A global fertility crisis is escalating, with new figures revealing that 53.6 million women aged 35 to 49 are currently unable to conceive. This figure, derived from an analysis of health data spanning 204 countries from 1990 to 2023, has sparked widespread concern.
The study, conducted by researchers at Chongqing Medical University and published in The Lancet Obstetrics, Gynaecology, & Women's Health, tracked the 'infertility burden' in women within this age group. The data indicates a steady increase since 1990, with the rate rising from approximately 6,001 per 100,000 women to 6,907 per 100,000 by 2023.
While women up to age 49 are sometimes included in reproductive-age statistics, fertility naturally declines sharply from the mid-30s and is typically very low by the late 40s. The research found the fastest projected rise in infertility is occurring among women aged 35 to 39. This does not suggest they are more likely to be infertile than older women, but rather that the overall impact of infertility is growing most rapidly in this younger segment of the 'advanced maternal age' group.
This trend is likely linked to more women delaying childbirth to pursue education and careers. By the time they decide to start a family, their fertility may have already diminished.
In the United Kingdom, for example, the average age of mothers giving birth in England and Wales reached a record 30.9 years in 2021, a significant increase from 26.4 years in 1973. Births among women over 40 have more than doubled compared to teenagers, a reversal from five decades ago when teenage mothers outnumbered those over 40 by nine to one.
The study's authors also noted potential contributing factors such as rising obesity rates and increased stress levels. Enhanced access to fertility treatments may also be a factor, potentially increasing both the number of women seeking help and the number of diagnosed cases.
Projections indicate that infertility rates will continue to rise across all analyzed age brackets (35-39, 40-44, and 45-49), potentially affecting 79.6 million women by 2036. Lead author Yuanyuan Du attributed the increase since the late 1990s to greater female participation in education and the workforce, leading to delayed childbearing and subsequent age-related infertility. A temporary dip observed between 2006 and 2010, coinciding with the global financial crisis, suggests that macroeconomic instability can influence reproductive decisions, though this might also reflect underdiagnosis due to economic barriers.
The growing infertility burden is not confined to lower-income countries. The data shows a shift towards higher-income and more developed nations, likely due to later motherhood, population aging, and changing reproductive patterns. However, women in lower-income settings continue to face significant obstacles in accessing fertility testing and treatment.
In 2023, East Asia reported the highest regional infertility burden, while Australasia had the lowest. At the country level, the Central African Republic recorded the highest burden, and Nepal the lowest.
Beyond the medical implications, the researchers highlighted the psychological, social, and economic effects of infertility in older reproductive-age women. These include distress, stigma, financial pressures, relationship strain, and broader consequences for aging populations and workforce participation. The study advocates for fertility care to be prioritized as a public health issue, emphasizing the need for better early detection, improved access to services, and policies tailored to diverse national resources and needs.