A little over a year ago, a nearly 1,000-square-meter commercial space in a luxury office building just down the street from the Miramar Ferris wheel in Dazhi sold for NT$450 million. The sales price set a new record for commercial real estate in Taipei, becoming a hot topic in the news. Naturally, it piqued quite a bit of curiosity as people wondered just what business with such deep pockets was going to move in.

The answer was revealed in October of 2018 with the grand opening of a fertility clinic, the Taipei branch of Stork 11.

The Stork fertility center, originally from Hsinchu, has staged a stratospheric rise in recent years to become one of Taiwan’s largest fertility clinics. A large number of patients from overseas is one of the clinic’s calling cards, with 700 patients from China, Hong Kong and Macau, and Japan accounting for half of the annual clientele.

Among these, Japanese comprise 20 percent of the customer base.

Why would Japanese couples having difficulty conceiving leave the world-class medical system of Japan and come all the way to Taiwan to seek help?

“Ninety-percent have already tried extracting eggs (oocytes) on multiple occasions, and have been put through the ringer in Japan” (before coming to Taiwan), says Lai Hsing-hua, Stork’s founder and director, formerly a renowned Hsinchu-based gynecologist.

The average age of the mentally and physically exhausted Japanese couples is close to 50. On average, each woman has had 10 and as many as 50 eggs harvested, the equivalent of harvesting an egg once per month each month for four years in a row.

The Hsinchu-based Stork Fertility Center attracts numerous patients from abroad, with as many as 700 coming from China, Hong Kong and Macao, and Japan each year for treatment, accounting for half of all patients. (Photo by Justin Wu)

Egg Donor Treatment in Taiwan, One-half of Patients from Overseas

Most of the Japanese patients seeking help are using donated eggs for in-vitro fertilization.

According to statistics from Taiwan’s Health Promotion Administration, in the three-year period between 2014 and 2016, Taiwan saw a tenfold increase in the number of treatment cycles with donated eggs, reaching 2,100. Of these, patients from overseas accounted for one-half of the treatments, chiefly coming from China, Hong Kong, and Japan.

Kyoko Kimura (a pseudonym), nearing 50, is one of them.

During a telephone interview from her home in Gunma Prefecture, about an hour’s drive from Tokyo, she related that she endured 12 years of infertility treatment at six different clinics in Japan, yet was unable to successfully harvest viable eggs. Four years ago, at the recommendation of a doctor at Notre Dame Hospital in northern Kyushu, she sought treatment in Taiwan.

Although Japanese law permits in-vitro fertilization with surrogate eggs, in actual operation there are countless hurdles.

First, only a minority of women is willing to donate eggs anonymously, and most end up having to ask for help from their own sisters or relatives. Further, they are required to undergo counseling during the treatment, as well as approval from the Ethics Committee, complicating the process.

Conversely, eggs are in plentiful supply in Taiwan, and the laws are relatively loose. According to the regulations of the Artificial Reproduction Law, anyone can proceed with artificial fertilization except for direct family up to fourth-degree relatives. Accordingly, the Northern Kyushu Notre Dame Hospital’s website directly lists the contact information and accomplishments of the Honji Fertility Center and the Stork Fertility Center, both Taiwanese fertility clinics.

However, Mr. and Mrs. Kimura hesitated whenever they thought about their child being only half “theirs,” unsure if they could love their child without reservation.

After thinking about it for six months, Mrs. Kimura took her husband to Taiwan to give conceiving a try at both clinics. She made a total of three visits to Taiwan, knowing only that the donor was Taiwanese and vague related statistics about her weight, education, hair color, and complexion, before ultimately confirming her desire to go proceed via email (in general, egg donors can make nearly NT$100,000 to cover “nutrition”).

After two egg extractions and implants, she gave birth to a baby girl weighing 2.3 kilograms. Last year, once again using an oocyte extracted at Stork, she had a second child, with each surrogate egg procedure costing between 1.6-2  million Japanese yen.

Eggs Are Tough Business, with up to 20% ‘Bad Debts’

“The biggest part of our business at this time, or the main source of income, is derived from our donor bank,” admits Lai Hsing-hua. Although Stork is known as Asia’s largest egg bank, the egg business is not as easy as outsiders might imagine. Patients like Mrs. Kimura, who considered the idea for six months before finally coming to Taiwan for a surrogate egg, are not a minority. And the risks the donor egg business carries are not insignificant, as Stork’s “bad accounts” rate of 20 percent demonstrates.

Statistics for 2017 show that the Gynecology department hospitalization rate at international medical clinics in Taiwan ranks second, behind only health examination centers and ahead of aesthetic medicine. (Photo by Kuo-tai Liu)

How does the “test tube baby” business have “bad debts”?

In the past, when the technology of egg preservation by freezing had not yet matured, donor eggs were matched fresh. If the donor’s health did not reach required standards, or her egg quantity and maturity was found to be poorer than expected after a luteinizing hormone injection, or in some cases if the donor had a change of heart, the recipient couple’s disappointed expectations aside, calculating the cost was complicated. As a result, many payments that had already been made became bad debts, forcing Stork to absorb the cost.

Frozen oocytes were Lai Hsing-hua’s solution. Identifying market opportunities, in 2008 he founded Biolove Biotechnology, a company dedicated exclusively to human oocyte cryopreservation (egg freezing).

In-vitro fertilization thus went from matching fresh eggs to the egg bank matching method in 2014. Failure is inevitable even with thawed oocytes, but the bad debt rate has been able to be reduced to the current rate at under 10 percent. However, as Lai Hsing-hua notes, “It goes back to preserving fertility at a young age.”

Stork has developed an app that allows female users to observe images on their mobile phones of their frozen eggs and embryos under the microscope, answering their ineffable expectations.

Overseas Demand for Infertility Treatment Even Higher than Plastic Surgery

Just before the 2/28 Memorial Day holiday in Taiwan, Arman, a four-year-old boy from the Philippines, energetically sang the classic song “You Raise Me Up” at the Lee Women’s Hospital, a half-hour drive from the Taichung High Speed Rail station.

Arman is the successful outcome of 42-year-old Philippine lawyer Violeta Banagen-Kito’s quest for help with conceiving a child. The same day she spoke with CommonWealth, Violeta underwent her second in-vitro fertilization, a nearly three-hour procedure, before heading back to her hotel to rest and recover.

With 30 years of treating infertility, Dr. Lee Mao-sheng (far left) specializes in conventional in-vitro fertilization. Violeta Banagen-Kito (far right), 42, came from the Philippines to seek help, finally conceiving her first child, Arman (second from right), now 4. (Photo by Kuo-tai Liu)

The Lee Women’s Hospital is another famous fertility hospital. Yet, unlike Stork, Lee only uses conventional test tube fertilization, and its clientele consists largely of patients from Southeast Asia.

Lee Women’s Hospital founder and national policy adviser Lee Mao-sheng, who has dedicated the last 30 years to treating infertility, successfully helped create the second “test tube baby” in Taiwan at the Chung Shan Medical University Hospital. Doctor Lee estimates that the international fertility treatment market is worth around NT$300 million per year, which, combined with tourism consumption, drives at least NT$500 million in demand.

Lee Mao-sheng, founder of the Lee Women’s Hospital, relates that, in spite of the extensive business opportunities, competition is intense throughout the industry. In response, it is necessary to upgrade technology and align with the international community to foster new growth opportunities. (Photo by Kuo-tai Liu)

Just how strong is the demand for infertility treatment among overseas patients coming to Taiwan? Statistics for 2017 indicate that the international medical clinic hospitalization rate for gynecology ranked second, trailing only health examination centers and exceeding even that of aesthetic medicine (plastic surgery). (Read: The Fertility Effect of National Health Insurance in Taiwan)

Competition Intensifying, Infertility Clinics Double in 20 Years

Despite the considerable commercial opportunities in infertility treatment, competition is also intensifying all the time.

According to the latest statistics from Taiwan’s Health Promotion Administration, over 34,000 in-vitro fertilization cycles were conducted in Taiwan in 2016, nearly four times higher than a decade before. Similarly, the number of resulting infant births climbed from 2,800 to nearly 9,000.

The number of government-licensed in-vitro fertilization clinics like Stork and Lee Women’s Hospital now stands at 82, nearly doubling in the last 20 years.

“(Taiwan’s) fertility medicine space is already saturated, so it must venture outward,” offers Lee Mao-sheng. Not only must it make technical improvements, it should also be in sync with the international community and undertake new multinational division of labor.

The Reproductive Sciences Medical Center (RSMC), a San Diego-based clinic, established operations in Shanghai last year and is one of Lee Women’s Hospital’s new international cooperative partners.

RSMC positions itself as a “one-stop shop,” with services spanning in-vitro fertilization, surrogate motherhood, pregnancy and birth. Speaking to CommonWealth, RSMC said that the way its cooperative model with Lee works is that patients can undergo in-vitro fertilization therapy at Lee Women’s Hospital, receive injections to stimulate ovulation, and then post-fertilization genetic diagnosis, after which RSMC ships the healthy embryo to the U.S. for implantation in a locally arranged surrogate mother.

The entire process is similar to the division of labor in the electronics industry commonly seen in Taiwan. “We’re responsible for parts and components, and RSMC (in San Diego) finishes the job,” quips Lee Mao-sheng.

Translated by David Toman
Edited by Sharon Tseng