One of the reasons I started interviewing women in Japan about their pregnancies was to highlight that although we all gave birth in Japan, our pregnancies and birth stories were unique. And for some, getting to the pregnancy part was a journey of its own.
When my husband and I had trouble conceiving following a miscarriage, we started to wonder about whether we would need help, such as fertility treatment. However, we didn’t know anyone who had undergone such a procedure. At least in our social groups, trouble conceiving and infertility were not something that people spoke about — in fact, we didn’t know some of our friends and family had miscarriages until we shared our own. Although we didn’t need fertility treatment in the end, I still wondered about what would happen if we wanted children later on and how Japan approached this topic. This is why I reached out to Pippa, a woman who successfully underwent IVF in Japan, and she very kindly agreed to answer some questions about her experience.
Pippa is a corporate eikaiwa teacher who also offers translation/proofreading services. Originally from the south-east of England, she moved to Tokyo back in 2012 to work as an eikaiwa teacher. Two years later, she met and started dating a PhD student. The couple tied the knot in 2016 and then moved to Osaka for her husband’s work, only for them both to be Kansai-incompatible.
They moved back to Kanto in 2018 where they bought a house in Kanagawa prefecture and settled, hopefully for good. They share their home with a Netherland dwarf rabbit named Holly (turning four years old in October 2020) and a Shikoku inu named Sky (who turned 2 in May 2020) who both love cuddles with humans but who unfortunately do not like each other very much!
Now Pippa and her husband have added another member to their family — they welcomed their rainbow baby, a little girl, to the world in April 2020!
I am so grateful to Pippa for taking the time to answer these questions about her experience with IVF in Japan. I hope this interview will be insightful and informative for readers who may be considering IVF, and for those who want to gain some understanding about parents who have to go the extra mile to bring a new life into this world. Their strength and dedication is truly inspiring.
As someone who has undergone IVF, could you briefly explain what it is?
IVF, as I’m sure you’re aware, stands for In Vitro Fertilisation, or “fertilisation in glass” aka a petri dish. IVF babies are sometimes inaccurately called “test tube babies”. The procedure involves chemically nudging the ovaries to produce several eggs, extracting (or “retrieving”) those egg cells, and then sprinkling them with sperm to enable fertilisation. Then, if fertilisation is successful and the fertilised cell begins to divide, it is then popped back into the host uterus and all involved pray for successful implantation. There is a whole lot of science involved in the first steps, but at the end of the day the last part is honestly just down to luck, which means that even in this technologically advanced age there is no guarantee of a positive outcome this way either, and many people try IVF repeatedly without success. Like many other medical procedures, it can also become prohibitively expensive, very quickly! There is also talk that IVF increases your chance/risk of getting pregnant with non-identical twins (or more!) but since technological advances have been made they actually don’t tend to implant more than one fertilised egg at a time like they used to, so the risk of having twins is far lower than it used to be. This is especially the case in Japan, since multiple pregnancies are higher risk and they are very cautious here about anything like that! With that said, I did end up getting pregnant with twins (one of whom sadly didn’t make it) but they would have been identical, since the split occurred post-implantation, and was not specifically related to fertility treatment.
What brought you to the decision to do IVF?
We started trying to conceive a few months after getting married, but despite religiously checking my basal body temperature (BBT) every morning, using ovulation predictor kits and keeping tabs on all of the changes my body went through during a cycle etc, no real pattern could be determined. I had an early miscarriage once, but then nothing else for another year or so. It got very frustrating and disheartening – as many couples who are trying to conceive will understand. Statistically, couples with no underlying issues who are trying to conceive will successfully manage to do so within a year of trying (though there are of course outliers) and so after two years with no luck we decided to visit a fertility clinic to get “checked out”, just to make sure there was nothing amiss.
Well, absolutely zero problems on my husband’s part, hooray! But my hormone levels were a bit off, which explained why I’d had so much trouble trying to figure out ovulation timing on my own. As it happened I was having anovulatory cycles – cycles without any eggs released whatsoever – but we didn’t find that out until later. So they started us off with as natural a method as possible for a few cycles – literally using an ultrasound wand to check the stage of follicle maturation in the ovaries, and saying “have sex tomorrow night!” to see if anything stuck – before moving on to clomiphene (commonly known as Clomid) and an hCG trigger shot to try to make ovulation happen more promptly. Again, this didn’t work, and after four unsuccessful Clomid cycles we decided to take a month off just for a bit of a mental recharge. I was really tired of crying every month, and my husband was worn out too. In that month off, I got pregnant with no assistance whatsoever! …but then lost it a few weeks later. We started to suspect that my wonky hormone levels made it difficult for a fertilised egg to stick around, and that more assistance might be necessary. Finally, in spring/summer 2019, we decided to give IVF a go.
What are the first steps someone needs to take if they want to undergo IVF in Japan?
First, find yourself a fertility clinic! Once you go there – with your partner, at first – they will help you work out the steps that you need to take in order to conceive. While IVF is pretty famous, there are plenty of other treatment options to consider, such as the Clomid that I started off on, or IUI (IntraUterine Insemination) which is cheaper and useful if the sperm doesn’t have quite enough motility to get to the egg cell on time, and so on. Talk things through with your doctor, and take all the tests you feel comfortable taking. I had one memorable test where they squirted me full of fluid to check that a) my uterus wasn’t an unconventional shape and b) that there were no blockages obstructing my fallopian tubes. That was a very wet experience! Of course, if you’ve already decided that you definitely want IVF you don’t have to faff about with other time/money-consuming options! But having an open and honest dialogue with your care provider is essential.
Did you have any concerns about doing IVF in Japan, such as language barriers?
I had already spent several months in Japanese hospitals because of a broken leg and surgery to repair a ruptured ACL (knee ligament), so I wasn’t particularly worried about being able to stumble around the fertility treatment system even though there was a lot of subject-specific vocabulary I didn’t know. Native English speakers are blessed indeed, as the majority of scientific papers these days are published in English which means that if you hit upon an unfamiliar term, there’s a good chance that your doctor knows how to write down the English version even if she can’t speak English herself! These days most doctors don’t object to you whipping out your smartphone to look up a word in the middle of a consultation, either. There was one doctor at my clinic who had studied and worked in England, though, and while he wasn’t my regular doctor I know that I saw several other foreigners in the waiting room who were there to see him, so good English-speaking doctors are definitely out there if you’re really worried about language difficulties.
How did you choose your IVF clinic?
Honestly it was nothing more complicated than looking up local clinics with good reviews online! We just wanted a decent fertility clinic at first, and had the option to try more than one location if the first place didn’t work out, but it just so happened that I really liked this first clinic we tried so we stuck with them.
Could you give a short overview of the procedure?
This may be more detail than anyone cares to have, but it’s a complicated procedure! Following blood tests and consultation with your doctor:
• On day 1-3 of your cycle you visit the clinic and have a transvaginal ultrasound (which is pretty gross) and they start you off on whichever ovarian stimulation protocol you’re going for. More intensive stimulation runs the risk of ovarian hyperstimulation syndrome (OHSS) so they generally try less intense methods if possible. We personally went down a mild/medium route which involved going to the clinic every other day for injections. I also had oestrogen patches to wear on my skin for 48 hours throughout.
• On day 8-10 you get to have more tests (transvaginal, blood) to see whether or not your follicles are the right size/your body is reacting appropriately. If so, you get a trigger injection. I got to take this one home and inject myself! The timing was VERY important. It literally had to be at precisely 9pm, a day and a half before retrieval. This trigger shot is the most important and there is therefore no leeway. Other injections and procedures etc can have a bit more flexibility but this one was pretty much set in stone.
• Egg (oocyte) retrieval then happened around 7:30am exactly two days later. Sperm was also (naturally) necessary at this point, and while we had the option of me taking a sample container of sperm to the clinic with me (stuffed between my boobs to keep it at a reasonable temperature) I opted to have the husband come with me! Retrieval is definitely unpleasant and they let you have a lie down afterwards. On the same day they also tell you how many eggs were successfully retrieved – the average is 8-12, we had one (1). It was at this point that we discovered I’d been having anovulatory cycles. There are people out there with no eggs collected whatsoever, so even one was something to be grateful for! Sperm quality is also assessed and fertilisation method discussed. One friend of mine had sperm so “powerful” that more than one sperm penetrated the egg at once and messed up the whole fertilisation process for more than one oocyte, so care must be taken at this stage as well.
• A couple of days later you go back to the clinic to find out whether or not fertilisation was successful, and you also learn about the “quality” of the egg (as in, its likelihood of growing well). I was deeply pessimistic following the shock of only having one oocyte retrieved and so was completely knocked sideways by confirmation of fertilisation! That one egg!
• At my clinic they then froze/cryopreserved the embryo and let my body finish out its cycle to give my uterus a chance to recover from the retrieval procedure.
• If your body still isn’t quite ready the next cycle (mine wasn’t) they can give you birth control pills to take for a week which then triggers a false period and allows your uterus to kind of “reset” and be ready for the transfer.
• On the day of the embryo transfer they let you know if it has survived the cryopreservation/if it is developing well, and then are super careful about checking patient information (wouldn’t want to transfer somebody else’s embryo!) before pinging the embryo inside you and then just sort of… hoping it sticks! There was no specific need to lie down for a long time or take the day off work or anything but I decided to take things gently all the same.
• And then you wait. For me, I still had to have oestrogen injections for a while, which then dropped down to just the oestrogen patches (my skin was tired by this point) and I also had progesterone pessaries to insert every night.
• Finally, exactly 10 days later, I went back to the clinic for the result. I walked into the consultation room and the doctor had a piece of paper on the desk saying ご妊娠された皆様へ、ご妊娠おめでとうございます (To everyone who has become pregnant, congratulations on your pregnancy) which I just stared at for a good thirty seconds because I was so, so programmed for it to have been a failure! Me, pregnant! My one, single, tiny, average-quality egg! Of course, conception is just the start of the journey so there was plenty more to come…
Did you have to take time off of work and if so, did that cause any problems?
I was able to organise my appointments around my work shifts and so didn’t have to take any time off work, and my husband’s company also didn’t offer any resistance to him taking time off/coming in late a couple of times either. I know we were lucky on that front too, and other companies may not be as flexible.
Did you refer to any resources about IVF apart from what was provided by the clinic?
Oh lord did I. I was a google monster! I mean, well before starting fertility treatments I was constantly looking things up online about anything and everything relating to conception anyway, so it was the natural next step for me to obsessively google absolutely everything relating to IVF as well, from random family websites to whatever medical research pdfs I could lay my e-hands on. I couldn’t even tell you which websites were of any use, because after a while it feels like they all end up saying the same thing anyway!
Did you experience any side-effects?
Eh, some. While I was on Clomid (pre-IVF) I got pretty intense breast pain every single cycle – I know for some people that’s one of the first signs of pregnancy, so it got my hopes up the first time round but I soon learned to dismiss it – but with IVF things were comparatively straightforward, once you get used to being stuck with needles all the time. The most unpleasant part of the procedure by far was when they extract the mature egg cells (oocyte retrieval). A friend of mine had her retrieval done under general anaesthetic and I can honestly say I am envious! I think I had a very “local” local anaesthetic but it did so little as to amount to nothing, and since I was nervous anyway that naturally made things hurt a lot more. They insert a really long needle in through your vagina, through the vaginal wall and into your ovaries to suck out any oocytes from their follicles, so you have to lie down for a bit afterward and take a couple of sanitary towels with you just in case you have any bleeding, too. I had residual pain from the retrieval for a good three days afterwards and had to move pretty slowly, but beyond that things were more or less okay. If I recall I was able to take diclofenac for the pain but it didn’t really do anything. My retrieval was on a Saturday so I could spend the rest of the weekend taking things gently, but I do remember work on Monday morning being distinctly uncomfortable. Fortunately at that particular point I was contracted to a company where they actually produce supplies for fertility clinics, so I straight-up told them about my retrieval and they encouraged me to take things really slowly. I know I was very lucky there!
Additionally, once I actually managed to conceive I had a lot of spotting for a while, as in blood every day for a good two weeks! It made me panic quite badly but once my doctor explained that it was most likely caused by skin sensitivity resulting from the continued use of progesterone pessaries and NOT actually coming from my uterus/a sign of an impending miscarriage, that helped me calm down considerably.
What did you think about the cost? Was it covered at all by insurance or could you get any subsidies?
The approximate total was ¥670,000 from start to finish, with all of the various treatments that we went through, but it’s worth considering the fact that we only needed one round of IVF and another cycle would have pushed the cost up a lot more. Certain things were covered by insurance but a lot wasn’t, so as you might imagine we had to budget really carefully. Our prefecture and city do offer a partial refund for the first round of IVF, so we were able to get ¥300,000 back from the prefecture and ¥100,000 back from the city, which helped a lot! However you do have to fill out a bunch of paperwork (naturally) and go to the local office to apply for it, and it can take a few months for everything to go through—even though we applied as soon as possible, the final ¥100,000 from the city only came into my account when I was already 29 weeks pregnant!
What was the most difficult part of the process?
Even if you’re mentally robust at the best of times, infertility does a real number on your mental health! That aspect of fertility treatment is seriously not to be underestimated. Partly this is because it’s a rough time in general, but partly this is because one aspect of the fertility process is often to boost your hormones beyond their usual levels, so pretty much everything is more intense – like how it is when you’re pregnant, only without the “up side” of actually being pregnant. I couldn’t deal with all of the friends around me getting pregnant and giving birth (and there were so many of them! All at once, babies popping out left, right and centre!), and even just seeing a pregnant person or seeing some news article about pregnancy would make me get teary-eyed. Even thinking about it would send me spiralling into a bleak and terrible mood, and I hated myself even more due to my inability to be happy for other people’s successes. There’s a certain type of anxiety and self-loathing that comes with infertility, an irrational feeling that you have completely failed your basic biological function. A large number of misogynist (and trans-exclusionary) movements in the west seem to base much of their concept of womanhood around the possession of a uterus and the ability to “give life”, and here was I, with ostensibly female body parts, wanting to get pregnant but without the capacity to get pregnant/maintain a pregnancy long enough for it to be successful. Women without breasts or uteruses are still women (think mastectomies and hysterectomies, for a start), and your success as a human being is not defined by your ability to procreate, and rationally I know that, but it didn’t stop my brain from eating away at itself one little bit.
What did you do to help yourself cope with these feelings? How was your husband during this time?
My husband was sympathetic and supportive but struggled to fully comprehend the depth of my feelings, largely because it was happening to me and not him. He was the one who suggested taking a bit of a break from treatment when I was getting too depressed though, and he never stopped being supportive and reassuring. We often had conversations about how many rounds of IVF we would/could do, what would happen if we couldn’t conceive etc. and he never stopped reassuring me that he would continue to love me even if we couldn’t be the family with kids that we’d imagined.
As for how I coped, I mostly just cried a lot! I have a really good relationship with my parents and regularly talked to them on FaceTime, which helped. After a certain point I honestly didn’t feel like I could talk to anybody else, partly because I felt conscious of harping on about the same thing over and over, and partly because my other friends were either a) childfree by choice and generally uninterested in children or b) already parents/got pregnant easily. I had one slightly older coworker who had struggled to conceive her daughter and so could relate to how I was feeling, and even though we only had one conversation on the topic that ended up helping more than I’d anticipated too, so if I were to go back and do things again I would definitely reach out to people who have had similar experiences – but be careful about where I look for it. There are a lot of blogs and forums out there where people just come to vent their misery and frustration, and it can end up dragging you further down if you’re not careful.
How was your overall experience with your clinic?
They were absolutely wonderful. When we had tons of questions they took the time to answer and explain everything clearly. When the stress of failing to conceive got too much and I burst into tears in the consulting room the doctor and nurses were all supportive and helped me out. When we failed to conceive for yet another month I really felt as though my doctor felt a kind of personal responsibility and felt bad about the fact that we hadn’t been successful, and when the twin wasn’t growing properly she was completely direct but unfailingly sympathetic about what was likely to happen. Not only was my doctor completely thrilled about our success when it finally happened, but she also requested that we find a way to pass a message to her once we gave birth and suggested that she might try to come and visit me (if that was okay). And not just the doctor! All of the nursing and reception staff at the clinic were hugely supportive, caring, and ready to explain exactly what was being done, and why. I have nothing but praise for my clinic and if by some miracle we have the money and energy to try for a second child we will definitely go back to them.
How long did it take before you successfully conceived? How did you feel?
From the first visit to the clinic to being discharged was about a year and a half, although from our first IVF counselling session to receiving a positive pregnancy result was a mere three months. As for how I felt… pessimistic, disbelieving and scared are the three words that first spring to mind. I so desperately wanted to be able to get pregnant (and to actually keep the baby!!) but was completely convinced that something would go wrong somewhere along the way. I thought, “Once I clear [hurdle x], it’ll start feeling real,” except as soon as [hurdle x] was cleared then hurdles y and z popped up to give me something new to worry about! I don’t think I really felt “properly pregnant” until the day we went to the shrine for Inu no Hi (during week 17, when I was already showing) and I felt the baby kick, completely unmistakably, for the first time.
What happened after you conceived? Were your prenatal appointments at the same clinic? Were there any special precautions you had to take?
The IVF clinic initially gets you to come in for a transvaginal ultrasound every single week, dropping to every other week from Weeks 10-12, at which point you get referred to a regular hospital where they treat you like any other pregnant person. This means I got a ton more ultrasound scans than many people in the first few months! But it also means I got to see the existence and then disappearance of my baby’s identical twin, who failed to grow at the same pace and eventually got reabsorbed into my body. Being able to see my babies every week was really helpful in calming some of the constant anxiety clanging around my head! At 12 weeks we then “graduated” the fertility clinic and moved down the street to the birth centre at which I gave birth. As it happens this hospital is the sister institution to the fertility clinic, so some of the doctors are the same and there is regular communication between the two. Oh, one thing that the fertility clinic asked us to do post-conception was to remove/conceal any “maternity mark” badge when we visited the clinic, for the sake of all of the patients who were still yet to conceive. I really appreciated the consideration that showed.
Based on your experience, what is the public perception of IVF in Japan?
I didn’t really talk about it to many people, but those I did said they felt it was really common, and that more and more people these days are seeking medical assistance. One of my friends even said that about two-thirds of his acquaintances with children had gone to fertility clinics! I personally think that’s a bit of an exaggeration, but it’s nice not to have heard any of the “crime against nature” opinions that some people seem to hold toward so-called test tube babies in some cultures.
What advice would you give to someone who is considering IVF in Japan?
The same advice I would give to anyone considering IVF anywhere: save up, and set a limit! My husband and I talked many times about how many cycles of IVF we could afford if it failed, at what point we would consider giving up, if we would consider adoption, and how we would feel about being childless for good. It wasn’t a nice conversation, but it was a deeply necessary one. The hope can become incredibly painful, and fear of failure is only exacerbated by the knowledge of how expensive the whole thing is. Make sure you have people to talk to. Make sure you get support. Take a break every now and then if you need to. To any of my comrades out there struggling with infertility both in Japan and internationally, I hear you and hold you in my thoughts.
Pippa can be found on Twitter as @703pippa (make sure to give her a mention if you want her to follow you back as Twitter often doesn’t notify her of new followers). You can also check out her blog, which she hopes to update in the near future: https://doubledelight.wordpress.com/