America’s Fertility Crisis: What Doctors Say Is Really Going On

America is in the midst of a growing fertility crisis—one that goes far beyond couples simply choosing to have children later in life. With fertility rates plummeting and the number of people struggling to conceive on the rise, a panel of medical experts has offered insight into the deeper causes—and solutions—for this troubling national trend.

A Sharp Decline in Birth Rates

In 2024, the U.S. fertility rate reached just 1.6 children per woman, well below the replacement level of 2.1 needed to maintain a stable population. Compare that to 2004, when there were over 66 live births per 1,000 women, and the scale of the issue becomes clear.

According to projections by the National Institutes of Health (NIH), over 7 million American women are expected to face infertility in 2025 alone. Globally, the World Health Organization (WHO) estimates that roughly 1 in 6 adults—of any gender—experience infertility during their lifetime.

Environmental and Lifestyle Factors at Play

While societal shifts—such as women choosing to start families later—do contribute to the crisis, experts say they’re only part of the story.

Dr. Jessica Sharratt, founder of Heal Los Angeles and an expert in Oriental Medicine, points to environmental toxins and chronic nervous system dysregulation as critical but often overlooked culprits.

“We’re swimming in a sea of synthetic chemicals,” she warns. “Pesticides on food, plastics in water, and hormone-disrupting skincare products silently interfere with our reproductive systems.”

A 2017 study published in JAMA Internal Medicine found that women who consumed two or more servings of high-pesticide produce per day (such as strawberries, grapes, and kale) were 18% less likely to become pregnant and 26% less likely to carry a pregnancy to term.

The Role of Chronic Illness and Mental Health

Dr. Jamie Stanhiser, a fertility expert at the Reproductive Partners Fertility Center in San Diego, adds that rising rates of conditions like polycystic ovary syndrome (PCOS), obesity, diabetes, and autoimmune disorders are all contributing to infertility.

“These conditions don’t just impact physical health—they disrupt the hormonal balance necessary for conception,” she explains.

PCOS alone, a condition marked by high androgen levels and irregular ovulation, is a significant contributor to female infertility.

But it’s not just physical health. The mental health crisis in America—characterised by rising rates of anxiety and depression—is also playing a key role. According to Dr. Stanhiser, the link between infertility and mental health is bidirectional: infertility can increase emotional distress, and emotional distress can in turn hinder fertility.

A 2024 literature review of over 3,000 studies showed a significant correlation between infertility and severe stress, anxiety, and depression—particularly in countries like Pakistan and Hungary, where the stigma around infertility may be more intense.

Male Fertility Is Declining, Too

It’s not just women affected. About 10–15% of American men trying to conceive now face fertility issues as well. Low sperm count, genetic conditions, depression, and even lifestyle-related stress can all play a role.

What Can Be Done?

Experts agree that lifestyle and nutrition are key in improving fertility outcomes.

Dr. Jamie Knopman, a reproductive endocrinologist at CCRM Fertility in New York, recommends a Mediterranean-style diet rich in fruits, vegetables, legumes, fish, and healthy fats.

“Fad diets don’t work. We want to reduce inflammation, and the Mediterranean diet is excellent for that,” she says.

She also encourages patients to stay active—even while undergoing fertility treatments.

Dr. Elizabeth King, a certified fertility expert in California, echoes this advice but adds another layer: nervous system regulation.

“From meditation to yoga to simply getting quality sleep, regulating the nervous system is crucial,” she notes. “An anti-inflammatory diet combined with mindfulness practices can fight oxidative stress and support reproductive health.”

When to Seek Help

For those actively trying to conceive, timing is crucial. Dr. Iris Insogna of Columbia University Fertility Center advises:

• Under 35? See a specialist after 12 months of trying.

• 35 or older? Seek help after 6 months.

• Over 40, LGBTQ+ couples, or single parents by choice? Don’t wait—consult a fertility specialist as soon as you're ready to begin your journey.

Be Kind to Yourself

Perhaps the most universal advice from every expert: compassion. Dr. Knopman reminds hopeful parents not to blame themselves.

“You’re not infertile because you had a glass of rosé or ate French fries. Fertility is nuanced. Be kind to yourself on this journey.”