Japanese Infertility Patients’ Attitudes towards Directed and Non-Directed Oocyte Donation: Analysis of a Questionnaire Survey and Implications for Public Policy

I. Introduction

The increasing prevalence of involuntarily childless Japanese couples has been accompanied by a rapid acceptance of assisted reproductive technologies (ART) including in-vitro fertilisation (IVF). The number of IVF cycles performed annually in Japan tripled during the last decade, from 76,073 in 2001 to 242,017 in 2010. More than 600 registered infertility clinics now exist throughout Japan (JSOG 2012). Thus, Japan is among the “most advanced” countries in the world with respect to non-donor IVF (IVF using a couple’s gametes) (Nygren et al. 2011).

However, third-party reproduction, or collaborative reproduction, has been performed only sporadically in Japan. The increasing prevalence of infertility in Japan is associated with a tendency to marry late and a delay in the onset of procreative life, resulting in age-related declines in ovarian function and in ova quality as the major causes of infertility. Thus, the prevalence of infertility patients who may benefit from IVF using donor oocytes (referred to as donor-oocyte IVF hereafter) has been increasing. However, despite wider acceptance of ART, donor-oocyte IVF has been performed only sporadically.¹

Uncertainties in public policies regarding third-party reproduction in general and oocyte donation in particular have contributed to the reluctance of Japanese infertility clinics to establish donor-oocyte programmes. Although medical, bioethical and legal experts have issued calls to legally regulate the practice of ART, no statute has been enacted thus far. In the absence of a legal infrastructure, the regulation of ART is left to medical practitioners’ voluntary compliance with policy statements, guidelines and recommendations issued by professional bodies and governmental committees. However, these are not in complete agreement.

Issues regarding whether oocyte donation is allowed, who should donate oocytes, and whether and how oocyte donors are to be compensated remain controversial in Japan. The Japanese Society of Obstetrics and Gynecology (JSOG) has taken a restrictive approach to oocyte donation.² JSOG’s 1983 statement recommended that members refrain from performing IVF using third-party gametes. Then, in 2001, JSOG’s ethics committee recommended that donor-oocyte IVF be practised only under the appropriate legislation and that oocyte donation be anonymous, non-directed and non-commercial in principle.³ More recently, the Japanese Society for Reproductive Medicine (JSRM) issued a more relaxed set of guidelines, according to which egg donation by a sibling or close family member of a patient may be permitted under limited circumstances. Some clinics have also established their own guidelines and begun to practise donor-oocyte IVF, but the number of cycles actually performed has been very limited thus far.⁴ In this context, it is important to resolve uncertainties and to develop clear legal regulations.

The unavailability of donor-oocyte IVF in Japan has led an increasing number of Japanese patients to travel overseas. Although the exact number of couples doing so remains unknown, “reproductive tourism” — defined here as medical tourism in the field of reproductive medicine involving commercialised third-party reproductive services, such as gamete donation and surrogacy — is increasingly commonplace in Japan, as is the case in many other countries (Ferraretti et al. 2010; Heng 2006a, 2006b; Pennings et al. 2008; Shenfield 2011; Shenfield et al. 2010, 2011). Brokering agencies are reportedly arranging cross-border reproductive care in the United States or in Asian countries so that Japanese patients can receive donor oocytes from local or Japanese donors (Hibino et al. 2012; Shirai and Hibino 2012). Reproductive tourism is associated with various medical, ethical and legal issues, and its growth also signals an urgent need to reconsider Japan’s national public policy on ART.⁵

In this context, we examined infertility patients’ attitudes toward donor-oocyte IVF. Based on the analysis of data from a questionnaire survey on third-party reproduction and cross-border reproductive care, we investigated the actual and potential need for oocyte donation and patients’ preferences for different kinds of oocyte donation. The public policy implications of our research findings are also discussed.

II. Materials and Methods

The present study...