Jang Min-ji, 34, and Park Joon, 35, thought they were late, but not too late.
They married, spent their first year together without trying for a baby and only later began preparing seriously for pregnancy. They tracked ovulation dates through mobile apps, used ovulation kits, cut back on alcohol and took supplements.
A year passed. There was still no pregnancy.
“We thought, somewhat naively, that we would not be infertile,” Jang told Korea Biomedical Review (KBR).
The tests were clarifying in a way the waiting had not been. Jang learned she had a tubal issue affecting the path to ovulation. Park was told he had a low count of motile sperm.
The couple, identified by pseudonyms because they had not disclosed the treatment widely at work, had thought time was the issue. The clinic showed them it was biology, timing and two bodies at once.
What had seemed like a delay became a schedule that would take over Jang’s evenings, body and working life.
Korea expanded IVF access and financial support as more couples delayed childbirth, but doctors warn the country’s maternity and neonatal care system is struggling to keep pace. (Image generated by Google Gemini)
For eight to 12 days, Jang injected hormones into her abdomen while doctors watched her follicles grow. Park went once, for sperm collection.
She had spent 10 years working as a pharmacist, but this was not mainly a problem of understanding medication. It was a problem of fitting injections, scans and morning procedures into a workday that did not make room for them.
In later conversations with KBR, Park described their evenings simply. They met after work at the clinic, sat through appointments and ate late dinners nearby before going home.
“It was not an easy process,” he said. “I was watching from the side, and my wife was going through much more than I was.”
Evening appointments
Korea has made in vitro fertilization (IVF) easier to start than in many countries.
Government support and insurance coverage have lowered the cost of treatment, and the number of infertility procedures rose to 200,007 in 2022, up 36.7 percent from 2019, according to the Health Insurance Review and Assessment Service (HIRA).
But the rise of IVF has exposed a gap in Korea’s birth policy. The country is helping more couples conceive at older ages, while the medical system needed to manage high-risk pregnancies and deliveries is shrinking.
“Pregnancy is determined by age,” said Professor Lee Hee-jun of CHA Gangnam Medical Center’s fertility center, in an interview with KBR. Couples are marrying later, he said, and more women are arriving at fertility clinics after their chances have already narrowed biologically.
“When women come to the hospital after 40, pregnancy is difficult,” he said. “This is not a medical problem. It is a social problem."
Professor Lee Hee-jun of CHA Fertility Center speaks during Merck Healthcare Korea’s Fertility Academy session in Seoul in November 2025, where he discussed rising infertility treatment demand among older women in Korea. (Credit: Merck Healthcare Korea)
Jang and Park succeeded on their first IVF cycle. They knew that made them fortunate. At the clinic, they had seen other couples return again and again, some eventually leaving for another hospital after repeated failures.
For Jang, even one cycle was enough to show how much of the process sits outside the formal language of medical support.
She moved to a clinic with evening hours because daytime appointments were nearly impossible with her job. Even then, egg retrieval and embryo transfer had to be done in the morning, forcing her to take leave.
She did not tell her company she was undergoing IVF. “There was also the possibility that the procedure would fail, so I did not want to tell them,” she said.
The physical burden, Professor Lee said, is built into the treatment itself. “Sperm can be collected at any time,” he said. “But egg retrieval has to follow the ovulation cycle.”
Women must take ovulation-inducing injections and return repeatedly for scans and medication adjustments, he said, because “the physical burden inevitably falls on women.”
After hormone treatment, fluid built up in Jang’s abdomen. Her stomach swelled. She grew dizzy on her commute, became short of breath and struggled to sleep.
Eventually, doctors drained about 1.8 liters of fluid.
Park said he kept watching for signs that they might need emergency care.
“She had to inject herself in the stomach at the same time every day,” he said. “Then the fluid kept building up in her abdomen. It became hard for her to even breathe.”
The government subsidy reduced the cost of treatment, but not enough to erase the financial strain.
After support, the couple still spent roughly 1.2 million to 1.8 million won (about $800 to $1,200) out of pocket on tests, medication and treatment-related costs.
Even after pregnancy, Jang needed progesterone suppositories every two weeks until around the 10th week, a non-covered medication that cost about 180,000 won ($120) every two weeks.
Professor Lee said Korea’s financial support for IVF is already among the strongest in the world. In many advanced countries, he said, one IVF cycle can cost close to 20 million won, while Korean patients often pay far less after insurance support.
“Further financial support for IVF itself may not have much meaning,” he said.
Instead, he argued, Korea should move earlier. He said women over 30 should be supported in checking ovarian reserve through anti-müllerian hormone (AMH) testing, unmarried women should receive more support for egg freezing and older couples should have broader access to donor eggs.
The point, he said, is that IVF cannot fully overcome the biology of age.
What IVF cannot solve
That is becoming clearer inside fertility clinics. The average age of women undergoing infertility treatment in Korea reached 37.9 in 2022, according to HIRA data. Pregnancy rates after fresh embryo transfer fall sharply with age, especially after 40.
Professor Kim Sung-eun, an obstetrics and gynecology specialist at Samsung Medical Center (SMC), said the policy debate has focused too heavily on pregnancy itself.
The harder part, she said, often begins after conception.
“Women who become pregnant through IVF are high-risk mothers,” Professor Kim told KBR. “But there are not many hospitals where those high-risk mothers can deliver.”
The number of obstetrics and gynecology clinics able to provide deliveries fell from 706 in 2013 to 463 in 2023, according to government and medical-sector data. Medical groups say the number has continued to decline.
Doctors increasingly describe the country’s fertility system as split in two: one side expanding access to conception, the other losing the capacity to safely manage difficult pregnancies and births.
Professor Lee said the economics of obstetrics help explain why the delivery system has weakened.
Compared with fields such as dermatology and cosmetic surgery, obstetrics carries emergency cases, overnight work, legal risk and relatively low financial reward.
“Who would run an obstetrics hospital with high medical accident risk and many emergency patients?” he said. “It is a problem of medical policy.”
For patients, the gap between policy and real life often shows up at work. Jang had a legal right to infertility leave, but using it would have meant saying out loud what she was still not ready to disclose.
“It is difficult even to bring up the words ‘infertility leave’ at work,” she said.
Before treatment, Jang and Park thought time might solve the problem. The clinic showed them that infertility could involve both partners, several causes and a process far more consuming than they had imagined.
“Preparing for pregnancy without knowing the exact cause drains not only time and energy, but also the heart,” Jang said.
Korea’s fertility policy has made it easier for couples to begin IVF. Doctors say the harder test now comes later: whether those pregnancies can be carried and delivered safely in a country where maternity wards are closing and neonatal intensive care is under strain.
Kim Ji-hye
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