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In response to the increasingly serious problem of Japan’s falling birthrate, patients and medical professionals involved in fertility treatment are calling for the cost of treatment to be covered by national health insurance.

They point out, however, that insurance coverage alone would not solve the problem.

On Friday, the last day of a three-day symposium in Tokyo organized by the Japan Society of Fertilization and Implantation and the Japanese Society of Fertility and Sterility, participants discussed ways to help people who are having problems conceiving.

According to the health ministry, approximately one in every 10 Japanese couples — or some 1.2 million couples — suffer from infertility.

Twenty percent of the total, or about 285,000 couples, were receiving some kind of treatment in April 2003.

One quarter of those couples were undergoing treatment such as vitro fertilization (IVF), in which an egg and sperm are incubated in a laboratory dish and returned to the womb, or intracytoplasmic injection (ICSI), in which a single sperm is injected into an egg.

While the cost of treatment is high, only a fraction is currently covered by insurance.

Yukari Senba, a member of The Friends of Finrrage, a self-help group for infertile women, said that while patients would welcome insurance coverage as it will help cut their financial burden, the government’s plan to directly link financial aid to any rise in the birthrate poses a serious danger.

She claims the proposal is similar to the war-time attitude that women should reproduce for the benefit of the state.

“Even if Japan was overpopulated, the feeling that we want a child will not change,” she said. “We are not trying to have children to redress Japan’s population situation.

“The government must see the two as totally different matters,” she said.

Though the number may be small, Senba said some patients oppose insurance coverage as they believe it will encourage people, such as a husband’s parents, to put more pressure on couples to undergo treatment, which may pose a health hazard due to the high amounts of hormones used.

The treatment is also time-consuming. For example, to undergo IVF, a woman usually has to go to hospital for up to 10 consecutive days.

Seiko Noda, a House of Representatives lawmaker who underwent treatment six times, said insurance coverage will be merely a drop in the ocean as a remedy for Japan’s low birthrate.

“If the state wants to increase the birthrate, the first thing it has to do is realize how hard the current environment is for women to have children and do something about it,” she said. “Many people are giving up having children for financial or career reasons.”

According to Shigeru Sasaki, vice chairman of the Japan Association of Obstetricians and Gynecologists, about 50 municipalities already grant subsidies to people who undergo fertility treatment.

To support these moves at the municipal level, the ruling coalition has already agreed to use part of the financial resources that will be available from January 2004 as a result of revisions to the tax system that will reduce special tax deductions currently granted to salaried workers with children and spouses.

“The move itself is good because it is the first time that the state has recognized patients’ financial difficulties,” Sasaki said. “But the proposed amount of 100,000 yen, with a limit of twice per patient, is far from reality, when a cycle of IVF treatment costs as much as 463,000 yen and ICSI costs about 568,000 yen.”

He added that insurance coverage is a more impartial means as subsidies differ in each municipality.

“The nation’s medical costs of 30 trillion yen are less than half of the construction investment of 85 trillion yen,” Sasaki said. “Japan should spend more on its people’s health.”

In November, health minister Chikara Sakaguchi said the ministry is considering extending insurance coverage for infertility treatment by the end of fiscal 2003.

The government has failed to address the problem, however, due to opposition from some lawmakers who claim infertility is not a life-threatening disease and that the successful rate of treatment is very low.

One in every 100 babies in Japan are born as a result of IVF or ICSI, but the rate among women who gave birth after IVF is just 12.4 percent of all those who received the treatment in 1999. Those who gave birth after ICSI stood only 14.9 percent in the same year.

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