Medical Experts Question US Fertility Crisis Claims

Recent claims of an infertility crisis in the United States have sparked debate among medical experts and researchers who point to complex demographic trends and health factors affecting reproduction rates.

Robert F. Kennedy Jr., President-elect Trump's nominee to lead the Department of Health and Human Services, has called for an investigation into fertility trends. Former surgeon and health influencer Dr. Casey Means, who has advised Mr. Kennedy, describes the situation as a "crisis." However, researchers say the reality is more nuanced, with social and economic factors like increased childcare costs, housing prices, and people choosing not to have children contributing to changing birth patterns in America.

Data from the Centers for Disease Control and Prevention (CDC) shows the U.S. fertility rate reached what appears to be a historic low in 2023, with about 54 births per 1,000 women of reproductive age. The total fertility rate stands at 1.6 births per woman, down from approximately two births per woman in 2001.

Jorge E. Chavarro, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health, notes that measuring fertility intentions at a population level presents significant challenges. "The intention to become pregnant is extremely, extremely difficult to measure — it's something we do not keep track of at a population level," Chavarro said.

CDC data from 2015 to 2019 indicates that 2.4 million married women of reproductive age were classified as infertile, defined as having had unprotected sex for at least a year without becoming pregnant. This figure excludes women who have undergone surgical sterilization.

The percentage of women between ages 15 and 49 experiencing impaired fecundity — difficulty getting pregnant or carrying a pregnancy to live birth — increased to 13.4 percent between 2015 and 2019, up from about 10 percent of women ages 15 to 44 in 1995.

Americans are having children later in life, with CDC data showing the average age of first-time mothers reached 27.3 years in 2021, a record high. The number of women over 40 giving birth has steadily increased over recent decades.

According to the American College of Obstetricians and Gynecologists, female fertility declines gradually around age 32, with a more pronounced decrease after age 37. Male fertility typically starts declining around age 35, affecting both sperm production and viability.

A recent study found nearly three-quarters of American adults are now overweight or obese, a trend that can impact reproductive health.

Dr. Mary Rosser, director of Integrated Women's Health at Columbia University Irving Medical Center, explains that obesity can affect women's ovulation patterns. The condition is also linked to polycystic ovary syndrome (PCOS), which causes irregular or absent ovulation. Research indicates that 70 to 80 percent of women with PCOS experience infertility, with higher miscarriage rates also reported. In men, excess weight has been associated with reduced sperm quality.

The CDC reports that sexually transmitted infections (STIs) have risen for decades in the United States, though some rates have leveled off recently. Factors contributing to the increase include reduced condom use and the closure of testing and treatment clinics.

Dr. Rosser notes that infections like chlamydia and gonorrhea can lead to pelvic inflammatory disease and fallopian tube damage if left untreated. These infections often present without symptoms, increasing the risk of fertility-related complications.

Research has identified links between reproductive health issues and exposure to various chemicals found in personal care products, air pollution, plastics, pesticides, and food items. Compounds like phthalates and bisphenol A (BPA) are classified as endocrine disruptors, which can interfere with hormone function.

Tracey Woodruff, director of the Program on Reproductive Health and the Environment at the University of California, San Francisco, says endocrine disruptors have been connected to infertility in both women and men. However, the precise impact of these substances on individual fertility remains unclear.

Dr. Vasiliki Moragianni, medical director at the Johns Hopkins Fertility Center, cautions against oversimplifying the relationship between environmental factors and fertility. "You're not going to be able to remove an endocrine disrupter, and then everybody gets pregnant," Moragianni said.

Researchers are investigating whether certain life stages might make people more vulnerable to endocrine disruptors. Genoa Warner, assistant professor in the Department of Chemistry and Environmental Science at the New Jersey Institute of Technology, points to puberty as a potentially sensitive period.

The distinction between declining birth rates and increasing infertility remains important. While Americans are having fewer children overall, this trend reflects both voluntary choices and medical challenges. The intersection of medical, environmental, and socioeconomic factors suggests that characterizing current fertility patterns requires careful analysis rather than broad generalizations.