The number of non-spousal artificial inseminations by donor (AID) performed in Japan has been declining for more than a decade due to a steady decrease in donors and operational facilities. However, demand is as high as ever, and Japan’s supply is failing to keep up.
Desperate would-be parents are taking matters into their own hands to purchase sperm via black markets on SNS, an unregulated practice which is fraught with potential risks. In the meantime, sexual minorities are being left in legal limbo.
While safer options include relying on overseas sperm banks that supply their customers by mail order, the process can be expensive and lengthy.
For the first time since 1899, when records started to be taken, experts anticipate that fewer than 800,000 babies will be born in Japan this year. The long-term effect of such a low birthrate has already contributed to Japan now having the oldest population of any large-scale industrialized nation. It would, therefore, not be too much of a stretch to think that the central government would be willing to do just about anything to encourage more people to have babies. Their efforts are, unfortunately, proving to be too little, too late—especially for those interested in the science of “non-spousal artificial insemination by donor (AID),” known in Japanese as jinko jyusei (人工授精). Home-grown sperm banks may provide a solution.
Demand is outstripping supply because Japan has very few locations where AID can be performed and the number of donors has been falling for years.
Limited Number of Approved Facilities with Few Donors
AID is a fertility treatment for males with azoospermia or museishisho (無精子症) in Japanese. It occurs when there are no sperm in the ejaculate. A fine catheter is inserted through the cervix into the uterus to deposit a sperm sample from a donor other than the woman’s mate directly into the uterus.
Despite having started in Japan back in 1948 with an attempt by Professor Koichi Ando (安藤畫一) of Keio University, there are still only 12 medical institutions across the entire country where this procedure can be performed legally.
The number of such procedures is relatively small. 2,641 treatments were given to 819 couples in 2019, resulting in only 90 births. The statistics have, in fact, been falling precipitously for the past several years since the legal rights of children born via AID were modified.
Legal Rights Discouraging Domestic Donors
Since 2005 so-called “right to know origin” laws were established in Japan to enable children born via AID to be able to identify the original donor. Remember the 2010 film The Kids Are All Right starring Annette Bening, Julianne Moore, and Mark Ruffalo? It was about what happens when two children conceived via AID seek out their biological dad and bring him into their non-traditional family life. Since the early 2000s, a story like this could become reality in Japan, too.
A side effect of this law is that it has become very difficult to attract potential sperm donors who desire to remain anonymous.
Since 2006, even Keio University Hospital in central Tokyo, one of the leading hospitals in the country and the site of Dr. Ando’s pioneering work in the field, stopped accepting appointments for new patients. This is because they are forced to counsel potential donors,
In the future, if a child requests disclosure of information, we must comply.
It has simply become too difficult to attract donors. As a result, many of the officially approved facilities for AID have reported that they have suspended treatment.
Thus, would-be desperate parents are often unable to obtain a sperm donation through the normal, regulated channels. More and more individuals have, therefore, resorted to searching for donors on their own and purchasing sperm directly via the internet.
Frustrated with the limited supply and the red tape associated with the official procedure for AID, people who want results quickly are simply taking matters into their own hands. If there were ever a situation for caveat emptor, or “let the buyer beware,” this is it! This kind of e-commerce can be very risky.
DYI Direct Sperm Trading via SNS
Lately, there has been a rash of reports of a new kind of “do it yourself” (DYI) sperm trading by people searching for donors on social networking sites. They receive their “delivery” by mail order, inject donated sperm into the vagina by themselves or use sperm from unregistered facilities.
Dr. Hiroshi Okada, a professor at Dokkyo Medical University and director of the Mirai Life Research Institute, Japan’s first sperm bank that just opened this summer, explained,
Not only is this a safety issue, but it can also be criminal and extremely dangerous…The semen that is handed over may carry infectious agents. We don’t know if the sperm belongs to the donor or not. When the child is born, it may turn out that the sperm is not Japanese. Such crazy things are happening.
Such an outcome would certainly be a surprise and is reminiscent of the famous sperm scene of the much older movie classic Everything You Always Wanted to Know About Sex But Were Afraid to Ask, featuring Woody Allen.
Kidding aside, Professor Okada and his team have concluded that 96.4% of the 140+ websites sites for “sperm donor” and “sperm bank” are not safe. Many are nothing more than hook-up scams masquerading as official medical resources.
There are also matching sites that connect would-be parents with prospective donors but act as a middle man. The prospective mother selects a sperm donor that meets her requirements and contacts the site directly to coordinate the actual exchange of freshly harvested semen. Such sites operate with almost no responsibilities to ensure that the transactions occur in good faith. Some of the sperm donors want to help those who are unable to have children, while others have a variety of reasons and purposes, such as wanting to preserve their own genetic “children.”
The medical risks with such sites are real. The semen may have been collected in an unsanitary manner. Germs may be introduced into the mother’s body when such semen are injected into the vagina with a syringe. If the donor is infected with HIV, hepatitis B, syphilis, or chlamydia, the woman may become infected through the semen. If the donor has a genetic disease, the necessary information will not be transmitted to the child. Furthermore, there is a possibility that the donor may have donated sperm that is in poor condition and not capable of conception.
Finally, there are no guarantees that the information about the donors is accurate.
The somewhat obvious risks of DYI sperm trading via SNS are scary enough to encourage many to at least attempt to try the official route at first, but some sexual minorities are unable to access this channel.
Sexual Minorities Left in Legal Limbo
In Japan, official sperm donation is limited to legally married couples, known as hoteki fufu (法的夫婦) in Japanese.
Single women (officially called “elective single mothers” or sentakuteki shinguru maza (選択的シングルマザー) in Japanese ), same-sex couples, and de facto married couples of female-to-male (FTM) trans persons who do not meet the conditions for gender reassignment in the family register are currently excluded from receiving sperm donation. These groups are, essentially, forced to try to obtain semen on their own via the internet.
The True Story of Hina and Waka
Hina (pseudonym), a 41-year-old woman, met her partner Waka (pseudonym), a 30-year-old woman who loves children, and they decided to have a baby together. They had their wedding abroad and spent the next four years searching for a way to have a child. An overseas sperm bank that sells frozen sperm had no Japanese donors, so they passed on the idea.
Hina’s next move was to seek help at a gay bar to attempt to receive a sperm donation from a gay man without the risk of being asked to have sexual intercourse. He solicited donors on the internet and found a willing gay man on a gay-only message board. This person agreed to reveal his real name and place of work. After doing some research Hina decided to trust this man and asked him to donate his sperm. Waka is now also trying to conceive a baby using the same man’s sperm. If the baby is born, they will be “half-siblings.”
Hina gave birth to her first son last year. While celebrating his first birthday with their parents Hina and Waka explained,
More and more same-sex couples are asking for sperm on the internet…Although my son does not have a father listed in the family registry, I want to raise him so that he can say with pride, ‘This is my team, so it’s okay,’ even if people around him say it’s strange.
Potential for Greater Inclusivity
Although the central government certainly continues to have its hands full with the coronavirus, perhaps the legal restrictions concerning AID may become more inclusive in the near future.
In a supplementary provision to the Law on Special Provisions of the Civil Code (enacted in December 2020), which stipulates the parent-child relationship for children born through assisted reproductive technologies, the Diet has decided to study the issue and take necessary measures within two years. They are also discussing the right of children to know their origins and whether to expand the scope of the law to include more than just legal couples.
For those weary of the very real risks associated with the “Wild West” of sperm trading on the internet and for people who face legal restrictions, are there not safer options?
Japan’s First Sperm Bank Offers Better Returns
The short answer is “Yes,” but options are still limited. For guaranteed quality and safety, a reputable sperm bank is probably a reasonably secure choice, but to date, Japan still only has one sperm bank. It is, moreover, still brand new. That is why more and more Japanese women have been ordering sperm from overseas via mail order.
Reliance on “Foreign Exchange”
Large commercial international sperm banks are usually regulated, have plenty of staff on hand to interview potential sperm donors, and routinely conduct thorough checks for infectious diseases.
Cryos International, one of the world’s largest sperm bank operators headquartered in Denmark, reported that more than 150 women purchased and used sperm between February 2019 and November 2020, when it set up a contact point in Tokyo. They still only have the equivalent of a “branch office” in Japan. Thus, it is somewhat of a stretch to call Cryos a true sperm bank in Japan. Nevertheless, their reputation proceeds them.
Cryos receives approximately 70% of their donations from medical facilities, which helps to maintain their reputation for high quality and safety.
One problem is, however, the cost. A typical purchase order from Cryos will cost several hundred thousand yen (US $2,500 ~ $5,000) including shipping costs. Despite this high cost, there is no guarantee of pregnancy.
Another problem is that at present there is still a shortage of Japanese sperm donors. Despite the thorny issue of “right to know origin” laws, since July Japan now finally has a real home-grown sperm bank.
First Domestic Sperm Bank Established
The Mirai Life Research Institute (みらい生命研究所), Japan’s first sperm bank, was established in Koshigaya City, Saitama Prefecture in July. The institute’s purpose is to cryopreserve sperm donated by non-spouses and provide it to medical institutions that have signed contracts with the institute after thoroughly testing for safety and viablity.
Dr. Okada (quoted above) leads this new resource which specializes in artificial insemination (人工授精) and intracytoplasmic sperm injection (顕微授精). The aim is to help patients suffering from male infertility caused by azoospermia and other conditions.
There are two types of azoospermia: obstructive and non-obstructive. Dr. Okada clarified,
In the case of obstructive azoospermia, all that is needed is to reconstruct the sperm’s pathway from the testes…In the case of non-obstructive azoospermia, there are no or very few places in the testes where sperm are being produced. Sperm must be extracted from the testes and delivered by intracytoplasmic sperm injection (ICSI).
Yields are still not all that good.
In the case of non-obstructive azoospermia the chances of obtaining sperm are only between 30 ~ 40%. Even when sperm can be harvested, usually only half of them will be viable.
Dr. Okada elaborated,
In other words, only 20% of patients with obstructive azoospermia will be able to have children, at best. 80% of patients will be left wondering what to do with the rest of their lives: first, live happily together without children, second, adopt, or third, have children. And the third option is AID.
The numbers for AID are even lower.
Ongoing Need to Increase Current Low Yields in the Sperm Bank
The pregnancy rate with AID is currently still only about 3%.
Dr. Okada cites the problem of sperm quality as the primary culprit. As a result, the institute conducts rigorous screening tests to check for infectious diseases and genetic disorders in the donors, as well as the function of the sperm. He explained,
This is where our years of research come into play. Only sperm with good function are selected for cryopreservation. We also melt the frozen sperm for a few months and examine them, and then send out only those sperm that are guaranteed to function properly. By adopting this approach, we would like to bring the pregnancy rate up to about 30%, the same level as other countries. This will make it easier for people to choose AID as an option.
Because of the rigorous testing, it is expected that only about 30% of those who offer to be sperm donors will actually qualify.
Dr. Okada and his colleagues are on a mission to improve the quality at their sperm bank and ensure that their service will help to ensure that women who want to conceive with donated sperm are able to do so with less risk.
The Mirai Life Research Institute may provide hope for a solution to Japan’s lack of donors for AID. At the very least the risk associated with the unregulated sperm trade on the internet is untenable. While a quick fix is unlikely, domestic sperm banks may, ultimately, lead to a long-term solution to Japan’s declining birthrate.
Mark Kennedy is a native of Chicago who has spent more than 20 years living, studying, and working in Japan. By day he is Country Head - Business Development, Nexdigm - Japan but becomes a writer after work. Mark is a lifelong student of the Japanese language and culture. He loves to travel throughout the country. Mark also is the author behind the "Real Gaijin" Substack, countryroadsjapan.com, as well as the Country Roads Japan and Coastal Sailing Japan YouTube channels. Photo supplied courtesy of the author who had stopped to check out the free-roaming horses and cows about half-way up to the summit of Mt. Aso, an active volcano in the center of Kyushu.