Global Infertility Burden Among Women Over 35 Could Rise by Almost 50% by 2036

IVF.net Newsdesk

20 July 2026

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The global burden of infertility among women aged 35 to 49 is expected to increase substantially over the next decade. A new analysis published in The Lancet Obstetrics, Gynaecology, & Women’s Health projects that approximately 79.6 million women in this age group could be living with infertility by 2036, compared with an estimated 53.6 million in 2023.

This represents an increase of approximately 48.6% in just 13 years. The associated burden measured in disability-adjusted life-years, or DALYs, is also projected to rise by nearly 50%.

The findings position infertility at advanced reproductive ages as an increasingly important global health issue. They also illustrate how reproductive biology, population ageing, later childbearing and unequal access to fertility care are interacting across very different social and economic settings.

The analysis used data from the Global Burden of Disease 2023 study, covering 204 countries and territories between 1990 and 2023. Researchers assessed the prevalence of infertility and associated DALYs among women aged 35 to 49. They examined trends at global, regional and national levels, evaluated health inequalities and used a Bayesian age-period-cohort model to project the burden through 2036.

In 2023, the estimated age-standardised prevalence rate was 6,907 cases per 100,000 women aged 35 to 49, although the uncertainty interval around that figure was wide. Across the period from 1990 to 2023, age-standardised prevalence increased by an average of approximately 0.45% per year. Infertility-related DALYs rose by around 0.47% annually.

The projected increase in the absolute number of affected women is therefore not simply a reflection of one factor. It combines changes in population size and age structure with a continuing rise in the estimated age-standardised burden. The largest numerical increase is expected among women aged 35 to 39.

Age remains central to the clinical picture. Ovarian reserve and oocyte competence decline as reproductive ageing progresses. This reduces natural fecundity, increases the probability of miscarriage and lowers the likelihood that an assisted reproductive technology cycle will result in a live birth. These biological processes are well established, but the population exposed to them is changing.

In many countries, first births are occurring later. Longer periods in education, delayed partnership formation, housing costs, employment insecurity, limited childcare and the difficulty of reconciling work with parenthood all influence reproductive timing. Greater awareness of infertility and increased use of diagnostic services may also contribute to the number of cases identified.

These factors should not be interpreted as evidence that later parenthood is simply an individual lifestyle decision. Reproductive timing is shaped by economic conditions, workplace policies, family support, access to health care and the wider social environment. Expanding IVF services can address part of the clinical need, but it cannot by itself resolve the structural conditions that lead many people to postpone attempts to conceive.

The geographical pattern is also changing. Asia currently has the greatest absolute need for fertility care, reflecting its large population, while Australasia has the lowest. At the same time, the study found that the burden has progressively shifted towards countries with a higher Socio-demographic Index, a composite measure incorporating income, education and fertility.

Higher-income settings tend to have older maternal ages and greater access to fertility investigation, diagnosis and treatment. This can increase both the underlying need for care and the visibility of infertility within health statistics. In lower-resource settings, infertility may remain underdiagnosed even when its personal and social consequences are severe.

The relative disparity in infertility-related DALYs between low-SDI and high-SDI regions narrowed by 23.1% between 1990 and 2023. This apparent improvement in global equity requires careful interpretation. A narrowing gap does not necessarily mean that outcomes have improved everywhere. It can also occur because the measured burden is rising more quickly in high-SDI countries.

Substantial inequalities remain within and between countries. Fertility investigations, ovarian stimulation, laboratory procedures, embryo culture, cryopreservation and repeated treatment cycles can place considerable financial pressure on patients. Where treatment is primarily self-funded, access depends heavily on income and geography. Even in publicly supported systems, age restrictions, eligibility criteria and long waiting periods can limit care.

The new estimates therefore have practical implications for fertility services. A rise from 53.6 million to almost 80 million affected women would create additional demand for diagnostic testing, counselling, ovarian stimulation, IVF, intracytoplasmic sperm injection, cryopreservation and donor treatment. Laboratories may need to plan for greater cycle volumes while maintaining rigorous standards for traceability, quality control, culture conditions and staff competency.

Demand is unlikely to be distributed evenly. Health systems will need local forecasting that accounts for population age structure, reproductive intentions, treatment-seeking behaviour and existing service capacity. Greater demand also makes efficient referral pathways increasingly important. Patients may lose valuable reproductive time when assessment is delayed or when care is fragmented between primary care, gynaecology and specialist fertility services.

Earlier access to accurate fertility information could help people make informed reproductive choices. This should include a realistic explanation of age-related changes in fertility and the limitations of assisted reproduction. IVF can improve the probability of conception for many patients, but it does not fully compensate for the effect of increasing oocyte age. Fertility preservation may extend reproductive options for some women, although it also carries costs, medical burdens and no guarantee of a future live birth.

Education must be delivered carefully. The purpose is not to pressure women into earlier parenthood or transfer responsibility for systemic problems onto individual patients. Fertility awareness is most useful when accompanied by policies that make family formation more achievable, including secure employment, affordable housing, parental leave, childcare and protection from workplace disadvantage.

The study also supports integrating infertility more fully into national health strategies and primary care. Earlier recognition of risk factors, appropriate investigation and timely referral could reduce avoidable delays. Mobile health services and remote consultations may extend access to information and specialist support, particularly in regions where fertility clinics are concentrated in major cities.

Clinical expansion should be accompanied by measures that protect affordability and quality. Increasing capacity without addressing cost could widen existing disparities. Similarly, expanding treatment without appropriate laboratory infrastructure, trained personnel and monitoring could compromise patient safety and outcomes.

The estimates should be understood as modelled population-level findings rather than a direct count of every woman experiencing infertility. The Global Burden of Disease framework combines information from multiple sources and uses statistical modelling where data are incomplete. The broad uncertainty interval around the prevalence estimate reflects variation and limitations in the available evidence.

Definitions and reporting practices may also differ across settings. Infertility is generally defined as failure to achieve pregnancy after 12 months of regular unprotected intercourse, but this clinical definition does not capture every reproductive circumstance. Women who are not currently attempting pregnancy, do not have a partner or cannot access diagnostic services may not be represented in the same way as patients actively seeking treatment.

The analysis focuses specifically on female infertility among women aged 35 to 49. It should not be read as suggesting that infertility is exclusively or predominantly the responsibility of women. Male factors, combined factors and unexplained infertility represent substantial components of the overall burden and require appropriate investigation.

Despite these limitations, the projected direction of change is clear. More women are reaching later reproductive ages in populations where childbearing is increasingly postponed, while fertility care remains expensive or unavailable for many of those who need it. The result is likely to be a significant increase in demand for both clinical treatment and wider reproductive health support.

For IVF providers, policymakers and laboratory professionals, the study offers a planning horizon rather than simply a warning. Capacity, affordability, workforce development and equitable access will need to advance together. The challenge is not only to perform more treatment cycles, but to build fertility services that are timely, evidence-based and accessible across different economic and geographical settings.

Nearly 80 million affected women by 2036 would make infertility among those aged 35 to 49 an even more prominent part of global reproductive health. Preparing for that future will require better fertility education, earlier assessment, realistic communication about treatment, stronger laboratory capacity and policies that recognise the social as well as biological dimensions of reproductive ageing.