The Future of Fertility

1 - The Rise of FemTech

Startups focused on women’s health have exploded in recent years, with fertility a big and growing businesses (think $400 billion in funding in 2018) as more affluent couples who waited to have children find they need to hack their own bodies to become parents. Startups like Mira and Ava use wearables or other devices to measure users’ ovulation, while others target younger women who may not want kids yet but just want an idea of the fertility challenges they may face in the future. While a startup is unlikely to replace a doctor, they can help women and couples take more control of their reproductive health.

2 - When Single Is Safer

For years, IVF (particularly in the U.S.) focused on using multiple embryos at a stroke in order to maximize the chance of conception. But pregnancies using that technology are more likely to miscarry or produce babies who spend longer in the NICU than single embryo implantation, which is finally catching up with stateside doctors after becoming the preferred option in Europe. Multiple embryo technology’s popularity in the U.S. is largely due to the fact that Americans pay far more per IVF treatment than Europeans do, but education about its dangers are increasing (and costs can actually be higher when you factor in infant ICU care and the exponentially larger hospital bills associated with multiple births).

3 - Could a Tampon Tell You How Fertile You Are?

Every month, a woman’s body sheds data, courtesy of her uterine lining. The blood and tissue collected in a tampon can be analyzed like any other biopsy — and entrepreneur Ridhi Tariyal decided to capture that data to help women hoping to evaluate their fertility even before they start trying for a baby. While some worry that disconnecting these tests from doctor’s offices will deprive women of vital information and guidance, Tariyal’s steaming ahead with her company, NextGen Jane, which hopes eventually to inform women not just about their fertility and potential for endometriosis, but also whether they have sexually transmitted infections. And she’s not the only person focused on endometriosis, which renders many women infertile: Heather Bowerman’s personalized medicine startup, DotLab, is focused on increasing testing for women, though hers loops in their doctors as well.

4 - Let’s Hear It For the Boys

Infertility is far from just a female problem. In fact, sperm counts in Western countries are thought to have dropped 50 to 60 percent from 1981 to 2013, a stunning plunge that sparked concern about the future of the human race. British scientist Sarah Martins da Silva has devoted her career to studying, understanding and (hopefully eventually) finding solutions for male infertility. Demystifying and destigmatizing the condition, she hopes, could benefit women as well by sparing them invasive and expensive fertility treatments when it’s their partners experiencing the issue.

5 - Nothin’ But a Number

That statistic about women’s fertility dropping off a cliff at 35 has been soundly debunked — it’s based on data about French women from the 18th and 19th centuries. In fact, more recent studies have determined that women aged 35 to 40 are only slightly less likely to get pregnant than those five years younger. And with women over 40 the only U.S. group for whom birth rates have been steadily increasing in recent years, technology has had to keep up too: Embryo adoption, where older women use a donor embryo, has been shown to send the chances that women in their late 40s can get pregnant skyrocketing. Now most fertility clinics offer the option, which can be significantly cheaper than traditional IVF.

6 - Fertility Folk Tales

Not comfortable with injections or implantation? You could always try sitting in a magic chair. Women visiting the French town of Saint-Émilion to sample the local wines can also stop in at La Grande Cave de Saint-Émilion, a cave where a storied Breton monk lived in the eighth century. Sit in the monk’s chair, the legend goes, and you’ll get pregnant. Other ancient fertility and contraception methods might have slightly more scientific backing: Women have used potions and herbs since time immemorial to keep from getting pregnant, and scientists in Nigeria and Iran are now studying traditional contraceptive aids like acacia and fennel only to find that they do have scientific properties that can be effective.

1 - Liberté, Egalité, Fertilité

Along with many other health services, IVF in France has long been state sponsored, but only for couples — until last January, when new legislation extended the benefit to lesbian couples and single women. But other fertility technologies may have a tougher battle: While surrogacy is accepted in the U.S., it’s forbidden in France and in most of Europe due to the possibility of exploitation, except in the U.K., Greece and Portugal. Even in the U.K., women who act as surrogates can’t be paid and instead must contribute their labor altruistically. That ethical debate has made it hard for some gay couples to become parents, prompting many to travel to the U.S. to pursue their dreams of parenthood.

2 - The Politics of Embryos

Anti-abortion lawmakers have long sought to offer human rights to embryos — but those laws could be having a chilling effect on the forward march of fertility science. For example, doctors who unfreeze a group of embryos know one may not survive. But they may be less willing to go forward with such procedures, common infertility treatments, if they might face murder charges for it. As a result, some doctors are hiring lawyers to fight against bills that mandate life begins at conception.

3 - China’s Maverick Baby Editor

Three years ago, researcher He Jiankui went public with claims that he used CRISPR gene-editing technology to make the world’s first edited babies — specifically so these babies didn’t have HIV even though their fathers did. But many in the scientific community pointed out that he was operating on human babies with no oversight, flouting medical ethics and recklessly endangering his subjects. Courts agreed, and in December 2019 he was sentenced to three years in jail.

1 - Disaster Area

Every time there’s a blackout or hurricane, people imagine what everyone was doing during the temporary pause — and predict there will be a baby boom. But it turns out “blackout babies” are an urban myth, and a survey of the British public in the spring found that very few people have sex on the brain. Add to that a global, worldwide recession on the heels of COVID-19 and you have a recipe for fewer babies, not more, as recessions tend to tamp down expensive activities like childbirth. Still, it may vary by country: Contraception supply chains have been disrupted by the virus, in developing countries, so even if the pandemic leads to a dip in birth rate for wealthy countries, it could still presage a boom in poorer ones.

2 - Cash for Kids

Dropping birth rates in wealthy countries were a concern long before the coronavirus came along. U.S. birth rates hit a 30-year low in 2019, down a full percent from the previous year and bringing it below the rate of replacement (the level needed to maintain a population). To combat this — a worldwide trend — many nations are actually paying people to have babies, with Japan and parts of Finland offering generous child benefits and Singapore bumping up the cash bonus it offers new parents. Italy’s far-right government even proposed a plan three years ago to give big families free farmland.

3 - American Exceptionalism

The United States is by far the most expensive place in the world to give birth (and, among developed countries, the most dangerous). But the costs don’t stop there. The nuclear family unit of two married parents and their children under one roof — long seen as the norm, at least in sitcoms — is actually in danger of dying out, thanks to falling rates of marriage and childbirth, combined with soaring housing costs that make it close to impossible for many to afford their own home as a family unit without roommates or other family members contributing financially.

4 - The Benefit of Family

Infertility is on the rise in the U.S., according to the CDC, which found that 6.7 percent of adult married women were unable to get pregnant after a year of unprotected sex. That could mean a shakeup in the business world, as startups like Peloton increasingly use the promise of fertility benefits to attract employees who may want to start families while working there … even if it takes a little technology to do so. That could make a massive difference to employees who often feel they have to hide the side effects of treatments like IVF or the pain of dealing with infertility — something 61 percent of women surveyed said was more stressful than divorce.

Quiz Time!!

Test your knowledge on the future of fertility in our quiz:

Which is thought to be the safer form of IVF, single embryo or multiple embryo?

True or false: Teenagers are the only age group in the U.S. for whom the fertility rate is rising.

Which term means implantation of a donated embryo?

Which of these is an herb traditionally used to aid contraception?

What’s one factor that could lead to there being more babies born during the pandemic?

In which of the following countries is surrogacy forbidden?

True or false: A majority of women surveyed say dealing with infertility is a more stressful experience than a divorce.

How much have sperm counts dipped in Western countries since 1981?

Answers:

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