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Tuesday, Aug. 28, 2012
Late pregnancies, little financial aid for fertility treatments conspire against rise
Revival eludes nation's birthrate
By MASAMI ITO
It sounds like a broken record: Japan is beset by a low birthrate and an aging society.
The nation certainly has a long "to do" list to finish before it can create an environment more conducive to raising children.
Amid a surge in singles, efforts were made to reverse the trend with what became known as "konkatsu," the spouse-hunting trend.
But finding a mate was just the beginning. The next, more important, stage was "ninkatsu," the pursuit of pregnancy.
How did the term ninkatsu come about?
Like konkatsu, ninkatsu borrows from the word "shukatsu," which is short for "shushoku katsudo" (job-hunting). It's a shortened form of the term "ninshin katsudo" (pregnancy activity), which pertains to women who are actively trying to get pregnant, not just those undergoing fertility treatment.
The older a woman gets, the harder it becomes to have a successful pregnancy, particularly after she turns 35. Medical experts are concerned that more and more women are having their first babies at an older age, which poses higher risks. They are advising women to start having kids when they are younger.
In the book "Ninkatsu Baiburu" ("Pregnancy Bible") published in March, Hidekazu Saito of the National Center for Child Health and Development said that in Japan, young girls and boys are taught how to avoid unwanted pregnancies and not enough about how to get pregnant.
He says the ovum holds the key to getting pregnant because the number of healthy eggs declines as a woman ages. And unlike women's improving ability to maintain a youthful outer appearance, "as of right now, no antiaging method has been found for the eggs."
Are more women undergoing fertility treatment?
Yes. According to the Japan Society of Obstetrics and Gynecology, 26,680 babies were born through in vitro fertilization in 2009, jumping from 11,119 in 1999. This means 1 out of every 40 babies is born through IVF.
There are no recent data on exactly how many women are undergoing fertility treatment, but health ministry data for 2002 said there were 466,900 patients.
Liberal Democratic Party lawmaker Seiko Noda underwent 14 IVF procedures unsuccessfully with her first husband.
"We were taught that those who try hard shall be rewarded, but my reality was that no matter how hard I tried, I couldn't get what I wanted and I became pretty emotionally unstable," Noda recalled in an interview with The Japan Times.
"The first time was the hardest because I really believed I would get pregnant, and after that it became all about probability, trying again and again. . . . I felt like I was chasing a hopeless dream."
After meeting her current husband, the couple first applied to adopt a child but were rejected for reasons that included her age and the fact that both spouses worked.
She finally became pregnant on her 16th IVF try by implanting the husband's semen and an American woman's egg inside her uterus in 2010. She gave birth to a boy at age 50, a decade after beginning the treatments.
Are more women giving birth later in life?
Yes. Health ministry data show that in 2011, the average age for initially giving birth was 30.1, passing 30 for the first time. In 1975 the average age was 25.7.
Doctors find the trend alarming because the miscarriage, chromosomal abnormality and other disability rates all go up with age. JSOG data from 2009 show that 17 percent of women aged 35 can get pregnant on their first IVF try. At age 40, the rate plunges to 8 percent.
In Noda's case, her baby is 19 months old but has never left the hospital. He has had seven surgeries so far and is about to go through his eighth.
But the former state minister of consumer affairs said that everything has been within her expectations and that she is grateful he was born.
"It didn't even occur to me not to give birth to him. He was a blessing and I felt it was my mission to have him," Noda said. "I think my son is amazing . . . and watching him grow in his own world means everything to me."
What constitutes infertility in Japan?
Medical experts say that if a couple have been having intercourse for two years and have been unable to conceive, they should consult a doctor.
Women should undergo a series of tests to check their hormone levels, remaining egg supply, and for infectious diseases, and should also have their uterus and fallopian tubes examined. Men usually have their semen tested for volume, motility and malformation.
If the doctor issues a clean bill of health for both, the couple would then be coached on how to have intercourse during peak ovulation times.
If this doesn't result in pregnancy, they would be advised to attempt artificial insemination or IVF.
What about using surrogate mothers and other women's eggs?
There are actually no laws regarding reproductive treatment, but neither procedure is widely conducted in Japan.
In 2003, a government-sponsored panel issued a report stating that couples should be allowed to use donated eggs only if there is no other way to conceive. This may be a natural step because AI using a donor's semen has been conducted in Japan for over 60 years.
But the same report also advised a complete ban on using surrogate mothers, mainly because a paternity conflict could develop between the couple and the surrogate mother.
There is only one institution that carries out surrogate-related procedures, the Suwa Maternity Clinic in Nagano Prefecture.
In a famous case, TV celebrity Aki Mukai and her former wrestler husband, Nobuhiko Takada, used a surrogate mother in the United States to give birth to twins in 2003. But Japan refused to acknowledge the children as theirs as Mukai, who had her womb taken out due to uterus cancer, did not physically give birth.
Experts agree that a legal framework is needed promptly, and Noda and some LDP lawmakers are in the process of drafting a bill that would allow surrogacy and egg donors under certain circumstances.
Is fertility treatment expensive?
Yes. While "general" fertility treatment, including ovulation induction, is covered by health insurance, AI and IVF are not. In general, the AI route costs around ¥10,000 to ¥30,000 per trial and IVF ranges from ¥300,000 to ¥500,000 for one try.
But given that it takes many women multiple attempts to become pregnant, the expenses snowball.
According to Internet marketing and research firm Buzz Labo Co., the average cost for women undergoing treatment was ¥1.4 million and it took 25 months on average to get pregnant.
To financially support those trying to conceive through IVF, the government began providing subsidies in 2004. For couples earning less than ¥7.3 million annually, the government will provide ¥150,000 per IVF trial for 10 attempts within five years. In the first year, the couple can undergo IVF up to three times, and from then on, up to twice a year.
Why doesn't the government provide more support if the birthrate is such a problem?
The annual budget for IVF subsidies is around ¥10 billion, but tight financial constraints make an increase unlikely, according to the health ministry.
Medical experts are also opposed because they believe IVF success largely depends on a woman's age, and the ages of many seeking treatment appear to be rising.
Noda disagreed, arguing that subsidies should be provided to all who want to become pregnant. The lawmaker recommended that the government pay the full amount for IVF treatments for the first few times for all patients and instead cut budgets for other treatments that can be overcome by individual effort, like quitting smoking.
"There are many people who had to give up on infertility treatment because of the costs, and that is sad. Subsidies would open the doors for many people, including those who are young that have the possibility" of getting pregnant through IVF, Noda said.
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