Medically Reviewed
By Dr. Puneet Rana Arora : Founder & Director, CIFAR — Centre for Infertility & Assisted Reproduction, Gurugram FRCOG (Royal College of Obstetricians & Gynaecologists, UK) | MSc Reproduction & Development, University of Bristol, UK
Last Review Date : 11 November, 2026
In 2023, Japan recorded 561,664 assisted reproductive technology (ART) treatment cycles and 85,048 babies born through ART. Behind this milestone was a major policy decision: in April 2022, Japan expanded its public health insurance coverage to include fertility treatments, including assisted reproductive technology (ART), helping reduce the financial burden of treatment and improve access for eligible patients.
For a fertility centre in India, where the financial and clinical picture looks very different, Japan’s experience is worth studying closely — not to copy it wholesale, but to understand what it gets right, where it’s starting to strain, and what that means for how IVF is practiced here.
How Japan Got Here
Before 2022, IVF and other assisted reproductive technology (ART) treatments in Japan were largely paid for out of pocket, with a single IVF cycle typically costing between ¥400,000 and ¥500,000 (approximately $2,700–$3,400). Following the introduction of public health insurance coverage in April 2022, ART utilization increased substantially—from 449,900 registered treatment cycles in 2020 to 543,630 in 2022 and 561,664 in 2023. Research also found that insurance coverage improved access particularly among patients aged 25–34, while patient growth was significantly higher in rural areas than in metropolitan regions.
What makes the Japanese story stand out isn’t just the volume — it’s the safety record alongside it. Japan has enforced single embryo transfer (SET) as the clinical default since 2008, and even after insurance expanded access, more than 80% of embryo transfers in 2023 remained single-embryo. Singleton delivery rates stayed above 96%. That combination — broader access without a corresponding spike in twin and multiple pregnancies, which carry meaningfully higher risk for both mother and babies — is what most fertility systems struggle to achieve simultaneously.
The Cautionary Footnote
The picture isn’t entirely straightforward, though. Japan’s public insurance covers a limited number of embryo transfers—up to six for women who begin treatment before age 40 and up to three for those aged 40–42.
In 2023, the multiple-pregnancy rate following frozen–thawed embryo transfer was 3.8%,- while the absolute number of multiple pregnancies reached its highest level in the national registry’s history.
Researchers have suggested that changes in embryo-transfer practices, including increased use of blastocyst-stage embryos in multiple embryo transfers, may have contributed to this trend. However, the exact reasons behind the increase—and the role of insurance coverage—require continued monitoring and further research.
It’s a useful reminder that insurance design and clinical safety aren’t automatically aligned. A system can expand access responsibly and still create pressure points at its edges, particularly for exactly the patients — older, later in treatment — who can least afford the added risk of a multiple pregnancy.
Where India Stands Today
India’s starting point is different in almost every respect. The Assisted Reproductive Technology (Regulation) Act, 2021 was a genuine step forward — it standardized clinic registration, ethical protocols, and donor protections nationally.
But it stops at regulation; it doesn’t touch financing. IVF is not covered under Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), India’s flagship public health scheme, and while the IRDAI has encouraged private insurers to offer fertility benefits, coverage remains inconsistent, usually capped at a small sub-limit against a cycle cost of ₹1.5–3 lakh. For most Indian couples, IVF is still paid for largely out of pocket, often across more than one cycle.
That financial reality shapes clinical decisions in ways worth being honest about. Where Japan’s multiple-embryo-transfer pressure shows up near the end of a subsidized treatment run, in India it can exist from the very first cycle — a patient funding treatment entirely herself has every financial incentive to maximize her odds on the attempt she can actually afford, even when a single, high-quality embryo would be the safer clinical choice. India also doesn’t yet have anything like Japan’s JSOG registry — a mandatory, near-complete national dataset that let researchers spot the 2023 uptick early. Without that kind of visibility, it’s harder for the field here to know, in real time, whether transfer practices are drifting in a risky direction.
A handful of state governments have introduced subsidized IVF schemes for lower-income couples, and the private fertility sector is growing quickly — India’s IVF services market is projected to roughly triple over the next several years. But growth in access, without the financing support and the clinical guardrails Japan built in tandem, is a different kind of story.
A Clinical Perspective from CIFAR
Dr. Puneet Rana Arora, Founder & Director of CIFAR — Centre for Infertility & Assisted Reproduction, Gurugram, has built her practice around a philosophy she’s spoken about publicly for years: that quality fertility care has to be both evidence-based and genuinely individualized, and that IVF should never be the reflexive first step. CIFAR’s own patient data reflects this — in a large share of cases the centre sees, conception is achieved through non-IVF approaches like natural cycle monitorings, IUI or targeted treatment of the underlying issue (PMOS/PCOS, fibroids, sperm-related factors) before escalating to IVF at all.
That same instinct is exactly what the Japan comparison points toward. A safer fertility system isn’t just about whether patients can afford treatment — it’s about whether the clinical incentives around them, insurance-driven or otherwise, are pushing toward the option that’s actually best for that patient, rather than the one that maximizes a single shot at success. Japan shows what’s possible when broad access and a strong single-embryo culture are built together. India’s task now is to build the second part — transparent outcome tracking, a genuine SET-first clinical norm, and patient counselling that treats embryo transfer decisions as a safety question, not just a numbers game — even while the financing question remains unresolved.
The Takeaway
Japan’s experience makes a strong case that affordability and safety don’t have to trade off against each other — but it also shows that safety takes deliberate design, not just good intentions, especially at the edges of any coverage system. India doesn’t yet have Japan’s financing model or its registry infrastructure. What it can build in the meantime is the clinical culture: informed, unhurried, evidence-first fertility care that treats single embryo transfer as the norm rather than the exception — regardless of who’s paying for the cycle.
This article reflects publicly available research and CIFAR’s documented clinical approach. For personalized fertility guidance, consult a specialist directly.
Source :
https://pmc.ncbi.nlm.nih.gov/articles/PMC11997234
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