Wonju→Seoul, Muan→Daegu... Hospital Hopping to Have a Child [Infertility Competition]

③ Infertility Treatments Started in Neighborhoods Eventually Head to Seoul

Editor's NoteThe era of a total fertility rate of 0.72. Long queues have formed in front of well-known infertility clinics in Seoul. This unprecedented low birthrate trend throughout history seems almost unbelievable. Last year, there were 250,000 infertility patients nationwide. In a reality where all medical infrastructure is concentrated in Seoul, infertile couples from provincial areas who travel for 'expedition treatment' 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 reality of expedition treatment for infertile couples from provincial areas who are full of determination to have children in South Korea, which is facing a low birthrate crisis.

The greatest wish of all couples undergoing infertility procedures is to succeed in pregnancy with just 'one procedure.' The representative infertility procedure, in vitro fertilization (IVF), has a reported pregnancy success rate of about 30-35% according to the Korean Society of Obstetrics and Gynecology. Numbers are just numbers, and the success or failure varies greatly depending on each individual's physical condition. The higher the age, the more infertility procedures are attempted. The average number of attempts for infertility procedures among domestic infertile couples is seven. For those in their 40s, the experience rate of procedures sharply rises to more than ten times. Couples from provincial areas who travel back and forth to hospitals inevitably face exponentially increasing physical, psychological, and economic burdens over time.

A subway seat reserved for pregnant women. Photo by Jo Yongjun jun21@

Local hospitals recommend transfer to Seoul... "5-hour traffic jams during vacation season"

Seunghyun Oh (pseudonym, 37), who travels from Wonju, Gangwon-do to Seoul for expedition infertility treatment, told the reporter that the hardest part when changing hospitals last July was scheduling. Married for four years, he began formal IVF treatment in February this year by retrieving eggs at a university hospital in Wonju. Although he underwent intrauterine embryo transfer at this hospital, just 10 minutes by car from his home, he did not achieve the desired result and moved to a hospital in Seoul last July.

"My attending physician said, 'It would be good to do preimplantation genetic testing (PGT, a test that diagnoses genetic diseases and chromosomal abnormalities at the preimplantation embryo stage and selects normal embryos),' but there is no place in the Gangwon area that can perform it, so he recommended transferring to Seoul. We looked at a list of hospitals that could perform the test and tried to find the hospital that would be least burdensome to move to from Wonju. When I first started IVF, people around me said it would be hard to commute to Seoul, so I started locally, but in the end, I had to go to Seoul."

A survey conducted by the Korean Women's Development Institute in 2021 targeting about 600 women undergoing infertility procedures revealed that 65.4% of respondents had experienced hospital transfers. Most transfers occur due to failure to conceive. More than half of those who experienced transfers moved to medical institutions outside their residential area. Especially for residents of 'Jeju/Gangwon,' the rate of transferring to hospitals in other regions was the highest at 80.0%. Among the regions of transferred hospitals, 55.4% headed to Seoul, the highest proportion, just like Seunghyun. Conversely, the rate of Seoul residents transferring to medical institutions in other regions was the lowest.

Long-distance treatment affects even scheduling hospital visits. Seunghyun, who runs a personal business, needs to arrive in Wonju by around 2-3 p.m. to fit his work schedule. He leaves Wonju before 7 a.m., finishes his consultation in Seoul in the morning, and drives back himself. It is difficult to match the schedule using intercity buses, so he drives 200 km round trip without breaks. Sudden hospital visits due to menstrual schedules or other reasons were troublesome. Each trip could take up to five hours round trip, and since the attending physician's consultation hours vary by day, visiting the hospital on time was not easy.

Especially in August, the vacation season caused travel time to double compared to usual. Seunghyun visited the hospital nine times that month just preparing for egg retrieval. At times, he traveled to Seoul up to three times a week for hospital visits. On days when the consultation lasted only five minutes after a five-hour round-trip drive, he said, "It felt really empty." The IVF process itself is stressful enough, and coordinating schedules and spending long hours traveling made it even more difficult.

In addition to expensive infertility treatment costs, transportation expenses were added on top. When attending the hospital in Wonju, he only considered hospital fees, but after moving to a hospital in Seoul, he explained that daily 'money wasted on the road' including round-trip fuel costs and highway tolls amounted to 70,000 to 80,000 KRW. "Earlier this year, my husband was seriously injured and went to a hospital in Seoul. Since I also started going to an infertility hospital, he said, 'This year, the number of times we've been to Seoul is probably more than the total visits in our lifetime.'"

Three years of trying for a child, moving from Gwangju, Bundang, Seoul to Daegu

42-year-old Eun-ae Tak, who has been undergoing infertility treatment for three years, recently transferred from a large hospital in Seoul to a well-known infertility clinic in Daegu. The intense competition for train tickets during the commute from her residence in Muan, Jeollanam-do to Seoul was a heavy burden. Also, when she had to revisit the hospital after 2-3 days, she stayed at relatives' homes or booked hotels, which incurred considerable accommodation costs. Eun-ae decided it was better to drive herself to Daegu, which is three hours and 250 km away by car.

Since starting infertility treatment in July 2021, Eun-ae has moved between hospitals in Gwangju, Bundang in Seongnam, Gyeonggi-do, Seoul, and now Daegu in pursuit of pregnancy. Before marriage, she had surgery for multiple uterine fibroids and is a high-order patient who has undergone 14 IVF cycles. Initially, she visited an infertility hospital in Gwangju, a large city near her residence. There are two infertility hospitals performing IVF in Jeollanam-do and three in Gwangju (as of March this year). After one egg retrieval at the first hospital, only three empty follicles were confirmed, so she transferred to a large hospital in Gyeonggi-do. She succeeded in pregnancy at the new hospital but suffered a miscarriage.

Syringes used for in vitro fertilization and oral medication. Photo by Jeong Hyunjin

"There are infertility hospitals in Gwangju, too. But for someone like me with 'extreme diminished ovarian reserve (severely reduced ovarian function)' or uterine diseases, I think it's like 'picking stars from the sky' to get treatment there. People receiving infertility treatment in provincial areas say things like that. Even if you undergo high-order procedures in the provinces and fail, going to the metropolitan area can succeed in one try."

Eun-ae adjusts her entire daily life to infertility treatment, including diet control, exercise, and taking supplements. She also adjusted the schedule of the reading and writing academy she runs to accommodate infertility treatment, but sudden schedule changes during procedures often required her to ask parents for understanding. Attending hospitals in Seoul caused many class cancellations, resulting in significant losses. Feeling frustrated, she directly contacted local governments such as Muan County, Jeollanam-do, and the Ministry of Health and Welfare to request support.

"The economic burden is the hardest. One IVF cycle costs at least 3 to 5 million KRW. Who can afford to put in 5 million KRW every month on a regular salary? On top of that, there are transportation, accommodation, supplement costs, and various examination fees. Although support has improved compared to before, it is still a heavy burden. The low birthrate issue is fundamental to the country. I hope they will consider it seriously."