In Japan, the declining birthrate is said to be one of the most pressing issues facing Japanese society. The number of births in 2021 was the lowest ever, at 840,000.

Many people who want to have a child but are unable to do so are seeking fertility treatment. However, infertility treatment is expensive. According to a survey conducted in 2017 by a research group of the Ministry of Health, Labor, and Welfare, the average cost of infertility treatment was 380,000 yen per IVF session and 430,000 yen per ICSI session. The survey also found that the total amount paid for treatment was most commonly less than 1 to 2 million yen, and the number of people paying more than 3 million yen has been increasing every year. The cost of infertility treatment has been considered an issue that needs to be resolved, as the declining birthrate is thought to be further exacerbated when people give up on the idea of having children because of the high cost of treatment.

The high cost of infertility treatment in Japan is related to the fact that it has been provided through free medical treatment that is not covered by the National Health Insurance or other public medical insurance. While free medical treatment has the advantage of allowing patients to try new medical treatments and drugs, it also has the disadvantage of higher treatment costs. In addition, it is sometimes perceived that “free treatment = not recognized as a disease,” and some people who have been treated for infertility in the past must have felt guilty about undergoing treatment, or felt bad about taking time off work to go to the hospital. If treatment can be provided by public medical insurance, it is thought that “infertility is a kind of pathology and is subject to treatment” will spread throughout society.

In Japan, as a result of deliberations at the national council (Central Social Insurance Medical Council), “general infertility treatment” such as artificial insemination, and “assisted reproductive medical treatment” such as in vitro fertilization and intracytoplasmic sperm injection, etc., whose effectiveness and safety have been confirmed by relevant academic society guidelines, etc., will be covered by insurance from April 2022. The Japanese Society for Reproductive Medicine (JSRM) has announced that the insurance will cover “general infertility treatment” such as artificial insemination and “assisted reproductive technologies” such as in vitro fertilization and ICSI from April 2022.

This is based on the Guidelines for Assisted Reproductive Medicine compiled by the Japanese Society for Reproductive Medicine after evaluating the level of evidence for the effectiveness of medical technologies used in assisted reproductive medicine and general fertility treatment in Japan.

The basic medical treatment for assisted reproductive technology, from egg retrieval to embryo transfer, is all covered by insurance, and additional treatment that may be performed based on the patient’s condition, etc., which is positioned as advanced medical treatment, can be used in combination with insurance treatment. In addition, the insurance coverage of infertility treatment will be extended to all other treatments that are covered by insurance.

With the introduction of insurance coverage of infertility treatment, the subsidy system for specific infertility treatment expenses, which had been implemented to reduce the financial burden of infertility treatment, will be terminated in March 2022. However, as a transitional measure, it is currently possible to apply for the subsidy for one treatment that straddles the fiscal year when eggs taken before March 2022 are implanted.

Because infertility had been treated freely in the past, society was not aware that infertility was a subject of treatment, and it was difficult to gain understanding of the need for treatment. Many people may not have been able to gain understanding from their workplaces about taking time off work or leaving work early for treatment. One of the major benefits of insurance coverage is that it will spread awareness throughout society that “infertility requires treatment,” and increase understanding of infertility treatment.

Insurance coverage of infertility treatment is positioned as a part of measures to combat the declining birthrate. However, in order to solve the current fertility problem in Japan, more fundamental measures must be taken. Reducing the financial burden and broadening social understanding through insurance coverage of treatment costs will help improve sexual and reproductive health/rights, but other measures are still needed to improve the birthrate.