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Positive and Negative Aspects of Public Insurance Coverage on ART With Respect to Multiple Gestation in Japan
Aisaku Fukuda1, Hiroshi Matsumoto1, Isao Tsuji1
1IVF Osaka Clinic Higashi-Osaka City Osaka Japan.
Reproductive Medicine and Biology
|July 22, 2026
Summary
Public insurance for assisted reproductive technology in Japan led to a significant increase in multiple blastocyst transfers (MBT) and multiple pregnancies (MP). This trend, particularly in older patients, necessitates evaluating its impact on maternal and neonatal safety.
Area of Science:
- Reproductive Medicine
- Health Policy
- Clinical Practice
Background:
- Public insurance for assisted reproductive technology (ART) was implemented in Japan in April 2022.
- The policy aimed to reduce the financial burden on patients undergoing fertility treatments.
Purpose of the Study:
- To investigate the association between public insurance for ART and changes in multiple blastocyst transfer (MBT) and multiple pregnancies (MP).
Main Methods:
- A retrospective comparison of 2,764 cycles from the pre-insurance period (Jan 2020-Mar 2022) and 4,326 cycles from the insurance period (Apr 2022-Feb 2025).
- Multiple pregnancies (MP) were defined as two or more gestational sacs.
Main Results:
- Multiple blastocyst transfer (MBT) incidence rose from 5.8% to 20.1%, and multiple pregnancies (MP) increased from 0.7% to 2.6% after insurance implementation.
- Insurance coverage was independently linked to higher MBT rates, especially in older patients.
- Upward trends in MBT and MP were observed as patients neared their final insured cycles.
Conclusions:
- The findings suggest a correlation between insurance cycle limits and a clinical focus on per-cycle success.
- While reducing financial strain, the policy may be associated with increased MBT and MP rates.
- Further deliberation on the policy's impact on maternal and neonatal safety is warranted.
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