"6 Hours of Travel a Day, 5 Minutes of Consultation" A Couple Traveling Hundreds of Kilometers for Treatment Cries [Nanimsang Gyeonggi]

① The Journey of Infertile Patients in Their 40s from Busan to Seoul

Editor's NoteIn an era of a total fertility rate of 0.72, long queues have formed in front of famous infertility clinics in Seoul. This unprecedented low birthrate trend throughout history seems almost ironic. Last year, there were 250,000 infertility patients nationwide. In a reality where all medical infrastructure is concentrated in Seoul, infertile couples from provinces who embark on 'medical pilgrimage' to have children continue to suffer today. Just receiving treatment is difficult enough, but medical inequality between regions blocks the path of infertile couples who desperately wish to conceive and give birth. We take a closer look at the actual conditions of medical pilgrimage by infertile couples from provinces full of determination to have children in South Korea, which is facing a low birthrate crisis.

Cha Eunhwa (44), who lives in Busan, married her same-age husband in January this year after dating for 10 years. She left Seoul, where she had lived all her life, quit her job, and moved to Busan to be with her husband who was working there. Recently, she has visited Seoul nearly 20 times over the past three months, traveling 400 km each time. This is because she started attending a large infertility hospital in Jamsil, Seoul, since May. There are 15 infertility specialized hospitals capable of in vitro fertilization (IVF) procedures in Busan as of March this year. She also underwent tests at hospitals in Busan before choosing to go to Seoul. However, she ultimately decided to have her first IVF procedure in Seoul. When met near the hospital last month, Eunhwa explained that she chose to seek infertility treatment in Seoul because she is 'in her 40s' and in a state of 'extreme diminished ovarian reserve (DOR).' Infertile patients aged 40 to 44 increased by 31.1% over the past five years until 2022 (according to the Health Insurance Review & Assessment Service 2023 report), showing the largest growth rate among all age groups.

Delayed Childbirth Due to Late Marriage, Increasing Infertility... Medical Institutions Concentrated in the Capital Area

The number of infertile couples visiting hospitals to have children is increasing. Infertility is defined as a couple who has not used contraception but fails to conceive within one year despite normal sexual relations. According to the National Health Insurance Service, the total number of infertility patients nationwide last year was 251,173. By gender, there were 160,000 women and 90,000 men. The number of infertility patients, which was about 230,000 five years ago in 2018, is steadily increasing. As people focus on employment, marriage is delayed, pregnancy is postponed while dreaming of housing stability, and economic activities continue, the timing of childbirth naturally gets delayed. Last year, the fertility rate of women in their early 40s was 7.9, more than twice that of women in their early 20s (3.8). This structure inevitably leads to an increase in couples visiting hospitals due to infertility issues.

In an era of a total fertility rate of 0.72, people who desperately wish to conceive and put in great effort are visiting infertility hospitals, making the word 'low birthrate' almost meaningless. Like most medical infrastructure, infertility hospitals are concentrated in the capital area. As of the end of March, the Ministry of Health and Welfare designated a total of 269 infertility treatment medical institutions. Among them, 21.9% (59) are in Seoul and 20.1% (54) in Gyeonggi Province, concentrated in the capital area. Infertility treatment medical institutions are hospitals designated by the government that perform representative infertility treatments such as artificial insemination and IVF. There are 154 hospitals nationwide that can perform both procedures. Of these, 45.5% are located in Seoul and the Gyeonggi area. Including Incheon, the capital area's share is exactly 50.0%.

Infertile couples nationwide flock to the capital area where medical facilities are concentrated. According to data from the Health Insurance Review & Assessment Service, the proportion of infertility treatment (assisted reproductive technology) patients receiving treatment at capital area hospitals is steadily increasing. The share of patients treated in hospitals in the three capital area regions?Seoul, Gyeonggi, and Incheon?rose from 64.5% in January 2019 to 67.7% in January this year, an increase of 3.2 percentage points over six years. This figure has shown a steady upward trend every year. This means that 68 out of 100 infertility treatments are performed at capital area hospitals. According to data submitted by the National Health Insurance Service to the National Assembly in 2019, among the top 20 infertility treatment medical institutions by patient numbers nationwide, 8 were in Seoul, 6 in Gyeonggi, 2 in Busan, and one each in Daegu, Gwangju, Daejeon, and Ulsan.

"When Unpredictable Schedules Arise, I Can't Get Train Tickets and Pace Anxiously"

Eunhwa is one of the infertile couples who decided to seek treatment in Seoul. Although she persuaded her husband, who opposed IVF, and chose the hospital with difficulty, Eunhwa confessed that it was much harder than expected. Having quit her job and started a personal business after marriage, Eunhwa said that if she had continued working, she would have had to either quit her job or give up the treatment. "I heard I had to visit the hospital often, but I didn't expect it to be this much. The waiting time is long. I've waited for three hours before. So even if my appointment is in the morning, I buy a train ticket back at 5 p.m. because I never know when it will end."

There are many difficulties that make Eunhwa's infertility treatment hard. She has to take injections and medicine several times a day at scheduled times. She visits the hospital countless times for procedures and tests. According to data from the Health Insurance Review & Assessment Service, the average number of hospital visits per infertile patient last year was six days, but IVF patients often visit several days a month for egg retrieval, ultrasound examinations, embryo transfers, and more. She also has to endure the severe waiting lines at large hospitals. Consultations last only about 10 minutes. It's inevitable to feel anxious about the results.

What makes Eunhwa's already difficult infertility treatment even harder is the issue of transportation. To visit the hospital for treatment, train or plane tickets are essential, but getting tickets itself is difficult. Eunhwa, who travels from Busan Station to Jamsil, Seoul via the Suseo High-Speed Railway (SRT), said she once booked train tickets for an entire week in advance to secure a seat. This is because the hospital instructs her to visit on the 2nd or 3rd day after menstruation starts, but the exact day is unpredictable. "There is a cancellation fee. But if I don't do that, I can't come to the hospital at all. So I had no choice but to do that."

If she cannot get a train ticket, she tries to urgently get a plane ticket to Seoul. On such days, she takes three or four types of public transportation in one day: from Busan to Gimhae Airport by taxi, Gimhae Airport to Gimpo Airport by plane, and Gimpo Airport to the hospital in Jamsil by taxi and subway. Traveling like this quickly drains her energy.

Spending 800,000 Won on Transportation in a Month Just for Hospital Visits... Plus Accommodation Costs

Transportation costs are also enormous. Even traveling alone for treatment costs about 150,000 won for a round trip in one day. If the couple travels together, it costs 300,000 won per day. This is why the husband only accompanies her when a guardian is absolutely necessary, such as for procedures requiring anesthesia. In August alone, Eunhwa spent 700,000 to 800,000 won on transportation for two egg retrieval procedures.

IVF procedures mainly consist of egg retrieval, embryo transfer, and various tests such as ultrasounds. Some procedures like egg retrieval require arriving at the hospital at an exact time; if she cannot arrive on time, the carefully prepared procedure cannot be performed. When such schedules are set, Eunhwa comes to Seoul the day before and stays overnight. Since she has experienced flight delays, this is an unavoidable choice to ensure she arrives on time. This adds an accommodation cost of 200,000 won.

Unavoidable Choice of Medical Pilgrimage for Infertility, That Harrowing Journey

"The egg retrieval was scheduled for 9:30 a.m. Even if I took the first flight, I couldn't make it on time, and the train would have required me to board before 6 a.m., which meant staying up all night. I needed to be in good physical condition, but it was impossible. In the end, I had no choice but to book accommodation. My husband said he was sorry and that if we had married earlier, I wouldn't have had to suffer, which made me upset."

This situation is not unique to Eunhwa. Infertile couples from provinces who have come to Seoul for treatment expressed similar sentiments: "As soon as we leave the consultation room, we book train tickets first," "I'm physically exhausted. I get lost in my thoughts, and my energy drops, making my head feel foggy," "Flying back and forth is costly, time-consuming, and physically demanding."

The only reason they endure this difficult process and choose to go to Seoul is one: to have a child.