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very interesting insight that is very counter-consensus. i live in Japan and am familiar with the ART options here. as you stated, it is rather expensive compared to average incomes; but i did hear that the government will pay for ART services soon if they are not already.

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https://landgeistdotcom.files.wordpress.com/2023/01/east-asia-fertility-rate-1.png

Japan is actually an outlier in fertility within East Asia

Other than underdeveloped regions (Outer Mongolia, North Korea, Tibet etc..) it actually has the highest fertility, compared to peer regions (South Korea, Taiwan, coastal provinces of China)

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