Can IVF Services Reverse the UK's 'Shrinking' Population Crisis?
THANOS PAPATHANASIOU MD(London) FRCOG FHEA
CEO & Medical Director at Bourn Hall Fertility Clinic UK, the world's first IVF clinic. Fertility Leader and Expert. Advocate for fertility and reproductive rights.
The United Kingdom faces a critical demographic challenge: a steadily declining #fertility rate that could reshape our future. The UK’s total fertility rate has dropped to 1.44 children per woman—well below the 2.1 needed to sustain the innate population. But what does this mean for our communities and the economy? Could we be doing more to support family-building across the UK?
Low fertility rates lead to an ageing society, with implications for our healthcare, pensions, and community structure. Currently, 19% of the UK population is aged 65 and over, projected to rise to 24% by 2045. As our society “greys,” fewer working-age people support a growing number of retirees.
One approach to counteract these trends is expanding government-funded Assisted Reproductive Technologies (ART), such as #IVF and #Donor inseminations. ART provides a path to parenthood for those facing infertility, yet access to ART in the UK remains limited, often constrained by eligibility and funding variations. NICE recommends up to three IVF cycles for eligible women under 40, but local Integrated Care Boards (ICBs) often restrict this further, providing fewer cycles or setting stricter criteria. Consequently, only about 35% of IVF treatments in the UK are funded by the NHS, leaving many to pay privately. As a result, only 2.3% of births are ART-related.
Denmark’s model shows how strong support for ART can make a difference. Around 7% of all births there come from ART, thanks to inclusive policies that offer up to three free IVF cycles for women under 40, including single women and same-sex couples. Such policies have helped Denmark maintain a fertility rate that is healthier than many European nations.
It’s worth reflecting on how family planning is shaped by broader social and economic realities. Factors like education, career progression, housing stability, and relationship status play major roles. Pursuing higher education and career advancement often delays childbearing; the average age of first-time mothers is now 30.9, compared to 26.4 in 1970. But with age, fertility naturally declines, reducing the chance of natural conception.
Economic pressures also weigh heavily. Housing affordability, for instance, remains a significant barrier. For many, student debt, high rent, and job instability make family-building seem out of reach. Could stronger ART funding help remove some of these barriers, especially for those struggling with infertility? By easing financial obstacles, more people could pursue ART, potentially supporting a healthier age distribution and stabilising our population.
Enhanced ART support also promotes inclusivity, creating opportunities for single individuals and same-sex couples. Reflecting modern values of equality and diversity, this approach could help address the demographic challenges tied to declining fertility rates. Although these groups are a minority, they rely almost exclusively on ART services in order to have a family.
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Another option worth considering is fertility preservation, specifically social egg freezing. While not a primary solution, egg freezing offers those who want to delay childbearing the option to store their eggs at a younger age. According to the Human Fertilisation and Embryology Authority (HFEA), egg-freezing cycles in the UK have been on the rise. But with costs around ￡7,000 to ￡8,000 per cycle, it still remains inaccessible for many.
Could making fertility preservation more accessible help with future family-building? Although success rates vary and ethical debates continue, social egg freezing delivered in a timely fashion may offer an additional source of ‘young’ eggs. Even if a woman who previously froze her eggs ends up having a child naturally, the frozen eggs may provide an opportunity for another child later in life, thereby helping to expand the family size.
In conclusion, expanding government-funded ART could play a role in addressing the UK’s declining fertility rate. Denmark’s experience suggests that accessible ART can encourage higher birth rates and a balanced age structure. While ART alone cannot fully reverse these trends, it should be an essential part of a broader approach that must also address housing affordability, economic stability, and parental support.
#IVF
#NHS-funded
#fertility
#fertilityrate
#populationcrisis
Consultant Obstetrician and Gynaecologist, Subspecialist in Reproductive Medicine at North West Anglia NHS Foundation Trust
3 个月Excellent points raised and sadly very valid. Through the current government pledged a judge sum of money to the NHS, I am not sure if expansion to fertility funding was on the agenda. The common obstacle that I note to couples getting funding is the outdated restriction due to have a child from previous relationship. This policy does not clearly support modern families. Another obstacle would have to be funding for child care. It is sad and disheartening to see lots of women that love their job not returning to it, as they simply cannot afford full time childcare- their entire salary is eaten up by nursery fees. The current government has lots of work cut out to make the birth rate going up again.
Professor of Ob&Gyn, Chief of Minimally Invasive Endoscopy Unit. Director, VESSALKA
3 个月You have made a very insightful argument. But I wonder how this decreased fertility rate came to be? Italy and Spain have had the lowest fertility rates despite the fact that they are very family oriented. Work definitely plays a role in women delaying fertility but have the statistics shown a huge increase in percentage of working women versus, say, 25 years ago? To the extent that it affects fertility? And with pay levels at what they are, the theory of economic deprivation as a factor in delaying conception would not really be relevant if we compare to much less well off countries in Eastern Europe who have higher fertility rates. A cultural change is at work here and needs to be investigated. It is not simply a matter of lack of finances.
Traditional families are unlikely to make a comeback any time soon for all the social and economic reasons cited. What couples must know when postponing pregnancy is that you will be in your 60's and have a teenager to deal with. That bundle of joy is now a costly pest who you cannot evict from the basement or cease playing video games. Free or government supported IVF has not moved the calculation for having a child as the tsunami of higher costs of living via inflation have the population in a morbid state of mind. Free IVF will increase taxes and enrich, perhaps, the clinics and their PE investors. Will the UK taxpayer agree to pay more? To be determined.
Founder and CEO of MolMart | Using Genomics to help individuals make informed choices about their future health | Winner Best Health Tech Start Up | Winner "One to Watch" | Ph.D, DipRCPath | Owner of MM&GK Property
3 个月You have raised some important points THANOS PAPATHANASIOU MD(London) FRCOG FHEA. How do we educate young career-focused women (let's face it, they are the ones we are talking about) of the significance of egg-freezing early on?
CEO Enhanced Fertility | TEDx Speaker | KCL Distinguished Alumni Entrepreneurship Award | Co-founder SedateUK
3 个月I’ve written about this recently and believe we will never be able to reverse the trend of women wanting to have children later in life - I can’t see us being able to convince 20 year olds these days to have children even with government policies and incentives. It is much easier to help those over 35 who have achieved financial stability, relationship and career goals to achieve their reproductive goals too - but as our fertility reduces with age, reproductive technology can definitely help. As for people in their 20s, more accessibility to fertility preservation can be very appealing to them. Maybe that way we can improve fertility rates and minimise the societal impact of an aging population.