Paradox Adoption of Medical Technology? Reshaping Fertility in Japan, 1983-2018

Novel medical technologies – including those that have demonstrated clinical efficacy – often struggle to gain widespread adoption. These arise from a range of factors, including: high cost of treatment; lack of robust ethical or regulatory frameworks; insufficient skills base for administration; or managing complex supply chains. Despite limited success rates, however, fertility businesses that offer assistive reproductive technology (ART) procedures such as in-vitro fertilisation (IVF), have experienced phenomenal growth over the past few decades. By 2018, the global fertility services market was estimated at $20.4 million (Data Bridge 2019). This paper examines the historical growth of the fertility business in Japan, with particular focus on the IVF segment since the country’s first procedure in 1983. The case of Japan highlights the paradox in which a technology with relatively low success rates achieve high levels of technological adoption. For instance, babies born from IVF in Japan increased from 18,168 (or 1.64% of total births) in 2004 to 56,617 (or 5.5% of total births) by 2017 (Ministry of Health, Labour and Welfare 2020). Furthermore, Japan accounts for the highest level of IVF procedures in the world, accompanied by the lowest rates of success. A 2016 study (Dyer et. al. 2016) indicated live birth rates of 7% in Japan, compared to well over 20% in France, Germany or the UK, or the United States. The paper contributes to a subject area often overlooked in business history scholarship and refers to the literature on technology adoption. In particular, it builds on works that explore how the “readiness” or “capacity” of a given setting to adopt a novel technology (Abrishami et al. 2014, Ulucanlar et al. 2013, Gardner 2017) and support the development of a frontier industry. It uses a range of sources, from official government reports, intra-governmental organisations, to newspapers and magazines.