As Marriage and Pregnancy Are Delayed, 1 in 7 Couples Faces Infertility

Editor's NoteWith the total fertility rate at 0.72, lines stretch long in front of Seoul's well-known infertility clinics. The unprecedented trend of low birth rates, both historically and globally, seems almost irrelevant here. Last year, there were 250,000 infertility patients nationwide. In a reality where all medical infrastructure is concentrated in Seoul, infertile couples from other regions who travel for "medical pilgrimages" to have children continue to suffer today. The treatment itself is difficult, but regional disparities in healthcare block the path of infertile couples who desperately wish for pregnancy and childbirth. We take a closer look at the reality of "medical pilgrimages" taken by infertile couples from outside Seoul who are determined to have children in South Korea, a country facing a low birth rate crisis.

② Current Status of Infertility Patients in Korea

Number of Infertility Treatment Patients Last Year: 139,000

Total Medical Expenses: 392.1 Billion KRW, 2.82 Million KRW Per Person

Impact of Social Structural Issues Such as Delayed Employment, Marriage, and Childbirth

Proportion of Mothers Aged 35 and Older Last Year: 36.3%

The number of couples diagnosed with infertility and undergoing major infertility treatments such as artificial insemination and in vitro fertilization continues to rise. Infertility is defined as a couple who, despite not using contraception and having regular intercourse, fails to achieve pregnancy within one year (or within six months for women aged 35 or older). As people focus on employment, delay marriage, pursue housing stability, and postpone pregnancy while working, childbirth is naturally delayed, leading to an increase in couples struggling with infertility.

A pregnant woman hospitalized. Photo by Jo Yongjun jun21@

Number of Infertility Patients Nationwide Surpassed 250,000 Last Year

According to the latest data from the National Health Insurance Service obtained by Asia Economy, the number of infertility patients nationwide exceeded 250,000 last year. Of these, 160,000 were women and 90,000 were men, all diagnosed with infertility at hospitals (medical diagnosis: infertility). By age group, the largest number was in the 35-39 age range, with 88,685 patients, followed by 83,702 in the 30-34 range, and 49,990 in the 40-44 range. The number of patients who received infertility treatments such as artificial insemination and in vitro fertilization last year was about 139,000, with total medical expenses reaching 392.1 billion KRW. The average medical expense per person was about 2.82 million KRW.

In 2018, the number of patients diagnosed with infertility was 228,000 (according to last year's Health Insurance Review and Assessment Service report), and the number of patients who received infertility treatments was 120,000. Over the past six years, the number of infertility patients has increased by 9.6%, and the number of infertility treatment patients by 16%. During the same period, the average medical expense per infertility treatment patient more than doubled, from 1.27 million KRW to 2.82 million KRW. While the gender ratio for infertility diagnosis is about 6:4, 95% of infertility treatment patients are women.

The World Health Organization (WHO) estimates the lifetime prevalence of infertility (the proportion of adults who experience infertility at least once in their lives) worldwide at 17.5%. The point prevalence, meaning the proportion of people currently experiencing infertility, is 12.6%. In Korea, a sample survey conducted by the Korea Institute for Health and Social Affairs in 2003 already found a domestic infertility rate of 13.5%, suggesting that about one in every 7 to 8 couples in Korea struggles with infertility.

As Marriage and Pregnancy Are Delayed, 1 in 7 Couples Faces Infertility

This rapid increase in infertility patients is interpreted as stemming from social structural issues such as delayed employment, marriage, and childbirth. Last year, the average age at first marriage was 31.5 years for women and 34.0 years for men, up 1.5 and 1.4 years, respectively, compared to 2015. The average age at first childbirth was 33.6 years. The proportion of mothers aged 35 and older was 36.3% last year, meaning nearly 4 out of every 10 mothers were in this age group. As age greatly affects fertility, these social changes are a factor driving more couples to seek medical help for infertility.

"In Their 40s, Infertility Treatment Begins Within a Year of Marriage"

According to the 2021 Family and Childbirth Survey Report by the Korea Institute for Health and Social Affairs, which surveyed 10,000 households nationwide, 17.2% of women in legal or de facto marriages experienced infertility. The older the age at first marriage, the higher the rate of infertility experience, with one in three married women aged 35 and older reporting having experienced infertility.

The later the marriage, the sooner infertility treatment tends to begin. A 2021 survey by the Korean Women's Development Institute of about 600 women who underwent infertility treatment found that the rate of infertility diagnosis within two years of marriage was relatively higher among women aged 35 and older compared to those under 35. In addition, the higher the age at marriage, the higher the response rate of having received infertility treatment within one year of marriage. Notably, among women in their 40s, 6 out of 10 respondents said they began infertility treatment within less than a year of getting married.

As a result, about 10% of newborns each year are born through infertility treatments. Kim Youngsang, director of Gamja and Snowman Clinic and a specialist in infertility, explained, "As people spend more years studying, their entry into society is delayed, and as marriage costs increase, people spend longer working to save money before marriage, leading to a vicious cycle of infertility. In reality, it is not so much that the number of infertility patients is increasing, but rather that the number of 'older couples' is rising, which in turn increases the number of infertility patients."