The women sit in a circle in a silent room.

One claims she suffers from panic disorder; another says she feels worthless, and divorce and distancing herself from her husband’s family are the only ways to relieve her pain.

Keiko Akagi, a counselor who runs this workshop for infertile women, also suffered depression from the high social expectations on women to conceive.

While in her 30s, she underwent treatment even though she knew her case was incurable, with both her fallopian tubes completely blocked.

“My mind could only be at peace when I was doing something, although I knew it was useless,” she recalls.

Now 54, Akagi is surprised to find that for today’s Japanese women, the pressures of being infertile seem even heavier than in her time.

“To be labeled ‘infertile’ is still a stigma in Japanese society and viewed as a disgrace, especially in rural areas,” she says.

“And although the causes can lie equally with both men and women, women are often blamed. One woman who was married to a farmer was asked by her husband to (divorce him and) go home. Another committed suicide.”

Ironically, the emergence of reproductive technologies aimed at helping the situation have actually created more stress for women, according to Yuriko Marumoto, director of Yuri Ladies Clinic in Koto Ward, Tokyo.

Many women nowadays feel that with a longer life expectancy and more job opportunities, they can plan ahead and have more control over their lives, she says.

“(But) fertility, which declines rapidly in women after 35, is one of the few things they cannot change.”

While factors other than age, including endocrine disrupters and the stress of modern life, are also blamed, the infertility rate, said to be about one in 10 couples in Japan, has not increased.

The availability of medical treatment, however, is prompting more people to seek help, and as many as 280,000 patients were being treated for infertility as of February 2000, according to the health ministry.

Amid the low birthrate, 11,929 babies, or one in 100, were born by assisted reproductive technology in 1999. As more couples make use of such treatments, some researchers expect the figure to reach one in 50 within a few years.

While the physical pain and side effects from hormones and other elements of the treatments are an issue, the most serious problem with assisted reproductive technology, or ART, is said to be the financial burden and time constraints when weighed against the low success rate.

Infertility treatment normally begins with a general check lasting one to two months.

If the cause cannot be pinpointed at this stage, the doctor instructs the patient on the best timing to try to conceive after examining her cycles. This is followed by artificial insemination. Both approaches can be accompanied by hormone injections.

When these prove ineffective, the treatment moves to a higher phase of ART, such as in vitro fertilization embryo transfer, where an egg and sperm are incubated in laboratory dishes, and intracytoplasmic injection (ICSI), where a single sperm is injected into an egg.

Satoko Nagaoki, an associate professor of biology at Keio University and a member of The Friends of Finrrage, a self-help group of infertile women, says that a single IVF or ICSI treatment can cost between 300,000 yen to 500,000 yen. Twenty percent of the group’s 857 members and former members said they spent more than 2 million yen at clinics and hospitals in 1999, while 4 percent said they invested more than 4 million yen. Many continue to undergo treatment.

“Clinics and hospitals use pregnancy rates when publicizing their success rate,” Nagaoki says. “But this is actually deceiving, because many pregnancies fail at a very early stage.”

She added that in 1999, only 12.4 percent of women treated through IVF and 14.9 percent receiving ICSI actually gave birth.

An increasing number of Japanese couples also hire surrogate mothers abroad, paying as much as 15 million yen and creating ethical questions.

In response to strong requests, mostly from patients, the Health, Labor and Welfare Ministry announced earlier this month it would consider allowing public health insurance to cover a greater part of infertility treatment by fiscal 2003. Currently, insurance pays for only a small part of the treatment.

While some oppose this on the grounds that infertility is not a life-threatening disease, there is opposition even among those directly involved.

“The high cost gives us an excuse to quit,” one 37-year-old patient says. “But if insurance becomes available, there will be even more pressure on us to continue the treatment, which is also potentially hazardous to health.”

Some say they fear insurance coverage will increase patient numbers, lengthening the already long waits at hospitals.

One 35-year-old woman says she has been left in an awkward position at work, at times having to go to the hospital daily for 10 days or so.

“At my Minato Ward hospital, I often have to wait three hours just to see the doctor or get an injection,” she says. “I’ve used up all my holidays and excuses to be out of the office. My job assessment is a disaster, but I won’t be able to afford the treatment if I quit work.”

Chiharu Wada is an editor at Shufunotomo Co., which publishes the quarterly magazine Akachan ga Hoshii (We Want Babies) and operates a Web site on the issue in hopes of making the problems more open and discussable.

According to Wada, some women suffer so much they can only identify themselves through their infertility.

“These women develop grave psychological disorders,” she says. “Because they used to hate pregnant women, they cannot accept themselves when they themselves successfully conceive, even though they underwent years of treatment.”

Mika Hisamatsu, director of the nonprofit organization Heart-Beat Club, thinks the pain of infertility also creates a wall between women.

Her group, whose members suffer from “recurrent pregnancy loss,” seeks separate social recognition from infertile people.

“We used to send e-mail to infertile women’s sites, hoping to be accepted as members, but we were slandered,” she says. “There’s always an infertile woman who says something like, ‘What are you complaining about? At least you can get pregnant!’ “

Likewise, women logging on to infertility sites who successfully become pregnant are asked to move to a separate chat room because their presence aggravates the others.

Meanwhile, promising new medical techniques continue to appear, making women feel they cannot give up, even if the possibility of a successful pregnancy is very low.

Earlier this month, researchers unveiled a new method, in which retrieved eggs are injected into the uterus immediately before ovulation and fertilized by sperm already in the woman’s body. The process is considered revolutionary because it is more natural than other methods and poses less of a burden on the woman.

Takahiro Takeda of the nonprofit organization Japan Research Association of Reproductive Medicine, which aims to relieve patients’ psychological stress by training counselors and in vitro fertilization coordinators, says recent health ministry research showed that 81 percent of all pregnancies through artificial insemination occurred within the first seven attempts.

Similarly, 88 percent of pregnancies occurred within the first four attempts of in vitro fertilization embryo transfer, and the first five ICSI attempts. But the success rate did not rise even when the trials continued.

“I hope these figures are convincing for both doctors and patients when they consider when the treatment should stop,” he says.

“We should all be able to lead a good life, with or without children.”

In a time of both misinformation and too much information, quality journalism is more crucial than ever.
By subscribing, you can help us get the story right.