Better than sex? The rise of assisted reproductive technologies as a reproductive norm.

Half a century after the birth of Louise Brown, assisted reproductive technologies (ART) have evolved from specialised infertility treatments to become a reproductive norm in specific societal contexts. In Japan-where sexlessness and declining birthrates are widespread-ART has emerged not only as a medical solution but also a societal workaround. This paper explores the ethical implications of ART's normalisation in Japan, focusing on three key concerns: (1) the commercialisation of ART and its framing as 'natural'; (2) pronatalist incentives that blur the line between support and coercion; and (3) the decoupling of sex and reproduction through medicalisation. Using Japan as a case study, the paper examines whether ART should require clear medical indications, whether societal factors like sexlessness justify its use, and how government and industry pressures subtly shape patient choices. Ultimately, it argues for the stricter regulation of ART practices and more effective pronatalist policies that directly address sexlessness, calling for a stronger emphasis on relational ethics to balance individual autonomy with societal needs in reproductive health.