The Future of Assisted Reproductive Technology Live Births in the United States

Abstract

As postponement of first births continues in the United States, women and couples will likely continue to turn to assisted reproductive technologies (ART) to overcome biological barriers to childbearing. This paper uses stochastic projections to estimate the potential impacts of ART on the US total fertility rate (TFR) overall and across sociodemographic groups using publicly available data. Assuming the trends in ART continue and the TFR remains at the mean estimate, the projection shows the ART TFR will rise from 0.023 accounting for 1.29% of the mean projected TFR in 2020 to 0.048 or 2.64% of the TFR by 2040. However, for the TFR of women over 30, this percentage is estimated at 2.68% in 2020 and 5.60% by 2040. Group-level projections quantify stratification by parity, race, and education assuming trends across these groups continue. Overall, the results show that if current trends continue, growth in demand for ART will likely increase, especially at older maternal ages, even as inequalities by race and social class remain. These projections provide a picture of ART births if inequality in access and outcomes is not addressed and highlight the need for attention to policies that address these disparities.

Keywords: Assisted reproduction; Disparities; Infertility; Stochastic projection.

Fig. 1

Observed and projected percent of the overall TFR due to ART 2009–2040 with alternative scenarios. ART Assisted Reproductive Technology, TFR Total Fertility Rate, NVSS National Vital Statistics System. The two scenarios presented are based upon the 80% prediction interval estimates for the ART TFR. However, as discussed in the text, 80% prediction intervals may be unreliable in reconciled forecasts and should be treated with caution

Fig. 2

Projected percentage of the group-specific TFRs due to ART 2020–2040 by parity (Panel A), race/ethnicity (Panel B), and education (Panel C). ART Assisted Reproductive Technology, TFR Total Fertility Rate, NHOPI Native Hawaiian or Other Pacific Islander, BA Bachelor’s Degree. Calculations use the mean ART and TFR projections within each group

Fig. 3

ART ASFRs for selected historical and projected years. ART Assisted Reproductive Technology, ASFR Age-specific Fertility Rates

Fig. 4

Percentage of the TFR due to ART 2020–2040 based on NASS and NVSS mean projections. ART Assisted Reproductive Technology, TFR Total Fertility Rate, NASS National ART Surveillance System, NVSS National Vital Statistics System

Fig. 5

Percentage of the TFR due to ART from the VAR and ARIMA Models (Panel A) and the ART TFR with 80% Prediction Intervals from the VAR and ARIMA Models (Panel B). ART Assisted Reproductive Technology, TFR Total Fertility Rate, ARIMA Autoregressive integrated moving average, VAR Vector Autoregression, PI Prediction Interval. As discussed in the text, 80% prediction intervals may be unreliable in reconciled forecasts and should be treated with caution