A Mild Approach to In Vitro Fertilisation: The Complexity of Reproductive Decision-Making in Japan

Abstract

Japan is distinct in its approach to in vitro fertilisation (IVF). Of all countries where IVF is widespread, the mild-stimulation protocol (mild IVF) is far more prevalent in Japan than anywhere else in the world. Although the efficacy of mild IVF has been extensively debated in medical research, an analysis of women’s own experiences is almost totally absent from the academic literature. This thesis uses a mixed-methods approach to investigate the political, historical, and socio-cultural frameworks underpinning the significance of mild IVF in contemporary Japan, and to explore women’s embodied experiences of the different protocols. I first examine the political and governance frameworks of assisted reproductive technologies in Japan. I argue that reproductive technology in Japan has evolved as the result of an ambiguous regulatory framework, which has allowed the emergence of a diversity of practices, and which as allowed certain medical professionals to become authoritative voices in the technical implementation of IVF. I then seek to unpack the historical and social factors underpinning the prominence of mild IVF in Japan, finding that social anxieties, ethical considerations, and a risk-averse culture (particularly in relation to older patients) have contributed to the popularity of treatments which seek to minimise medical interventions. The reliance on mild IVF has been further strengthened by limitations to capacity in Japanese clinics. I move on to examine the choices and embodied experiences of women. I find that the choice of clinic and treatment protocol are significantly intertwined with individuals’ daily lives and responsibilities. Women seek to balance the intensive physical and mental requirements of IVF treatment with the demands of their daily lives, and to minimise disruptions against multiple social responsibilities. Clinical indicators are also a key component of decision making. Japanese IVF patients have a clear desire to make informed choices based on mutual trust with doctors, and the availability of mild IVF provides meaningful flexibility for Japanese patients on the path to successful treatment outcomes. However, I find that patients often lack comprehensive and accurate information on IVF treatment, and there is an urgent need for improvement in this respect. Finally, I critically assess whether mild IVF is as ‘patient-friendly’ as many physicians claim. I find that the increased choice associated with the availability of multiple treatment protocols in Japan does empower women in their decision-making. However, some aspects of the mild-IVF treatment regime fail to prioritise the patient’s needs: treatment schedules are inflexible, options for pain management are inadequate, cost-effectiveness is questionable, and the rhetoric that mild IVF improves the quality of eggs places the burden of reproduction squarely on women, rather than acknowledging the fact that successful IVF treatment depends on a wide range of factors and contributions.