Embryo freezing

The median patient payment for embryo freezing (total cost of controlled ovarian stimulation, oocyte retrieval, IVF, ICSI, culture, and embryo freezing fees) was 500,000 yen per treatment. A total of 282 treatments were subsidized by 46 prefectures in FY2021, and the total treatment cost was estimated to be approximately 141 million yen. In FY2022, 47 prefectures provided 458 subsidies, and the total treatment cost was estimated to be approximately 229 million yen. The maximum subsidy for fertilized embryo freezing-related treatment was 350,000 yen per treatment (Fig. 1a). Thus, as the median patient payment was 500,000 yen and the subsidized amount was 350,000 yen, a patient would be required to pay 150,000 yen. In examining facilities with patient payments that exceeded the 75th percentile, there was a significant range in the amount of patient payments, spanning from approximately 600,000 yen to roughly 1.2 million yen (Fig. 1a). We also divided Japan into six regional blocks and analyzed the cost of fertility preservation in each block. There were no significant differences in patient payments for the treatment of embryo freezing among regional blocks. Rather, it was found that each reproductive health facility, regardless of the regional block, set their own prices (Supplementary Fig. 1).

Fig. 1

a Total cost of freezing embryos (controlled ovarian stimulation, oocyte retrieval, IVF, ICSI, embryo culture, and embryo freezing fees) b Total cost of freezing unfertilized oocytes (controlled ovarian stimulation, oocyte retrieval, and unfertilized oocyte freezing fees) c Total cost of freezing ovarian tissue (preoperative examination fees, hospitalization fees, oophorectomy surgery fees, ovarian tissue freezing fees, and fees for collection and freezing of unfertilized eggs during oophorectomy) d Cost of sperm freezing treatment e Total cost of sperm freezing by TESE (preoperative examination fees, hospitalization charges, TESE surgery fees, and sperm freezing fees). The dots in the graph show the average amount of payments by patients at each facility. Red line: median payment by patients. Blue line: maximum subsidy amount

Oocyte freezing

The expenses for patients who opted for oocyte freezing ranged from approximately 100, 000 yen to 800,000 yen, depending on each facility (Fig. 1b). The median payment by patients for treatment related to unfertilized oocyte freezing (inclusive of controlled ovarian stimulation, oocyte retrieval, and oocyte freezing fees) was approximately 300,000 yen per treatment. A total of 337 treatments were subsidized by 46 prefectures in FY2021, and the total treatment cost was estimated to be approximately 101 million yen for the country. In FY2022, 47 prefectures provided 537 subsidies, and the total treatment cost was estimated to be approximately 161,100,000 yen. The maximum subsidy for the treatment of frozen oocytes was 200,000 yen per treatment (Fig. 1b). Thus, as the median patient payment was 300,000 yen and the subsidized amount was 200,000 yen, a patient would be required to pay 100,000 yen.

Ovarian tissue freezing

The median patient payment for ovarian tissue freezing (total cost of preoperative examination, hospitalization, oophorectomy, ovarian tissue freezing, oocyte collection, and freezing fees at the time of oophorectomy) was 600,000 yen each time. In FY2021, 46 prefectures subsidized treatment 46 times, and the total treatment cost was estimated to be approximately 27,600,000 yen. In FY2022, 47 prefectures provided 80 subsidies, and the total treatment cost was estimated to be approximately 48,000,000 yen. The maximum subsidy was JPY 400,000 per treatment (Fig. 1c). Thus, as the median patient payment was 600,000 yen and the subsidized amount was 400,000 yen, a patient would be required to pay 200,000 yen.

Sperm freezing

The median patient payment for sperm freezing was approximately 25,000 yen per treatment. In FY2021, 46 prefectures subsidized 265 treatments, and the total treatment cost was estimated to be approximately 6,625,000 yen. In FY2022, 47 prefectures subsidized 472 treatments, and the total treatment cost was estimated to be approximately 11,800,000 yen. The maximum subsidy amount was 25,000,000. The maximum subsidy per treatment was 25,000 yen (Fig. 1d). Although the median payment by patients and maximum subsidy amount were consistent, the amount paid by patients increased at high-cost medical institutions.

Testicular sperm extraction and sperm freezing

The median patient cost for treatment related to sperm freezing by TESE (inclusive of preoperative examination fees, hospitalization fees, TESE surgery fees, and sperm freezing fees) was 300,000 yen per treatment. In FY2021, 46 prefectures subsidized 5 treatments, and the total treatment cost was estimated at approximately 1,500,000 yen. In FY2022, 47 prefectures subsidized 11 treatments, and the total treatment cost was estimated to be approximately 3,300,000 yen. The maximum subsidy was 350,000 yen per treatment, indicating that many treatments were provided within the scope of the subsidy (Fig. 1e).

ART using frozen embryos

The median patient cost for ART using frozen embryos was 150,000 yen per treatment. In FY2022, 47 prefectures provided subsidies, and approximately 13,200,000 yen was paid based on the median treatment cost. The maximum subsidy was 100,000 yen per treatment. As the median payment by patients and the maximum subsidy were 150,000 yen and 100,000 yen per treatment, respectively, approximately one-third of the cost was borne by the patients (Fig. 2a).

Fig. 2

a Cost of assisted reproductive medical treatment using frozen fertilized embryos b Cost of assisted reproductive medicine using frozen unfertilized oocytes c Cost of assisted reproductive medical treatment after reimplantation of ovarian tissues d Cost of assisted reproductive medicine using frozen sperm. The dots in the graph show the average amount of patient payments at each facility. Red line: median patient payment. Blue line: maximum subsidy amount

ART using frozen oocytes

The median patient payment for ART using frozen oocytes was 325,000 yen per treatment. In FY2022, 47 prefectures provided 27 subsidies, and the total treatment cost was estimated to be approximately 8,910,000 yen. The maximum subsidy was 250,000 yen per treatment (Fig. 2b).

ART after ovarian tissue reimplantation treatment

The median patient payment for assisted reproductive medical treatment after ovarian tissue reimplantation was approximately 500,000 yen per visit. However, the maximum subsidy was approximately 300,000 yen per visit, which did not cover all costs (Fig. 2c).

ART after sperm freezing

The median payment by patients for ART using frozen sperm was approximately 500,000 yen. However, the maximum subsidy amount was approximately 300,000 yen, which did not cover all costs (Fig. 2d).

Maintenance fees per year

The median payment by patients was 35,000 yen per year for embryo maintenance (Fig. 3a), 35,000 yen per year for oocyte maintenance (Fig. 3b), 35,000 yen per year for cryopreservation of ovarian tissue (Fig. 3c), and 20,000 yen per year for sperm cryopreservation maintenance (Fig. 3d). Cryopreservation maintenance fees are not publicly subsidized in Japan, as of March 31, 2024; however, designing a future subsidy system is necessary.

Fig. 3

a Embryo cryopreservation maintenance fees for fertilized embryos b Cryopreservation and maintenance fees for unfertilized oocytes c Ovarian tissue cryopreservation and maintenance fees d Sperm cryopreservation and maintenance fees The dots in the graph show the average amount of patient payments at each facility. Red line: median patient payment