Prime Minister Yoshihide Suga's pledge to boost fertility treatment support has offered rays of hope to couples longing for babies, but experts say the policy will not be a panacea for reversing the nation's declining birth rate.

As Japan, with the world's oldest population, struggles with dwindling numbers of newborns, Suga has vowed to make often costly fertility treatment eligible for coverage by national health insurance, with government officials eyeing the change as early as 2022. In the run-up, subsidies for couples undergoing such treatment will be sharply increased. 

Many couples who have undergone years of fertility treatment at the cost of millions of yen were encouraged by the move, but some experts say it may not be enough to boost the birth rate at a time when it is under fresh strain as the coronavirus pandemic darkens the economic prospects of working-age people.

Japan's new Prime Minister Yoshihide Suga listens to a question from a reporter during a press conference at his office in Tokyo on Sept. 16, 2020. (Kyodo) 

Japan's total fertility rate -- the average number of children born per woman during their reproductive years -- stood at 1.36 in 2019 with a record-low 865,234 babies born that year. The government aims to raise the rate to 1.8.

A 37-year-old Tokyo woman, who gave birth to a child after spending 2 million yen ($19,000) on four years of fertility treatment since she was 30, said she was "heartened" by Suga's push for expanded support. 

The woman, who changed clinics twice in the pursuit of better treatment, expressed hope that the public insurance coverage "will help improve the quality of medical care" provided at fertility clinics because their technology and equipment differ.

She also said she had not been correctly informed about rates of successful treatment at fertility clinics. Currently, as they operate outside insurance coverage, there are no standards covering their disclosure of clinical outcomes.

Another woman, a 35-year-old resident in an area north of Tokyo, also welcomed the new premier's initiative after spending 8.5 million yen on six years of fertility treatment. But she expressed concern that "women could be regarded as 'child-bearing machines' if the policy is only targeted at reversing the declining birth rate."

At present, most of the fertility treatment in Japan, except for the initial phase, such as tests to look into infertility and provision of ovulation-inducing drugs for timed intercourse, is not covered by the public health insurance, under which patients shoulder 30 percent of costs.

Photo shows a microinjection in which a single sperm is injected into an egg. (Photo courtesy of IVF Namba Clinic)(Kyodo)

More advanced methods such as in vitro fertilization, where eggs are collected from ovaries and fertilized by sperm in a lab, and microinjection, which resembles regular IVF but in which a single sperm is injected into an egg, can cost several hundred thousand yen per cycle.

Even though public subsidies totaling 1.05 million yen are available for couples for up to six IVF cycles, there is an age limit for women, currently set at 43. There is also a cap on a couple's combined annual income, set at 7.3 million yen in most municipalities.

"It's easy for couples comprising two full-time workers to exceed the annual income threshold," said Ran Kawai, a journalist specialized in childbirth issues. Furthermore, many recipients of the subsidies cannot cover the total costs despite the assistance, she added.

Under Suga's initiative, the health ministry is considering scrapping the annual income cap as well as relaxing restrictions on the number of IVF cycles and boosting the amount of subsidies from next April, ministry officials said.

Supplied photo shows Akiko Matsumoto,  head of nonprofit group Fine that supports those suffering from infertility. (Kyodo)

In countries such as France, Germany, Belgium and Israel, fertility treatment is covered by public health insurance to some degree, mostly with limits on the number of cycles and women's age, according to their authorities and data compiled by the NLI Research Institute.

But Japan has not opted for insurance coverage, with infertility not defined as a disease, despite a record 56,979 babies born in 2018 via 454,893 IVF cycles, or one in 16 newborns that year for the highest rate ever. In 2015, 18.2 percent, or one in every 5.5 couples, underwent infertility tests or fertility treatment.

The number of IVF cycles conducted in Japan is the largest among major countries, according to the International Committee for Monitoring Assisted Reproductive Technologies.

Akiko Matsumoto, head of nonprofit group Fine that supports those suffering from infertility, said momentum for seeking expanded assistance for them grew among Japanese political circles with then-Chief Cabinet Secretary Suga receiving a petition from ruling party members on the matter in June.


"When we organized a study session in parliament on fertility treatment in January, about 100 participants came, which was much larger than expected, and some of them enthusiastically discussed the matter," she said.

"It was encouraging to see the issue has gained public awareness, with some talking about their own fertility treatment experiences or someone close to them," Matsumoto said.

Akiko Matsumoto (2nd from L), head of nonprofit group Fine that supports those suffering from infertility, submits a petition to Akira Amari (2nd from R), leader of a Liberal Democratic Party group seeking expanded support for fertility treatment, to call for reduced burdens on patients on July 15, 2020. (Photo courtesy of FINE)(Kyodo)  

Among the lawmakers of the ruling Liberal Democratic Party pushing for insurance coverage of fertility treatment and other support is Seiko Noda, currently the party's executive acting secretary general, who gave birth to a boy at the age 50 in 2011 through IVF using a donated egg in the United States.

The major opposition Constitutional Democratic Party of Japan similarly submitted a petition to the health ministry in February, calling for insurance coverage and other patient support. CDPJ leader Yukio Edano's twin sons were born in 2006 after four years of fertility treatment.

The CDPJ also stressed that expanded public support for fertility treatment should not lead to increased pressure on couples to bear a child.

Tomoko Abe (3rd from L)  of the major opposition Constitutional Democratic Party of Japan, submits a proposal on boosting support for fertility treatment to an official of the Health, Labor and Welfare Ministry (2nd from R) on Feb. 28, 2020. (Kyodo)

Both Kawai and Matsumoto said they hope lowering the economic burden through insurance coverage leads more young couples to start advanced fertility treatment early, as their success rate is higher compared with that for older couples, possibly shortening the treatment period.

According to 2018 data from the Japan Society of Obstetrics and Gynecology, the rate of childbirth per total IVF cycles stood at 21.6 percent for women aged 30, but fell to 9.5 percent for those aged 40.

"About two-thirds of advanced fertility treatment patients in Japan are aged 35 or older. If the government can boost financial assistance to people through the universal insurance coverage, they can feel free to start receiving it any time," Kawai said.

The journalist also argued it is unreasonable that IVF treatment for those with such problems as tubal obstruction and lack of sperm in semen has not been covered by health insurance.

A Fine online survey conducted for four months through January 2019, which drew responses from some 1,500 people who have undergone fertility treatment, found the largest group of 24 percent shouldered costs of from 1 million yen to less than 2 million yen.

More than half of the respondents said they have become hesitant about, postponed or given up receiving advanced treatment due to economic burdens, with percentages high among those under 35.

The health ministry is set to conduct by next March a survey on some 600 IVF clinics and the general public in Japan on fertility treatment costs. Since the amount of the current subsidies is based on the ministry's fiscal 1998 survey, Matsumoto said such research is "long overdue."

Kawai said boosting support for fertility treatment should be seen as only one of several measures needed to help reverse the declining birth rate as Japanese women's lifestyles diversify, with many marrying later in life.

She suggested that another factor stemming from the coronavirus pandemic that may affect the birth rate besides the expected drag from the economic impact is that many young people may be missing opportunities to go out and find partners.

"The number of newborns is expected to sharply drop this year," she said.

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