Yes — by every measure that can be counted consistently, infertility is more common now than it was a generation ago. WHO-commissioned estimates put the share of adults who have experienced infertility at 17.5% worldwide, roughly 1 in 6, and a Global Burden of Disease analysis found diagnosed female infertility rose 84.4%, from 59.69 million cases in 1990 to 110.09 million in 2021 (WHO, 2023; Gynecological Endocrinology, 2026).
This article compares four independent evidence sources: the WHO systematic review (12,241 records screened, 133 studies, data 1990–2021), a GBD 2021 analysis covering 204 countries, a 223-study meta-regression of sperm counts, and US national birth records. All figures were compiled by the ProIVF Medical Editorial Team and checked against the primary publications by the ProIVF Medical Advisory Board.
How Common Is Infertility, Really?
17.5% of adults — about 1 in 6 — experienced infertility at some point in their lives, according to the WHO-commissioned analysis published in 2023 — WHO, 2023. That figure counts individuals, not couples, and it covers anyone who tried for at least 12 months without achieving a live birth — not only people who reached a fertility clinic.
| Dataset | What it counts | Headline number | Period |
|---|---|---|---|
| WHO systematic review (133 studies) | Adults who experienced infertility | 17.5% (≈1 in 6) | 1990–2021 |
| GBD 2021 analysis (204 countries) | Diagnosed female infertility | 59.69M → 110.09M cases, +84.4% | 1990–2021 |
| ACOG committee opinion | Couples meeting the clinical definition | up to 15% | 2019 |
| Sperm-count meta-regression (223 studies) | Mean sperm concentration, unselected men | −51.6% | 1973–2018 |
The definitions differ, which is why the percentages differ. The 15% figure that most US clinicians quote describes couples meeting a clinical threshold at a point in time — ACOG Committee Opinion 781; the WHO 17.5% describes individuals across a lifetime. Neither number includes people who never sought care.
Is Infertility Rising Faster in Rich Countries?
Yes, and the gap is measurable. The GBD 2021 analysis puts the average annual rise in age-standardised female-infertility prevalence at 0.70% globally, but 1.43% per year in high-SDI (socio-demographically developed) regions — roughly double the global slope — Gynecological Endocrinology, 2026.
The age shape changes too. Globally, infertility prevalence peaks in the 35–39 age band; in high-SDI regions the peak shifts to 40–44. The authors link that shift directly to delayed childbearing, and project continued growth across all cohorts through 2050.
Absolute burden still sits elsewhere. Middle- and high-middle-SDI regions carry the largest number of cases, driven by untreated genital infections and metabolic risk factors, while the steepest rate of increase belongs to the developed world.
Why Is Infertility on the Rise? Four Drivers the Data Supports
Four mechanisms are documented well enough to cite. They add up to most of the increase, but not all of it.
Driver 1: People start trying later than their parents did
Mean age at first birth in the US rose from 26.6 years in 2016 to 27.5 years in 2023, a 0.9-year increase in seven years, based on all US birth records — NCHS, 2025. Women in large metropolitan counties had the highest mean age at first birth (28.5), and those in noncore rural counties the lowest (24.8).
This matters because fecundity — the probability of conceiving in a single cycle — falls steadily from the early 30s and steeply after 35. Pushing the start of trying later does not change biology; it only moves more people into the age band where time-to-pregnancy lengthens.
Driver 2: Sperm counts have halved in 45 years
Among unselected men across all continents, mean sperm concentration declined 51.6% between 1973 and 2018, with total sperm count down 62.3% in the same window — Human Reproduction Update, 2023. The pooled analysis covers 223 studies and 288 estimates.
The decline is accelerating, not linear. The annual rate of fall steepened from 1.16% to 2.64% in samples collected after 2000. The same authors report the trend in unselected men from North America, Europe and Australia at −1.27 million/mL per year, with a smaller but significant slope in South America, Asia and Africa.
Driver 3: Infection in some regions, metabolic disease in others
The GBD study attributes the largest share of female infertility to tubal blockage, followed by reduced ovarian reserve, hormonal dysregulation, chromosomal abnormalities, environmental exposures and postponed parenting — Gynecological Endocrinology, 2026. Tubal damage from untreated sexually transmitted infection and post-partum sepsis remains dominant in lower-SDI settings.
In higher-SDI settings the pattern inverts. Endometriosis affects up to 10% of women, and a 2025 JAMA review reports 26% of patients with endometriosis present with infertility, with diagnosis delayed 5–12 years on average — JAMA, 2025. Polycystic ovary syndrome (PCOS), insulin resistance and rising BMI in the reproductive-age population sit in the same bucket.
Driver 4: Some of the rise is measurement, not biology
More of the increase reflects better counting. Ovarian reserve testing (anti-Müllerian hormone, or AMH, plus antral follicle count), semen analysis standardisation and insurance-coded diagnosis all expanded over the study period, so cycles that would once have been labelled “unexplained” or simply never investigated now appear as cases.
Be careful with the word “prevalence”. The GBD series measures diagnosed female infertility, so an expanding clinic population raises the number even if underlying fecundity is unchanged. What cannot be explained away this way is the sperm-count trend, which rests on direct laboratory measurement in men not selected for fertility problems.
Does the Increase Mean Everyone Should Freeze Eggs?
No, and the data does not support that reading. Population-level decline in average fecundity does not translate into an identical individual risk, and egg freezing is an option for a specific situation rather than a default.
What the numbers do support is timing your evaluation, not your treatment. The clinical definition of infertility is 12 months of regular unprotected intercourse without conception, shortened to 6 months for women aged 35 and over, and waived entirely when a known cause exists — ACOG Committee Opinion 781. Most people who conceive with treatment do so after an assessment that started at the right point, not an earlier one.
Age remains the single largest variable in treatment outcomes. In our breakdown of IVF live birth rates by age, single-cycle live birth rates run 45–50% at 30–34 and 20–30% at 38–40, and natural conception follows a comparable age curve. See also trying to conceive after 35.
Where the “Infertility Epidemic” Coverage Gets It Wrong
Three errors appear repeatedly in commentary on this topic.
- Conflating infertility with IVF need. Only a minority of infertility cases reach assisted reproductive technology (ART); many resolve with ovulation induction, tubal surgery, weight change, or treating a partner’s varicocele.
- Reading prevalence as incidence. Lifetime prevalence (WHO: 17.5%) is not the share of couples currently unable to conceive — and it is not the same as the number of patients on a clinic’s waiting list.
- Ignoring the male half of the picture. Male factors are the sole cause in about 20% of couples and a contributing cause in another 30%, yet evaluation still typically begins with the woman, which delays simple answers. Read male factor infertility and what a semen analysis measures.
What Changed for Three People Who Waited
The accounts below are composite patient cases drawn from typical patterns, not identifiable patient records. Names, ages and amounts have been generalised, and the costs shown are illustrative out-of-pocket amounts.
Maya, 38, Toronto. Maya spent four years on “keep trying” advice before anyone ordered tests. Her AMH came back low for her age and her partner’s semen analysis showed a concentration of 9 million/mL. Two cycles of ovulation induction with timed intercourse produced nothing; her first IVF retrieval yielded three blastocysts, one euploid (chromosomally normal). The transfer did not implant. “Nobody told me the four years were the expensive part,” she says. Her two retrievals cost C$31,000 out of pocket, and Ontario’s public plan funds one IVF cycle for eligible patients, which she had already used.
Wei and Lin, 41 and 39, Shanghai. They married at 33 and 31, both with careers accelerating, and started trying at 37. “We thought fertility was a light switch we could turn on,” Wei says. Lin’s tubal patency test was normal, her antral follicle count was not. They flew to Bangkok for IVF because the waiting list was shorter and the price far lower: US$9,400 for a cycle including medications, versus a quoted ¥280,000 for the same plan at a private clinic in China. Two transfers, one live birth, born at 35 weeks by caesarean.
Priya, 34, Pune. Priya’s infertility was secondary: a healthy first child at 27, then seven years of nothing. Her tubal blockage traced to an infection after that delivery that was never fully treated. Laparoscopic repair failed to restore fertility, and IVF succeeded on the second attempt at a cost of ₹430,000 (about US$5,100). “Secondary infertility is invisible,” she says. “Everyone assumes you already proved you can do it.”
For a wider view of what an evaluation involves, see signs and symptoms of infertility.
FAQ
Q: Is infertility really increasing?
Yes — diagnosed female infertility rose 84.4% in absolute terms between 1990 and 2021 (59.69M to 110.09M cases), and the age-standardised prevalence rose alongside it. Part of that trend reflects broader diagnosis rather than new biology; the remainder is driven by later parenthood and falling sperm quality.
Q: How common is infertility in 2026?
WHO’s estimate is 17.5% of adults worldwide, or about 1 in 6, with a lifetime experience of infertility. The regional split is narrow: 17.8% in high-income regions versus 16.5% in low- and middle-income regions, which is one reason WHO frames access to care, not prevalence, as the main inequity.
Q: What percentage of infertility is caused by age?
Age is not a cause in the same sense as tubal blockage, but it is the dominant modifier. Fertility declines measurably from about 32 and more steeply after 37; the global prevalence peak sits at 35–39, moving to 40–44 in high-income countries, a pattern the GBD authors attribute primarily to delayed childbearing.
Q: Are sperm counts actually dropping?
Yes, in the populations measured. The pooled analysis of 223 studies and 288 estimates found mean sperm concentration down 51.6% and total sperm count down 62.3% across the 1973–2018 window, and the annual pace of the fall has steepened since 2000.
Q: Is infertility mainly a problem in wealthy countries?
No — the burdens run in opposite directions. Middle- and high-middle-SDI regions carry the largest absolute number of diagnosed cases, driven by untreated genital infections and metabolic risk factors, while the fastest annual rise is in developed regions (1.43% per year versus 0.70% globally).
Q: When should a couple get evaluated?
Under ACOG guidance, testing begins after 12 months of regular unprotected intercourse without conception for women under 35, and after 6 months for those aged 35 or older. Skip the waiting period entirely with a known cause: irregular or absent periods, prior pelvic infection or surgery, endometriosis, cancer treatment, or a partner with known sperm parameters outside the reference range.
Q: Does treating the cause restore fertility?
Partly — ovulation induction resolves the majority of anovulatory cases, while tubal surgery can restore patency without restoring function. Where tubes are severely damaged or ovarian reserve is low, assisted reproductive technology (ART) bypasses the problem rather than fixing it, and age still sets the ceiling: live birth per retrieval cycle runs 20–30% at 38–40, 10–18% at 41–42 and 5–10% over 42 (see IVF success rates by age).
Compare programs in our hospital directory.
Where to Go From Here
The statistics describe populations; your decision needs your own numbers. A cycle of basic fertility testing — hormones, ultrasound, semen analysis — is the cheapest information you will buy in this process.
One US patient who shared her itemised bill paid US$835 for the entire workup — less than one-tenth of a single treatment cycle in most US price lists.
ProIVF lists fertility centres in the US, Thailand, Japan, Spain and the Czech Republic with published pricing and verified patient reviews. Compare programs by country in our hospital directory, or send us your age, location and budget through the contact form and we will shortlist three clinics that fit.
“Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue.” — Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research, World Health Organization, 2023
About this content. This article was researched and written by the ProIVF Medical Editorial Team from primary sources (WHO 2023, GBD 2021 analysis in Gynecological Endocrinology 2026, Levine et al. in Human Reproduction Update 2023, NCHS data brief 2025, ACOG Committee Opinion 781, and a 2025 JAMA endometriosis review), and reviewed for medical accuracy by the ProIVF Medical Advisory Board. ProIVF is an independent information platform; we receive no commission from the clinics we list, and some hospitals mentioned in linked pages are our partners. This page is general health information, not medical advice, and cannot replace an individual consultation with a licensed reproductive specialist.
Medical disclaimer: All decisions about fertility testing and treatment should be made with a qualified physician.
Last updated: October 7, 2026
