A parliamentary forum on introducing fertility screening for women of reproductive age was held at the National Assembly Members’ Office Building on Wednesday. (KBR photo)
Calls are growing for infertility policy to shift its focus from post-diagnosis treatment support to early detection and preventive reproductive health management.
Experts argue that as marriage and childbirth are increasingly delayed and the proportion of mothers aged 35 and older continues to rise, supporting treatment costs only after infertility occurs is no longer sufficient.
These calls were made at a National Assembly forum titled “Parliamentary Discussion on Introducing Fertility Screening for Women of Reproductive Age,” jointly hosted on Wednesday by National Assembly Health and Welfare Committee Chair So Byung-hoon and lawmaker Seo Mi-hwa.
At the forum, the Korean Society of Obstetrics and Gynecology emphasized the need for a national support system that uses anti-Müllerian hormone (AMH) testing and gynecologic ultrasound to assess young women’s reproductive health at an early stage and connect them with counseling and fertility preservation treatment when necessary.
However, experts also noted that simply providing tests would have limited policy impact unless accompanied by reimbursement for specialist counseling and a structured referral system linking patients to appropriate medical institutions.
AMH testing evaluates ovarian reserve, while ultrasound enables early detection of uterine and ovarian diseases
Professor Kim Hoon
Professor Kim Hoon of Seoul National University Hospital, who delivered the first presentation at the forum, explained the clinical value of AMH testing and gynecologic ultrasound as a starting point for discussions on fertility screening.
AMH, or anti-Müllerian hormone, is secreted by small ovarian follicles and is widely used as an indicator of ovarian reserve.
“Even women of the same age can have very different ovarian function,” Kim said. “In IVF procedures, patients can show dramatically different responses even when given the same dosage of medication.”
He explained that while AMH testing allows a more objective evaluation of ovarian reserve, the results should not be interpreted based on a single number alone, but rather in the context of age-related changes and longitudinal trends.
AMH testing is also useful for assessing changes in fertility before and after cancer treatment or ovarian surgery. Professor Kim cited decreases and partial recovery in AMH levels following chemotherapy, as well as ovarian function decline after ovarian cyst surgery, noting that “being able to show changes in fertility numerically helps patients better understand their condition and make treatment decisions.”
In addition, AMH can help evaluate the possibility of polycystic ovary syndrome (PCOS). “PCOS is not merely an issue of irregular menstruation; it can affect long-term health overall,” Kim said, stressing the importance of early diagnosis.
The importance of gynecologic ultrasound was also highlighted. Ultrasound examinations allow real-time visualization of uterine and ovarian diseases without radiation exposure and are widely used in gynecologic care for conditions, including uterine fibroids, endometriosis, ovarian tumors, abnormal bleeding, and infertility evaluation.
Kim pointed out that although severe menstrual pain is a hallmark symptom of endometriosis, many women dismiss it as normal menstrual discomfort, leading to delayed diagnosis.
“It can take seven to 10 years to confirm endometriosis,” he said. “A culture in which women simply endure menstrual pain or hesitate to visit gynecology clinics contributes to delayed diagnosis.”
At the same time, Kim cautioned against immediately applying ultrasound screening universally to asymptomatic women under the national screening system.
“Ultrasound is unquestionably clinically useful, but evidence remains limited regarding whether it should be routinely provided as a general screening test for asymptomatic women,” he said.
Nevertheless, he added that ultrasound should still be considered because it offers “an opportunity for appropriate counseling beyond the test itself.”
Supporting infertility after it occurs is too late; proposal for life-cycle fertility screening for women aged 20–39
Professor Lee Kyung-wook
Professor Lee Kyung-wook of Korea University Ansan Hospital, who delivered the second presentation, proposed concrete policy considerations for implementing fertility screening, including target populations, screening intervals, reimbursement, and healthcare delivery systems.
Lee criticized the current infertility policy as being centered primarily on subsidizing treatment costs after an infertility diagnosis.
“Modern medicine is shifting from treating diseases after they occur toward prevention and early intervention,” Professor Lee said. “Infertility, too, should now be approached from the perspective of prevention and preparedness rather than post-treatment care.”
He explained that ovarian function is the key indicator of female fertility and that both the quantity and quality of eggs decline with age. Fertility is known to decrease sharply after age 35, yet marriage and childbirth are occurring increasingly later in life.
According to data presented during the forum, the average age of first marriage among women in Korea rose from 29 in 2010 to 32 in 2024, while the proportion of mothers aged 35 and older increased from 12 percent to 38 percent during the same period.
“Young women rarely have opportunities to receive reproductive health testing or counseling,” Lee said. “Many marry and attempt pregnancy later in life, only to discover after visiting a hospital that their ovarian function has already declined and infertility treatment is needed.”
Demand for infertility treatment is already concentrated among older women. Referring to domestic IVF statistics, Lee noted that women aged 35–39 and 40–44 account for the largest share of treatments.
“In other words, infertility treatment demand is concentrated precisely when fertility is already declining,” he said.
As a policy proposal, Lee suggested a “customized life-cycle fertility screening program” targeting women aged 20 to 39. Specifically, he proposed providing AMH testing and gynecologic ultrasound examinations every five or 10 years.
“The goal of screening is not merely to confirm numbers,” Lee stressed. “It is to detect declining ovarian function or uterine and ovarian diseases early and connect women to specialist counseling and treatment when needed.”
Lee estimated the number of women aged 20–39 in Korea at approximately 5.88 million. Assuming AMH testing costs around 60,000 won ($40), and ultrasound examinations around 140,000 won, he estimated that nationwide screening would require roughly 230 billion won annually under a five-year cycle, or about 110 billion won annually under a 10-year cycle.
“Further review is needed to determine precise budget requirements,” he said. “But if early intervention can identify hidden fertility risks among young women, it would be a worthwhile investment.”
'Testing alone is not enough'; counseling reimbursement and specialist referral systems are seen as essential
Medical panelists at the forum agreed on the need for fertility screening but emphasized that the core issue lies in what happens after testing. They argued that simply handing out test results is insufficient and that an integrated management system is needed to interpret findings and connect patients with treatment or fertility preservation options.
Professor Lee Jung-ryeol
Professor Lee Jung-ryeol of Seoul National University Bundang Hospital said fertility screening is necessary because “once reproductive health deteriorates, it is difficult to reverse.”
He warned that declining ovarian function, uterine fibroids, and endometriosis can severely impair fertility once they progress, leading to refractory infertility, mounting treatment costs, and worsening low birth rates.
“If fertility decline can be detected early and preventive intervention becomes possible, the social value would be extremely high,” Professor Lee said. “Incorporating fertility screening into the national health screening system is a key area for improving current infertility support policy.”
He also criticized the current infertility policy structure for focusing on treatment only after fertility has already declined.
“In 2024, 15.1 percent of all newborns in Korea were born through infertility treatments, and about 80 percent of infertility patients in 2022 were aged 35 or older,” he said. “Infertility treatment has become a major pillar of the response to low birth rates, but aging patients are reducing treatment success rates while increasing social and economic burdens.”
Lee added that the current fertility screening support program remains application-based and selective, meaning asymptomatic young women or those without immediate pregnancy plans may miss the optimal intervention window.
“We need to shift toward universal life-cycle screening and establish an integrated management system that extends from test interpretation and counseling to treatment,” he said.
Director Joo Chang-woo
Another panelist, Director Joo Chang-woo of Maria Fertility Hospital, said demand for fertility screening is already increasing in clinical settings.
After the Seoul Metropolitan Government initially launched support for ovarian reserve testing and ultrasound screening and expanded it nationwide in 2024, screening participants have become younger, and participation rates have rapidly increased, he said.
“More women are coming in shocked after seeing their fertility test results, or realizing too late that they are approaching the age when pregnancy rates decline,” Director Joo said. “Fertility screening aligns with the broader purpose of national health screening — early detection and prevention.”
Still, he stressed that “the purpose of testing is not simply to receive a results sheet, but to have specialists interpret the findings and guide future care.”
“Evaluating ovarian function and fertility is difficult for the general public to interpret on their own,” Joo said. “Patients need to be connected to obstetricians and gynecologists or fertility specialists. Without accurate guidance, women may either overestimate their fertility or develop unnecessary fears, and some may waste critical time relying on unproven supplements or treatments.”
Government supports fertility screening goals but urges caution on national screening inclusion
Government officials expressed support for the goals of fertility screening and acknowledged positive outcomes from existing pre-pregnancy health support programs, but maintained a cautious stance toward immediately incorporating fertility screening into the national health screening system.
Jeon Eun-jung (left), director of the Health Promotion Division, and Choi Young-joon, director of the Birth Policy Division, at the Ministry of Health and Welfare (KBR photo)
Director Jeon Eun-jung of the Health Promotion Division of the Ministry of Health and Welfare said national health screenings must consider factors such as public acceptability, target appropriateness, and screening principles.
Director Jeon also noted that, since the Ministry’s Birth Policy Division already operates a pre-pregnancy health management support program, additional review is needed before fertility screening can be directly incorporated into the national health screening framework.
Director Choi Young-joon of the Birth Policy Division said the current pre-pregnancy health support program has already shown measurable results.
The program provides women with up to 130,000 won in support for AMH testing and gynecologic ultrasound examinations, while men can receive up to 50,000 won primarily for semen analysis.
According to the Birth Policy Division, the number of participants increased from fewer than 80,000 shortly after the program launched in April 2024 to nearly 300,000 in 2025. The average age of female participants also declined from around 33 in 2024 to 32.34 in 2025.
“One of the hardest goals in public health policy is changing people’s behavior,” Director Choi said. “The fact that more people are seeking testing earlier is being viewed as a positive outcome.”
However, he added that whether fertility screening should become part of the national health screening system “requires a comprehensive review of screening principles and practical considerations,” including both the advantages and limitations proposed by experts and the outcomes of existing programs.
'Debate should not focus on pressure but on women's right to health and decision-making'
One message repeatedly emphasized throughout the forum was that fertility screening should not be perceived as a policy designed to pressure women into childbirth.
Experts stressed that the purpose is not to force pregnancy or childbirth, but rather to help women understand their reproductive health and secure the ability to make informed choices.
Professor Kim Hoon said, “This kind of screening should not be understood as pressure to give birth. It should instead be approached from the perspective of protecting young women’s health and strengthening their reproductive autonomy.”
Professor Lee Kyung-wook likewise stated, “Providing women with opportunities to assess and preserve fertility while their reproductive function remains healthy is important. This can both guarantee individual self-determination and reduce the burden of repeated infertility treatment and national healthcare costs.”
The forum marked a significant first step in discussions surrounding government support for fertility screening among women of reproductive age.
Still, experts acknowledged that major issues remain unresolved, including screening targets and intervals, cost-effectiveness, interpretation standards, counseling reimbursement, referral systems, and broader social acceptance.
Even so, the overall message from experts was clear: infertility should no longer be viewed solely as a condition to treat after it occurs. Instead, policy should move toward early detection, counseling, and providing women with informed reproductive choices within the broader framework of lifelong reproductive healthcare.
Kim Yun-mi
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