Assisted reproductive technology (ART) is playing an increasingly important role in the realization of childbearing intentions in advanced societies. While ART is more accessible than ever, its usage varies across social groups, Alice Goisis, Jenny Chanfreau and Øystein Kravdal note, and its true contribution to overall fertility remains complex and uncertain.
ART: A response to delayed parenthood
The past decades have seen a global trend toward delayed parenthood. Driven by factors such as investments in education, professional career ambitions and evolving societal norms, more people are seeking to conceive later in life, when their fecundity is lower. Yet, the increased use of assisted reproductive technology (ART) reflects not only a delayed pattern of family formation but also greater availability of ART treatments, lower stigma around its use and rising awareness of fertility options. Countries with robust healthcare systems and favourable policies have seen notable growth in ART-conceived births. As a result, ART has gained relevance and popularity.
However, undergoing ART remains an often costly and lengthy process – as women might need to undergo several cycles before eventually conceiving and giving birth to a child – and is not equally accessible to everyone. If we are to study the impact of ART on fertility rates we need a better understanding of who gives birth after ART.
Who uses ART? Not just a question of age
While age is a key driver of ART use, it does not tell the whole story. Some groups rely on ART more than others, and not solely because they start their families later. For example, ART services are used relatively more frequently by highly educated individuals, possibly due to greater financial means, more flexible jobs which make it easier to accommodate the intense ART schedules and geographical proximity to fertility clinics. A large proportion of ART users are also first-time parents.
In a recent publication (Chanfreau, Goisis and Kravdal 2025), we show the importance of paying attention to this variation across population subgroups when calculating the contribution of ART to fertility. For example, although ART births have increased over time across all groups considered, the much larger contribution of ART to the fertility of highly educated couples compared to lower educated couples gets lost if we only look at the national average. Calculating the contribution at the national level gives the impression that ART makes a fairly small difference overall, because, on average, the need for fertility treatment at the population level is relatively limited. Figure 1, which refers to Norway in the years 1986–2018, illustrates this point visually. It shows, by women’s level of education, the ART total fertility rate (absolute contribution) and the ART contribution as a percentage of the fertility rate of each subgroup (relative contribution). The contribution of ART to fertility rates has increased over time for all educational subgroups, both in absolute and in relative terms. However, absolute/relative differences have not narrowed over time and the ART total fertility rate among highly educated women is at least double of that of lower educated women.
How much does ART actually boost fertility?
ART undeniably contributes to fertility rates, but by how much? Quantifying its impact is more complicated than simply counting births. Clearly, without ART, many couples who want children would remain involuntarily childless or with fewer children than desired. But others who experience difficulty conceiving and receive treatment might eventually conceive even without the help of ART. Moreover, it is unclear how one should interpret naturally conceived births that follow an ART birth. On the one hand, this situation may signal “overtreatment”, i.e. that the couple would have been able to conceive without ART, suggesting that the ART birth should not be included when calculating the contribution. On the other hand, the use of ART may have been essential for that birth and either the treatment, the hormonal changes during pregnancy or the reduced stress of achieving a much-wanted birth may have helped overcome the infertility and made it possible to have a naturally conceived child later. It would then be appropriate to consider the subsequent births as contributions from ART.
We argue that whilst it might be difficult to precisely establish the contribution of ART to fertility rates, an important step in this direction can be taken by considering a range of scenarios and reflecting on how plausible they are in the context under study.
The future of ART and fertility policy
As ART becomes more mainstream, governments and healthcare systems must adapt to its growing role. Policymakers face several critical questions: Should ART be publicly funded to ensure equal access? How should societies balance the benefits of ART with ethical considerations? And what measures are needed to prevent misinformation about ART’s success rates?
Decision-makers in countries concerned about declining birth rates may look to ART as part of a broad set of policies to slow down or reverse the decline. However, other policy elements would likely be more effective, such as supporting an attractive work-life balance, providing affordable childcare, and encouraging gender equality.
The availability of ART itself may be influencing behaviour. In the context of delayed childbearing, some individuals or couples may see ART as a form of insurance, a reliable fallback option in case conception does not occur naturally. If people overestimate its success rates, such beliefs will contribute to reduced fertility. This raises important questions about how ART shapes reproductive choices, given the various structural factors that encourage postponement, and whether current policies support informed decision-making.
Moreover, the persisting, and possibly increasing, educational stratification of the contribution of ART warrants further attention. We need to better understand whether and to what extent these patterns can be explained by differences in needs, or whether they indicate social inequalities in access, use or success of treatment.
In conclusion, ART has transformed the reproductive landscape, offering hope to millions while raising new challenges. While ART has helped many individuals and couples achieve parenthood, it is not a panacea for declining fertility trends. Its role in shaping fertility trends will only grow, making it an essential area of study for demographers, policymakers, and healthcare providers alike.
References
Chanfreau Jenny, Goisis Alice, Kravdal Øystein (2025) Conceptualizing and Measuring the Contribution of Assisted Reproductive Technologies to Fertility Rates. Population and Development Review, online first, https://doi.org/10.1111/padr.70009.
Kravdal, Ø., Flatø, M. & Torvik, F.A. Fertility among Norwegian Women and Men with Mental Disorders. Eur J Population 41, 17 (2025). https://doi.org/10.1007/s10680-025-09739-5