Technological advancements, increasingly due to artificial intelligence, are transforming the fertility industry and redefining who can have a child. But they are not likely to reverse population decline.
Last June, Dr. Zev Williams led medical professionals at Columbia University Fertility Center in announcing the first-ever pregnancy forged through Sperm Track and Recovery. Currently in its clinical phase, STAR is designed to offset azoospermia, or male infertility issues preventing pregnancies, by using an AI algorithm to detect sperm cells undetectable to the human eye.
But Williams and other industry experts told the Washington Examiner that while developments in the field are pushing the boundaries of fertility access, AI-assisted IVF treatments can’t be relied upon to salve plunging birth rates, which first hit Asia, then Europe, and now the United States. In fact, innovations allowing women to have a child past the traditional childbearing age could only further incentivize people to wait to build families, according to demographic expert Lyman Stone, which could ironically harden falling birth rates.
“STAR is helping people who had zero chance of success,” Williams said during an interview. “So previously, it wasn’t even a cost issue. People, if you couldn’t find sperm, they couldn’t have a child, a biological child. STAR is now enabling people to do that. But population decline is driven by factors far beyond just people who want to have a child and are not able to have one.”
Dr. Aimee Eyvazzadeh, who heads what she described as one of the country’s busiest private fertility clinics, noted that in-vitro gametogenesis, which creates sperm and egg cells in a lab, is another groundbreaking procedure that is making it possible for women to become pregnant years past the age where they can biologically have children. During a phone call this week, the California-based doctor said she is witnessing a trend of increasingly older women coming to her fertility center, where she sees up to 32 patients a day, seven days a week. Eyvazzadeh foresees a near future where it is the norm for women to have kids in their 50s. People will consider “35-year-olds the teenage pregnancies in the future,” she said.
In such a society, IVG will be absolutely essential to providing a pathway for children to be born, according to Eyvazzadeh. The procedure is still in the research phase. Dr. Kotaro Sasaki, a University of Pennsylvania professor leading IVG research, told the Washington Examiner that scientists are currently relying on “extensive iterative experimentation” and manual work to develop the procedure, though he added AI can be used to “assist” parts of the process. The emerging technology has provoked controversy due to sweeping ethical concerns about human life being created in a lab, and that it could be used for “embryo farming” and to craft “designer babies.” Eyvazzadeh said IVG would “basically disrupt the entire way we do IVF, and make it so that egg donors, even sperm donors, don’t even need to exist.”
Stone, who is a Senior Fellow and director of the Pronatalism Initiative at the Institute for Family Studies, said data show that the availability of such reproductive technology only “accelerates postponing behavior.”
“You get a time shift in births, but not a major shift in actual completed fertility,” he said, pointing to an analysis he recently completed of four studies on fertility access. “Yes, there are people who struggle with infertility, but the net effect of these technologies has been to enable people to postpone fertility, not to actually increase completed fertility.”
Eyvazzadeh made similar observations, saying that deeper societal shifts mean many women simply want to wait longer to have children, a trend she’s seen at her clinic over the past two decades.
“I think the population decline is really related to people waiting to want to have babies,” she said. “My prediction is that my children won’t have kids until they’re in their 50s. When I started my practice, the average age was 32 this is almost 20 years ago. Then over about 10 years it shifted to 37, and now, around the average age of 42, and if you look at the number of patients 45 to 55 coming in, it’s astronomical.”
The shifts come as experts warn that falling birth rates in the U.S. and across the world promise to have a sweeping effect on global power dynamics. And a federal fix could cost trillions annually, as data show deaths now outnumber births across nearly half of the 50 states, Alex Nowrasteh, the Cato Institute’s senior vice president for policy, previously told the Washington Examiner. The average age for first-time mothers in 2023 was 27.5, according to the Centers for Disease Control and Prevention, up from 21.4 in 1970.
While they won’t solve deepening concerns about global population decline, innovations in the fertility industry do promise to lower the cost of reproductive care for families, Williams said.
“For example, someone needs three IVF cycles to have a baby, but because of AI or new technologies, we’re able to do that in one cycle. You’re dramatically lowering the cost, and you’re also making the whole process much less demanding and difficult for the patient herself,” he said, pointing to emerging innovations in AI technology that could allow for more successful selection of embryos. CHLOE and Aura, systems used to automate 205 manual steps in IVF, are just a few of the AI-centric systems proponents say could be used to improve outcomes.
Eyvazzadeh emphasized the role AI models such as ChatGPT can play in patient advocacy by helping couples break down complex fertility diagnoses and symptoms. AI-centric ovulation tracking systems and time-lapse incubators for embryo monitoring are among other innovations improving outcomes, she said.
THE AGE OF AI IS HERE — HOW SHOULD IT BE REGULATED?
Williams noted that many AI innovations, including Aura, remain in the early stages of development. While he views AI as “a force multiplier” that allows for professionals to deliver “more precise care, improve success rates, and help patients achieve their desired family size with fewer treatments,” it will take time, he said, to determine exactly the impact it will have on fertility access.
“We’re in the earliest moments, the dawn of AI infertility care,” he said. “I think it’s hard to predict when that moment will come where you’re seeing meaningful improvements in those different areas, I think they will. I just think it’s hard to predict.“
