Five years ago, singer Kumi Koda caused an uproar when she joked on a late-night radio show about how a woman’s amniotic fluid (yōsui) becomes “spoiled” as she gets older. The subtext of the comment was the advantage of having babies at a younger age, but those quick to ridicule Koda’s lack of gynecological expertise (including this column) fixated on what they saw as a swipe at women who put off having children due to careers and other exigencies of life.
If Koda made the remark today, she might not receive such a negative response. Though amniotic fluid does not “spoil” as one gets older simply because it does not remain in a woman’s body over time, the notion that it is more difficult for older women to have children is now an intensely discussed health issue in Japan, where the birthrate continues to decline.
And while Koda’s grasp of biology was flawed, her premise — that an essential feature of a woman’s ability to procreate becomes obsolete with age — wasn’t far from the mark. Ovarian follicles, which produce eggs for reproduction, are present in a female’s body before birth, and decrease in number as she gets older. Scientists estimate that the average girl has about 300,000 follicles at the onset of puberty, and thereafter loses about 1,000 with each menstrual cycle. When the number reaches 25,000, the chances of becoming pregnant drop considerably, which happens at about age 37, depending on the individual.
This past spring, the government announced it would produce and distribute a handbook about pregnancy and childbirth for teenage girls in order to get them thinking about having children, but women’s groups objected to the implication that women’s only value to society lies in their ability to reproduce. The plan has since been shelved, but in a sense it had the desired effect, and not only on the targeted demographic. According to a recent article in Aera, an increasing number of working women in their 20s are seeking advice on in vitro fertilization later in life. Interest in the procedure was sparked by an NHK documentary aired late last year about the difficulties experienced by women over 35 when they try to conceive and bring a child to term. Aera says this interest has boosted the profiles of services that offer to freeze eggs. Women who think they may want children someday have their eggs extracted and stored so that they will have viable material if and when they do decide to become mothers.
The government has not weighed in on these services, but a health ministry advisory panel is currently working on new guidelines for fertility treatments, which are not covered by national health insurance. However, the government does provide partial subsidies to married couples who undergo such treatments. At present there is no age limit for receiving the subsidy, only an income ceiling (¥7.3 million a year), and a couple can be reimbursed for up to 10 treatments over a period of five years. Subsidies were first made available in 2004, when 17,000 were granted. Last year, 135,000 payments were made for a total of ¥20 billion. The maximum amount of a single payment is ¥150,000, while the cost of IV fertilization is between ¥300,000 and ¥400,000. Since 2010 only 29,000 babies were born as a result of IV procedures covered by the subsidy.
The new guidelines will take into consideration the effects of aging on childbearing. A woman’s chances of conceiving a baby drop from 1 in 5 at age 32 to 1 in 50 at age 43. In addition, the rate of miscarriage increases by 50 percent after 35. Consequently, the panel is recommending an age limit of 42 for the subsidy. Asahi Shimbun reports that the panel originally wanted to set the limit at 39, but 30 percent of subsidies now go to women over 40. In addition, the number of subsidies allowed for one couple would be cut from 10 to six, but the time period will be removed.
The purpose of the revisions is to persuade couples to have children earlier, whether it be by natural or artificial means. But the operative word is still “couples,” and while the implied inclusion of men in the decision-making process might placate people who think that too much of the burden for increasing the birthrate is being shouldered by women, limiting the discussion to married people has had an effect the government probably didn’t intend.
In all the Aera interviews, young women say they are interested in egg storage as a fallback measure. They want to do something now to increase their chances of conceiving later in life, but none are married. Nor do they have boyfriends (one does, but she doesn’t consider him husband/father material). Though they attend matchmaking sessions and are on the lookout for potential mates, they are too busy with work, and Aera implies this isn’t going to change. For one thing, men know about this biological-clock problem, too, and those who associate marriage with families are looking for younger mates, which would seem to mean the older these women become, the less their chances of getting hitched. If they still want to take advantage of their stored eggs when they’re older, many may end up doing it alone.
Dr. Yasunori Yoshimura, a health ministry advisor, tells Aera that women need to be better informed of the drawbacks of the technology, but he also says the government has to look at the issue in a larger context. Sex education should not just be about contraception and STDs. It should also be about the “social environment” of having children, including a woman’s choice to give birth without a partner, something the government discourages by limiting subsidies to married couples. And according to a survey carried out by Asahi, many doctors advocate using national health insurance to pay for such treatment, though, of course, given the probability of success such a move would benefit health-care professionals more than it would the government. In the cold terms of cost-performance, maybe having kids isn’t worth it.
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