The Future Of Fertility: Access, Equity, AI And Innovation

Reflecting on the New Year

Infertility: From Hippocrates to 2025

Infertility has served as a significant medical and social preoccupation since the beginning of human existence. There are documents dated as far back as 1900 BC showing gynecologic disorders and patients experiencing difficulty with conception. Early records from Egypt, including scriptures and artwork, have also depicted infertility, particularly male infertility. And writings from Hippocrates in Greece discuss fertility treatment options, while Roman-era texts explore the role and influence of gods on chances of pregnancy. Lest we forget the numerous biblical references from the Old Testament about the ‘barrenness’ of women, and the importance of being ‘fruitful’ to ‘multiply.’

If some call the end of the twentieth century a renaissance for ART (assisted reproductive technology), it’s quite possible that the roaring 2020’s are amounting to be even more fruitful and rapid in scientific, medical, and legal advancement.

Fast forward to the nineteenth and twentieth centuries, in 1898 the official definition of ‘fertilization’ was created: the union of an egg and sperm. In 1978, the first ‘test tube’ baby was born in England, followed by the first American IVF baby born in 1981. If some call the end of the twentieth century a renaissance for ART (assisted reproductive technology), it’s quite possible that the roaring 2020’s are amounting to be even more fruitful and rapid in scientific, medical, and legal advancement. 

Pregnantish Celebrates 8 Years + One Billion Reached

It’s humbling to consider the history of this industry, and the role we play in its path forward. As we reflect on where we started, it is important to codify where we are today and where we are headed.

For team pregnantish, that reflection hit home a little deeper at the turn of the new year, as we celebrated an eight year anniversary of our company and an exciting company milestone – our fertility focused content and education has reached one billion worldwide since inception.

When we first launched, pregnantish filled a much-needed gap in the category – we became the first media company solely dedicated to infertility and helping people navigate fertility treatments with our content and storytelling. While serving both patients and the healthcare industry through educational campaigns and events, pregnantish has actively changed the conversation in ART. Our storytelling has always included people traditionally left out of the conversation – men, LGBTQ, singles, patients under 35 – and our commitment to diversity has helped us garner a global audience. Our team is proud to be an established, trusted voice in this category.

As we look ahead, we’ve identified three key trends in the industry that are our tentpoles at pregnantish: Equity and Inclusion, Technology and Innovation, and Awareness and Access to Care. We’ve interviewed prominent industry opinion leaders to capture their insights on these areas that impact the future of fertility.

Listen here to the newest pregnantish podcast Welcome to the Future of Fertility…and Where We’re Still Behind.

Equity: Birth Rates Are Dropping Around the World

A Global TFR Decline

It’s now become commonplace to see headlines about birth rates falling across the globe. However the recent focus and attention on men, and male factor infertility, is new and long overdue.

Global fertility rates have been steadily declining over the past few decades, with significant implications for population growth and demographic trends. The global total fertility rate (TRF) has fallen from approximately 4.9 children per woman in 1970 to about 2.3 children per woman in 2020. A TRF of 2.1 is considered the ‘replacement level,’ meaning that the numerous countries that fall below this threshold are officially in a population crisis. 

For example, in 2020, the fertility rate was 1.6 children per woman in the United States, 1.3 in Japan, and 1.5 in most European countries. Some countries, like South Korea, have fertility rates as low as 0.8 children per woman, one of the most declined in the world. Other countries with particularly low fertility rates include Taiwan (1.0), Hong Kong (1.0), Germany (1.5), Italy (1.2), Spain (1.3), and Singapore (1.1). 

In 2020, the fertility rate was 1.6 children per woman in the United States, 1.3 in Japan, and 1.5 in most European countries. Some countries, like South Korea, have fertility rates as low as 0.8 children per woman, one of the most declined in the world. 

Socioeconomic and cultural shifts have undoubtedly influenced fertility rates. Increased education, economic pressure, high cost of living, work-life imbalance, changing attitudes towards marriage and parenthood, and an aging population of intended parents are some factors to name. Though demographic changes are notable, the medical component of the infertility diagnosis is also undeniable. 

We are Finally Looking at Sperm Factors and Male Fertility

According to the World Health Organization, approximately 17.5% of the adult population – roughly 1 in 6 worldwide – experience infertility. We know that statistic is likely greater, as that is just what’s reported.

One recent shift here is the rise in male factor infertility and more attention to sperm than in years past. Male factor infertility is a significant and increasing contributor to the global crisis. Research shows a decline in sperm counts around the world. For example, Human Reproduction reported that sperm had decreased by more than 50% from 1973-2011 spanning the globe. Estimates suggest that 15-20% of men worldwide may have low sperm count – defined as fewer than 15 million sperm per milliliter of semen. 

Research shows a decline in sperm counts around the world. For example, Human Reproduction reported that sperm had decreased by more than 50% from 1973-2011 spanning the globe. 

Thomas D’Hooghe, Head of Global Medical Affairs, Fertility and Vice President at Merck, shares: 

“I have spent 25 years in the medical-scientific field, and the landscape of reproductive health has evolved significantly. We are witnessing a trend of advanced reproductive age, and in many regions, the cost of a single treatment cycle with assisted reproductive technology can equate to a year’s salary or the savings of entire families. There remains a pervasive skepticism surrounding assisted reproductive technology globally. To address these challenges, empowering patients to co-lead their fertility treatment is essential for fostering their sense of ownership in their journey toward parenthood. By ensuring that patients are equipped with the right information and support, they can make informed choices that align with their personal circumstances and values.

Improving access to treatment is a critical component of this empowerment, as it allows patients from diverse backgrounds to engage in their fertility journeys without financial or systemic barriers. At Merck, one of our strategic pillars is to enhance access to care and influence health policies. With declining fertility rates observed in Europe, America, and Asia, our ‘Fertility Counts’ Initiative stands out as a beacon of hope. We collaborate with health economists to analyze the region’s health economy, reproductive medicine landscape, and social dynamics, aiming to identify successful models/policies enhancing access to infertility care,  and advocate for policy changes that empower underserved demographics. This holistic approach not only improves patient outcomes but also helps to create a more inclusive healthcare system that prioritizes the needs of all individuals seeking fertility care.”

At Merck, one of our strategic pillars is to enhance access to care and influence health policies. With declining fertility rates observed in Europe, America, and Asia, our ‘Fertility Counts’ Initiative stands out as a beacon of hope. 

Technology and Innovation

Recent Developments in ART

There have been several exciting and innovative steps forward in ART spanning oocyte assessment, sperm quality, surgeries, and more. To name a few:

• For women who have lost their ovaries due to surgery or disease, Theriogenology published that scientists, veterinarians, and engineers are studying the creation of bioprosthetic ovaries to restore ovarian hormones and house follicles.
• According to the NIH, surgeries for repair of the uterine cavity have reported higher success rates in recent years. 
• For men with low sperm counts or blockages, research has offered new techniques for sperm extraction, like testicular sperm extraction (TESE) for those with male factor.
• Microfluid devices are transforming IVF practices. Integration of a single oocyte trapping and embryo culture in microfluidic devices allows for precise manipulation of the specimens. Scientists can now trap a single oocyte and ensure it receives optimal conditions for maturity. Microfluids can also enhance nutrient delivery to embryos, allowing for real-time monitoring of growth and better assessments of viability. Studies published in SLAS Technology show that using these devices could increase the chances of successful implantation.

Though these innovations are groundbreaking, the most notable change towards the future of fertility is undoubtedly the introduction of AI in reproductive healthcare.

AI: A New Frontier in Fertility 

AI is everywhere. From artwork shared on social media, to the commonly used ChatGPT, to Meta’s new high-tech glasses that can remind you where you parked your car, AI algorithms are increasingly involved in our daily lives.

By and large, the most significant trend within technology and innovation is the exploration and adoption of artificial intelligence (AI) to help improve patient outcomes (and this spans beyond infertility). Millions of dollars are being invested in companies that are utilizing AI in the fertility industry. 

Columbia University Fertility Center recently launched a new AI system designed to locate healthy semen. Columbia researched and developed the new STAR method (Sperm Tracking And Recovery), which employs high-powered imaging technology to scan through an entire sperm sample, taking over 8 million images in under an hour and using AI to identify healthy sperm.

AI can potentially help doctors identify optimal embryo transfer timing, and improve decision-making throughout the stimulation cycle and ovulation tracking, supporting timed intercourse, and facilitating intrauterine insemination (IUI). The goal is to help patients achieve pregnancy earlier in the process, saving patients the financial, physical and emotional struggle.

In the lab, automation is one of the most important benefits of AI, which leads to increased productivity and efficacy. AI in an embryology lab helps to increase safety of gametes and embryos, and free up staff of mental, manual, and time-consuming tasks such as embryo grading, semen analysis, embryo and oocyte cryopreservation, quality control, and quality assurance.

Emma Whitney, Director of Embryology and Genetics at The Evewell, shares:

“AI is definitely the future. We’re about to introduce AI into our lab. We have hundreds of embryos on any given day that we have to manually log and annotate the divisions. I believe that our skill set is better used elsewhere.

AI should allow us to manage patients’ expectations better. It’s an incredible predictive tool. The anxiety of what is going to happen is often the hardest thing for patients, so if we can be more predictive of what the outcome will be, that can only be a good thing. AI will be able to bring patients on the journey, and let them be able to see what we see. It shouldn’t be so secretive in the lab – the transparency is helpful for patients’ anxiety and our jobs will be easier, too. AI will also have a role in male fertility. We’ll be able to look more closely at male patterns of sperm health. But AI cannot make up for poor clinical practice. Patients still need to be looking into laboratories. You can have the best embryo, but if you don’t do the freezing properly it won’t matter.”

AI cannot make up for poor clinical practice. Patients still need to be looking into laboratories. You can have the best embryo, but if you don’t do the freezing properly it won’t matter. 

Emma continues, “My passion for educating others started because I lost a baby at 22 weeks – I had a termination for medical reasons. I felt overwhelmingly anxious, and I couldn’t find any stories that related to me. A lot of my sadness and fear came from not knowing what was happening to me. I realized that I have a huge wealth of knowledge in embryology, and I am able to empower patients to ask the right questions and advocate for themselves. My aim is to reach far, be honest – sometimes brutally honest – and help people to get the language they need to know.”

Digitization and AI have the potential to help healthcare professionals to standardize, automate, and improve outcomes for the benefit of patients undergoing ART. Collaboration between AI developers and healthcare providers is of the utmost importance as we enter this new wave of medical advancements. 

Louis Villalba, Chief Executive Officer of TMRW Life Sciences, weighs in:

Assisted Reproductive Technologies represent some of the most remarkable innovations of our time. The impact of fertility preservation, genetic testing, and other protocols have been profound for millions of people around the world. As awareness and access grows, clinics are seeing more patients than ever before, plus the shift from fresh to frozen embryo transfers has dramatically increased the number of specimens entering cryostorage.

Despite this evolution and exponential growth, reproductive health is one of the last frontiers in healthcare that hasn’t fully embraced digitization. Patients invest so much—financially, emotionally, and physically—into their fertility journeys, and yet the storage of their precious eggs and embryos has remained largely unchanged and analog. We are still hearing of devastating instances of mix-ups and errors and it’s unacceptable.

At TMRW, our mission is to safeguard those precious cells using cutting edge technology. For the first time, frozen specimens can be digitally identified and tracked, safely managed with automation, and remotely monitored around the clock. Looking ahead, I believe technology will continue to transform reproductive health. By enhancing safety, improving lab efficiency, and enabling new treatments, the possibilities are endless when we embrace innovation.

Access to Care

Fertility Law: An Emerging Field

Bioethical discourse has been long debated, specifically around IVF. In 2024, decisions concerning the surplus of cryopreserved gametes and embryos took front and center.

The Alabama Supreme Court ruled that frozen embryos have the legal rights of children. This decision has precipitated legal uncertainty surrounding ART procedures across the country. More than a dozen other U.S. states have laws in place that could be interpreted as bestowing personhood rights on an embryo, even pre-implantation or pregnancy. 

Though these rulings will significantly influence the administration of IVF and other ART procedures, and as we covered in our spotlight on the pregnantish podcast with REIs and a VP at Planned Parenthood, recent Pew Research Center studies demonstrate that Americans overwhelmingly believe access to IVF and ART practices is a good thing. 7 in 10 adults say access to IVF is a positive thing, and there are only modest differences in views across most demographic and partisan groups. 

Alexis Cirel, a Founding Partner of the Fertility Law Group at Warshaw Burstein, LLP, in New York City, helps individuals build and protect their families. She shares:

“As fertility attorneys, we set out to establish and secure the parentage rights of intended parents in the eyes of the law – even where those parents may not be genetically linked to the child and/or did not give birth to the child – and we cut off any inapplicable presumed rights of third party donors and surrogates. We also address issues relating to ownership of frozen genetic material like embryos – for example in the event of a divorce – and the implications on legal parentage that flow from that. In many ways, assisted reproductive technology has outpaced the law and we’re playing catch up. As medicine advances, new social norms and legal issues arise and we work to adapt our jurisprudence accordingly across the country, expanding and redefining how we think about families conceived using this science.

Cost and insurance coverage for fertility treatment generally and for third party arrangements are also huge challenges. In many states, there is no mandate that insurers cover fertility preservation or IVF under certain circumstances, including where there is no diagnosis of infertility. This disproportionately and unfairly limits access to care for individuals and same sex couples, and it calls upon us as a community to advocate for a modernized definition of ‘infertility’. And in the majority of surrogacy cases, intended parents are required to pay for health insurance for the surrogate’s pre and post natal care, on top of the direct IVF costs. Many health insurance policies specifically exclude coverage for a surrogate pregnancy, and some impose liens where surrogates receive compensation.

The current political climate is also a big issue impacting the practice of fertility law. We’re in some scary times. We’ve seen judicial decisions like the Supreme Court’s decision in Dobbs and the Alabama LePage decision threatening reproductive freedoms, personhood laws, and the rights of many families in the LGBTQ community. It’s important to remember that state laws impacting assisted reproduction vary and there is no uniform approach to any of this. It’s often a case by case, state by state analysis. I hope patients can take some comfort in knowing that just as we evolve and adapt the law to follow advances in science, we in the legal community are always working to ameliorate political threats with legal solutions.”

The current political climate is also a big issue impacting the practice of fertility law. We’re in some scary times… I hope patients can take some comfort in knowing that just as we evolve and adapt the law to follow advances in science, we in the legal community are always working to ameliorate political threats with legal solutions.

Serving the Underserved

While the fertility industry has advanced significantly in the expansion of technology and treatment options, underserved communities continue to face systemic challenges in accessing care due to a combination of financial, cultural, and geographic barriers. 

A recent study found that Black women are 2-3 times less likely to receive fertility care, despite having similar or higher rates of infertility, compared to white women. The CDC also notes that Asian women experience significantly lower rates of fertility treatment, in part due to cultural stigmas surrounding infertility. 

Access also includes geography – it is crucial for everyone to have the ability to physically access the care they need. People in rural areas often face transportation and logistical issues when seeking care, and are 40% less likely to seek treatment due to geographic isolation and travel costs. ASRM reported that 75% of fertility clinics in the US are located in cities, leaving huge swaths of rural Americans without local access to specialists. 

Addressing these disparities requires policy changes, expanded insurance coverage, and more inclusive and culturally competent care.

David Powley, Vice President, Reproductive Medicine, Ferring Pharmaceuticals explains:

“At our core, we believe that everyone has the right to build a family no matter who they are, or where they live…There’s more work to be done to expand the number of providers and support them through education. We’ve launched a new initiative – Breaking Barriers, Building Families – which was created from the shared desire with others from across the community to help aspiring parents in underrepresented communities. Black women face greater obstacles when seeking fertility care, and are less likely to pursue treatment, often due to systemic hurdles. We’ve worked with Morehouse School of Medicine to explore the lived experiences of Black women seeking fertility care and have introduced the FertilityEquity™ eLearning modules designed to help clinicians & staff provide equitable care. This is just the first step to helping address the diverse needs of underrepresented communities through education and resources that champion equity in fertility care. 

At our core, we believe that everyone has the right to build a family no matter who they are, or where they live… We’ve launched a new initiative – Breaking Barriers, Building Families – which was created from the shared desire with others from across the community to help aspiring parents in underrepresented communities. 

We are also working with ASRM, RESOLVE and other industry partners to help raise awareness, improve access, and show support for IVF legislation. Progress has been made – 21 states and Washington, D.C. have passed fertility insurance coverage laws – but that means that there’s a great need for action in the remaining states to ensure they’re doing everything they can to support aspiring parents across the U.S. 

Through this broad-based approach, we’ve been helping people become parents for more than 50 years. We are committed to supporting the diverse paths to parenthood, developing treatments, advocating for greater access to fertility care and supporting the educational needs of patients and providers. I have a strong sense of fulfillment and purpose working in the fertility field, though I am not satisfied with the current state — we need to do more and faster. However, I am excited for the future due to the commitment of all my colleagues at Ferring and our partners across the community who are doing the work that’s necessary for us to get closer to where we need to be to support aspiring parents.”

Advancing Care & Breaking the Silence

The Founder of pregnantish, Relationship Expert and Fertility Advocate, Andrea Syrtash, has often said that there’s never a good time to be infertile — but that it’s a better time now than in years past due to incredible technological advancements in ART and more people talking about it.

“When I went on television in 2017 to share that I had endometriosis and infertility, many people thought that I was talking about a ‘niche’ topic. We know now that there’s nothing niche about needing better access to fertility treatments to have a baby, and for more research in these areas. This is something that impacts so many people globally and it’s my goal, since we launched, to make infertility less of a silent epidemic.”

The future of fertility is evolving rapidly. More education and awareness, technological advancements, AI, better treatment options, a growing recognition of the need for equity in care, and the expanding accessibility of reproductive services mark a fruitful time for the fertility industry.

As we look ahead, the global push for more inclusive and equitable care offers hope for overcoming the challenges faced by many suffering in silence. However, significant work must be done to push the needle towards a more inclusive environment for the diverse paths to parenthood.

We are grateful for the thought-leaders driving this forward and know that we can uphold our original mission, that we stated in our welcome video in 2016, to break the taboo and elevate the conversation together.