The Rising Tide of Infertility: Economic Drivers of IVF, Population Decline, and the Revolutionary Role of Fertility Pathways
Summary
Global infertility rates have risen steadily since the 1990s, affecting an estimated 17.5% of adults worldwide in 2025, up from lower prevalence in earlier decades. This trend, driven by factors like delayed childbearing, environmental toxins, and lifestyle changes, has fueled the explosive growth of in vitro fertilization (IVF), a market projected to reach $37.7 billion by 2027. While IVF offers economic advantages through high revenue for clinics and long-term fiscal gains for governments via productive offspring, it remains inaccessible to most due to costs exceeding $60,000 per live birth in the U.S. Concurrently, declining birth rates—now at a global total fertility rate (TFR) of 2.2 in 2025—signal a demographic crisis, with projections of population decline in over half of countries by 2050, leading to economic strains like shrinking workforces and overburdened social systems. Amid this, Fertility Pathways emerges as a groundbreaking innovation: a unique protocol designed to help families and deliver personalized, cost-effective infertility care, achieving live birth rates of 60% without IVF and 84% with it—far surpassing national averages (please read our other articles).
This white paper explores these dynamics and positions Fertility Pathways as a transformative solution to democratize fertility care.
The Rise of Infertility
Infertility, defined as the inability to conceive after one year of unprotected intercourse, has evolved from a niche medical issue in the 1990s to a widespread global challenge by 2025. In 1990, global female infertility cases numbered approximately 59.7 million. By 2021, cases surged to 110 million for females alone, an 84.4% increase, driven by population growth to 7.9 billion and ASPR rises (0.49% annually for males, 0.68% for females). Projections for 2025 suggest over 115 million female cases, with total infertility (both sexes) impacting 150–200 million people, or roughly 1 in 6 adults.
Key drivers include:
- Delayed Childbearing and Aging: Women in high-income countries now delay parenthood, with fertility declining sharply after age 35. In the Asia-Pacific region, infertility burdens grew 58% from 1990 to 2021 due to urbanization and career priorities.
- Environmental and Lifestyle Factors: Exposure to endocrine disruptors, obesity, and stress has contributed to sperm quality decline (e.g., 1% annual drop in sperm concentration since 1973) and ovulatory disorders.
- Infections and Health Issues: In low- and middle-income regions, sexually transmitted infections (STIs) account for rising cases, with attributable infertility increasing from 11.3 million in 1990 to 19.1 million in 2021.
Regionally, sub-Saharan Africa and South Asia bear the highest burdens, while high-income areas like Europe and North America see stable rates but higher absolute impacts from aging populations. Years lived with disability (YLDs) from infertility rose 84.4% globally, underscoring socioeconomic costs like emotional distress and lost productivity. Overall, people are less fertile today, with more affected in absolute terms due to population growth and modest rate increases.
The Rise of IVF and Its Economic Advantages
Since the 1990s, IVF has transitioned from an experimental procedure for tubal infertility to the dominant treatment for various subfertility causes, including unexplained, male-factor, and endometriosis-related issues. U.S. IVF cycles surged from under 10,000 in the early 1990s to over 330,000 annually by 2025, producing 60,000+ babies yearly. Globally, the IVF market grew from niche status to $13.6 billion in 2018, projected at $37.7 billion by 2027 with a 9.5% CAGR, driven by rising infertility.
Economic advantages include Clinic Revenue and Market Fragmentation: IVF is lucrative, with U.S. clinics (450+ mostly small practices) Average IVF cycle costs $15,000-$20,000 (excluding meds; total per live birth ~$60,000-$100,000 with multiples) [source: Resolve.org 2025 estimates; Forbes Health 2024] yielding high margins despite 30% success rates per transfer. Private equity investments have consolidated the market, boosting profits.
Additionally, IVF's high cost ($60,000+ per live birth) limits access to 14% of infertile couples, exacerbating inequalities and prompting calls for alternatives.
Innovation in Fertility Care: Introducing Fertility Pathways
Fertility Pathways represents a paradigm shift in infertility management. Based on the proven Rockford Protocol (also known as the Holden Protocol), this system guides PCPs—such as nurses, family practitioners, and non-specialist OB/GYNs—through individualized diagnosis and treatment without requiring specialized training. The protocol, refined over 20 years, emphasizes root-cause correction (hormonal, anatomical, and ovulatory issues) before conception attempts, achieving 59.8% live birth rates — nearly double the previous highest level: Denmark's 34.2% without IVF.
Success rates: 63.1% without IVF (vs. 25% national average) and 89.4% with IVF (vs. 30%). By empowering PCPs and preparing patients for IVF if needed, it removes barriers (cost: $60,000+ savings; geography: remote access; culture: ethical alternatives to IVF), potentially serving the 86% untreated infertile population with a reduction of the cost by approx 91% per live birth.
Conclusion
The rise of infertility, IVF's economic dominance, and impending population decline demand innovative, accessible solutions. Fertility Pathways addresses these by democratizing care, boosting outcomes, and aligning with global needs for sustainable reproduction.
As TFR falls and costs soar, our approach offers hope—empowering providers and patients to build families affordably and effectively.
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Published By
Timothy G. Leeds MD
Dr. Timothy G. Leeds, MD, is a board-certified OB-GYN with over 38 years’ experience, practicing in Nevada and Ames, Iowa, and affiliated with local medical centers.