In a new report from the Centers for Disease Control, the birth rates among women ages 34 and younger have fallen, while the birth rates among women ages 35 and up have increased.
The total fertility rate, which is the number of births a woman is expected to have during her lifetime, is at 1.73, a new record low. According to the CDC, in order for a generation to replace itself, the number of births needs to be at 2.10.
The U.S. total fertility rate was at its peak in 1957 at 3.77 births per woman. In 1965 the expected births fell to 2.91, then continued to fall to 1.84 in 1980. With the exception of 2006 and 2007, the total fertility rate has been below the 2.10 replacement level since 1971.
While the CDC did not offer an explanation for the falling fertility rates, new reports attribute the trend to women pursuing motherhood later in life in order to focus on career and finances. This factor combined with a dropping teen pregnancy rate and a lack of support for new mothers, such as paid financial leave and affordable daycare options, may also contribute.
In Illinois, we are lucky to be in a state that mandates fertility coverage. A mandated state requires certain insurance plans to include a specific health insurance benefit. There are exceptions to the mandate, but it does provide more access to treatment coverage.
We asked our physician team to weigh in on the CDC’s report:
“The CDC’s report on falling birth rates reflects the changes I have been seeing in practice for many years. The opportunities for fertility have not changed, but the desire to have a family during a woman’s peak fertility has declined – women and couples wait to have a family until careers have progressed, finances are more secure, and various life goals have been met. At Fertility Centers of Illinois, we have seen patients ages 35 and up to increase by 35% over the past 9 years, with patients 40 and up increasing by 23% in that same time period. We now have the ability to slow that decline down by freezing eggs at a young age to be utilized when women are older. For those that pursue pregnancy at a later age, genetic screening of embryos for genetic abnormalities and disease is the most valuable tool for lowering genetic risk and reducing the chance of miscarriage.”
“This data is not surprising but consistent with the trend we see in clinical practice. Women are waiting to have their careers established before starting to have a family. Although in many ways “40 is the new 30”; our ovarian health has not caught up to that trend and we know fertility peaks in our late twenties with decreases seen most dramatically mid-30s. As women are focused on their career, we in reproductive health, need to inform patients of the timeline for ovarian reserve so when can consider treatments such as egg freezing or having a family in a perceived “bad time”. A comprehensive approach to women’s health includes supporting women with contraception options, knowledge of their fertility, egg freezing options and support so family and work can occur in parallel.”
“Sociodemographic studies have noted a gradual decline in the birth rates of women under the age of 30 and an increase in those after that age. This trend started after the baby boom in the 1950s and persisted, making fertility rates in younger women after 2007 at their lowest numbers in the modern age. However, conception in the later reproductive age is accompanied by a number of challenges that are rarely encountered under the age of 30. This is mainly explained by female reproductive physiology and the “biological time clock” of a woman. In the era of women empowerment, there is an absolute need to empower women on a reproductive level. While there are few therapeutic measures for women attempting to conceive at a later reproductive age, the most efficient, by far, remains elective ‘egg freezing’ in the late ’20s to early ’30s.”
I have been observing the shift in the ages of our patients for many years. The changes in social structure have led to this shift: more couples are two-income families, the traditional male role as the provider has given way to shared responsibility, and more women are focusing on their advanced education and careers. Women need to know that their fertility drops incessantly from their early 20s with a more severe drop in their late 30s, and it is in their interest to freeze their eggs no later than their early 30s as an insurance against the reduced probability of having a baby when older. They should not be fooled by Hollywood celebrities who trumpet their pregnancies in their late 40s: they are deceiving the public because they use a donor egg. The reality is a woman is unlikely to get pregnant on her own even with treatment using her own eggs if she waits to her 40s to start a family.