A Deeper Look: What’s Behind the Rise in Infertility Across the Globe?
By Dr. Chelsea Dakers ND; Assisted by AI
Infertility is no longer just a private struggle—it’s becoming a public health concern in countries that span continents, cultures, and income levels. From Asia to North America, a wave of fertility challenges is emerging with distinct national patterns, but common threads begin to appear when we look closer. These insights can help us understand not just the “what,” but the “why”—and how root-cause, holistic care can meet people where they are.
Let’s take a closer look:
South Korea
Fertility rate: ~0.72 (lowest globally)
Key challenges: Ultra-competitive academic and work culture, high cost of living, delayed marriage and childbearing, rising rates of PCOS, and low sperm motility.
Unique note: Cultural expectations often push parenthood later in life, yet stigma persists around infertility. Many women face pressure to "do it all" while systems don’t support family life.
China
Infertility prevalence: 15–18% of couples
Key drivers: Legacy of the one-child policy, environmental pollution, male factor infertility, and widespread use of industrial chemicals in agriculture and manufacturing.
Unique note: The gender imbalance and urban migration trends post-policy have complicated partner dynamics and fertility timing.
India
Infertility prevalence: 15–20 million couples; up to 25% in urban areas
Key drivers: High levels of environmental toxins, poor air and water quality, stress, processed diets, increasing obesity, and delayed parenthood in cities.
Unique note: Deep cultural importance is placed on childbearing, yet conversations around fertility struggles remain taboo. Access to ART is expanding but remains uneven.
Iran
Fertility rate drop: From >6 to <2 in ~30 years
Infertility prevalence: ~20% in some studies
Key drivers: Lifestyle changes, high rates of cesarean births, declining sperm quality, endocrine issues.
Unique note: The Iranian government has reversed population control policies and is now incentivizing fertility—yet social stigma around infertility still deters couples from seeking support.
Turkey
Key challenges: Urban stress, hormonal imbalance, and underreported infertility due to stigma.
Unique note: Religious and cultural beliefs strongly shape reproductive decisions. Demand for ART is rising, especially among educated, urban populations, but many remain silent about fertility struggles.
Egypt
Cultural context: Pronatalism is strong; large families are culturally valued.
Key challenges: Environmental pollution, untreated infections, low reproductive health literacy, and inadequate public fertility services.
Unique note: Infertility is increasingly recognized as a marital issue, not just a woman’s issue, which is a cultural shift in framing responsibility and care.
Italy
Average maternal age: 31.6 years (among the highest in Europe)
Key challenges: Age-related infertility, economic precarity, and declining sperm parameters.
Unique note: A nation with strong family values yet insufficient infrastructure to support young families—especially housing, childcare, and financial incentives.
United States
Infertility prevalence: 1 in 8 couples
Key challenges: Rising obesity and metabolic disease, exposure to endocrine disruptors, widespread sperm quality decline, chronic stress, and delayed reproduction.
Unique note: Stark racial disparities: Black and Indigenous women experience higher rates of infertility, but face lower access to fertility care, and lower success rates in ART interventions (Dieke et al., 2020).
What These Countries Share in Common
Despite their unique cultural, political, and economic contexts, these countries share several overlapping contributors to rising infertility:
Environmental exposures: Persistent organic pollutants, pesticides, plastics, and air pollution are globally implicated in hormonal and sperm disruption.
Endocrine imbalance: PCOS, hypothyroidism, metabolic syndrome, and irregular ovulation patterns are on the rise worldwide—especially in urban women.
Chronic stress & trauma: The nervous system’s response to prolonged stress affects ovulation, implantation, and libido, especially in women navigating burnout cultures.
Delayed parenthood: As more people pursue careers and delay partnerships, age-related decline in egg and sperm quality becomes more impactful.
Male factor infertility: Sperm concentration has reportedly declined by over 50% in the last 40 years globally, likely due to environmental and lifestyle factors (Levine et al., 2017).
Healthcare inequity: Access to fertility evaluations and ART is disproportionately available to urban, wealthier, or majority ethnic populations—leaving many silently struggling.
Why This Matters in Clinical Practice
These global fertility trends are not random—they are systemic signals. As clinicians, educators, and advocates, we can’t afford to ignore the ecological, societal, and spiritual health of those seeking to conceive. We must be willing to ask not just how someone is struggling to conceive, but why—and help them reclaim their path with clarity, cultural safety, and whole-person care.
Would you like this formatted as a visual table or infographic for your blog or webinar deck? I can create a visual summary that highlights shared root causes and unique national contexts.
References
Centers for Disease Control and Prevention. (2023). Infertility FAQs. https://www.cdc.gov/reproductivehealth/infertility/index.htm
Dieke, A. C., Zhang, Y., Chen, L., & Zhang, Y. (2020). Racial and ethnic disparities in the use of and success of fertility treatments: Analysis of data from a national ART registry. Fertility and Sterility, 114(6), 1231–1239. https://doi.org/10.1016/j.fertnstert.2020.06.041
Farland, L. V., Missmer, S. A., Rich-Edwards, J., Chavarro, J. E., Barbieri, R. L., & Grodstein, F. (2016). Use of fertility treatment among women with a history of infertility. Fertility and Sterility, 105(6), 1505–1513. https://doi.org/10.1016/j.fertnstert.2016.02.015
Inhorn, M. C., Patrizio, P., & Serour, G. I. (2020). Third-party reproductive assistance around the Mediterranean: Comparing Sunni Arab, Shi’ite Iranian, and secular European perspectives. Reproductive Biomedicine & Society Online, 10, 1–14. https://doi.org/10.1016/j.rbms.2019.10.003
Jenkins, A. L., & Ranjit, N. (2020). Environmental injustice, health disparities, and reproductive health in Indigenous communities. Environmental Justice, 13(5), 169–178. https://doi.org/10.1089/env.2020.0019
Levine, H., Jørgensen, N., Martino-Andrade, A., Mendiola, J., Weksler-Derri, D., Mindlis, I., ... & Swan, S. H. (2017). Temporal trends in sperm count: A systematic review and meta-regression analysis. Human Reproduction Update, 23(6), 646–659. https://doi.org/10.1093/humupd/dmx022
Ministry of Health and Medical Education (Iran). (2022). National Infertility Report: Trends, Causes, and Interventions [Farsi Report Summary Translated].
United Nations, Department of Economic and Social Affairs, Population Division. (2022). World Population Prospects 2022: Summary of Results. https://population.un.org/wpp
World Health Organization. (2023). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility
Zhou, Z., Zheng, D., Wu, H., Li, R., Xu, S., Kang, Y., ... & Zhu, Y. (2018). Epidemiology of infertility in China: A population-based study. BJOG: An International Journal of Obstetrics & Gynaecology, 125(4), 432–441. https://doi.org/10.1111/1471-0528.14966