The future of fertility
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Illustration: Maura Losch/Axios
The rise of the pro-natalism movement and a historic low in new births have thrust the future of reproduction and fertility into the spotlight.
Why it matters: While there are many reasons Americans might be having fewer children, scientific advancements are creating extraordinary — and sometimes ethically fraught — new possibilities.
Where it stands: The pro-natalism movement's advocacy for women to have more children has been gaining notoriety, especially after the NYT report that President Trump shares those interests.
- Meanwhile, the U.S. fertility rate in 2023 dropped to its lowest point in nearly a century, and the number of overall births increased by only 1% in 2024, per CDC data.
The big picture: America's declining birth rate is a health care issue, but it's much more than that. From a demographic perspective, the aging population is expected to drastically shape future demands on the health care system.
- Fertility and reproduction have not only drawn the attention of scientists and politicians, but also spawned a booming multibillion-dollar industry.
- At the same time, fertility is an economic issue and a cultural issue spanning well beyond the boundaries of health care.
- "I think the right question to be asking is why the birth rate and the fertility rate is down, because any solution to it needs to be correctly identifying the problem," said Peggy Heffington, a historian whose focus includes motherhood.
Between the lines: At a macro level, Americans who aren't having children either don't want to, want to but feel like it's untenable, or can't.
- The most common reason cited by adults under 50 who say they're unlikely to ever have children is that they just don't want to, according to a Pew survey from last year.
- Other top reasons include wanting to focus on other things, concerns about the state of the world and not being able to afford to raise a child. Only 13% of Americans under 50 cited infertility or other medical reasons.
A lack of desire for children is not really a health care problem.
- But infertility is, and some of the solutions underway are opening new doors for people trying to conceive while also posing fascinating ethical dilemmas.
New breakthroughs could help make IVF both more accessible and more effective. But new developments have also allowed parents to be more selective about which embryos become children.
- AI could help personalize the process and select the highest-quality embryos, some researchers argue. Others argue a combination of medical advancements, technological advancements — especially automation — and scientific advancements "promise to greatly expand IVF utilization and lower its cost."
- Reproductive options could also soon move beyond IVF; some researchers are working on in-vitro gametogenesis, or the production of reproductive cells outside of the body using non-reproductive cells.
- This could, for example, allow human eggs to be derived from other types of cells, like skin cells. (The New Yorker explored these efforts in depth in a 2023 piece.)
