For millennials, career aspirations, economic realities, and rapidly advancing fertility treatments are changing the way we approach family planning.
By pulling together several expert interviews, a new Healthline survey of 1,214 people, and Healthline’s proprietary search and social data, we’ve developed a comprehensive overview of the current fertility landscape. In this report, Healthline explores how American parenthood is drastically changing — and how it will continue to evolve over the next few years.
Key findings from the Healthline report are:
- 1 in 2 millennial men and women are delaying starting a family.
- 53 percent of millennial women would consider freezing their eggs, driven by not having sufficient financial means for a child yet (42 percent), choosing to focus on a career (39 percent), health issues (34 percent), indecision about having a family (32 percent), focus on education (25 percent), and not having a partner to parent with yet (18 percent).
- 7 in 10 millennial women say they understand the impact of a woman’s age on fertility, but 68 percent of them weren’t aware that 40-50 percent of women over age 35 need medical intervention, such as IVF, in order to become pregnant.
- 58 percent of millennial women believe they should check their fertility health between ages 25 and 34, while doctors recommend fertility be checked by age 25.
- 37 percent of millennial women are open to using IVF to get pregnant.
- 47 percent of all people surveyed believe health insurance companies should cover fertility treatments. 51 percent think everyone, regardless of their marital status or sexuality, should be eligible for fertility benefits.
- Most millennials talk to their OB-GYN (86 percent) or primary care physician (76 percent) about their fertility. But many also turn to Google searches (74 percent), health sites like Healthline.com (69 percent), and fertility organization websites (68 percent) to find answers to their fertility questions.
Findings are based on a national sample of 1,214 Americans, age 18+, recruited from Survey Monkey’s Contribute panel. The survey was executed March 30 to April 2, 2017.
Family planning over generations
Baby boomers, born between 1946 and 1964, largely followed the same stereotypical path to adulthood as the generations before them: Soon after school was finished they got married, and children came along a few years later. Most families were complete by the time couples hit the age of 30.
Millennials, born between 1982 and 1999, and currently 18 to 34 years old, are changing that dynamic entirely.
Millennials are over 75 million strong in the United States, overtaking baby boomers in 2015 to become the largest living generation. The prospects for traditional careers and families have been dramatically altered by forces outside of their control. The sluggish economy, combined with the fact more women are pursuing fulfilling careers, is driving millennials to delay traditional life milestones.
Today, many millennials are postponing the start of their families far beyond what previous generations did. In 2014, Gallup found that almost 60 percent of millennials had never been married. At the same point in their lives, just 16 percent of Gen Xers had never been married, and only 10 percent of baby boomers hadn’t said, “I do.”
Healthline’s recent survey found that putting off parenthood is also a reality for 1 in 2 millennial men and women. Between 2007 and 2012, for example, birth rates among 20-something women declined more than 15 percent.
That’s not to say this generation doesn’t want to settle down and have kids. In fact, a Gallup poll found that 87 percent of millennials say they want children someday.
But as millennials’ ages increase, their fertility decreases more dramatically than most of them realize.
This critical fertility awareness gap is affecting older millennials who are trying to start families and are now facing the tough truths of delaying having kids. And it will potentially affect the rest of the generation over the next two decades.
“A combination of things is pushing millennials to wait longer to start families. Millennial women are focusing on their career success, online dating has made relationships more casual, and the tough economy has shifted millennials’ timelines for having their first child back,” explains Valerie Landis, who founded the egg freezing website Eggsperience.
While it’s true millennials are delaying many of the milestones of adulthood that traditionally come before parenthood — marriage, financial security, a first home purchase — they’re not taking their fertility decision-making and planning lightly.
In the Healthline survey, we found that 32 percent of millennial women open to fertility treatments aren’t sure if they want to have a family. In order to reserve the option, they’re turning to a procedure that was quite rare just a decade ago: egg freezing.
Egg freezing and many other fertility options are becoming more popular because of advances in both assisted reproductive technology and awareness of the fertility options available.
“Eight years ago, there were very few people who were aware of the effectiveness of freezing eggs, and thus the value that it might play in their early 30s,” said Pavna Brahma, MD, a reproductive endocrinologist and fertility specialist at Prelude. “The awareness has definitely gone up, in particular in the population of people that are financially comfortable and know they’re not going to conceive in the next four to five years.”
Andrew Toledo, MD, a reproductive endocrinologist at Prelude, added that young women interested in freezing their eggs often come in with a relative or are driven by a major life event, like a breakup of a long-term relationship.
Landis told Healthline about her decision to freeze her eggs. “As I progressed into my 30s, I realized that every year was going by faster than the last, but that I still hadn’t found a parenting partner. I took advantage of egg freezing at 33 to give myself more options for the future,” she explained. “I’m hopeful I can get pregnant naturally with a partner. But you don’t know where life is going to take you.”
According to National Public Radio (NPR), and the Society for Assisted Reproductive Technology (SART), only about 500 women froze their eggs in 2009. SART removed the “experimental” label from the procedure in 2012, and more women have been taking advantage of the technology since then. In 2013, nearly 5,000 women used the preservation procedure, and fertility marketer EggBanxx predicts 76,000 women will have frozen their eggs by 2018.
Healthline’s survey found that the primary motivations for egg freezing included not having sufficient financial means for a child yet, choosing to focus on a career, and health issues. Surprisingly, only 18 percent of women in the survey said that not having a partner yet was their primary motivation for egg freezing.
“I see many young married couples around 30 who know they want to have kids in the future coming in to freeze eggs,” said Aimee Eyvazzadeh, MD, MPH, a reproductive endocrinologist and fertility expert.
Also, many couples choose to freeze embryos, or a woman’s egg fertilized by sperm, instead. Embryos and fertilized eggs are more robust than eggs, and therefore able to better survive the freezing and thawing process, according to Julie Lamb, MD.
Other than couples, Eyvazzadeh shared, “A little over 50 percent of women who are freezing their eggs at my clinic are in relationships. They have boyfriends or significant others, but they haven’t decided that this is the right guy or the right time to have a child. A lot of single women come in with their mothers as well.”
Still, Eyvazzadeh cautioned, the idea of egg freezing may sound easy, but it’s important to remember many fertility treatments are invasive and sometimes physically and emotionally difficult.
Landis recounted the unexpected physical and emotional response she had to her fertility medications. “I was very bloated and the hormones made me feel like I was on a rollercoaster — to the point that I didn’t feel like myself and avoided seeing friends for those three weeks,” she said.
While the number of women freezing eggs is rising, Eyvazzadeh pointed out that it isn’t as common as some may believe. “The idea that women everywhere are running to clinics to freeze their eggs is just not accurate. As long as the procedure involves several shots, a surgery, and feeling bloated, it’s never going to be that way,” she said. “Even when companies like Facebook and Apple are paying for 100 percent of egg freezing for employees, people still aren’t taking advantage of the technology that’s available to them.”
The majority of millennial women consider themselves well versed in fertility and conception, but our survey found that they actually don’t have the important facts straight.
Healthline’s survey found that 7 in 10 millennial women believed they understood egg health and fertility, but 68 percent of them weren’t aware that 40-50 percent of women over age 35 will need medical intervention in order to become pregnant. Furthermore, 89 percent of survey respondents were unaware that 80-90 percent of women over 40 will need intervention to have a baby.
With so many millennial women delaying parenthood, the reality is many of these women will face more fertility problems than older generations, and they may also not fully understand the many facets of fertility that affect their chances of becoming pregnant.
For example, delaying pregnancy reduces conception chances. According to the Southern California Center for Reproductive Medicine, a woman in her 20s has a 20 to 25 percent chance of conceiving naturally during each menstrual cycle. Women in their early 30s have about a 15 percent chance per cycle. After 35, it slips to 10 percent, and after 40, it’s just 5 percent. By the time a woman is over 45, her chances of getting pregnant during each menstrual cycle are less than 1 percent.
That’s all while the risk of miscarriage rises with age.
“Women’s most fertile time, unfortunately, is when societally, career-wise, and relationship-wise, it’s not a good time,” Toledo noted.
It’s this gap between perceived knowledge and actual fertility literacy that presents an opportunity for millennial women — and their doctors — to talk more openly about their fertility and options before their peak childbearing years have come and gone.
Millennial moms have already significantly affected the cultural acceptance of postponing motherhood, as well as national statistics for maternal age.
From 2000 to 2014, the average age of first-time mothers increased 1.4 years, from 24.9 to 26.3. During that same time period, the proportion of women aged 30 to 34 who had a first child rose 28 percent, and the number of women over age 35 who had their first child climbed 23 percent.
Deciding to have a baby later in life increases the likelihood that it will be harder getting and staying pregnant. And just as millennial women may be unaware of how many women need fertility treatment, they’re also waiting too late to check on their own fertility health.
The Healthline survey found that 58 percent of millennial women believed they should check their fertility health between ages 25 and 34. Only 14 percent suggested they get their fertility tested earlier, between ages 20 and 24.
That decade between ages 24 and 34 is later than most doctors recommend, however. Discovering fertility problems in the later years during this time can leave women vulnerable to genetic conditions that could make conception — even in their early 30s — difficult. That’s why most doctors recommend women first test their anti-mullerian hormone (AMH) levels by age 25. The test provides an estimate of a woman’s egg supply, or remaining eggs in her ovaries.
“I think every woman should get her fertility levels checked by the time she’s 25 years old,” said Eyvazzadeh. “If, however, she’s had an ovary removed, she has a family history of endometriosis, or her mom went through early menopause, she should check earlier.”
You don’t need to see a specialist for this test. During your annual pelvic exam or physical, ask your doctor for an AMH level test. If your level is 1.5 or below, it’s a good idea to check on the number annually. If it begins to fall, you may want to consider egg freezing if you’re not ready to have a child yet, or artificial insemination (IUI) or in vitro fertilization (IVF) if you are.
Even withincreasing awareness of treatments for infertility, Toledo hasn’t noticed a change in the number of women under age 30 asking to have their fertility checked. “Proactive fertility testing is something we need to engage in and teach to 25- to 30-year-olds,” he said. “But right now, it’s really the 30-plus-year-old ringing the bell. Younger women need to at least be checking on themselves and learning sooner if they have circumstances that decrease fertility, other than just age.”
Millennial women in our survey said age 30 was the best time to freeze eggs, which is considered a great time to start the process. Yet 14 percent of women in the survey said they’d wait even longer, until age 35, before they’d freeze their eggs. That, Toledo says, is a bit too late for many women.
“I would like to see patients somewhere between 30 and 34, and hopefully they have a good AMH. To me, that patient is more mature than someone in their 20s,” he said. “She’s probably in a better place financially, she’s out of school, and she’s probably had some relationships. She’s got a sense of what she’s looking for in a future mate … or might be putting her career first, then looking to become a single mom.”
Brahma echoed Toledo’s reasons for letting women wait until their early 30s to freeze their eggs. “We want to make sure we’re recommending a prophylactic treatment that they may actually use,” she said. “We’re not trying to get people to freeze their eggs and not ever use them, and people can see their future more clearly in their 30s.”
Today, 1 in 8 couples experience infertility, and after a woman turns 35, 1 in 3 couples are infertile. As millennials wait longer to start families, the realities of a delayed pregnancy emerge.
Fertility problems, which were once taboo and hidden, are discussed more openly by many women and couples. Frankness about infertility struggles also raises awareness, and that’s encouraging millennials to be more candid about their concerns and more proactive in planning for their futures.
In our survey, nearly half of millennial women (47 percent) who wanted to conceive said they were concerned about their fertility and ability to conceive. More than one-third of them proactively tracked their ovulation cycles.
Women or couples will likely have to try longer to conceive the later in life they try to have a baby. However, fertility doesn’t drop off a cliff when a woman turns 35.
Of those women who experience infertility, 44 percent seek treatment, according to RESOLVE, a national fertility education and support group organization. More than half of those who seek treatment (65 percent) eventually give birth.
“Infertility is heartbreaking. When you struggle with infertility, you experience grief every month looking at the pregnancy test and seeing it’s not positive,” said Stacey Skrysak, who underwent IVF at age 33, and writes about her experience on the blog Perfectly Peyton.
Fertility problems fall equally on men and women: one-third of women and one-third of men. The final third is caused by a combination of the two sexes.
Advanced maternal age
As fertility drops with age, the risks of birth defects and pregnancy complications increase.
For example, the danger of miscarriage rises, and the risk for developing hypertension, diabetes, and preeclampsia goes up too. It’s also more likely the baby will be born prematurely or have Down syndrome or autism.
Most survey participants labeled age 50 as the age at which it’s too late to have a child. That’s the same age the
The role of male fertility
Three-quarters of the millennial women surveyed knew that many factors affect a man’s fertility.
Diet, anxiety, physical activity, and alcohol and drug use and abuse play into male fertility. Only 28 percent of people in the survey knew marijuana use lowers a man’s fertility. In the last decade, marijuana use among adults has
In fact, a recent study published in Human Reproduction Update found that from 1973 to 2011, there was more than a 52 percent decline in sperm concentration, and a 59 percent decline in total sperm count among men from North America, Europe, Australia, and New Zealand.
Unlike women, who reach the end of fertility when they enter menopause, men are fertile longer. But still, becoming a father after age 40 comes with
With that in mind, Eyvazzadeh said women and men shouldn’t fall into the trap of only focusing on freezing eggs or measuring a woman’s fertility. Couples should focus as much on sperm as they do on eggs.
Fortunately for men, preserving sperm is much easier — and cheaper — than freezing eggs. The total for all the fees — plus the storage — for freezing sperm is around $2,500. In comparison, egg freezing costs a woman around $15,000.
Fertility helicopter parenting
Parents and grandparents of millennials seem to be worried about the younger generation’s baby-making prospects, too. According to the survey, almost one-third of women with daughters, nieces, or granddaughters of child-bearing age were concerned these women were waiting too long to conceive. Almost one-fifth (18 percent) were willing to pay for an egg freezing cycle to help preserve their loved one’s fertility.
That’s something both Toledo and Brahma have experienced in their practices.
“Most of the patients that we’ve dealt with have the financial capability, have some sort of insurance coverage, or have a relative that wants to be a grandparent that’s paying for the procedure,” Toledo shared with Healthline.
The emergence of the intervention generation
The first children born through IUI and IVF are now old enough to be parents themselves. When these intervention methods first began, like egg freezing just a decade ago, they were extremely rare. Today, a third of millennials told Healthline they’re willing to use these fertility options to help them conceive.
Donated sperm has been used for decades by women without a fertile partner, but donated eggs are a little newer to the fertility treatment list of options. Still, only 12 percent were willing to use an egg donor, and 15 percent were OK with using a sperm donor.
On the other hand, they also said they wouldn’t hesitate to donate an egg to someone else who was having trouble conceiving.
Along with physical and emotional turmoil, people who are struggling with infertility and eager to start their families face shockingly expensive bills. It’s a bitter pill for many couples and single parents to swallow, but in the name of conceiving, almost 200,000 pay up each year.
IVF treatments carry one of the heftiest price tags. During this procedure, an egg and sperm are joined in a lab, and a doctor places the fertilized embryo into the uterus. A cycle of IVF costs $23,747, on average, which includes testing on each embryo. Some women require multiple cycles of IVF before they’re able to have a baby.
“Choosing to go through with IVF was not an easy decision. We went into it knowing we might need to go through more than one round of IVF. It’s scary that you’re spending $12,000-$15,000 just in hopes that maybe it’ll work,” Skrysak said.
Skrysak and her husband went through one round of IVF and she became pregnant with triplets. Skrysak went into labor very prematurely and eventually two of her babies passed away. “It’s not only the physical and emotional burden of infertility. There’s a financial burden. It’s now three years after IVF and we’re still dealing with medical debt because of fertility treatments and a premature birth. We probably still have five years of medical debt left to pay off, and I have a lot of grief over that,” she noted.
IUI is another option, and many of the women Healthline surveyed either didn’t know what the procedure was or weren’t aware of the significant cost difference between IUI and IVF.
During IUI, sperm is placed inside a woman’s uterus. Directly placing the sperm there increases the chances of sperm entering the fallopian tubes and fertilizing the egg. The average price for an IUI treatment is just $865, but many doctors charge far less, about $350 for a cycle.
For everything from the medications to storage of frozen eggs, egg freezing can set you back around $15,000. Testing of fertility levels is often covered by insurance, but is about $200 out-of-pocket.
“There’s a paradox where maybe you can’t afford egg freezing in your late 20s when you should really do it based on fertility health, but when you can afford it in your 40s, you have to do it three times more because your quality of eggs has diminished,” Landis acknowledged.
“That’s why I want to educate women in their 20s — so that they’ll be able to plan and save for egg freezing like they do their 401(k),” Landis said.
Insurance coverage of fertility
Hopefully, as millennials shape the future of parenthood, they’ll push insurance policy to keep up with their needs.
Insurance coverage of fertility issues varies widely. In June 2017, Connecticut became the first state to cover fertility preservation, or egg freezing, through health insurance when the procedures are considered medically necessary. Fifteen states also have mandates for fertility treatment. Insurance companies in Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island are required to cover some infertility treatments.
While pregnancy coverage is one of the essential health benefits of the Affordable Care Act (ACA), fertility treatments are not. Companies and individual plans have the freedom to offer fertility coverage as part of a plan, but it’s not required.
Fertility IQ’s Best Companies to Work for as a Fertility Patient report found that more than half (56 percent) of people had no fertility benefits, while nearly 30 percent had full fertility benefits. The prospect of fertility benefits is even being used as a recruiting tool for some businesses.
Some tech companies offer fertility coverage at a 35 percent higher rate than other similarly-sized companies. That may be in large part because tech companies are in a talent war with one another, and any edge over a competitor can help them win a prized recruit.
Whatever the sector, the millennial workforce is seeking more financial help with covering the costs of their fertility treatments. Nearly half (47 percent) of people polled in the Healthline survey believed health insurance companies should cover fertility treatments. Even more millennials (56 percent) who took the survey agreed with this sentiment.
Americans also believe fertility coverage should be highly inclusive. According to the Healthline survey, 51 percent of adults surveyed and 64 percent of millennials believe all couples or single parents, regardless of their marital status or sexuality, should be eligible for fertility benefits.
Scientists have made huge leaps over the past few decades when it comes to understanding infertility and developing treatments to help individuals and couples become parents.
Still, there’s a lot of room left to improve infertility diagnosis, treatment, and embryo selection.
The current success rate for egg retrieval in women under age 35 is 48.2 percent. That percentage falls as women get older. By the time a woman is over 42, her chance of getting pregnant from each egg retrieval cycle is 3.2 percent, yet the rate of women 40 or older pursuing IVF is growing six times as fast as for women under 35.
The introduction of IVF led to a steep increase in births of multiples, but recent advancements in IVF efficiency have helped reduce the rates of multiple births. In 1998, new guidelines discouraged doctors from transferring more than three embryos at a time. This was designed to reduce the risk of a multiple birth with triplets or more.
And it worked — since 1998, the rate of multiple births fell by nearly 30 percent to just 1 percent of all births. Still, in the United States in 2013, 41 percent of all pregnancies that resulted from IVF were multiples.
Soon, doctors hope advancements in infertility treatments will help them make better embryo selections before implanting them in a woman’s womb.
Currently, for genetic testing, doctors rely on Preimplantation Genetic Screening (PGS). It started being used around 2008, and women were increasingly choosing to utilize it — for about an additional $4,000 — to make their IVF cycle more successful.
“There are so many advances that make IVF more efficient and more successful,” Brahma said. “Back in the ’80s, every fresh IVF cycle probably resulted in one opportunity for a child. Now, many people who do IVF in a prime setting can probably build their whole family off of one cycle. We can do PGS and select the best embryos, and we can minimize miscarriage. The success rate has taken off since we can now select embryos so well.”
“It takes the fertility space about five years for trends to finally catch on,” Eyvazzadeh explained. “Genetic testing of embryos took a long time to catch on. Now in the [San Francisco] Bay Area, I’d say most families are using PGS.”
Fertility doctors predict there will be more advancements in embryo selection and endometrial (tissue lining the womb) receptivity science in the near future. Brahma gave us an overview of the promising developments: “For embryo testing, we’ll be able to drill down into the embryo at the genetic, mitochondrial, and molecular level to make sure we’re selecting the best embryos. There will also be a lot more work around the endometrial receptivity issue.”
Eyvazzadeh predicted that people will start doing the fertility gene tests first, as part of the fertility awareness panel that they’re doing, to see if they can wait to freeze their eggs.
That prediction plays into a current trend Eyvazzadeh mentioned to Healthline. “The idea that there’s no such thing as unexplained infertility is gaining speed. We’re at that point now with technology that you can look at someone’s genetic profile and explain to them why it’s so hard for them to get pregnant.”
Most millennial women and couples initially turn to their doctors to talk about fertility options — 86 percent talk to their OB-GYN, and 76 percent talk to their primary care physician. But also, the generation that was born at the dawning of the internet turns to what it knows best: Google. Three quarters (74 percent) use Google search for their fertility questions. They also use health sites like Healthline.com (69 percent) and fertility organization websites (68 percent).
But the internet — and its myriad venues — also provides another outlet for these fertility-seeking millennials. Online platforms allow people to connect with one another, and many of these sites and online groups have helped lift the stigma and cloud of shame that once surrounded infertility.
According to our survey, 1 in 3 women turn to these online portals to connect with women who are dealing with similar issues and sharing their own infertility stories. Thirty-nine percent of women said they connected via social media channels with fertility themes, such as Facebook, Instagram, and YouTube. Facebook groups and pages like Infertility TTC Support Group (17,222 members), Mommy and Infertility Talk (31,832 members), and PCOS Fertility Support (15,147) bring together women from every corner.
Chat rooms and online communities are also used by 38 percent of women, and 32 percent follow fertility bloggers.
“During my infertility journey, I found a lot of support through RESOLVE,” shared Skrysak. “Thanks to online message boards, I was able to share the emotional roller coaster that is IVF and realize that I’m not alone in the journey.”
Instagram has called attention to many health conditions, from psoriasis to infertility. Searching hashtags allows someone to connect with a community of people from across the world. The most popular Instagram hashtags for fertility issues include:
|#TTC (trying to conceive)||714,400|
Healthline proprietary infertility information
For this report, Healthline conducted proprietary traffic and search analysis of fertility topics. Within the search traffic Healthline received for fertility, the largest area of search centered around treatments (74 percent of searches). While 37 percent of treatment seekers were searching for a fertility clinic or doctor. Many people also showed high interest in natural treatments (13 percent). The most popular natural fertility treatment was acupuncture.
Today, the outlook for women and couples facing infertility is more optimistic than for any previous generation. The first IVF baby was born a few decades ago, in 1978. And since then, millions of women have received fertility treatments.
“Whether you have a baby through IVF or you adopt, there’s an amazing love that you can’t explain until your baby’s in your arms. Even though we had a bittersweet experience of having a survivor but also losing two children, it is all worth it in the end. We were meant to have a family and we feel like our family is complete thanks to having IVF,” Skrysak told Healthline.
Solutions to expanding access to infertility treatments are getting more creative, too.
For example, INVOcell is a device that allows a woman to grow embryos inside her vagina for five days instead of in a lab before transferring the best embryo back to the uterus. INVOcell costs about $6,800, including medication — a fraction of the cost of IVF. While more research is being done to evaluate the effectiveness of INVOcell vs. IVF, one clinical trial involving 40 women found the success rates for both methods were not significantly different.
Innovative programs with greatly reduced costs will hopefully see larger expansion as millennials look for ways within reach to solve infertility and start families later in life.
In addition, as people are recognizing they share in this struggle with many people they know — and millions more they can connect with on the internet or through social media — the “shame” of infertility is disappearing.
Waiting to start families may help millennials feel more prepared for parenthood, but it doesn’t change some significant realities. Specifically, waiting increases the chances for complications such as birth defects and difficulty conceiving.
While the Healthline survey found that millennials were versed in many aspects of fertility, there’s still a lot left for them to learn. As women near their late 20s to early 30s, their doctors and fertility experts should look for ways to educate and start conversations on the subject.
“We want people to feel empowered, not be afraid,” Toledo says.
As having children later in life becomes more normalized in our culture, it will be increasingly important to help millennials understand — as early as possible — the benefits and consequences of delaying pregnancy so they can make the best choices for themselves and the families they may want to start — eventually.