How to Increase U.S. Fertility Rates

On the same day that Japan recorded the lowest number of births in a century, I met up with an old friend and her new baby. We talked about her winding road to becoming a mom. Nothing happened as simply as she hoped. She met her partner later in life, battled years of infertility, and then finally welcomed her daughter after three rounds of IVF that ate up her family’s savings. 

Now, as an older mom in postpartum with a slowing metabolism, she felt totally estranged from her own body. After talking to her doctor about starting GLP-1s, she was devastated to find them denied by her insurance. 

“I just feel like at every turn I’m being punished,” she told me.

In my conversations with patients, doctors, and loved ones, I see first-hand the wide range of factors conspiring to depress birth rates every day. The percentage of Americans who want kids, and even the ideal family size, has not changed for decades. Women are not rejecting having children writ large. Rather, many are responding rationally to a healthcare system that feels expensive, fragmented, and, frankly, punitive.  

The United States and several other leading economies, from China to Italy to Poland, have set higher birth rates as a core policy goal. Fortunately, unlike many of the problems plaguing our healthcare system, better care that enables family-building is actually within reach.

We are living in a time of unprecedented consumer health innovation. Nearly 60% of GLP-1 users are women. More than 40 million people are turning to generative AI tools like ChatGPT for healthcare questions. Women are highly engaged in considering and planning their reproductive futures. They are researching, preparing, hedging, and calculating. 

For policymakers, this presents an opportunity. By capitalizing on reinvigorated consumer health excitement, we can give women more confidence to navigate their own fertility. This is the most direct pathway to improving the birth rate—a boon for America and a blueprint for many other countries moving forward. 

These are rare, bi-partisan priorities, and they represent an opportunity for material economic and healthcare wins. 

We've seen positive policy steps in the past 10 months: advancements in fertility drug accessibility so that more people can access IVF, as well as improved menopause support by removing the black box labels on menopausal hormone replacement therapy. 

We need to go further. Here are additional advancements that would move the needle.

First, fertility care must become affordable, predictable, and less invasive.

Today, most medical guidance is structured around waiting—up to a year for younger women, six months for those over 35—before a doctor will evaluate why conception hasn’t happened.  Once they do meet the threshold for care, the average family can be expected to undergo more than two rounds of IVF before conceiving, spending close to $50,000 on treatment. This rivals the down payments for many houses, and by itself blocks millions of families from pursuing a dream of conceiving children.

Investing in better care here means treating it as mandatory infrastructure, not as a luxury. Consider models like HSAs or 401ks, through which policymakers incentivize forms of savings we wish to prioritize. The Trump administration’s recent move to expand fertility benefits and lower costs for key IVF drugs is a great first step. As a follow-on, we can follow the lead of countries like Ireland, France, and the United Kingdom, all of which mandate fertility coverage for people under a certain age. In Denmark, an estimated 10% of babies are born via IVF. In the U.S., it is 2.6%. 

Such mandates should rightly include a range of pathways to parenthood—egg freezing for young women, IUI for couples with no preexisting conditions, sperm and egg donation for LGBTQ families, and male fertility testing that finally brings men into the conversation. Among the one in six couples suffering from infertility globally, approximately half stem from male fertility challenges. 

Second, we need to treat metabolic care as women’s health care.

New use cases for GLP-1s are emerging seemingly every month. Among the most consequential and often overlooked is the deep connection between metabolic and reproductive health. For women with polycystic ovary syndrome (PCOS), a condition that affects about one in 10 women and has been underfunded and underresearched for decades, the early evidence is encouraging: treatment plans incorporating GLP-1s show great promise in improving fertility for millions of women who might otherwise have been high-risk. And the benefits cascade: better metabolic health improves natural conception rates, strengthens IVF outcomes, cuts pregnancy complications, and speeds postpartum recovery into menopause.

Today, GLP-1 coverage within the fertility space is often trapped in a false binary, given strong associations with weight loss and diabetes management. That framing doesn’t just limit access. It actively undermines women seeking to make informed decisions about their own bodies and futures. If we’re serious about supporting family building, we need to fund research and ensure broad coverage for fertility-related usage. 

Third, we need technology to bridge fertility and maternity care so women know quality pregnancy support awaits them on the other side.

Today, these two disciplines operate in silos. Women often repeat the same medical histories and tests to different specialists because no single platform connects their care. Meanwhile, over 2.3 million women of reproductive age in the U.S. live in counties without an OB/GYN - — and that number is growing. Providers are leaving states where conflicting regulations have made practicing reproductive medicine legally precarious, taking with them not just abortion care but prenatal care, fertility treatment, and postpartum support for every woman in the region. These confusing state regulations push nearly a quarter of women to delay prenatal care into their second trimester. After birth, the system unplugs: many new moms skip their six-week postpartum visit not because they don’t need it, but because of limited access. For instance, a hours-long drive with a newborn for a 15-minute appointment simply isn’t realistic for every family. It's little wonder one in three report postpartum loneliness.

True, high-quality care incorporates a wide variety of specialists. Doulas, lactation consultants, midwives, and therapists ultimately make childbirth more bearable, even though they’re in short-supply for in-person appointments. What technology can now offer is something more powerful than virtual access alone: the ability to anticipate. AI-powered virtual care models can monitor risk continuously by tracking blood pressure trends, flagging early signs of postpartum depression, identifying the woman who is quietly heading toward a complication her doctor hasn't seen yet, and route her to the right specialist at the right moment. 

This moment, happily, is a rare moment of alignment. A bipartisan quorum of policymakers, business leaders, and consumers now agree that healthcare for family building is a priority worth supporting and investing in. As the consumer health revolution crests from scientific and technological advances, we have an opportunity to start by fixing the systems women rely on at the most consequential moments in their lives. 

If we want people to have children, we need to support them like we mean it.