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Wednesday, Sept. 8, 2010
When a baby can't come naturally
Quest by Noda, other women to get pregnant yields success stories, failures, risks, controversy
By MIZUHO AOKI
Seiko Noda, a Liberal Democratic Party lawmaker, surprised the public late last month by revealing in a magazine article that she got pregnant at age 49 through artificial insemination using a donated egg from a third person.
When she turned 50 on Friday, she made an official announcement about her pregnancy at a political fundraising party in Tokyo.
Noda has already made public her in vitro fertilization attempts with her former partner in her book "Watashi wa Umitai" ("I Want to Give Birth"), in which she wrote about her years of fertility treatment that resulted in a miscarriage.
With her present partner, Noda tried to adopt a child but was turned down because she is considered too old to raise a child and because she is a busy working woman, according to the article in the magazine Shukan Shincho.
When the door to adoption was shut, she headed for the U.S. in May to get pregnant via a donated egg.
"To be a mother, that was the only way left for me," Noda wrote in the magazine.
Today, as the trend to marry at a later stage in life continues, more couples suffer from infertility, and more women, like Noda, seek in vitro treatment using donated eggs from third parties, according to experts.
While the use of such advanced fertility technologies remains highly controversial in Japan for ethical and legal reasons, medical experts say the government urgently needs to establish clear guidelines or a law on in vitro fertilization using donated ova, because such cases are expected to increase.
Fertility declines after the age of around 35, and the chance of getting pregnant becomes extremely slim after around 42 because as women age both the quantity and quality of their eggs decline, experts say.
"When the reason for infertility is due to women's age, it is difficult to be treated. For some, the only way to have a baby is to use donated ova (of young women)," explained Toshio Hara, head of Hara Medical Clinic in Shibuya Ward, Tokyo. The facility specializes in fertility treatment.
Although it is not illegal to use donated eggs from third parties in fertility treatment, the Japan Society of Obstetrics and Gynecology effectively bans this option among its members. But the absence of a law regulating the use of donated ova has placed it in a gray zone.
"There may be some clinics that carry out in vitro fertilization using donated ova behind closed curtains. But because of the lack of clear guidelines, we do not know who is actually conducting the treatment in Japan. This is our biggest concern," said Yahiro Netsu, director of Suwa Maternity Clinic in Nagano Prefecture.
Suwa Maternity Clinic is the first and one of very few clinics in Japan openly conducting in vitro fertilization using donated eggs. It also practices a highly controversial surrogate mother program.
Since 1996, under its own guidelines, the clinic has conducted 150 treatments using donated eggs, through which 66 children were born and seven women are currently pregnant, according to Netsu.
"If an accident happens under such situations, a doctor may not take responsibility and a patient can fall victim. To avoid this, medicine must be practiced openly, especially when it deals with the birth of a human life," Netsu said.
In 2003, an advisory panel at the Health, Labor and Welfare Ministry released a report that recommended allowing the use of assisted reproductive technology using donated eggs from anonymous third parties under certain conditions.
However, no law followed this up because there were many opinions on the issue and no consensus, according to Yoko Izumi, a director in the health ministry's maternal and child health division.
As for the mother and child relationship, under the current law, the woman who gives birth is registered as the child's mother. That means, in Noda's case, she will be the mother of the child she is carrying.
Osamu Ishihara, professor and chairman in the department of obstetrics and gynecology at Saitama Medical University, said Japan is among the few developed countries where donated eggs are almost unused.
"Donated ova were used for about 3 percent of the babies who were born with assisted reproductive technology in the world. In the case of America, the ratio is about 12 percent," Ishihara said.
According to Ishihara, Italy and Turkey are the only countries in Europe that as of 2009 continued to ban the use of both donated sperm and eggs from third parties.
Although the government has not made significant progress, many children have been born via assisted reproductive technologies, or ART.
Nearly 20,000 babies, or 1 in about 56, were born through ART in 2006, according to the Japan Society of Obstetrics and Gynecology.
While no records exist on the number of Japanese women who had fertility treatments using donated ova, more people are seeking the treatment overseas, experts say.
Yukari Kawada, head of IntroMed, Inc. IFC, a fertility treatment coordinating agency in San Francisco, said the number of Japanese patients who enter its donated egg program is on the rise.
Since Kawada founded the agency 16 years ago, it has arranged for more than 700 Japanese couples to have assisted reproductive technology using donated ova from third parties in the U.S.
"Nearly 130 couples are currently under our donated ova programs," Kawada said in an e-mail.
One treatment costs about $55,000 on average, excluding travel fees, Kawada said.
More than 60 percent of the agency's patients are in their 40s and the agency boasts a 75 percent pregnancy rate. The agency accepts patients up to age 53.
Hara of Hara Medical Clinic warned of the risks of pregnancy at an older age.
"As long as a woman's uterus is in good condition, she can become pregnant by using donated eggs, regardless of her age. But by carrying a baby, her body needs to function for two people, and that puts the body in danger," he said.
According to Hara, pregnancy at over age 45 comes with many risks, including higher rates of miscarriage, pregnancy-induced hypertension and premature birth.
"It is up to medical doctors to judge the use of donated eggs. But everything is too vague and we are scared of crossing the lines," Hara said. "(The government has to provide) legislated guidelines to keep medical practice safe."
Women who go through fertility treatments meanwhile say they experience enormous mental and physical burdens. Orie Amada, 38, who got pregnant in her third in vitro fertilization attempt at age 34, said if she was still struggling with getting pregnant and if the use of donated eggs from third parties was available in Japan, she might have thought of undergoing the new option.
"I was desperate to have my own child no matter what happened to my body," Amada said. "Looking back now, I think my mental state wasn't normal during that time."
Misako Takahashi, 41, who tried in vitro fertilization about a decade ago but didn't get pregnant, voiced her concern over the spreading use of fertility treatments.
"I wasn't craving a child that much before the treatment. But as I went through the physical pain and sense of loss after failed attempts, I was obsessed with making a baby," Takahashi recalled.
After realizing it's not healthy for both her body and mind, she dropped the treatment.
"I think, for some, the use of donated eggs is good news. But people should know that not all can have a child by receiving fertility treatments. No matter how advanced medical treatment gets, there will be people who cannot give birth," Takahashi said. "Women should be aware of that."