Korean society faces an unprecedented demographic crisis. The total fertility rate in 2025 stands at 0.8, a slight increase from 0.72 in 2023, yet it remains the world's lowest and is recognized as a structural problem threatening the nation's sustainability. Against this backdrop, the government has expanded support for infertility treatment, and the number of people receiving such treatment has steadily increased. In 2022 alone, more than 78,000 infertility treatments were carried out, with the total number of procedures exceeding 200,000. In Seoul, one in five babies is now born through assisted reproduction — a share that is growing rapidly. Infertility treatment is no longer elective medicine; it has become a critical pathway to childbirth.
Yet we must now ask an important question: "Are women's health interests being adequately protected throughout this process?" Infertility treatment is not a simple technology. Ovarian hyperstimulation, egg retrieval, and repeated procedures place cumulative physical and psychological burdens on women. Research shows that roughly one-third of women experience depression or anxiety during treatment, and some suffer long-term mental health problems even after treatment ends. Cases of chronic anxiety persisting for more than 10 years have also been reported.
Physical risks cannot be overlooked either. Multiple pregnancies that can result from in vitro fertilization (IVF) raise the risk of gestational diabetes, preeclampsia, and preterm birth. Newborns are also more likely to show adverse health indicators such as low birth weight and low Apgar scores, which measure a newborn's health status. In other words, infertility treatment is a medical intervention that affects the overall health of both mothers and newborns — one that cannot be evaluated solely by pregnancy success rates.
Korea already has experience with cases where women's health and ethical concerns emerged in the pursuit of scientific advancement. The Hwang Woo-suk scandal was a prominent case that drew public attention to ethical problems and health risks associated with egg harvesting. That incident led to stronger bioethics regulations, but in today's new context of expanding infertility treatment, we face the same question once again: Are policy goals being placed ahead of individual health?
With this awareness, Korea has begun to make changes. Free psychological counseling is provided through the Central Infertility and Depression Counseling Center, and the National Institute of Health has recently launched a cohort study to track the long-term health effects on women who undergo infertility treatment. This lays an important foundation for evidence-based policymaking.
Nevertheless, current support remains "procedure-centered." Counseling services rely on voluntary participation and have not yet been organically integrated into the treatment process. As a result, many women who need help are unaware that such programs exist or fail to receive support at the appropriate time.
The United Kingdom, where the world's first successful IVF was achieved, is a leading example of a country that has institutionalized not only infertility treatment support but also mental health care. The UK recognizes infertility not merely as a matter of achieving pregnancy but as a quality-of-life and health issue, and has reflected this understanding in public policy. Our policies must now take the next step. First, mental health assessments for women undergoing infertility treatment should be included as a standard part of care, not an option. Second, integrated health management guidelines covering before, during, and after procedures must be established to strengthen the safety of women receiving infertility treatment. Third, a system should be built to evaluate the long-term effects of repeated procedures on women's health, based on the National Institute of Health's cohort study.
Efforts to raise the birth rate are undoubtedly important. But if women's health is sacrificed in the process, such policies can never be sustainable. Infertility treatment is not a matter of technology but a matter of life, directly connected to human dignity.
We must now change the question we ask. Instead of asking how many children can be born, we should ask how healthily they can be born and how healthily their mothers can live. Expanding infertility treatment is only the beginning. Only when the state takes responsibility for what comes after does its policy become complete.