Structural Infertility: Why This Generation Finds Having Children Nearly Impossible

In an episode of Vox's podcast The Gray Area, host Christine Emba spoke with journalist Anna-Louise Sussman about her new book, Inconceivable: The Impossibility of Family in an Age of Uncertainty. The conversation raised a pointed question: why do so many people who want children find building a family nearly impossible?

The answer is far more complex than "young people just don't want kids." Sussman's central concept — structural infertility — reframes the reproductive crisis not as a matter of personal choice, but as a systemic social failure.

From Medical Condition to Structural Crisis

Historically, infertility referred to a clearly defined medical condition: blocked fallopian tubes, sperm production issues, implantation difficulties. But Sussman argues that a new, more insidious form of "infertility" has emerged.

"What you see now," she explains, "is that it takes longer to get that first promotion, to establish yourself in a career; it takes longer to stop renting and own your own home; it takes longer to meet the right person and fall in love, because there are so many choices. All of these larger structural factors are actually producing a kind of functional infertility."

In other words, when society pushes every life milestone further back, the biological clock doesn't wait. This compounds with environmental factors — Sussman notes a growing body of research linking air pollution, particulate matter, wildfire smoke, and extreme heat to adverse pregnancy outcomes — together painting a picture of "infertility" far broader than any traditional medical definition.

The concept of "structural infertility" echoes sociological discussions of "social infertility." Traditional reproductive medicine defines infertility as the clinical failure to conceive after 12 months of regular unprotected sex, meaning WHO statistics only capture those with identifiable physiological causes. But researchers like Sussman observe that a growing number of people are not unable to reproduce — they are being denied the conditions that would make reproduction viable. This population is entirely invisible in the data. Related to this is the widening "intention-fertility gap": surveys consistently show that people's ideal family size exceeds their actual birth rates, and this gap has grown in virtually every high-income country over the past two decades. The structural infertility framework shifts the explanation for this gap from "people don't want to have children" to "social conditions make it impossible to do so" — a conceptual reframing with significant policy implications.

It's Not Just Money — It's How Money Reshapes Lives

Money is inescapable when discussing root causes, but Sussman's analysis goes beyond the overused phrase "can't afford it."

She breaks down several hard economic barriers: housing costs (especially in cities where jobs are concentrated) and childcare expenses. Using her own situation as an example, full-time childcare runs $2,500 to $3,600 per month after taxes — tens of thousands of dollars in cumulative costs before a child enters the public school system.

The deeper issue is that money doesn't just affect bank balances — it reshapes the psychological architecture of how people live. "It changes how you think about time, how you prioritize work versus relationships, what you believe a child needs to succeed in this world."

Sussman introduces the framework of "Project Me vs. Project Someone Else": people spend years accumulating personal capital — paying off student loans, stabilizing their mental health, buying a home — before they feel entitled to consider "investing in that potential future child." And as the social safety net frays, this threshold keeps rising.

The Anxious Class and the "Rug Rat Race"

The conversation draws on economist Robert Reich's concept of "the anxious class" to explain the pervasive sense of precarity. In America, losing a job doesn't just mean lost income — it means losing the ability to pay rent and losing health insurance.

Sussman describes a "dumbbell economy": a vast base of low-wage workers, a narrow peak of McKinsey consultants, finance professionals, and tech workers, with the middle largely hollowed out. Even those lucky enough to reach the upper tier know the cracks beneath their feet — social mobility has fallen from "a 90% chance of doing better than your parents" to "roughly 50%, like a coin flip."

This fear has produced what economists call the "rug rat race" — a parenting arms race in which opting out unilaterally feels nearly impossible, even when everyone knows a one-month-old baby doesn't actually need to be enrolled in classes.

"The anxious class" is a term Robert Reich uses to describe Americans above the poverty line who nonetheless live in a state of persistent economic insecurity — people whose lifestyles depend on maintaining health insurance, stable employment, and home values, where the collapse of any one element can trigger a cascading breakdown. The "rug rat race" comes from a 2010 study by economists Garey Ramey and Valerie Ramey, who found that highly educated American parents dramatically increased the time they spent on their children beginning in the 1990s, and that this increase closely tracked the rising competitiveness of college admissions. This model of "intensive parenting" transforms child-rearing into a full-time project, raising the psychological threshold for feeling "ready" to have children and creating a self-reinforcing cycle of delay.

Climate Anxiety: A Real but Misplaced Burden

The conversation also touches on climate change. According to two scholars cited in the discussion, roughly 12.5 million childless Americans have chosen not to have children at least partly due to climate concerns.

Sussman recounts the story of a couple in her book: a young man who grew up in a loving family and always wanted children, but retreated because of climate anxiety — fearing not just food and water scarcity, but the political fallout of mass migration and the ugliness it might bring out in humanity.

Host Emba raises a critical counter-question: isn't this a displacement of responsibility? "Is it really individual babies who are destroying the planet? Or should we be putting pressure on fossil fuel companies and governments?"

Sussman agrees. She points out that the very concept of the "carbon footprint" was invented by a PR firm commissioned by BP, precisely to transfer responsibility from the roughly hundred companies responsible for 70% of emissions onto individuals through guilt. She critiques the notion of "sexual stewardship" — the idea that women in lower-income countries should have fewer children to save the planet — calling it both wishful thinking and a convenient way to avoid holding men, militaries, governments, and corporations accountable.

The "carbon footprint" concept can indeed be traced to a communications campaign that BP launched around 2004 in partnership with the PR firm Ogilvy & Mather, which included an online carbon footprint calculator prompting individuals to measure and reduce their personal emissions. Researchers argue the core effect of this messaging strategy was to shift climate responsibility from corporate production to individual consumption, creating a sense of moral equivalence that diluted political pressure for systemic regulation of the fossil fuel industry. In the context of reproduction, this logic extends to the claim that "having fewer children is the biggest thing an individual can do for the planet" — a statement that originated in a widely circulated 2017 study, but whose methodology (attributing a child's and all descendants' emissions to the parent's decision) has been broadly criticized by climate scientists and demographers. The "sexual stewardship" narrative Sussman critiques further layers this individualized responsibility discourse onto women in higher-fertility, lower-income countries — a framing that postcolonial critics identify as a contemporary iteration of population control ideology.

Reproductive Technology: A Double-Edged Sword

One rising "solution" to this uncertainty is the mainstreaming of assisted reproductive technologies: IVF, egg freezing, surrogacy. Sussman acknowledges these technologies have performed miracles — IVF has helped bring roughly 10 million babies into the world in the four-plus decades since its invention.

But she remains wary of the financialization of the fertility industry. She describes KindBody driving trucks into tech campuses to offer free AMH testing as a marketing hook, and egg-freezing information sessions held over wine and cheese, all delivering the same message: "You should freeze your eggs now — yesterday, actually."

More troubling is the founder of the Prelude Network's enthusiasm for genetic testing of all embryos — arguing it would reduce hereditary disease and lower societal healthcare costs. Sussman states plainly that this "slides pretty quickly into eugenics," and that it presupposes everyone has embryos to test — in other words, that IVF is universal.

She cautions that the success rates for these technologies are only one-third to one-half, even lower for those over 40 — and that they are largely available only to those who can pay, making parenthood increasingly an option for the privileged few.

AMH (Anti-Müllerian Hormone) is a blood marker used clinically to assess ovarian reserve — lower levels generally indicate fewer available eggs. Fertility tech companies like KindBody use free AMH testing as a customer acquisition tool, with the commercial logic of generating anxiety about "declining ovarian reserve" and nudging women toward purchasing egg-freezing services. Critics note, however, that AMH's predictive value remains contested in the medical literature — it can reflect egg quantity but cannot reliably predict the probability of natural conception, and its clinical significance in healthy women without fertility issues is particularly limited. The Prelude Network is one of the largest fertility clinic chains in the United States, with a business model centered on embryo genetic screening. Given that eugenics was historically weaponized by state power to forcibly sterilize marginalized populations in the name of "improving the population," Sussman's invocation of the term is a warning: when genetic screening is combined with the economic logic of reducing societal healthcare costs, the underlying value assumptions bear a structural resemblance to historical eugenicist discourse.

Even Scandinavians Are Pulling Back

One striking finding in the conversation: even in Norway and Denmark, with their robust social safety nets, birth rates are falling.

Sussman's explanation: their baseline has held relatively steady, but the world around them has changed. People there face the same pressures of rising parenting expectations and soaring housing costs. A Norwegian demographer's parents had children in their twenties, confident that "things would work out" — but that faith in the future is disappearing.

This points to what Sussman sees as the deeper absence: trust and belief. Host Emba shares a finding from her own reporting — that religious faith seems to lower the fear threshold around having children, because it provides a reason to have them that isn't purely instrumental: "a child is a good in itself." The challenge is how to offer secular people a comparable sense of meaning.

A Way Forward: Starting with Interdependence

Sussman describes the reproductive retreat as "a vote against the future" — a dissatisfaction with the present so profound that people are unwilling to bring new life into it.

She insists this should not be reduced to a conversation about "population" or "fertility rates" (she explicitly calls out the Elon Musk school of thought on this). The people in her book are not "replacement-level fertility" — they are real individuals who want to bring a loving relationship into their lives but find themselves unable to.

Her prescription is interdependence: at the macro level, using a fairer tax structure to provide a floor beneath people's lives, building the kind of basic security the United States has never truly tried to create; at the micro level, rebuilding community — knowing your neighbors, supporting each other — rather than outsourcing every solution to the market.

"When you create a profoundly inhospitable world, when corporate leaders openly say they want to eliminate as many jobs as possible and replace people with robots, people are going to hesitate before bringing more people into a world that is not very friendly to humans," Sussman says. Her conclusion is simple but powerful: making reproduction "conceivable" again requires not just technology or subsidies, but a future worth trusting.