In January 2025, “The Atlantic” published “The Anti-Social Century,” an article by Derek Thompson. The piece was long, but his thesis brief: Americans find themselves in an epidemic of loneliness.
Data shows that for the past five or more decades, Americans have spent more time alone. This changing social structure impacts politics, culture, personality—nearly everything—including the work of Wendy J. Schillings, M.D., medical director of fertility preservation at Newark- and Dover-based RADfertility, a member of the nationwide CCRM Fertility Network.
“[The birth rate] has been going down for the past 50 years,” Schillings says. “This decline in birth rate is not new—[fewer] couples are having kids. I think there’s more isolation and less partnering among twentysomethings, which means couples are partnering later in life—and the longer you wait, it’s more difficult to get pregnant.”
Schillings says about one in six couples will have difficulty conceiving, and while other factors contribute to those numbers—like smoking, sexually transmitted diseases, and environmental or biological issues—it often comes down to how a woman’s age equates to egg health and quality.
“I always tell my patients, ‘You do not fall off a cliff at 35,’” Schillings says. “But that is when fertility rates start to decrease. Not only are you born with all the eggs you will ever have, but you lose them over time.” Additionally, eggs that stay unfertilized in a woman’s body the longest are more likely to be chromosomally abnormal. “Between [ages] 38 and 43, there’s an exponential rise in chromosomal abnormalities.”
According to Anne Hutchinson, M.D., a fertility specialist with Shady Grove Fertility in Newark, the impacts of environmental factors on fertility—for women and men—are also being studied. “We’re doing a lot of research trying to understand what exposure to endocrine disruptors and pollutants, increased stress, and obesity does, and whether or not that plays a role.”
One of the big misconceptions is that male fertility isn’t a concern, Hutchinson says. “Studies and semen analyses have shown that sperm health has [also] declined over the last 50 years. We’re seeing fewer sperm in the ejaculate…yet fertility treatments tend to allow us to overcome aspects of male fertility [issues].”
Researchers are trying to find reasons for the decline in sperm health, but it’s likely that lifestyle factors play a part, Hutchinson says. “Whether it’s diet, increased rates of diabetes and obesity, or environmental factors like microplastics or other issues, we’re doing a lot of research to try to pick that apart.”
Even with compounding issues like delayed coupledom, declining sperm health, and a sagging global birth rate—according to the Centers for Disease Control and Prevention (CDC), the U.S. birth rate plummeted to 1.64 expected births per a woman’s lifetime in 2020—both Schillings and Hutchinson say they’ve treated more patients over the past five-plus years. It’s a base that includes single women, heterosexual couples, and LGBTQ+ couples, all representative of Delaware’s full socioeconomic makeup.
Breaking a Stigma
Hutchinson thinks one reason for the growing trend is that vulnerable women are sharing their journeys. “There are a lot of societal expectations placed on women, and one of the biggest is that we are expected to be able to be mothers, and we are expected to become one perfectly and easily,” she says. “I think in situations where that doesn’t happen for women who want to have a baby, when there isn’t a lot of open discussion and a judgment-free space, people [feel] very isolated and reflect internally, feeling like a failure for [not doing] what their body was supposed to do. There are deep emotional layers of shame and guilt.”
One positive thing to come from social media over the last decade, she notes, is that people are sharing their experiences. “More women understand infertility is common.”
Schillings points to June 2018, when then-Gov. John Carney signed into law SB 139, Delaware’s Fertility Care and Preservation Bill. As a result, Delaware became the 16th state to mandate fertility insurance coverage for in vitro fertilization (IVF)—the process of retrieving eggs from a woman, fertilizing them with sperm outside of the body, and transferring the resulting embryos back into the woman’s uterus—and the fourth to cover fertility preservation, or “egg freezing,” in which eggs are retrieved for fertilization much later.
“Certain states have IVF mandates, but Delaware is one of [the] few that have included fertility preservation,” Hutchinson explains. “This mandate is largely why I came to practice here [from Pennsylvania]. Few people have access to IVF or preservation because it can be so cost-prohibitive, but the mandate has provided much greater access.” To be eligible for insurance, employees must work at a Delaware employer with more than 51 workers.
Like RAD, Shady Grove is a national medical provider, with offices in many states without a mandate. But they do have a shared-risk program for those without insurance-coverage options, in every state they practice. In this arrangement, there is a guarantee of a positive outcome for patients who pay out of pocket. “If treatment does not result in a live birth, we will offer a 100% refund,” Hutchinson says. (RAD also offers a refund program.)
Know Your Numbers
Although Schillings is grateful for the mandate and the uptick in patients, she says misconceptions abound about infertility—mainly, that age plays such a critical factor.
If a woman is under 35 and has been trying to become pregnant without success for a year, that’s the ideal time to speak with a fertility doctor, Schillings says. “If you’re [over] 35, I typically say six months.”
Other factors like irregular menstrual cycles should dictate an earlier check-in. For her LGBTQ+ clients, she advises them to begin discussions as soon as they’ve decided to create a family.
“‘Know your numbers’ is what I tell most of my folks,” Hutchinson says. “Women should be proactive about fertility screening [and] have an idea of what their menstrual cycles are like. Are their cycles regular? Painful? Heavy? Those can be signs of underlying conditions that may make it more difficult to get pregnant down the line. For folks [who] think they may not [build] their family until later in life, fertility preservation, or freezing eggs, is a really good option to try to keep that door open in the future.”
Both doctors also agree that lifestyle choices—maintaining a healthy weight with diet and exercise—reinforce healthy reproductive systems.
Treatment options can feel overwhelming, Schillings notes, but there are options on the way to IVF. “With younger patients, we try the simpler things first, which could be helping people ovulate or taking the sperm and injecting it into the uterus,” she explains. “It’s reasonable to try that first, although most success comes with IVF.”
When Schillings started, the success rate with IVF was “maybe 15%, 20%,” she says. “I was training when the first IVF babies were being born. Now we have over a 50% success rate. And the field continues to get better.”
Hutchinson, too, is energized by advancements in technology. “Innovations in our embryo lab have allowed us to get better at having high-quality embryos growing. We are moving toward more efficient treatment options as well as lower-cost options,” she says. “There’s more awareness and open conversation, expanded access to care, [and] less-invasive treatments—and personalized treatments are really coming to the forefront of what we do to allow the best possible outcomes.”
She says her patients are also becoming increasingly well-informed. “They are coming to their visits asking appropriate questions. All this tells me how much the conversation about fertility has kind of changed outside of the immediate environment of our field. I hope it’s a conversation that will continue to evolve and get louder.”
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