THE sterile façade of Kato Ladies Clinic gives little hint of the fecundity inside. Nestling among a plantation of high-rises in a business district of Tokyo, the clinic implants fertilised eggs in an average of 75 women a day. That makes it one of the busiest fertility hospitals in the world, says Keiichi Kato, the medical director.
Japan has come a long way since journalists were warned off the taboo story of Princess Masako’s visits to fertility clinics 20 years ago. The wife of the crown prince, then in her late thirties, was being nudged to produce an heir to the throne (in the end, she disappointed traditionalists by having a girl). Today Japan has less than half America’s population, but more than a third more hospitals and clinics that offer fertility treatment. Over 50,000 babies were born last year with the help of in vitro fertilisation (IVF)—5% of all births.
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Nearly a fifth of Japanese couples struggle to have children, says the health ministry. Women are postponing marriage; social pressures mean there are far fewer babies born out of wedlock than in other rich countries. The upshot is that around 40% of Japanese women who undergo IVF do so in their forties, twice as many as in Britain or France.
Partly as a result, annual births have dipped below 1m for the first time since 1899, when the state began compiling statistics. The total fertility rate (the number of children a typical woman is expected to bear over her lifetime) is well below the number needed to keep the population stable. The pledge of Shinzo Abe, the prime minister, to stop the population from falling below 100m still assumes it will slump by a fifth from the present 127m.
In 2004, alarmed by the baby drought, the government began offering subsidies for IVF, which is not available under the public health-care system. The government is mulling extending them to unmarried couples. Recipients get ¥150,000 ($1,362) towards their first attempt and a limited number of follow-ups. But that does not cover the full cost. Women older than 43 and couples earning more than ¥7.3m a year are ineligible. Many would-be parents end up paying ¥300,000-500,000 per attempt, says Akiko Matsumoto of the Fertility Information Network, an NGO.
Most of that is wasted. Fewer than 10% of local IVF treatments succeed, says Yoshimasa Asada, a fertility specialist, and the proportion is falling. “We have the world’s highest IVF numbers and the lowest success rate,” he laments. “It’s an embarrassment.” Hospitals sell rosy expectations to older women, he says, and are happy to take their money for repeat visits. Doctors avoid prescribing the stronger drugs needed to help them conceive, partly because of popular fears about side-effects.
Experts say Japan needs a law to regulate the industry, including a ranking system for hospitals. As it is, couples must rely on word of mouth, says Klaus Jacobsen, president of Origio Japan, a Danish company that sells IVF products. Surrogacy and the donation of eggs and sperm are regulated by the mostly male Japan Society of Obstetrics and Gynaecology, whose rules are unduly restrictive. Every year hundreds of Japanese end up going abroad to find donors and surrogates. Mr Jacobsen thinks that with better guidelines and more financial aid Japan could produce an extra 300,000 babies a year. That is roughly the number by which deaths currently outstrip births.