Although many people are choosing to have children later in life, biological fertility limitations remain unchanged. Innovations in biotechnology, such as egg quality therapeutics, womb transplants, show promise as alternatives to address reproductive longevity
Across the world, people are having children later in life, and neither our biology nor our public policy is keeping pace. This misalignment has far-reaching socioeconomic repercussions, as older would-be parents struggle to conceive, and declining birth rates threaten economies and welfare states. While the biotech sector is developing innovations to extend the human reproductive window, most nations’ healthcare systems and reproductive policies are not evolving in line with the science. Tackling this age-related infertility crisis requires both pioneering biotech innovation and urgent policy change.
The reality of reproductive ageing
Across the OECD, the average age of a mother at first birth has risen from 26.5 in 2000 to 29.7 in 2022. In England and Wales, the figure reached a record high of 31.0 in 2024. Longer education, dual-career households, and soaring living costs make delaying parenthood an economically rational choice; yet, biology has not adapted accordingly.
Female fertility is bound by a finite reserve of eggs that declines in quality over time. Meiotic aneuploidy (eggs with the wrong number of chromosomes) is a primary cause of age-related infertility and IVF failure. Male fertility also declines as sperm quality reduces with age. Lifestyle and environmental factors can accelerate or delay this timeline, but the biological clock is a stubborn reality.
Consequently, many are turning to IVF, but its success rates diminish with age. The Human Fertilisation & Embryology Authority (HFEA) reports live-birth rates per embryo transfer of just 26% for patients aged 35-37, falling to 5% by ages 43-44. Each additional cycle multiplies the emotional and financial strain on individuals. This challenge also deepens existing health inequalities, with Black and Asian patients reporting longer waits and lower satisfaction with fertility services.
The innovation pipeline
Fortunately, scientific progress continues to march forward. Biotechnology research and development are converging on two complementary goals: extending the years in which eggs and sperm remain healthy and improving outcomes when treatment is needed.
One of the most promising frontiers is in egg quality therapeutics, where specialist biotech firms are pioneering treatments to enhance egg quality for women in their mid-30s and older. By targeting the molecular drivers of egg ageing, these therapeutics could integrate into existing IVF protocols, potentially boosting success rates and reducing the number of cycles required.
Encouraging progress is also being made in several other areas. The first UK birth from a living-donor womb transplant occurred in 2025, and the US FDA is reviewing protocols for ex-utero fetal support (EUFS), known colloquially as artificial wombs. Both approaches target the growing cohort of patients whose infertility is uterine rather than egg-based. In another advancement, a 2025 case series on mitochondrial-replacement therapy (MRT) reported a 36% live-birth rate among patients, demonstrating that refreshing an egg’s energy supply can offset some age-linked decline. Finally, AI-powered embryo-ranking systems and non-invasive genetic testing are being developed to improve selection and reduce failed transfers, miscarriages, and the associated distress.
A call for coordinated policy action
Unfortunately, policy is not currently keeping up with scientific progress and innovation. We need to see coordinated policy action to ensure that these innovations translate into equitable reproductive health outcomes. To address deep inequalities and modernise care, the UK must pursue an integrated national strategy. This begins with streamlining regulation and investing in infrastructure, such as linked biobanks and adaptive regulatory pathways, to hasten the evaluation of new treatments while ensuring safety. In parallel, promoting fertility literacy in schools and universities can empower young people with the knowledge to plan effectively. This must be combined with family-friendly employment policies, including affordable childcare and equitable and flexible parental leave, to reduce the economic pressure to delay parenthood. Finally, to ensure fair access for all, the government should establish nationally consistent NHS criteria for publicly funded egg, sperm, or embryo freezing, creating a system where reproductive choices are not dictated by income or location.
For too long, reproductive longevity has been overlooked, and society is now shouldering the cost. By embracing biotech innovation and enacting complementary policies that promote public literacy, equitable access, and supportive workplaces, we can empower individuals with the flexibility and options fit for today’s world. The opportunity to align our policies with modern life is here; we must act now to ensure no one faces unnecessary barriers to building a family.
