"Traditional Korean medicine seems to have prescriptions too. Are those covered by insurance?"On the 16th, during the Ministry of Health and Welfare work briefing, remarks by President Lee Jae-myung
Talks to include infertility treatment with traditional Korean medicine in national health insurance benefits are moving quickly with President Lee Jae-myung's interest. The traditional medicine community is demanding coverage, saying the "effect has been proven" based on domestic and international studies, but the Ministry of Health and Welfare and the medical community still question "whether there is sufficient scientific evidence that anyone would recognize."
There is concern that policy is moving ahead before verification of effectiveness is complete. Especially as the national health insurance finances are tightening, questions are being raised about whether it is appropriate to include treatments without scientific consensus in the benefits package.
The Rules on Standards for National Health Insurance Medical Care Benefits state the criteria for determining coverage relatively clearly. The Minister of Health and Welfare must decide whether to include a service in the benefits package by considering "medical validity, medical seriousness, clinical usefulness such as treatment effectiveness, cost-effectiveness, the degree of patients' out-of-pocket costs, social benefits, and the financial status of health insurance."
Moon Je-won, academic director of the Korean Association of Obstetricians and Gynecologists in Private Practice, said, "Nowhere—including the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE), internationally authoritative academic bodies in infertility and reproductive medicine—says there is sufficient evidence that adjunctive therapies such as Korean medicine or Chinese medicine provide tangible benefit to patients with infertility."
◇ The international standard for infertility treatment is the live birth rate… "No evidence traditional medicine improves it"
When evaluating outcomes of infertility treatment, the metric most valued by infertility clinics and regulators worldwide is the live birth rate. The benchmark is not simply whether pregnancy occurred, but whether a baby was actually born.
The representative study that comprehensively reviewed the effect of acupuncture under this standard is the Cochrane review. Cochrane is the world's most authoritative organization that systematically selects and integrates randomized controlled trials (RCTs) published to date, rather than a single study. In 2013, Cochrane concluded, "There is no evidence that concurrent acupuncture at the time of embryo transfer or oocyte retrieval improves the live birth rate."
A key question is whether any high-quality research has since overturned this conclusion. A large RCT of 824 people published in 2018 in JAMA reached the same result. The live birth rates were 18.3% in the acupuncture group and 17.8% in the sham acupuncture control group, with no statistical difference.
Most studies published afterward were observational, had small sample sizes, or focused on indicators such as pregnancy rate, ovulation rate, or hormonal changes, leading to assessments that they fall short as a basis for policy decisions.
A domestic study that sought to verify the effectiveness of herbal treatment also faced rejection from the international academic community. Three Korean medicine hospitals conducted a study from 2015 to 2019 over four years with 620 million won in support from the Ministry of Health and Welfare's Korean Medicine Industry Division. The gist was that the pregnancy success rate among infertility patients who received traditional medicine treatment was higher than among those who underwent intrauterine insemination. The researchers submitted it in 2019 to the SCI-indexed journal Medicine.
But Jack Wilkinson, Cochrane's statistical editor and a biostatistician at the University of Manchester's Centre for Biostatistics, refused to review it, saying, "The conclusions are not connected to the study design at all." He posted the process on social media, even calling it "ridiculous" and "not science." The problem was that the researchers calculated the success rate of traditional medicine infertility treatment as cumulative pregnancies over seven menstrual cycles for women, while using only the success rate from a single procedure as the comparator for intrauterine insemination.
◇ There may be particularities in infertility… but clinical cases and statistics are lacking
Even herbal treatments, which received a recommendation of "B/moderate," meaning clinical adoption should be considered, in the Women's Infertility Traditional Medicine Standard Clinical Practice Guideline published in 2024 by the National Institute for Korean Medicine Development (NIKOM), do not have a broad evidence base.
There are only five RCTs underpinning that recommendation, with a total of just 325 participants. The limitations were also noted: blinding was often inadequate or uncertain, sample sizes were small, and results lacked consistency across studies.
The traditional medicine community does not deny the lack of large RCTs. NIKOM also stated in the guideline, "Due to a lack of large-scale controlled clinical studies, treatments widely used in real-world practice may be excluded from the recommendations for lack of evidence."
In response, the traditional medicine community emphasizes that "the particularities of infertility treatment must be taken into account." Kim Seok-hee, public relations director of the Association of Korean Medicine (AKOM), said, "Many patients receiving traditional infertility treatment have already tried treatments covered by national health insurance, such as intrauterine insemination or IVF, and still failed to conceive," adding, "It is practically difficult to design controlled trials under identical conditions for patients whose fertility status varies widely."
The traditional medicine community also offers "field cases" accumulated over the past decade or so through local government programs as evidence. As of September 2025, 201 basic local governments nationwide are running support programs for infertility treatment with traditional medicine. Designs vary by locality, but the general approach is to support women or couples with infertility for three to six months with herbal treatments and expenses for tests and counseling. Gyeonggi Province alone allocated a related budget of 1 billion won this year.
But these materials also clearly have limitations for verifying scientific effectiveness. Many basic local governments support only 10 to 50 people per year, and even metropolitan governments average around 100. Treatment duration and methods, as well as inclusion and exclusion criteria, differ by locality, making integrated analysis itself difficult.
The Ministry of Health and Welfare applies stricter criteria. Yoo Jeong-min, head of the ministry's Health Insurance Benefits Division, said, "Coverage applies to medical services whose clinical effectiveness and cost-effectiveness have been verified above a certain level," adding, "It is a process of comprehensively determining whether there is a more cost-effective alternative for the same funding and whether it is indeed desirable to inject public funds."
The official added, "It is difficult to say that standardized evidence has been sufficiently accumulated to make such a determination for traditional infertility treatments."
NIKOM also said in the clinical practice guideline, "No domestic or international studies have yet evaluated cost-effectiveness."
◇ The policy clock is speeding up… For treatments set to receive taxpayer money, where are the standards?
Still, policy is moving quickly. Above all, the president's interest is strong. Since serving as Seongnam mayor, Lee has personally overseen related programs, and as Gyeonggi governor, he increased the budget from 500 million won to 800 million won.
The legal basis has also been laid. In 2024, the National Assembly passed a partial amendment to the Mother and Child Health Act to allow the state to support expenses for traditional infertility treatment. In the same year, the National Assembly's Health and Welfare Committee, while reviewing the Ministry of Health and Welfare's 2025 budget, newly allocated 6 billion won for a "voucher program for traditional medicine infertility treatment."
The medical community's concerns appear to be growing. They warn that as patients spend time on treatments whose effectiveness has not been verified, their chances of pregnancy may decline irreversibly.
Kim Mi-ran, an obstetrics and gynecology professor at Ajou University Hospital, said, "I have often seen patients subjected to cruel hope," adding, "If traditional treatments were that effective, Korea's infertility treatment outcomes should be much higher than those in the United States, Europe, and Japan, where such treatments are scarcely used."
Park Sang-ho, chair of the Korean Medical Association Organization's Special Committee on Countermeasures for Korean Medicine, said, "This is not about questioning patients' freedom to choose treatments; the moment public funds are invested, the standard must shift to scientific evidence."