwan are now born via IVF

  • The rise of FemTech: new apps help women understand and manage their reproduction

  • Podcast: US state ballot measures on reproduction

• Population Policies & Trends

  • Carolina Population Center: American women still want about the same amount of children (2.1 for a recent cohort), but often fail to have them

  • Podcast: Jesús Fernández-Villaverde explains how focusing on output per working adult can help us understand low fertility’s economic impact

  Genetic Studies

  • Central Italy’s genetics became more Near-Eastern and less European during the late Roman Republic

• Further Learning

  • Homo spatialis: Can genetic testing and gene editing make space travel safer for humans?

  • Top countries growing GM crops and what those crops are

Repro/genetics

“Expanded IVF subsidy program marks 3rd anniversary with over 20,000 newborns” (Focus Taiwan)

• Over 20,000 IVF babies have been born in Taiwan since a subsidy program to assist infertile couples with was expanded three years ago.

• Introduced on July 1, 2021, the Expanded Subsidy for Infertility Treatment Program has helped 18,157 couples struggling with infertility and had led to the birth of 20,539 babies through IVF by 31 July 2024.

• Health Minister Chiu Tai-yuan said at a news conference that the government expanded the program to “support and help infertile couples achieve their dream of parenthood while easing the financial burden of IVF treatments.”

• Assisted reproductive technology (ART), including IVF, has gained increased attention in Taiwanese society, with the number of ART treatment cycles among Taiwanese increasing from 14,325 in 2011 to 49,300 in 2021, according to a report from the Health Promotion Association (HPA).

• In 2013, the average age at first marriage in Taiwan was 32 years for men and 29.7 years for women, with 194,939 newborns recorded that year. By 2023, the average age at first marriage increased to 32.9 years for men and 31 years for women, while the number of newborns dropped to 133,895.

• The original IVF subsidy program, implemented in 2015, was only available to low-income and middle-low-income households, with just 12 to 20 applications approved each year and no newborns resulting from the program during its implementation period from 2015 to June 2021.

• In July 2021, the program was expanded regardless of socioeconomic status as long as one spouse is a Taiwanese citizen. The wife must be under 45 years old and diagnosed by a physician with infertility and requiring IVF treatment.

• Regarding the amount of financial support from the expanded subsidy program, low-income and middle-low-income households can receive up to NT$150,000 (US$4,686) per treatment, while other couples can receive up to NT$100,000 for their first treatment and up to NT$60,000 for subsequent treatments.

• Women under 40 years old can apply for a subsidy for up to six treatments per pregnancy, while those aged 40 to 45 are eligible for subsidies covering up to three treatments per pregnancy.

• Tsai Way-yi, deputy division director of the HPA’s Maternal and Child Health Division, said most IVF procedures in Taiwan cost around NT$200,000, and the government subsidy aims to cover approximately half of the treatment cost.

• Tsai cited 2021 data showing that 9,774 babies were born in Taiwan as a result of ART treatments, including those from the expanded program, which accounted for 6.22% of the total 157,019 newborns that year.

• Many Japanese couples go to Taiwan for fertility treatment due to the cheapness and high quality of the island’s services. Reportedly, 70,000 children are born every year in Japan via IVF, or about one in 11 children born.

• Taiwan has an ultra-low fertility rate of 0.9 per woman.

“Growing tech markets, GRL PWR, and government pronatalism: Investigating the intersections of FemTech and fertility” (NDPCS)

• Kathryn Sheridan of the Nuffield Department of Primary Care Health Sciences writes on her work investigating the rise and implications of FemTech.

• Advances in wearable health technology, mobile health (mHealth) applications, patient-empowerment movements, and commitments from high-income countries to promote a patient-centered approach in health care delivery have produced an explosion of patient-reported data.

• A small but rapidly growing section of the digital health market is FemTech: technological software, diagnostics, products, and services focused on women’s health.

• The term FemTech was coined by Ida Tin, CEO of menstruation tracking app “Clue,” to make women’s health technology more palatable to overwhelmingly male investment panels at venture capital firms.

• FemTech has since ballooned into a formidable slice of the digital health market, with a predicted value of $103 billion globally by 2030.

• Proponents of FemTech frame it as a women’s empowerment movement seeking to revolutionize digital care. Its critics argue industry has used the moniker to popularize tools that surveil women’s reproductive data for profit.

• Fertility management products are some of the most popular Femtech apps in terms of downloads and are pioneering patient-managed app, testing, and device integration with fertility and ovulation tracking wearables such as AVA and Oova.

• Drivers behind the popularity of fertility digital health interventions include national movements to digitize health systems, attention from individuals and governments on falling fertility rates, and affordable convenience.  

• The digital shift has also been seen in fertility care: some fertility clinics successfully converted to delivering consultations via telemedicine.

• As fertility services were disrupted by the pandemic, digital applications emerged as a cheap and quickly accessible alternative for education and self-management.

•  Women’s fertility data is valuable to advertisers: having a baby is increasingly expensive and soon-to-be parents are a profitable advertising target audience.

• Analyses of top menstruation tracking apps found that 61% of data was automatically transferred to Facebook as soon as the app was opened, and assessments of industry data purchasing practices found several top apps breached the the EU’s data protection regulation (GDPR) and their own privacy policy to sell ovulation tracking data.

• Digital apps offer a way to expand affordable access to fertility care, especially educational, to women who are unable to access traditional care. Sheridan suggests such apps could be vetted and advertised via the NHS. However, apps sharing misinformation or erroneous fertility windows could cause harm. 

Fertility on the ballot in US states (ASRM Today Podcast)

• The hosts discuss the dynamic landscape of ballot measures related to reproductive rights, including abortion, IVF, and contraception, across several U.S. states this election season.

• These measures are citizen-led initiatives that require substantial effort to gather signatures and secure approval, covering recent developments in Arizona, Colorado, Florida, and other states, emphasizing the significance of voter engagement.

More on repro/genetics:

• “UK fertility clinics’ safety improves despite major incident” (PET)

• “First newborns tested for more than 200 rare genetic conditions in England” (PET)

• “23andMe is on the brink. What happens to all its DNA data?” (NPR)

Population Policies & Trends

“Falling birth rate not due to less desire to have children” (Carolina Population Center)

• Birth rates are falling in the United States, but it isn’t because Americans say they want fewer kids. Young Americans haven’t changed the number of children they intend to have in decades.

• Women born in 1995-1999 wanted to have 2.1 children on average when they were 20-24 years old, essentially the same as the 2.2 children that women born in 1965-1969 wanted at the same age, according to new research by researchers at the University of North Carolina at Chapel Hill and Ohio State University.

• The results suggest today’s young adults may be having a more difficult time achieving their goals of having children, said Sarah Hayford, co-author of the study and professor of sociology at Ohio State University.

• “People feel more worried about the future than they might have been several decades ago,” Hayford said. “They worry about the economy, child care and whether they can afford to have children.”

• Hayford conducted the study with Karen Benjamin Guzzo, professor of sociology at the University of North Carolina at Chapel Hill and director of the Carolina Population Center.

• The researchers used data from the National Survey of Family Growth, which has been asking people about their childbearing goals and behaviors for decades.

• The percentage of people who said they don’t plan to have any children has increased, from about 5-8% in the 1960s and 1970s to 8-16% in the 1990s and 2000s. But that alone can’t explain the decline in the number of babies being born.

• The number of unintended births, especially among people in their 20s, has declined in recent decades, which has helped reduce the birth rate.

• “But that doesn’t change the fact that people aren’t having as many children as they say they want, especially at earlier ages,” Hayford said. “It may be that they’re going to have those kids when they’re 35, but maybe they won’t.”

• The study found some evidence that people are reducing the number of children they say they intend to have as they get older.

“How does low fertility affect economic growth, worldwide?” (Rocking Our Priors Podcast)

• University of Pennsylvania Professor of Economics Jesús Fernández-Villaverde discusses low fertility’s impact on economic growth, the accuracy of UN population projections, the drivers of fertility, as well as what can be done to mitigate these trends.

• Fernández-Villaverde and colleagues recently published a working paper modeling GDP growth per working-age adult, rather than GDP per capita. The authors believe this can lead to better economic forecasting and understanding than the traditional metric of GDP per capita.

More on population policies and trends:

• “The fertility crisis: More than you wanted to know” (Sol Hando)

• “Why is France different?: How policy has caused millions more French people to be born” (Boom)

• “The problem with pronatalism: Pushing baby booms to boost economic growth amounts to a Ponzi scheme”

• “What might push fertility back up?” (David Friedman)

• “Debunking the ‘stork theory’: Why do low-fertility societies tax their own reproduction” (IFS)

Genetic Studies

Italy’s genetics became more Near-Eastern during the late Roman Republic (bioRxiv)

• Italian genetic history was profoundly shaped by the Romans. While Iron-Age Central Italy was genetically comparable to contemporary European regions, the region’s gene pool underwent significant influence from Near Eastern ancestry during the Imperial age.

• This study suggests that the spread of this genetic ancestry took place during the late Republican period, predating the onset of the Empire by two centuries.

• The diffusion of this ancestry may have occurred due to early East-to-West movements, since eastern Mediterranean regions were already under Roman political influence during the Republic, or even as a result of migration from southern Italy where Greeks and Phoenicians settled.

More on genetic studies:

• “Ancient human DNA from a South African rock shelter sheds light on 10,000 years of history” (The Conversation)

Further Learning

A still from Ridley Scott’s The Martian (2015).

“Space travel is dangerous. Could genetic testing and gene editing make it safer?” (MIT Technology Review)

• Astronauts and commercial space travelers are subject to damaging radiation and microgravity, along with potential injuries. Long-distance space travel can wreak havoc on human health.

• Some bioethicists are exploring the idea of radical treatments for future astronauts, arguing we should edit the genomes of astronauts ahead of launch to offer them the best protection. This might result in the creation of an all-new species: Homo spatialis.

• Space travel is risky: a space launch essentially involves strapping humans into a capsule and exploding a bomb beneath them, says Paul Root Wolpe, who served as NASA’s senior bioethicist for 15 years.

• Higher levels of radiation increase risk of cancer and neurological disorders, and can also harm body tissues, resulting in cataracts or digestive diseases.

• Microgravity can lead to internal fluids pooling at the top of the body. Muscles don’t need to work as hard when there’s no gravity and astronauts tend to experience loss of muscle and bone mass.

• Five years ago, scientists working with NASA published the results of a groundbreaking study comparing two identical twins—one of whom spent a year in space while the other remained on Earth. The twins, Mark and Scott Kelly, were both trained astronauts. Researchers were able to compare them to assess the impact of long-term space travel on how genes work. The effects in the space-faring brother lasted for more than six months. These changes are thought to be a response to the stress of space travel and perhaps a reaction to the DNA damage caused by space radiation.

• Space travel comes with other risks, including weight loss, permanent eye damage caused “spaceflight-associated neuro-ocular syndrome,” and psychological distress as a result of being far from friends and loved ones.

• Injuries are also common on space missions, says Wolpe, who is now founding director of the Center for Peace Building and Conflict Transformation at Emory University. Tools and equipment can float around, knocking into people. Bungee cords snap. “Astronauts are supposed to wear safety goggles at all times, but they didn’t,” says Wolpe. “The injury list is lengthy … it’s really surprising how many injuries were [sustained] by astronauts on the space station.”

• People who have adapted to high altitudes on Earth have genetic factors that allow them to thrive in low-oxygen environments—what if we could confer these factors to astronauts? Why not throw in some more genetic changes—ones that might protect them from bone or muscle loss, for example?

• There are currently no gene therapies that have been designed for people undertaking space travel. But one day “it might be in the best interests of the astronauts to undergo some genetic intervention, like gene editing, to safeguard them,” says Rosario Isasi, a bioethicist at the University of Miami. “It might be more than a duty, but a condition for an astronaut going on these missions.”

• Wolpe is not keen on the idea. “There is some integrity to being human, and to the human body, that should not be breached,” he says. “These kinds of modifications are going to … end up with a number of disasters.”

• In the meantime, genetic testing could be helpful for both astronauts and space tourists, says Wolpe. Some body tissues are more vulnerable to radiation damage, including the thyroid gland. Genetic tests that reveal a person’s risk of thyroid cancer might be useful for those considering space travel.

“Top 10 countries growing genetically modified (GM) crops” (Statista/GLP)

• In terms of worldwide acreage, the most commonly genetically modified crops are soybeans, corn, cotton, and canola as of 2019.

• In that year, 48.2% of all soybean plants and 13.5% percent of all the cotton grown worldwide was genetically modified.

• Genetically modified foods are very common in the United States. Genetically modified organisms are a controversial topic in the United States, with 39% of U.S. consumers believing that genetically modified food is less healthy than non-genetically modified food.

More on human nature, evolution, and biotech:

• Reprotech

  • “The DNA dreams of the new eugenics” (LA Review of Books)

• Agrifood

  • “CRISPR gene editing key to preserving crop genetic diversity” (Bernama/GLP)

  • “Tastier and healthier Chardonnays in Italy: More sustainable fungal fighting gene-edited vines planted in Italian trial” (GLP)

Disclaimer: We cannot fact-check the linked-to stories and studies, nor do the views expressed necessarily reflect our own.