Infertility is on the rise, and it’s not just due to women’s health. Other variabilities include men’s health, family health, population health, health equity, and planetary health.

• Around 1/3 of infertility is attributed to the female partner, 1/3 to the male partner, and 1/3 to combination and unexplained.
• 1 in 8 families struggles with infertility, and around 90% of infertility cases can be overcome by science.
• The average healthy couple has a ~20% fertility rate each month.

Male Infertility

• The sperm count has dropped almost 60% since 1973. Researchers like Dr. Shanna Swan predict sperm count could reach a median of zero by 2045 without interventions.

Women’s Health Conditions

• One in 10 women has Polycystic Ovary Syndrome (PCOS), and one in 10 has endometriosis in her childbearing years. One of the main symptoms of PCOS and endometriosis is the increased likelihood of infertility.

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Why is infertility on the rise?

Age remains the most proven predictor of fertility, according to the Center for Human Reproduction. Simply put, couples are having children later in their lives. Women are more likely to delay pregnancies compared to previous years, in addition to increased access to contraception. We see more fertility issues due to attempting to get pregnant at an older age.

The National Library of Medicine points out that there is a strong association between lifestyle factors and fertility in men and women, mainly including experiences of increased BMI, poor nutrition, obesity, excessive smoking, and drug use. Additionally, environmental issues are, without a doubt, at play here as well. The plastics and products we consume daily contain hormone-disrupting chemicals that can lead to fertility complications in both genders.

What's being done to address infertility?

Fertility solutions: a workplace perk

Google, Apple, and Facebook were the earliest employers to offer fertility benefits to employees. Fertility benefits can include anywhere from $20,000 - $80,000 in financial support for egg-freezing cost, in vitro fertilization (IVF), surrogacy, and more. They’ve become a top workplace perk as companies try to attract talent and remain competitive in a tight labor market.

As of 2020, more than two-fifths (42%) of large U.S. employers with over 20,000 staff members offered coverage for IVF treatment, while almost one-fifth (19%) offered support with egg freezing costs. This demand has made Progyny the first fertility benefits company to go public.

Other companies, like YC-backed Lilia and private fertility clinics, are hosting egg-freezing social soirees to pitch women on its benefits and empower them to feel confident about their decision to freeze their eggs. In 2015, more than 6,200 women froze their eggs at fertility clinics in the U.S., up from only 475 in 2009.

The question that’s now raised is how equitable and accessible these fertility solutions are, and whether they are inclusive enough to provide care for everyone.

Access to fertility care: a health equity issue

The CDC has identified infertility prevention, diagnosis, and management as a public health priority. Disparities in accessing and utilizing infertility services exist among racial and ethnic minority groups compared to white women. There are higher rates of infertility in Black, Latino, Native American, and Arab American families than in white families. And the rates of IVF and fertility treatment are higher too. The statistics of communities of color being left behind are dismal and must be addressed.

In addition to experiencing a higher risk of fertility complications, marginalized groups also suffer from a lack of access to care. Evidence suggests patients of color are referred to fertility specialists less often than white ones. Black women are at higher risk of health issues such as diabetes and fibroid tumors. But a National Library of Medicine study showed that only 16% of physicians identified Black women as the group most at risk for infertility. According to FertilityIQ, Black women and couples are nearly twice as likely to suffer from fertility issues yet are wrongly assumed by physicians to be more fertile than white women.

Many BIPOCs are also excluded from outreach about fertility options. An Indiana Law Journal review of fertility clinic advertising found 63% only featured white babies. These discriminatory practices place a higher burden on the patient to self-diagnose and self-treat. Such implicit biases from physicians can begin to be addressed by educating the broader community. It can be done by relying on the lived experiences of diverse medical professionals. Because they may be more knowledgeable when understanding and relating to patients from similar backgrounds.

There are parallels in the experiences of fertility prevention, management, and treatment among marginalized racial and ethnic populations in the U.S. First, this increased risk of infertility is often related to environmental factors, including residing in urban areas where exposure to toxins that can affect reproductive health is greater.

Additionally, Black, Latino, and Arab American cultures have historically been known to value reproduction and family. As a demographic that also presents higher rates of infertility, these couples can experience added emotional stress when they're unable to reproduce. Even more unfortunate, Black, Latino, and Arab American communities have been exposed to discriminatory practices and may have trust issues with the healthcare system.

Emerging markets: global inequities

In addition to marginalized racial and ethnic minority groups, couples living in emergent countries also suffer from inaccessible fertility care. For example, India's general fertility rate (GFR) has declined by 20% over the past decade. Despite the spike in demand for IVF treatments, the costs of IVF services in India (70,000-300,000 rupees) make it largely unaffordable for low and middle-income families, especially when considering that couples may need more than one cycle depending on the success of their first IVF attempt. While almost half of large U.S. employers offer workplace fertility benefits, in many countries worldwide, that isn't the case.

By 2000, IVF services were only available in about one-quarter of the world's nations. The majority of the globe has yet to establish the necessary infrastructure to support those who need care. For example, Iraq and Syria were both in a nascent stage of IVF development when wars broke out in 2003 and 2011. As only one IVF clinic existed in the city of Erbil, Iraqi men and women experiencing infertility would travel to neighboring Iran for treatment. Now, IVF clinics are much more present in Iraq. Still, it's important to acknowledge that individuals and couples living in countries of economic instability, conflict, and inhibited access to external resources are often omitted from such advancements.

Startups like ScreenMe are partnering with companies, clinics, and hospitals in the Middle East to scale fertility support resources to the MENA region. Fertility care is a necessary public health resource - patients deserve equitable, dignified access to such treatments without needing to travel elsewhere.

Innovative startups in fertility tech: now and moving forward

Big Data is making waves in the fertility space. This allows industry solutions to crunch the numbers. And they can predict which protocols work best based on various factors that comprise an individual’s personal fertility profile. Fertility tech is becoming personalized and breaking free from the traditional “one size fits all” approach. The market is flooding with disruptive solutions that fearlessly challenge the status quo of an individual’s choices regarding having or not having a baby.

The need for effective and equitable fertility solutions is on the rise. So is the number of solutions in the market to address this need. VC investors are well aware of the promising innovation brewing in the fertility tech space. This year, fertility support startups raised $345m in VC investments, which has almost tripled since 2019. The business of fertility treatments is expected to be a $43bn market by 2026.

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The industry is booming, with innovative startups bravely tackling this sensitive need. Fertility solutions acknowledge the need to call men into the equation and provide patients with cost transparency and financial support. They are more receptive than ever to providing individualized, personalized care options. Early-stage startups are in a position where they can have a front-row seat in driving access and education about fertility care beyond the clinic setting. The decision to have a baby should be a decision of dignity and an opportunity to choose better health care options.