In 2010, one of Japan’s most prominent female politicians, Seiko Noda, sparked controversy by bearing a child at age 50 through artificial insemination after years of infertility treatment.
“What bothered me is that especially in the initial stage (of the therapy), I wasn’t even able to say it out loud that I was going through (infertility treatment) and I felt as if I were doing something you just don’t tell people about,” she said while looking back on the push to improve infertility care in Japan.
Although infertility treatment options and access to such care in Japan have expanded over the years, the stigma associated with infertility has for decades made women keep their struggles under wraps. Ten years after Noda’s own experience, the government is eyeing health reforms, primarily aimed at reducing the cost of infertility treatment using more advanced reproductive techniques, as early as April 2022. But the veteran lawmaker believes that easing financial burdens will not be enough to help women in pursuit of motherhood raise their chances to conceive.
In a recent interview, the executive acting secretary-general of the ruling Liberal Democratic Party said the government’s recent move to boost insurance coverage for infertility is a response to her yearslong push to improve accessibility to such treatment. But she said that further societal changes will be critical in addressing the nation’s infertility problem.
Noda, who has expressed her desire to become the country’s first female prime minister, has throughout most of her career been encouraging women to play a more active role in politics and the economy, making the tackling of gender inequality a part of her agenda. She has also been a representative member of a coalition of lawmakers seeking revision of the existing infertility treatment subsidy system and laws regulating reproductive rights by clarifying parenthood in infertility treatment.
Prime Minister Yoshihide Suga has vowed to expand public insurance coverage for infertility treatment, which in many cases can cost millions of yen. Currently, 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.
Noda acknowledges she was financially privileged. But many couples have been forced to give up or discontinue treatment due to rising expenses. So far, the government has offered subsidies, allowing married couples with an annual household income of less than ¥7.3 million to seek grants of up to ¥300,000 for first-time in vitro fertilization or microinsemination, and then up to ¥150,000 from the second time onward.
From January, the government has decided to revise the system and offer subsidies worth ¥300,000 for the first six IVF rounds and abolish the income cap until 2022, when such treatment options will be covered by public health insurance.
But money is not the only problem infertile people longing for children face, Noda said. While praising Suga’s fertility push, Noda points out that the government will need to provide further support to alleviate the psychological burden infertile couples carry alongside their efforts to conceive.
“There are lots of discussions about the financial burden of infertility care, but (even) in my case, the real struggle was balancing the treatment with my work schedule,” the 60-year-old recalled.
In pursuit of her ardent wish to become a mother, Noda dove into infertility treatment at 40, soon after entering a common-law marriage with her partner at the time, Yosuke Tsuruho. Noda’s struggles to conceive naturally were caused by blockage of the fallopian tube.
The lawmaker learned the hard way about the burden for women going through infertility treatment and tried to adjust her therapy and doctor visits to her daily routine in her fast-paced lifestyle as a politician. Her treatment plan required stimulating ovulation with fertility drugs on a daily basis, frequent blood tests and daily hormone injections. Until Noda separated from Tsuruho in 2006, she underwent 14 artificial reproductive treatments. One of the attempts resulted in pregnancy but ended with a miscarriage.
“This was a heavy load to carry even from the perspective of someone with some grit (to compete in the political arena),” she said, recalling difficulties to change an appointment on the day of egg retrieval during IVF, a process in which mature eggs are collected from ovaries and fertilized by sperm in a lab.
While infertility of course affects men as well, women often carry the overall burden of treatment by undergoing IVF. But Noda pointed out that the public needs to recognize that infertility is not just about women, stressing that further health reforms won’t work without encouraging a healthy work-life balance.
Noda described her infertility journey, which ended with the miscarriage, in her book “Watashi wa Umitai” (“I Want to Give Birth”). With her present husband, Fuminobu Noda, she initially sought to adopt a child but was turned down due to her age and lifestyle. She eventually got pregnant by using a donated egg and gave birth in the U.S. The mother of a 10-year-old boy later elaborated on the continuation of her attempts to conceive, her pregnancy and the childbirth in her second book, “Umareta Inochi ni Arigato,” which roughly translates as “I’m Grateful You Were Born.”
According to the most recent available data from the National Institute of Population and Social Security Research, 1 in 6 couples in Japan had undergone tests or some kind of treatment for infertility. While for most couples infertility is a grim reality, a survey conducted on infertile couples in 2017 by the health ministry showed that 16% of those undergoing infertility treatment had quit their jobs.
Noda laments that the proposed changes didn’t happen sooner. She pointed out that despite infertility being a disease, most advanced treatment methods have not been covered by the national health insurance system due to their low success rates, contrasting with tobacco cessation treatment and care for metabolism disorder, which are often associated with unhealthy lifestyles.
However, the lawmaker stressed that women undergoing such therapy also carry a psychological burden, saying that the system now under revision and attitudes toward infertility stem from the notion that when a woman can’t get pregnant, it’s simply her fault.
She said existing policies on infertility care have so far reflected Japan’s male-dominated political landscape, where laws and regulations including those related to women’s health have been deliberated and agreed upon mostly by men. In contrast with care for women’s infertility, sperm donation as a solution to men’s infertility has long been supported, she said.
Noda has also voiced concerns about insufficient support for adolescent and young adult cancer survivors between the ages of 15 and 39, who are at risk of ovarian failure and infertility. Not all forms of cancer treatment lead to infertility, but certain types of chemotherapy can cause permanent damage to eggs and sperm cells.
Noda believes the changes to the health care system should include coverage of costs incurred to preserve young cancer patients’ fertility, enabling them to freeze their eggs and sperm before they start treatment for cancer.
But efforts to raise awareness of the problems surrounding inability to conceive and, eventually, increase the chances of becoming pregnant, should start at an earlier age, Noda said. She pointed to the lack of accurate sex education in Japan, with curriculums omitting the topic of infertility, thereby creating unrealistic expectations that possibly raise the odds of infertility.
“I started treatment when I was 40 but now I am aware the chances of having a baby are extremely low after the age of 40,” she said. “At that time (when I was trying to conceive) no one would explain it to me or stop me (from pursuing my dream to get pregnant) and I simply clung to the hope that I would get pregnant.”
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