As U.S. Fertility Rates Keep Falling, Couples Are Left Wondering Why This Is Happening

For 41-year-old professional Megan Dunn, the journey to having a baby has been fraught with years of painstaking frustration, heartbreak, and a sense of loss for which nothing can prepare you. “I always knew I wanted children, especially growing up in the South — you expect to be married with kids by your early 30s,” she tells The New York Sun. “But my husband and I didn’t get married until later. Now, I’m at a place where if it happens, it happens. But it’s hard.”Ms. Dunn detailed the emotional toll, the feelings that one’s body is failing, and even having to take months off work to lower stress levels as she moves from treatment to treatment, and the jarring bank account strain given that most fertility treatments are not covered by insurance. “In California, we pour money into so many things, but those of us paying into the system and trying to have kids can’t even get much of the basic care covered,” she said. Ms. Dunn is hardly alone in her struggle to grow a family as infertility rates rise and population replacement numbers plummet across the country. “We’re definitely seeing infertility more and more, and not just with age,” Reproductive Endocrinologist at CNY Fertility, Dr. Tarita Pakrashi, tells the Sun. “But there isn’t one simple explanation. There are several contributing factors — some medical, some societal.”The Numbers The United States fertility rate continues to fall, reaching what appears to be a historic low in 2023, according to the most recent comprehensive data available. According to the Centers for Disease Control and Prevention, the general fertility rate — measured as live births per 1,000 women aged 15 to 44 — dropped to 54. This marks a 3 percent decline from 2022 and continues a long-term downward trend.Another key metric, the total fertility rate, estimates the average number of children a woman will have over her reproductive lifetime. In 2023, that number stood just above 1.6 — well below the replacement level of 2.1 and down from about 2.0 in 2001.The birthrate, which calculates births per 1,000 people in the overall population, also shows a decline. In 2022, it was 11 per 1,000 — compared to 14.8 in 1995 — reflecting that Americans are having fewer children overall.These statistics don’t distinguish between those who choose not to have children and those struggling with infertility. Recent data, however, pinpoints that about one in six couples of reproductive age globally experience infertility at some point in their lives.Political leaders are taking note. Infertility has emerged as a focal point for the Trump administration. The President has pledged to have Robert F. Kennedy Jr., his head of the Department of Health and Human Services, probe the factors behind this growing health concern as the White House grapples with ways to encourage Americans to have larger families. Mr. Kennedy has bluntly questioned the nation’s declining fertility rates in a post on X, asking, “Why are so many couples infertile?” while his ally, former surgeon and wellness advocate Dr. Casey Means, has gone so far as to label infertility a national “crisis.”So, from a medical perspective, what is going on?The Medical FactorsSeveral health trends raise concern among researchers tracking why more people struggle to conceive. One major factor is age. Americans are waiting longer to start families, with the average age of first-time mothers now over 27 and rising. “Many of our patients are choosing to start families later in life, which often means we are working with lower egg counts or reduced egg quality,” Medical Director of the Tree of Life Fertility Center at Los Angeles, Dr. Vuk Jovanovic, tells the Sun. “Eggs are, unfortunately, one part of a woman’s body that does not regenerate over a lifetime. This biological reality plays a significant role in fertility outcomes as age increases.”Births among women older than 40 have also grown steadily. Biology, however, hasn’t changed: fertility begins to decline in the early 30s and drops sharply after 37, the American College of Obstetricians and Gynecologists reports. As women age, their eggs’ number and quality decline, with a noticeable drop accelerating after age 37.By 40, chances of conceiving naturally fall significantly. Male fertility also declines with age, typically starting around 35, as both sperm count and quality decrease. Rising obesity rates are another concern. “Medically, we’re also less healthy. We’re fatter than ever, which impacts fertility in men and women,” Dr. Matt Tipton, a Tennessee-based physician, tells the Sun.Nearly three-quarters of U.S. adults are overweight or obese. For women, excess weight can disrupt ovulation and is closely tied to conditions like polycystic ovary syndrome, a leading cause of infertility. In men, obesity has been associated with lower sperm quality.Sexually transmitted infections such as chlamydia and gonorrhea — both of which have been on the rise — can damage reproductive organs and affect fertility if left untreated.Environmental exposures are also being scrutinized. Chemicals commonly found in plastics, cosmetics, pesticides, and air pollution — especially those known as endocrine disruptors — may interfere with hormone function. Even small amounts of these substances have been linked to reproductive challenges in both sexes, though how they affect individual fertility is still being studied.The Overlooked Side of Infertility: MenWhile often overshadowed by discussions of female fertility, male infertility plays a role in nearly half of all cases. Common issues include low sperm count, poor motility, abnormal sperm shape, and delivery problems such as blockages or ejaculation disorders. Varicoceles — enlarged veins in the scrotum — can also raise testicular temperature, impairing sperm production.“Among couples coming in for fertility issues, 50 percent of the time it was female-related, but the other 50 percent is male-related,” urologist and infertility medicine expert Dr. David Shusterman of New York Urology tells the Sun. “Nowadays, it seems almost every guy who comes in with fertility issues has some level of sperm deficiency. Now, it’s not always severe — some of them may still be able to have kids — but it takes longer.”He attributes the widespread dip in testosterone to a multitude of modern-day factors, from chemicals in food, pesticides, microplastics, and medications and substances to stress, obesity, alcohol, and drug use.Dr. Pakrashi also pointed out that “environmental and lifestyle factors are paramount” to male fertility woes. Despite its prevalence, male infertility is less frequently addressed, often due to stigma or lack of awareness. “One major concern is sperm quality. There has been a rapid decline in sperm count and testosterone levels in recent decades — changes that are too fast to be genetic, so they must be environmental,” she said. “We’re talking about exposure to endocrine-disrupting chemicals like phthalates and BPA, often found in plastics, as well as synthetic estrogens in our water systems. These compounds can suppress hormone production and fertility.”These changes not only affect conception but may also contribute to early pregnancy loss.Searching for SolutionsFertility technologies have seen remarkable growth in recent years, expanding both in effectiveness and accessibility. Options now range from traditional IVF and IUI to advanced techniques like egg and embryo freezing, preimplantation genetic testing, donor sperm or eggs, and even emerging innovations like in vitro gametogenesis and uterus transplants — offering new hope to individuals and couples facing fertility challenges.“Fertility preservation, like egg or sperm freezing, should also be considered at a time when fertility potential is still good,” Dr. Jovanovic said.These procedures are, however, costly. Treatments like IVF can run between $12,000 and $30,000 per round, with total costs often exceeding $60,000 for those who pursue multiple attempts. Because of these high costs, most clinics are clustered in wealthy urban areas — 80 percent of them in New York City alone, with nearly a third in Manhattan — making care even less accessible for those in lower-income or rural regions. Compounding the barriers to treatment is that insurance coverage is inconsistent and often unavailable, leaving many to pay out of pocket. Most of the budding technologies still carry below-average success rates, particularly as maternal age increases. IVF over 40, for example, comes with a 7 percent live birth rate per cycle. Dr. Shusterman’s advice to younger generations is to “get married and have children young, prioritize family first and then focus on career.”“I know it goes against current social norms — and it’s not politically correct — but it is scientifically correct. But if that isn’t going to be the case, treatments like IVF are going to play a bigger and bigger part in the country’s future,” he surmised. “Thankfully, some politicians are now advocating for IVF coverage under insurance, which would be a game-changer. Right now, insurance companies are saving money because people have fewer children, but what will the cost to society be in the long run?”President Trump signed an executive order in February calling for policy changes to protect access to IVF and significantly reduce out-of-pocket and insurance costs. The directive “recognizes the importance of family formation” and emphasizes that “public policy must make it easier for loving and longing mothers and fathers to have children.”Dr. Jovanovic also underscored the importance of people having “clear and timely information about how age and health impact fertility.”“Many patients come to us saying they simply didn’t know how much these factors could affect their chances,” he said. One of the proposals for boosting fertility rates being considered by the Trump administration is menstrual cycle education for women, which would likely detail ovulatory cycles. Data from prominent female health app Flo indicates that more than half of women do not know how many days a month is considered the “fertile window.”Some medical professionals worry that, despite the administration’s pledges to encourage families to have more children, the endeavor may be hindered by the White House’s own funding cuts. Under Mr. Kennedy, the Health and Human Services Department has eliminated the team overseeing the federally mandated fertility clinic monitoring system, which could halt the collection and release of updated fertility clinic success rates, restricting public access to essential reproductive health data.Why It MattersThe world is entering a phase of steady population decline, driven by falling birth rates that are already below replacement levels in many countries. This shift is leading to older populations and shrinking workforces, placing strain on healthcare systems and social support programs. With fewer laborers to sustain economic growth and fund public services, the United States could face serious long-term challenges.From that vantage point, Dr. Tipton stressed the importance of a fruitful economy and affordable cost of living for families to flourish. “If the Trump administration wants more babies, then young people have to feel hopeful about the future,” he said. “They need to believe they can get married, afford a home, and raise a family.”Dr. Pakrashi also highlighted that bolstering fertility begins with lifestyle. “Improving cardiovascular and metabolic health, reducing processed foods, managing weight and inflammation. Building good habits early has lifelong impacts,” she continued. “And, if we want to raise the fertility rate, we need to start treating reproductive health as a priority — like we do heart disease or diabetes. We also need to support parents more broadly — with childcare, flexible work, and community support.”For those couples struggling for years, however, there are silver linings of success. After several early losses, former television journalist Louise Pennell went on to have two healthy baby boys naturally — at 39 and then at 46. After her doctor confirmed the latter spontaneous pregnancy, she was shocked when he basically told her to “talk to her OBGYN about procedures to terminate” without question. “Thankfully, my OB looked at me and said, ‘Let’s do this.’ Both my boys were born full-term, are in school now, no health issues,” Ms. Pennell added. “I understand that medically, I am the exception, not the rule. But this idea of a ‘geriatric pregnancy’ or ‘advanced maternal age’ after 35 — I hate those labels. Is it ideal to have a baby at 46? No. Is it possible? Absolutely.”

As U.S. Fertility Rates Keep Falling, Couples Are Left Wondering Why This Is Happening

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