In the female reproductive system, infertility may be caused by:

A wide variety of people, including heterosexual couples, same-sex partners, older persons, individuals who are not in sexual relationships and those with certain medical conditions, such as some HIV sero-discordant couples and cancer survivors, may require infertility management and fertility care services. Inequities and disparities in access to fertility care services adversely affect the poor, unmarried, uneducated, unemployed and other marginalized populations.

Addressing infertility can also mitigate gender inequality. Although both women and men can experience infertility, women in a relationship with a man are often perceived to suffer from infertility, regardless of whether they are infertile or not. Infertility has significant negative social impacts on the lives of infertile couples and particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. 

In some settings, fear of infertility can deter women and men from using contraception if they feel socially pressured to prove their fertility at an early age because of a high social value of childbearing.  In such situations, education and awareness-raising interventions to address understanding of the prevalence and determinants of fertility and infertility is essential.

While assisted reproduction technologies (ART) have been available for more than three decades, with more than 5 million children born worldwide from ART interventions such as in vitro fertilization (IVF), these technologies are still largely unavailable, inaccessible and unaffordable in many parts of the world, particularly in low and middle-income countries (LMIC). 

Government policies could mitigate the many inequities in access to safe and effective fertility care. To effectively address infertility, health policies need to recognize that infertility is a disease that can often be prevented, thereby mitigating the need for costly and poorly accessible treatments. Incorporating fertility awareness in national comprehensive sexuality education programmes, promoting healthy lifestyles to reduce behavioral risks, including prevention, diagnosis and early treatment of STIs, preventing complications of unsafe abortion, postpartum sepsis and abdominal/pelvic surgery, and addressing environmental toxins associated with infertility, are policy and programmatic interventions that all governments can implement.

In addition, enabling laws and policies that regulate third party reproduction and ART are essential to ensure universal access without discrimination and to protect and promote the human rights of all parties involved. Once fertility policies are in place, it is essential to ensure that their implementation is monitored, and the quality of services is continually improved.

Infertility statistics worldwide

Infertility statistics in the United States

Infertility statistics by sex

Infertility statistics by age

“Typically, my infertility patients are as young as their early 20s and as old as their mid to late 40s,” Sara Mucowski, MD, a fertility specialist at Dallas IVF.

Infertility statistics by race and ethnicity

 

 The fertility rate of a country is the average number of children that women from that country will have throughout their reproductive years. In the United States in 1800, the average woman of childbearing age would have seven children over the course of their lifetime. As factors such as technology, hygiene, medicine and education improved, women were having fewer children than before, reaching just two children per woman in 1940. This changed quite dramatically in the aftermath of the Second World War, rising sharply to over 3.5 children per woman in 1960 (children born between 1946 and 1964 are nowadays known as the 'Baby Boomer generation, and they make up roughly twenty percent of today’s US population). Due to the end of the baby boom and increased access to contraception, fertility reached its lowest point in the US in 1980, where it was just 1.77. It did however rise to over two children per woman between 1995 and 2010, although it is expected to drop again by 2020, to just 1.78.

 

"That's a pretty big thing; most of the world is transitioning into natural population decline," researcher Prof Christopher Murray told the BBC.

"I think it's incredibly hard to think this through and recognize how big a thing this is; it's extraordinary, we'll have to reorganize societies."

Why are fertility rates falling?

It has nothing to do with sperm counts or the usual things that come to mind when discussing fertility.

Instead, it is being driven by more women in education and work, as well as greater access to contraception, leading to women choosing to have fewer children.

In many ways, falling fertility rates are a success story.

Which countries will be most affected?

Japan's population is projected to fall from a peak of 128 million in 2017 to less than 53 million by the end of the century.

Italy is expected to see an equally dramatic population crash from 61 million to 28 million over the same timeframe.

They are two of 23 countries - which also include Spain, Portugal, Thailand, and South Korea - expected to see their population more than halved.

"That is jaw-dropping," Prof Christopher Murray told me.

China, currently the most populous nation in the world, is expected to peak at 1.4 billion in four years' time before nearly halving to 732 million by 2100. India will take its place.

The UK is predicted to peak at 75 million in 2063, and fall to 71 million by 2100.
(Statista, 2019)

 

·  How do countries fight falling birth rates?

The researchers warn against undoing the progress on women's education and access to contraception.

Prof Stein Emil Vollset said: "Responding to population decline is likely to become an overriding policy concern in many nations, but must not compromise efforts to enhance women's reproductive health or progress on women's rights."

The population of sub-Saharan Africa is expected to treble in size to more than three billion people by 2100.

And the study says Nigeria will become the world's second-biggest country, with a population of 791 million.

Prof Murray says: "We will have many more people of African descent in many more countries as we go through this.

"Global recognition of the challenges around racism is going to be all the more critical if there are large numbers of people of African descent in many countries."

However, this will be a truly global issue, with 183 out of 195 countries having a fertility rate below the replacement level.

Why is this a problem?

You might think this is great for the environment. A smaller population would reduce carbon emissions as well as deforestation for farmland.

"That would be true except for the inverted age structure (more old people than young people) and all the uniformly negative consequences of an inverted age structure," says Prof Murray.

 

The world faces a shift from young to old

The study projects:

·         The number of under-fives will fall from 681 million in 2017 to 401 million in 2100.

·         The number of over 80-year-olds will soar from 141 million in 2017 to 866 million in 2100.

Countries, including the UK, have used migration to boost their population and compensate for falling fertility rates.

However, this stops being the answer once nearly every country's population is shrinking.

"We will go from the period where it's a choice to open borders, or not, to frank competition for migrants, as there won't be enough," argues Prof Murray.

Some countries have tried policies such as enhanced maternity and paternity leave, free childcare, financial incentives, and extra employment rights, but there is no clear answer.

Sweden has dragged its fertility rate up from 1.7 to 1.9, but other countries that have put significant effort into tackling the "baby bust" have struggled. Singapore still has a fertility rate of around 1.3.

Prof Murray says: "I find people laugh it off; they can't imagine it could be true, they think women will just decide to have more kids.

"If you can't [find a solution] then eventually the species disappears, but that's a few centuries away."

Why is 2.1 the fertility rate threshold?

You might think the number should be 2.0 - two parents have two children, so the population stays the same size.

But even with the best healthcare, not all children survive to adulthood. Also, babies are ever so slightly more likely to be male. It means the replacement figure is 2.1 in developed countries.

Nations with higher childhood mortality also need a higher fertility rate.

Prof Ibrahim Abubakar, University College London (UCL), said: "If these predictions are even half accurate, migration will become a necessity for all nations and not an option.

"To be successful we need a fundamental rethink of global politics.

"The distribution of working-age populations will be crucial to whether humanity prospers or withers."

(Boivin J, Bunting L, Collins JA, et al, 2021)

 

 

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https://www.who.int/news-room/fact-sheets/detail/infertility