Falling Fertility Isn't Just About Money — It's "Structural Infertility" Spreading
Infertility used to be a medical problem like blocked fallopian tubes; now it's more often produced by housing prices, childcare costs, slower career advancement and an excess of dating options — what the author calls structural infertility.
The video won't play here. Listen to the audio instead:
The argument · tap a timestamp to hear it
Upward mobility fell from nine in ten to five in ten
The author pins the "age of uncertainty" to one concrete number: in the US, your odds of doing better than your parents have fallen from 90% to about 50%, roughly a coin flip. That means people who want children no longer have a future they can count on — the idea that a child will do better than you has gone from default premise to a bet you have to place. Layer on near-suffocating inequality and steadily deteriorating job quality, and uncertainty isn't a mood, it's a structural change with indicators behind it.
— Anna-Louis SussmanChildcare is an after-tax cash outlay
The author gives her own math: if you want to keep working, full-time childcare runs $2,500 to $3,600 a month in after-tax income, paid until the child can enter public school — tens of thousands of dollars over three to four years. Housing is another hard cost, especially in big cities with good jobs. But she stresses this isn't purely material — money reshapes how you understand time, how you rank work and relationships, and what you expect "what a child needs to succeed" to be.
— Anna-Louis SussmanThe pandemic baby bump happened only among white-collar workers
There was indeed a small fertility rebound in 2021, but it broke along class and racial lines. The author explains it through "social reproduction": feeding yourself and those around you, cleaning, tidying — the labor that keeps life running is never counted in GDP. During the pandemic, white-collar workers stayed home, commutes vanished, life got more stable, and men may have been forced to shoulder a bit more, so this group saw a modest baby boom. Blue-collar and frontline workers who had to leave the house had no such conditions, and so had no such rebound.
— Anna-Louis SussmanClimate anxiety is fear for the child, not fear of emissions
Two scholars estimate 12.5 million childless Americans have given up having children at least partly for climate reasons. The man in the couple in the author's book isn't unwilling to cut emissions for the planet — it's "I really want a child, but I'm too afraid of the world that child will face." His family is Lebanese, migrated to Germany, and has seen far-right anti-immigrant sentiment firsthand, so he doesn't trust the future to provide clean air and water, or humans to respond with compassion. The author also notes that pinning responsibility on individual reproductive choices is a deflection — the very concept of a carbon footprint was invented by a PR firm for BP.
— Anna-Louis SussmanInfertility went from a medical problem to a structural one
The author proposes "structural infertility": infertility used to be specific medical conditions like blocked fallopian tubes, sperm problems, implantation problems; now it's the first promotion arriving later, buying a home and stopping having roommates arriving later, meeting and falling in love arriving later (because there are too many options) — these larger structural factors functionally cause infertility. She also mentions the environmental dimension: air pollution and particulates are at least correlated with poor pregnancy outcomes, and wildfire smoke and extreme heat are topics she's currently writing about.
— Anna-Louis SussmanThe fertility industry now has an investment thesis
Assisted reproductive technology has genuinely worked miracles — IVF has produced an estimated at least 10 million babies in the forty-plus years since its invention. But the author points to the other side: some people hold an investment thesis that "more and more people will experience structural infertility and need this help," and with it comes venture capital and private equity money, and consolidation of fertility clinics — older doctors retiring sell their practices to big chains, in some cases pushing prices up. She is especially wary of egg freezing being pitched as "bank your eggs," as if you must invest in your own reproductive capital and get that baby you long for as the return.
— Anna-Louis SussmanEvery path leads to egg freezing
The author describes running to three to five egg-freezing info sessions in New York in one winter, each with wine and cheese and crackers. The pitch is a closed loop: if your ovarian reserve is low, hurry and grab the last few eggs; if your reserve is high, all the more reason to freeze more early. Either way, the conclusion is freeze now. She names Kind Body for having driven a van to tech campuses to offer free AMH testing, and the founder of Prelude Network for publicly arguing for genetic testing of all embryos to lower US healthcare spending — the author thinks this has slid toward eugenics, and presupposes IVF becoming universal.
— Anna-Louis SussmanNordic welfare didn't change; the reference point did
If the problem were just a lack of money and security, welfare states like Norway and Denmark shouldn't show the same fertility decline. The author's explanation: their safety nets and family policies are indeed stable, but their baseline is their baseline — the world around them changed. Parenting expectations rose, housing prices rose far too much, and one Norwegian demographer said his parents had him and his sister in their twenties, renting a small apartment, and simply had a belief that "we'll always figure something out." Once that belief disappears, life milestones that could once be completed later become more important instead: you have to steady the ground under your feet before you dare to jump.
— Anna-Louis SussmanIn their own words · checked verbatim
We know that social mobility, especially in the U.S., has declined dramatically. It's gone from a 90 percent chance that you'll be better off than your parents to about 50 percent, which is, you know, as good as a coin toss.
Anna-Louis Sussman6:28
I don't think it's purely material, you know, circumstances. I think money structures our lives in a way that goes far beyond just what's coming in and out of your bank account.
Anna-Louis Sussman8:40
even the idea of carbon footprint, like that concept was actually invented by a PR company at the behest of British petroleum as a way to shift responsibility from, you know, the hundred companies that were causing 70% of emissions to individuals and making them feel bad so that they wouldn't bother with pushing anyone else.
Anna-Louis Sussman30:57
Historically, infertility was a medical condition. Your fallopian tubes are blocked. You had issues producing sperm. You know, maybe you had issues with implantation. There was sort of specific things or there was, you know, unexplained infertility. But now it's these things like the fact that it takes so much longer to get your first promotion and to get established in your career.
Anna-Louis Sussman32:00
there's almost an imperative once that option exists that, well, you know, according to a sort of neoliberal idea, you have to invest in your reproductive capital, your eggs.
Anna-Louis Sussman36:08
when you create a really inhumane world, when you have corporate leaders basically saying, we don't care about workers. We just want to get rid of as many jobs as possible and replace them with robots. We don't really care about people's lives. Like when all this stuff is being said out loud, it's not the quiet part anymore. People will hesitate to bring more humans into this world because it's not hospitable to humanity on so many different axes.
Anna-Louis Sussman52:59
they're missing out on an experience that's a really fundamental human experience that people have had for generations. It wasn't a privilege. It was just part of being human that if you wanted to have a baby and love it to pieces
Anna-Louis Sussman55:00
Figures
| US social mobility (odds of doing better than parents) | from 90% to about 50% | 6:28 |
| US full-time childcare monthly cost (after tax) | $2,500-$3,600 | 7:33 |
| Estimated number of childless Americans who gave up having children for climate reasons | 12.5 million | 25:41 |
| Estimated number of babies born worldwide since IVF's invention | at least 10 million | 35:05 |
| Global infertility prevalence (WHO estimate) | 1 in 6 people | 45:34 |
| Projected increase in infertility cases among women aged 35-49 (Lancet forecast, through 2036) | up 50% | 45:34 |
| Assisted reproductive technology success rate | about one-third to one-half, depending on age group, lower above 40 | 46:37 |
Glossary
- structural infertility
- Functional infertility caused by social-structural factors such as housing prices, childcare costs, slower career advancement and an excess of mate choice.
- social reproduction
- The unpaid labor — feeding, cleaning, caring — that keeps life running but is never counted in GDP.
- anxious class
- A term the author borrows from economist Robert Reich, referring to people whose rug could be pulled out at any moment and who lack a safety net.
- barbell economy
- An economic structure with a mass of low-income people and a tiny top tier, with the middle hollowed out.
- AMH testing
- Testing anti-Müllerian hormone, used as a rough reflection of ovarian reserve.
How to listen
Founders and investors watching demographics, fertility policy, consumption and healthcare investment; and readers weighing their own fertility decisions who want to understand their situation isn't a personal failure.
The sponsor read at 15:59-18:08, and the several episode promos at 41:18-44:31, can be skipped outright.