|Year : 2018 | Volume
| Issue : 2 | Page : 71-73
Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan
Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
|Date of Web Publication||22-Feb-2019|
Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama
Source of Support: None, Conflict of Interest: None
Fertility preservation (FP)/oncofertility is a crucial facet of cancer supportive care. The publication of FP guidelines is becoming increasingly prevalent in Japan. However, the viability of the guidelines is predicted on a well-developed FP network comprising of cancer hospitals, assisted reproductive technology (ART) hospitals/clinics, and oncofertility center, and the quality of the FP network in Japan varies greatly based on the region. Oncofertility care availability is influenced by the sustainability of each network and public financial support which may be facilitated by oncofertility registry system which recently launched in Japan.
Keywords: Cancer supportive care, cryopreservation, fertility preservation, oncofertility
|How to cite this article:|
Takai Y. Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan. Onco Fertil J 2018;1:71-3
|How to cite this URL:|
Takai Y. Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan. Onco Fertil J [serial online] 2018 [cited 2019 Jul 18];1:71-3. Available from: http://www.tofjonline.org/text.asp?2018/1/2/71/252690
| Fertility Preservation Guidelines in Japan Require Oncofertility Care Delivery System|| |
Many academic societies in Japan have issued guidelines, recommendations, and statements regarding fertility preservation (FP). The first FP guideline in Japan was published for breast cancer patients in 2014. Then, the Japan Society for Reproductive Medicine and the Japan Society of Obstetrics and Gynecology (JSOG) have published statements regarding oocyte and ovarian tissue cryopreservation (OTC), initiating the standardization and spread of the technology. The JSOG mentioned FP in their clinical practice guidelines for the first time in 2017. Finally, the Japan Society of Clinical Oncology issued FP guidelines for children, adolescent, and young adult (CAYA) patients with female reproductive, mammary, urinary, pediatric, hematologic, bone/soft tissue, cerebral, and gastrointestinal malignancies in 2017.
However, the viability of these guidelines and recommendations is predicated on a well-developed oncofertility care delivery system that conducts counseling and FP.
| How Many Japanese Hospitals/clinics Are Engaged in Fertility Preservation?|| |
Among a total of 94 hospitals or clinics registered with the JSOG that conduct FP (oocyte and/or OTC), as of October 31, 2018, there are 36 hospitals/clinics who deal with unfertilized oocytes and ovarian tissues, 57 hospitals/clinics who deal with only unfertilized oocytes, and 1 hospital who deals with only ovarian tissues.
FP hospitals/clinics are concentrated in major metropolitan areas, and there are a few FP hospitals/clinics along the Sea of Japan coast and in the Tohoku (northeastern) region.
| Significance of Oncofertility Network in Japan|| |
As of 2017, Japan had 432 Cancer Hospitals and 15 Pediatric Cancer Hospitals designated by the Ministry of Health, Labour and Welfare (MHLW), in addition to 605 assisted reproductive technology (ART) hospitals/clinics registered with the JSOG [Figure 1]. There are 108 centers which are both MHLW-designated cancer hospitals and JSOG-registered ART hospitals/clinics, only 48 of which also conduct some form of FP. Similarly, there are ten centers which are both MHLW-designated pediatric cancer hospitals and JSOG-registered ART hospitals/clinics, only five of which also conduct some form of FP. Thus, the majority of cancer hospitals do not conduct ART or FP, a state of affairs that suggest that the delivery of oncofertility care requires the establishment of a system for referring patients to specialized centers.
|Figure 1: Japanese hospitals and clinics engaged in cancer treatment (adult and pediatric), assisted reproductive technology, and fertility preservation|
Click here to view
The numbers represent the number of hospitals and clinics belonging to each population. Japan has approximately 179,000 hospitals and clinics. Cancer treatment is also performed at hospitals and clinics other than MHLW-designated cancer hospitals, whereas ART and FP (red) are performed only at hospitals and clinics registered with the JSOG.
| Regional Oncofertility Networks in Japan|| |
To streamline coordination between cancer treatment hospitals and reproductive care hospitals/clinics in Japan, individual prefectures have been sponsoring the construction of regional oncofertility networks. As of November 2018, oncofertility networks have been established in 22 prefectures. However, in Tokyo, many cancer hospitals and ART hospitals/clinics each coordinate in unique, complex fashions; as a result, it is difficult to establish a comprehensive network or understand the state of affairs within a given institution.
| How to Support Fertility Preservation-Deficient Prefectures?|| |
The distribution of the JSOG-registered FP hospitals/clinics is skewed toward large cities. There are 11 prefectures without JSOG-registered FP hospitals/clinics, which indicate that these prefectures' oncofertility care delivery systems are underdeveloped. Therefore, for the CAYA cancer patients, their families, and their attending physicians in these regions, it would be desirable to be able to consult with the Telemedicine Secretariat of the Japan Society for FP (JSFP) in a setup similar to the National Cancer Center Japan's Cancer Treatment and Pregnancy Consultation Service.
| Medical Cost and Fertility Preservation Availability in Japan|| |
As shown in [Table 1], medical cost for OTC, as well as its transplantation, is much higher than those for embryo and oocyte cryopreservation in Japan. JSOG recently reported that 44,678 neonates (4.6% of the total) were born from frozen embryos in 2016. Accordingly, oocyte/embryo cryopreservation is preferred over OTC, which may cause OTC to remain at the research stage in Japan.
| Public Financial Support for Fertility Preservation in Japan|| |
Several regional governments recently started financial support for FP, but residents in only five prefectures are eligible as of October 2018. The JSFP considers that transparency and proper decision-making in oncofertility care provided by each regional network should be warranted for the expansion of public support. On the other hand, establishment and expansion of regional oncofertility networks, in which regional governments usually participate, will facilitate public support in each region.
| Japan Oncofertility Registry|| |
To facilitate quality assurance and quality control in regional oncofertility networks, the JSFP has launched online registration system named Japan oncofertility registry (JOFR) November 2018. The JSFP is now planning to promote JOFR, together with each regional network, by appealing that public financial support should be associated with online registration through JOFR, which could improve transparency and traceability for individual FP procedures.
| Conclusion and Hints from Fertility Preservation Network in Japan for Panel Discussion on “fertility Preservation Network in Asia”|| |
Regional oncofertility networks, which comprise cancer hospitals, ART hospitals/clinics, and oncofertility center, may be useful for oncofertility care. Oncofertility care availability is influenced by the sustainability of each network and public support which may be facilitated by oncofertility registry system which recently launched in Japan.
- Regional FP networks, which comprise cancer hospitals, ART hospitals/clinics, and oncofertility center, may be useful for oncofertility care
- There remain many issues to be discussed on FP networks;
- FP networks, as well as FP hospitals/clinics and FP-affirmative health-care providers, are often maldistributed
- Telemedicine and nation-wide FP services may be useful for FP-deficient cancer patients
- FP network availability is influenced by its sustainability and public support which may be facilitated by FP registry.
- Creation of multidisciplinary FP navigators (contents) may be more important than FP network (boxes).
I am deeply grateful to Drs. Nalini Mahajan and Nao Suzuki for giving me this opportunity in ASFP and FPSI and to Drs. Nalini Mahajan and Pankaj Talwar for moderating the Session “Fertility Preservation network in Asia.”
This work was supported by a Health Science Research Grant from the Ministry of Health, Labour and Welfare, Japan (H27-Gantaisaku-Ippan-005 and H28-Kodomokosodate to Y. T.).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Takai Y. Recent advances in oncofertility care worldwide and in Japan. Reprod Med Biol 2018;17:356-68.
Saito H, Ishikawa T, Ishihara O, Kugu K, Kuwabara A, Sawa R, et al
. Assisted reproductive technology in Japan: A summary report for 2016 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology. Reprod Med Biol 2018;70:1817-76. [Japanese]
Furui T, Takenaka M, Makino H, Terazawa K, Yamamoto A, Morishige KI, et al.
An evaluation of the Gifu Model in a trial for a new regional oncofertility network in Japan, focusing on its necessity and effects. Reprod Med Biol 2016;15:107-13.