Japanese Health Insurance Coverage of Fertility Treatment in 2022: Does Coverage Change Patient Perspectives?

Objective: This study aimed to evaluate the change in the patient's background and attitude toward infertility treatment both before and after the initiation of insurance coverage and to explore future issues from the patients' perspectives.

Materials and methods: A cross-sectional survey was conducted in a fertility clinic in Japan from February to June 2022. An original questionnaire was given for two groups of new patients at a fertility clinic on their first visit: before fertility treatment insurance coverage started (Before-coverage) and after fertility treatment insurance coverage started (After-coverage).

Results: The study included 75 patients (Before-coverage = 25; After-coverage = 50). Multivariate analysis revealed increases among patients who consider infertility a "disease" rather than a "condition" (odds ratio (OR): 5.03, p < 0.05), those preferring in vitro fertilization (IVF) as an initial treatment (OR: 2.54, p = 0.03), and those who recommend oocyte freezing for one's child (OR: 3.88, p = 0.04), with statistical significance in the After-coverage group compared with the Before-coverage group. However, the anticipated financial burden did not change significantly (e.g., cost per IVF, cost to achieve pregnancy).

Conclusions: More patients had an impression of infertility as a "disease" and preferred IVF as the first treatment option after coverage than before coverage. Furthermore, many patients wanted to recommend oocyte freezing for their children despite the lack of insurance coverage. However, patients' anticipated economic burden for treatment was not different between both groups. The economic burden anticipated by patients remained unchanged, revealing the challenge of disseminating information to patients in the future.