A fertile business
Europe is helping Japan to improve its birth rate
Text by David McNeill
Text by David McNeill
It shouldn’t be a surprise that a country running short of children has one of the world’s busiest fertility hospitals. The Kato Ladies Clinic in Shinjuku, central Tokyo, performs an average of 27,000 in vitro fertility (IVF) cycles per year. Dozens of women file through its operating suites every day to have their eggs stimulated, extracted, fertilised, frozen and implanted. All that effort produces about 4,000 successful pregnancies annually, says a spokesperson for the clinic.
That’s still a relative drop in the bucket. In 2016, the number of births in Japan dipped below one million for the first time since the government began keeping statistics in 1899. Japan’s fertility rate — the average number of children a woman will bear over her lifetime — is 1.44, only a slight increase on the postwar low of 1.26 recorded in 2005, but still far below the population replacement rate. Without a change in Japan’s immigration policy, government estimates predict the nation will lose a third of its current population of 127 million by the middle of the century.
Fertility treatment can help soften this demographic crunch, says Klaus Jacobsen, president of Origio Japan. Origio is a Danish company that sells IVF products and services to many of the roughly 600 hospitals in Japan that help infertile couples. The firm provides everything from the devices used to extract eggs to the cryopreservation technology to freeze them.
“Between one in five and one in six couples in Japan now struggle to conceive,” Jacobsen points out.
That makes Japan a growing market — and a distinctive one.
IVF treatment helped bring over 50,000 Japanese babies into the world last year — 5% of all births in the country — according to the Ministry of Health, Labour and Welfare. The figures are a testament to how badly many parents want to conceive, despite the cost: about ¥300,000 to ¥500,000 per attempt, and sometimes more.
Japan has the highest rate of IVF treatment in the world, according to Akiko Matsumoto, president of the NPO Fertility Information Network (Fine) — and, she laments, the lowest success rate of about 20%. One reason for this is the increasingly advanced age of recipients: Japanese women are, on average, older than Europeans when they first attempt IVF. And the older women get, the harder it is for them to conceive. Career pressures and the cost of living are forcing many to put off marriage; social pressures mean there are far fewer babies born out of wedlock than in Europe. The upshot is that many are trying to get pregnant in their late thirties or their forties.
Another key issue, notes Origio’s Jacobsen, is the big gap in success rates of clinics.
“There is no independent auditing or ranking,” he says. Specialist training for embryologists is in short supply, too, he adds.
Still, scientific advancements have dramatically improved success rates since Japan’s first “test-tube” baby was born in 1983.
For example, analysis of hormone levels, which can reveal causes of infertility, can today be done extremely quickly.
“It is very important to evaluate hormone levels during a consultation to determine the diagnosis and the course of treatment,” explains Mikio Matsumoto, manager of the Clinical Marketing Group at Roche Diagnostics K.K., a Swiss-based healthcare firm and manufacturer of in vitro diagnostics medical equipment. “Our analysis equipment and reagents used for hormone-level measurement takes only 18 minutes to yield results, and they are used in many IVF clinics.”
Additionally, more and more women are successfully giving birth later in life.
“These days it is possible to reach pregnancy at a higher age than ever before,” says Kaoru Koyama of Vitrolife, a Sweden-based company with an office in Tokyo that also offers assisted reproduction services. “However, the cost of adopting these technologies is also on the rise.”
Without better insurance coverage, she says, many will have to rule out IVF treatment.
Unlike many European countries, Japan’s national health insurance does not cover treatment. However, since 2004, a subsidy system pays for the first attempt and ¥150,000 for a limited number of follow-ups — with conditions: the recipient must be under age 43 and not earning more than ¥7.3 million a year. These subsidies are dispersed for about 160,000 cases annually. Thousands more people pay out of their own pockets; Matsumoto says one woman who came to Fine for help had tried four times a year for over a decade.
In a country where deaths now outstrip births by about 300,000 a year, more could be done, bemoans Matsumoto. She notes that hundreds of Japanese people travel abroad for donors and surrogates every year.
“The government should offer better financial and emotional help,” Matsumoto says.
With proper legal guidelines and financial aid, IVF could help produce 300,000 to 400,000 more babies in Japan annually, claims Jacobsen of Origio.
There is some shifting ground. Starting this year, the health ministry will extend its IVF subsidies to include couples who are not married, a recognition that many common-law partners also want children.
IVF is emerging from the shadows: for years, women often underwent difficult and emotionally draining treatment in secret. Japan has come a long way since journalists were warned off discussing the taboo subject of fertility treatment for Princess Masako, wife of Crown Prince Naruhito, who gave birth a few days before her 38th birthday in 2001 to Princess Aiko.
Yet, prenatal screening, sperm donors, oocyte (egg) freezing, surrogate pregnancy and other aspects of reproductive healthcare are still vaguely and unsatisfactorily governed by “guidelines” issued mainly by the — mostly male — Japan Society of Obstetrics and Gynecology. According to Matsumoto of Fine, government ministers still cling to the comforting certainties of natural birth and traditional families. Fine, Origio and other organisations are lobbying for a comprehensive IVF law.
The legal foot-dragging will become more glaring as the industry advances. IVF technology now allows for the freezing of oocytes and ovaries to preserve fertility. Donation is becoming more sophisticated. The hot topic today, says Koyama of Vitrolife, is pre-implantation genetic analysis.
“This makes it possible to reduce the risk of passing on genetic diseases to offspring,” she says.
It can also improve the chances of getting pregnant. Screening for, or selecting, certain genetic traits will become increasingly common. Ultimately, though, notes Jacobsen, it is politicians, not technicians, who will help shape the industry’s future.
“You need a political agenda,” he says, “or nothing will change.” •