When Prime Minister Yoshihide Suga vowed to expand national health insurance coverage for infertility treatment that can cost millions of yen, it shed light on the struggles that come with the treatment.

Going through the treatment is, for many, physically, emotionally and financially draining, to say the least. Suga has offered to ease the financial element, lifting a huge burden for the people, mostly women, going through the treatment.

But at the same time, money is not the only problem they face, and experts cite a need to create a better environment making it easier for people to undergo the treatment.

What kinds of infertility treatments are available in Japan?

With some 600 clinics and hospitals offering infertility treatment nationwide, the country has been seen as a leader in the field.

But despite easy access to specialist treatment, many people are forced to give up or discontinue treatment due to rising expenses, said Akiko Matsumoto, who heads the nonprofit organization Fine, which provides support for people suffering from infertility.

Currently, given that infertility has not been defined as a disease in Japan, the nation’s public health insurance covers only drug therapy with ovulation inducers, nonsurgical and surgical treatments for fallopian tube blockage, as well as surgical therapy in infertile men with seminal tract obstruction.

In vitro fertilization, which is considered the most effective form of assisted reproductive technology, is currently not covered by the national health care program. | GETTY IMAGES
In vitro fertilization, which is considered the most effective form of assisted reproductive technology, is currently not covered by the national health care program. | GETTY IMAGES

However, more advanced reproductive techniques are not covered by public health insurance.

One of those treatments is in vitro fertilization (IVF) — considered the most effective form of assisted reproductive technology — extracting eggs from the ovaries and fertilizing them with sperm in a lab. The embryos are then transferred to the uterus.

Another effective treatment is microinsemination, also called Intracytoplasmic Sperm Injection (ICSI), which is a specialized form of IVF treatment with one single sperm cell being injected directly into a woman’s egg under a special microscope.

How much does treatment cost?

For treatment covered by national health insurance, patients only pay 30 percent of the costs.

But for treatment outside of what’s covered by insurance, doctors and clinics are allowed to set their own prices, pushing up medical costs that can even exceed ¥500,000 per round.

An online survey conducted by Fine between September 2018 and January 2019 on people who had undergone infertility treatment showed a growing number of infertile people have spent more than ¥3 million for such care.

“Treatment is expensive because it’s not covered by insurance, and the reason it doesn’t have public insurance coverage is because it’s not deemed as a disease,” Matsumoto said.

Are there many couples who undergo infertility treatment?

According to the most recent available data from the National Institute of Population and Social Security Research, based on a 2015 study on fertility, 1 in 6 couples in Japan had undergone tests or some kind of treatment for infertility.

In general, infertility is defined as not being able to conceive after engaging in unprotected sex over the course of a year or longer.

Norihisa Tamura | KYODO
Norihisa Tamura | KYODO

Social changes are one of the reasons for this trend. As more women continue to work and remain financially independent, they tend to get married, and thus start a family, later in life, raising the odds of infertility.

Meanwhile, Japan’s birth rate has remained low.

The number of newborns has been falling for the past five decades, with only 865,234 babies born in 2019, down from about 2.1 million in 1973. Japan’s total fertility rate — the average number of children that a woman is estimated to give birth to in her lifetime — stood at 1.36 in 2019.

Does the government offer financial aid for infertility treatment?

Yes. Infertile couples have largely been heavily relying on the country’s infertility treatment subsidy system, which was introduced in 2004.

Under the system, married couples with an annual household income of less than ¥7.3 million can receive up to ¥300,000 for first-time in vitro fertilization or microinsemination, and then up to ¥150,000 from the second time onward. Men can also receive ¥150,000 for certain fertility-related surgeries.

In fiscal 2018, subsidies relating to infertility treatment were handed out in a total of 137,928 cases, according to the health ministry’s most recent data.

But with an age and income cap in place, not all can receive the subsidies.

Therefore, many local municipalities have introduced their own subsidy programs. For instance, the Tokyo Metropolitan Government offers subsidies to those who aren’t eligible for the central government system — those with an annual income of between ¥7.3 million to ¥9.05 million and also common law couples.

When is the government expected to expand the national health care program to cover infertility treatment?

Suga has vowed to expand insurance coverage from as early as fiscal 2022. But health minister Norihisa Tamura said that “it will take some time because the safety and effectiveness of infertility treatments need to be confirmed.”

In the meantime, the health ministry is considering raising the cap on annual household income eligible for infertility treatment subsidies and allowing common law couples to be eligible as well from April next year.

Are there concerns about covering the treatments under the national health insurance program?

Despite high costs for treatment, infertile couples can currently receive treatment tailored to their individual needs. But the planned expansion of insurance coverage is raising concerns about health risks and treatment quality.

Fine’s Matsumoto worries that with the change, services may be reduced to limited standardized treatment options provided in packages that would not be in line with personal needs.

Prices for treatments covered by the national health care program are decided by the government in detail, and patients pay medical costs based on the treatment they’ve received in accordance with that price list.

Prime Minister Yoshihide Suga has vowed to expand national health insurance coverage for infertility treatment that can cost millions of yen. | AFP-JIJI
Prime Minister Yoshihide Suga has vowed to expand national health insurance coverage for infertility treatment that can cost millions of yen. | AFP-JIJI

But if treatments are covered by health insurance, doctors may be restricted in terms of the treatments they offer, offering fewer options for patients.

“If Japan is to offer insurance coverage (for people struggling with infertility), it will need to ensure access to mixed treatment with partial coverage by health insurance and tailored services without such insurance coverage,” she said. “Otherwise it will be difficult to maintain the quality of care offered today.”

What are other challenges couples undergoing infertility treatment face?

Matsumoto stressed that people struggling with infertility face four types of challenges: physical burden, emotional struggle, financial burden and time constraints.

She explained that for those reasons many couples find it hard to juggle work with their efforts to conceive using assisted reproductive methods, which require regular medical checkups and urgent embryo transfers if the patient is in cycle or require urgent stimulation.

Matsumoto lamented that people struggling with infertility face a lack of understanding in society, where infertility is often viewed as shameful and demeaning, and that many infertile women report acts of discrimination or prejudice tied to their infertility.

In fact, a survey conducted on infertile couples in 2017 by the health ministry showed that 16% of people undergoing infertility treatment quit their jobs. Fine has also found through its survey that around just 7% of companies offer support to employees undergoing infertility treatment.

Matsumoto believes that education and work-style reforms are the key to help address challenges surrounding infertility and to raise awareness.

“Japan needs to aim for creating a social environment that will be conducive to childbearing and child-rearing,” Matsumoto said, warning that the current social climate is among the reasons why women delay childbirth, raising the odds of infertility.

“Currently children learn about contraception and abortion in schools, whereas infertility is not included in the curriculum — although it should be part of sexual health education. Educational programs should help (young people) plan their future career goals knowing that fertility decreases with age.”

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