{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:17:59Z","timestamp":1787318279546,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,9]],"date-time":"2025-02-09T00:00:00Z","timestamp":1739059200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K12542"],"award-info":[{"award-number":["24K12542"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>How has the treatment policy changed since the introduction of health insurance coverage for assisted reproductive technology (ART) in Japan?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted as a nationwide fact\u2010finding survey to determine the current situation of ART treatment in Japan, the IZANAMI project. Among the 616 ART facilities across Japan, 283 (45.9%) that responded to the first (December 2021\u2013February 2022) and second surveys (December 2023\u2013January 2024) were recruited. Information on the clinical practices was collected via a questionnaire survey and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the facilities with \u2264200, 201\u2013500, 501\u20131000, 1001\u20132000, and \u22652000 annual oocyte retrieval (OR) cycles, 93.9%, 88.7%, 75.0%, 69.7% and 42.9% performed \u226580% of their OR cycles using health insurance, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas 51.9%, 53.7%, 41.0%, 40.0% and 12.5% exhibited an increase in number of OR cycles, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Therefore, a significantly higher proportion of smaller\u2010scale institutions than larger clinics had insured treatment and an increase in the number of OR cycles. Significantly more large clinics than small facilities selected mild stimulation, intracytoplasmic sperm injection, and freeze\u2010all embryo cycle; however, no significant transitions were observed in the main policies for ART, regardless of facility size. However, the indication for mild stimulation significantly increased in normal to high responders, and the choice of ovarian stimulation protocol according to the patient's wishes was significantly reduced.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Small\u2010scale institutions were more likely to offer insured treatment and increase the number of OR cycles than large facilities; however, the main protocols did not significantly change.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.16234","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T04:48:19Z","timestamp":1739249299000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Nationwide survey on the transition of treatment protocols after the introduction of insurance coverage for assisted reproductive technology in Japan: The\n                    <scp>IZANAMI<\/scp>\n                    project"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2759-9159","authenticated-orcid":false,"given":"Keiji","family":"Kuroda","sequence":"first","affiliation":[{"name":"Center for Reproductive Medicine and Endoscopy Sugiyama Clinic Marunouchi  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Juntendo University Faculty of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-5714","authenticated-orcid":false,"given":"Seung Chik","family":"Jwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5300-0037","authenticated-orcid":false,"given":"Hiromitsu","family":"Shirasawa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyuki","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Osuga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-316X","authenticated-orcid":false,"given":"Mitsutoshi","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2024.07.009"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12620"},{"key":"e_1_2_9_4_1","unstructured":"Japan Health Policy NOW.Japan's health insurance system.https:\/\/japanhpn.Org\/en\/section-3-1\/2024 [cited 2024 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