Infertility is a Chronic Health Condition - WHO

Increased male Vitamin D increases fertility

Decreased Fertility if decreased Vitamin D Receptor

WHO infertility report 1990 - 2021

$5 of Vit D improves 1) Female and male fertility 2) Pregnancy health 3) % of life births 4) Offspring health

Might the global falling fertility rates be considered a chronic health problem? Perplexity AI Deep Research Feb 2025

The Global Fertility Decline: A Multifaceted Health and Societal Challenge
The global decline in fertility rates represents one of the most profound demographic shifts in human history. From an average of 4.8 children per woman in 1950, the global fertility rate has plummeted to 2.2 in 2024 and is projected to fall further to 1.8 by 2100 1 13. This trend, characterized by its persistence and wide-reaching implications, raises critical questions about whether it constitutes a chronic health problem. While fertility decline is driven by both voluntary societal choices and biological factors, its intersection with reproductive health, environmental stressors, and long-term public health challenges positions it as a complex issue with significant chronic health dimensions.
Biological Foundations of Fertility Decline
Age-Related Fertility Reduction
Human reproductive capacity is intrinsically tied to age, particularly for women. Female fertility begins to decline markedly after age 35 due to diminishing ovarian reserve and egg quality, with a sharp drop post-37 4 15. By age 40, the likelihood of conception per menstrual cycle falls to 1 in 10, compared to 1 in 4 for women in their 20s 15. Male fertility also declines with age, albeit more gradually, as sperm quality and motility deteriorate 9. These biological constraints are compounded by lifestyle factors such as obesity, smoking, and environmental toxin exposure, which further impair reproductive health 8 9 16.
Rising Prevalence of Reproductive Disorders
Medical conditions contributing to infertility—including polycystic ovary syndrome (PCOS), endometriosis, and diminished ovarian reserve—are increasingly prevalent. PCOS alone affects 8–13% of women globally and is the leading cause of anovulatory infertility 9. Male factor infertility, driven by poor sperm quality or structural issues like varicocele, accounts for 40–50% of infertility cases 4 9. The World Health Organization classifies infertility as a disease of the reproductive system, underscoring its status as a chronic health condition affecting 1 in 6 couples globally 9 12.
Environmental and Lifestyle Contributors
Endocrine Disruptors and Toxins
Exposure to endocrine-disrupting chemicals (EDCs)—found in plastics, pesticides, and personal care products—has been linked to reduced sperm counts, ovarian dysfunction, and hormonal imbalances 8. Air pollution, particularly fine particulate matter (PM2.5), is associated with lower live birth rates in IVF cycles and increased miscarriage risk 8. Nanoplastics, now ubiquitous in food and water supplies, have been shown to penetrate placental barriers, potentially interfering with fetal development 8.
Delayed Parenthood and Societal Pressures
The average age of first-time mothers in OECD countries has risen from 28.6 in 2000 to 30.9 in 2022 1. This delay, driven by educational and career pursuits, exacerbates age-related fertility decline. Economic pressures, including housing costs and stagnant wages, further deter family formation, creating a feedback loop where financial insecurity perpetuates low fertility 10 16.
Demographic and Health System Implications
Aging Populations and Dependency Ratios
By 2060, the OECD projects that the ratio of individuals aged 65+ to working-age adults will double from 30:100 to 59:100 1. This inversion strains healthcare systems, as older populations require more medical care for chronic conditions like cardiovascular disease and dementia. Japan, where 33% of the population is over 65, spends 11% of GDP on healthcare—a burden that low-fertility countries will increasingly face 16.
Economic Stagnation and Workforce Shortfalls
The Institute for Health Metrics and Evaluation (IHME) estimates that by 2100, 97% of countries will have fertility rates below replacement level 6. Without immigration, this could reduce global GDP growth by 0.4–0.8% annually, as shrinking workforces struggle to support retirees 16. Countries like South Korea, where fertility fell to 0.7 in 2023, already face labor shortages in critical sectors such as healthcare and manufacturing 1 6.
Chronic Health Dimensions of Fertility Decline
Infertility as a Chronic Disease
Infertility meets the criteria for a chronic condition: it is persistent, requires ongoing medical management, and significantly impacts quality of life. The psychological toll—including depression, anxiety, and marital stress—is comparable to that of cancer or HIV 12. Assisted reproductive technologies (ART), while effective, are inaccessible to many due to cost, with IVF cycles averaging $12,000–$15,000 in the U.S. 12. In low-income countries, limited healthcare infrastructure leaves millions untreated, perpetuating cycles of poverty and social marginalization 5 12.
Epigenetic and Intergenerational Effects
Emerging research suggests that environmental toxins may induce epigenetic changes, altering gene expression related to reproductive health across generations 8. For example, prenatal exposure to phthalates has been linked to reduced ovarian follicle counts in female offspring, potentially perpetuating fertility decline 8. These findings position low fertility not merely as a demographic trend but as a multigenerational health crisis.
Policy and Public Health Responses
Targeted Reproductive Healthcare
Expanding access to fertility preservation (e.g., egg freezing) and subsidizing ART could mitigate age-related infertility. Denmark’s model—where public funding covers 70% of IVF costs—has maintained higher birth rates than similarly developed nations 12. Simultaneously, addressing underlying conditions like obesity (a factor in 12% of infertility cases) through preventive care could improve fecundity 9 15.
Environmental and Occupational Reforms
Regulating EDCs and reducing workplace exposure to reproductive toxins (e.g., pesticides for agricultural workers) are critical. The EU’s REACH regulations, which restrict hazardous chemicals, offer a template for safeguarding reproductive health 8. Urban planning initiatives to curb air pollution, such as low-emission zones, could further protect fertility 8.
Economic Support for Families
Pronatalist policies like Sweden’s gender-equal parental leave (480 days per child) and Singapore’s Baby Bonus cash grants (up to $10,000 per child) aim to alleviate financial barriers to childbearing 10 13. However, such measures must be paired with affordable housing and childcare to address root causes of delayed parenthood 16.
Conclusion
The global fertility decline transcends mere demographic change, embodying a chronic health challenge with biological, environmental, and societal roots. While voluntary choices play a role, the rising prevalence of infertility-related medical conditions, coupled with toxic environmental exposures, underscores its status as a public health crisis. Addressing this issue demands integrated strategies spanning healthcare reform, environmental regulation, and economic support—failure to act risks entrenching a cycle of demographic decline and deteriorating population health. As the OECD warns, without intervention, the consequences will be "devastating for future generations" 1
8 16.

Birthrate notes from personal VitaminDWiki database

100 Koreans of childbearing age will produce, in total, about 12 grandchildren.
In 1960, Singapore had a fertility rate of 6. By 1985, it became 1.6 (and down to 0.97 in 2023 - Perplexity)
—a rate that threatened to roughly halve its population in two generations.
Outside of Seoul - There were a hundred and fifty-seven elementary schools that had no new enrollees scheduled for 2023.
Haenam disappears into the sea at a windswept cape called Ttangkkeut, or “End of the World.” Not far away, there is a school that once had more than a thousand elementary-age students. When I visited, in November (2024), it had five.
https://www.newyorker.com/magazine/2025/03/03/the-population-implosion
– – – – – –
Fertility rates are crashing around the world - many reasons, vitamin D can reduce some of them
By 2050, >75% (155 of 204) of countries will not have high enough fertility rates to sustain population size over time;
this will increase to 97% of countries (198 of 204) by 2100. Lancet free PDF
sub-Saharan Africa accounting for one in every two children born on the planet by 2100.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00550-6/fulltext?
Why Americans Aren’t Having Babies - excellent July 2024 many many reasons
2/3 of the reason for the drop are women who are NEVER going to have a child
https://www.msn.com/en-us/lifestyle/parenting/why-americans-aren-t-having-babies/ar-BB1qlbC8?
Birth rates will increase with increased vitamin D
Far easier pregnancies
infants will sleep better
Increased Fertility
future parents can anticipate healthier/less expensive chldren (less of a burden)
Far less medical expense from conception to end of life
Fertility at age 20 is what the fertility of grandparents had at age 35
– – – – – – –
Most of a women's reasons for being child-free were rooted in fear.
Once upon a time, Bombardieri says, most of her clients ultimately decided to have kids.
But these days, the breakdown is closer to 50-50.
Bombardieri tries to help people interrogate their preconceived notions about parenthood and visualize what they’d gain or give up on either path.
Perhaps most importantly, she helps people grapple with the idea of regret, which haunts many fence sitters.
The goal is to figure out which road will lead to fewer regrets, and to grieve those feelings rather than suppress them.
She found role models who’d successfully balanced interesting careers in academia with motherhood and got more comfortable around children while working in day-care centers
https://time.com/7174932/merle-bombardieri-profile-baby-decision-book/
she us active on the Reddit group of “fence sitters"
Baby Decision 2016 - new book Baby or Childfree?, in early 2026
- - - - - - - - -
Fertility is difficult to test:
For many couples, having a baby is far more difficult than it was made out to be in sex ed. While many women in heterosexual couples get pregnant within a few months of trying, studies suggest up to 15% of couples are unable to conceive after a year of having unprotected sex. That means they meet the clinical definition of infertility: not conceiving within a year if the woman is younger than 35, or within six months if she’s 35 or older.
Ovarian-reserve testing is fairly easy, but it’s not always an accurate predictor of future pregnancies, Schon says. In a major 2017 study, the results of which were replicated in 2022, researchers found that AMH levels were not significantly correlated with later pregnancy and birth. Ovarian reserve tests are “poor independent predictors of reproductive potential. Therefore, they should not be used as a fertility test,” the American Society for Reproductive Medicine said in a 2020 policy statement.
https://time.com/6253707/fertility-testing-difficult/
– – – – – – –
Plunging birth rate - National Emerency in S Korea - not find it worth it to have kids 0.72 replacement rate
$280 billion spend on improving the rate - 90% of people ignore the incentives/messages
half of the drop- due to reducing carrier opportunities - less of a problem with healthy children - less time off work
– – – – – – – –
Baby Bust - Foreign Affairs
https://www.foreignaffairs.com/world/age-depopulation-surviving-world-gone-gray-nicholas-eberstadt
The movement that is desperately trying to make more babies - VOX discusses many aspects
Russia began offering lump-sum payments of about $7,000 to families with more than two kids.
Hungary started offering newlyweds loans of $30,000, which Orbán said would be forgiven if the couple had three children.
$4,000 in subsidies from governments in Italy and Singapore, which really amounts to just a couple months of child care aid.
Elon Musk, who claimed the falling fertility rate is “the biggest danger civilization faces, by far.”
https://www.vox.com/policy/363543/pronatalism-vance-birth-rates-population-decline-fertility?
“horrors” of childbirth, risks associated with pregnancy, a flighty potential partner, exorbitant child care costs.
great reduction in 3 of the 4 with Vitamin D NYT Aug 2024
When the survey was conducted in 2023, 47 percent of those younger than 50 without children
said they were unlikely ever to have children, an increase of 10 percentage points since 2018.
Further reasons included the desire to focus on other things, like

their career or interests;
concerns about the state of the world;
worries about the costs involved in raising a child;
concerns about the environment, including climate change; and
not having found the right partner.

For some, having children is simply not an option: 13 percent of those surveyed by Pew who were under age 50 said they didn’t plan to have children because of infertility, and 11 percent said that it was their partner or spouse who did not want kids.
Many were “averse to embracing the kinds of risks that having children implies,”
Further reasons included the desire to focus on other things, like their career or interests; concerns about the state of the world; worries about the costs involved in raising a child; concerns about the environment, including climate change; and not having found the right partner.
https://www.nytimes.com/2024/07/25/well/mind/child-free-adults-pew-study.html
– – – – – –
Increase # of babies Born with Vitamin D (and Omega-3) - reverse population decline without immigration
- reduce costs, fear of un-healthy infant, fear of complications when older
improved fertility and man and woman (eliminate $20,000 barrier of IVF for 10%? of couples)
Fewer miscarriages
Fewer still births
Fewer preemies
Fewer autistic children
Pregnancy: less depression, preeclampsia
Infant sleep better
Infant has less colds/flu
Might improve fertility for womem over age 40
– – – – – – –
Higher costs, fewer children (1 in 5 are calculating they can't afford a child)
Squeeze on income means one in five now putting off having children. Young families’ costs are around £1,000 a month higher than they were in early 2023.
Have a child? the exhaustion! the uncertainty! the expense!
  Vitamin D can reduce all 3!
https://www.washingtonpost.com/advice/2024/07/02/carolyn-hax-ambivalence-parenthood-kids/?
– – – – – – -
Benefits to countries by increasing birth rates (reduce reasons to not have a child)
far lower cost than rewards given by a few countries for births
income tax reduction, straight cash (Russia for 2nd child)
reduce the costs and problems associated with pregnancy and early life of the offspring
fewer early onset cancers, respiratory problems, sepsis, miscarriage, preeclampsia, still birth, lack of gender identity, autism, sleepless nights, premature birth,
use Dr. Coimbra's picture of health infant
- perhaps have him involved in this and other study of high-level vitamin D groups
Zoos became maternity wards with D given to the animals
Analogy to Turkey given vitamin D for free to greatly reduce rickets
Also reduces cost of becoming pregnant $10 of vitamin D vs $10,000 for IVF
Perhaps an ROI of 600 X - but unaware of any group that could benefit - exception: improved birth rate for the country
Did Hollis, Wagner do any followup on health after birth?
   enough vitamin D for 2 months before conception (for 2), during pregnancy, and 1 year after
      50K weekly for 2 months before conception for 2 people = 16
      50K biweekly for 9 months = 18 (perhaps 50K weekly for last month - higher BMI)
      50K biweekly for 12 months = 25 Total = 59 (16+18+25). X 20 cents = $5
consider also Magnesium and Omega-3?
Probably increases chance of conception for older women - any proof?
– – – – – –
Can IVF solve the fertility crisis? MIT Review July 2024
around one in six people is affected by infertility,
“Europe today has 10% of the population, 20% of gross domestic product, and 50% of the welfare expense of the world,”
By one recent estimate, the global fertility rate is declining at a rate of 1.1% per year.
TFR in South Korea was just 0.8—well below the 2.1 needed to maintain the population. I
. IVF is already involved in 5% to 10% of births in high-income countries.
in 2020, the use of ART increased the (US) fertility rate by about 1.3%.
In Australia, however, ART boosted the fertility rate by 5%.
Why the difference? It all comes down to accessibility. IVF can be prohibitively expensive in the US—without insurance covering the cost, a single IVF cycle can cost around half a person’s annual disposable income. Compare that to Australia, where would-be parents get plenty of government support, and an IVF cycle costs just 6% of the average annual disposable income.
– – – – – – -
Several countries have used “pronatalist” policies to encourage people to have children. Some involve financial incentives: Families in Japan are eligible for one-off payments and monthly allowances for each child, as part of a scheme that was recently extended. Australia has implemented a similar “baby bonus.”
Other benefits - increase GDP (like adding Iodine) - added 11% to income of stats that had high goiter)
https://vitamindwiki.com/tiki-index.php?page_id=9880
ALSO: increase lifespan/health span are important (but many of the lives saved are for those beyond working age)
Wonder what % of saved lives are in those < age 65: Obesity, Diabetes,
– – – – – – –
IVF - always frozen egg? NO !
https://www.bloomberg.com/news/newsletters/2024-08-14/fertility-firms-conceivable-gameto-oviva-work-to-make-ivf-better?
Any woman who has endured in vitro fertilization or egg freezing can tell you that the process is brutal — you’re cranky, bloated and a whole host of other things that are TMI to discuss here. Despite this, it’s not an uncommon experience: In 2021, the most recent year for which Centers for Disease Control and Prevention data is available, procedures rose over 26% compared with the previous year, to more than 413,000.
Marcia Inhorn, a Yale anthropologist and author of the book Motherhood on Ice, found that more women are choosing to freeze their eggs as a way to cope with this reality. She concluded that there’s a mating gap. Society has changed in a way that just makes it harder to start a family earlier. In her study of women who froze eggs, 82% of them were single “with no partner in sight.” The rest were in unstable relationships with men or waiting for their partner to be ready for parenthood. The stories of women in her book were just like me. It wasn’t until I was past my fertile prime that I met someone to start a family with.
Yet the majority of people must still pay out of pocket for intensive treatments that average roughly $50,000 per patient and have no guarantee of
– – – – – – -
Replacement birth rate 2.1, China Average now 1.2, some cities 0.7 - Zeihan
fastest aging society in human history
China dependant of globalization - large imports of oil, food as well as large exports
Birth rate fell by 60% in just the past 6 years
Fastest urbanizing society in human history
https://www.youtube.com/watch?v=0MSV2bh48MA&ab_channel=ZeihanonGeopolitics

Infertility is a Chronic Health Condition - WHO

VitaminDWiki – Vitamin D greatly improves Fertility

WHO infertility report 1990 - 2021

$5 of Vit D improves 1) Female and male fertility 2) Pregnancy health 3) % of life births 4) Offspring health

Might the global falling fertility rates be considered a chronic health problem? Perplexity AI Deep Research Feb 2025

Birthrate notes from personal VitaminDWiki database