Presentation (CTI)

OBJECTIVES: South Korea provides National Health Insurance (NHI) coverage for fertility treatments. The number of procedures has increased annually, rising 36.7% from 146,354 cases in 2019 to 200,007 cases in 2022. As procedure volumes grow, concerns regarding adverse events have correspondingly increased; however, a national surveillance system for fertility treatment-related adverse events remains absent. This study aimed to estimate the incidence of adverse events associated with fertility treatments and identify priorities for clinical management and long-term surveillance.
METHODS: To calculate the incidence of ovarian hyperstimulation syndrome (OHSS), intraperitoneal hemorrhage, and pelvic inflammatory disease (PID), a cohort of fertility treatment episodes (n = 128,423) was constructed using nationwide NHI claims data (2017-2024). Severity classifications for each condition were defined through a literature review, and incidence rates were estimated stratified by severity.
RESULTS: As of 2024, the overall and severe incidence of OHSS was 3.8% and 0.55%, respectively. For intraperitoneal hemorrhage, overall and severe incidence was 0.11% and 0.02%, respectively; corresponding rates for PID were 0.12% and 0.02%. All rates fell within the ranges reported in international literature. Notably, despite the increasing volume of fertility treatments, the incidence of adverse events across all conditions demonstrated a declining trend over the study period.
CONCLUSIONS: In the short term, severe OHSS should be prioritized for clinical management given its substantially higher incidence relative to other adverse events. To establish a long-term surveillance framework, development of a fertility treatment registry linked to national claims data is warranted. To our knowledge, this study is the first nationwide analysis to estimate the incidence of fertility treatment-related adverse events in South Korea using eight years of population-level claims data.