Fertility rates are declining in nearly every country with notable exceptions in sub-Saharan Africa. 

Interestingly, research (Eisenberg et al, 2021) in the United States has demonstrated that while fertility rates in that country are in decline, biological fecundity – meaning the physiological ability to conceive among reproductive age women in the general population – has remained relatively stable. 

On a global scale falling total fertility rates are primarily the result of socio-economic factors and the growing number of women in the workforce.

A study by C. Goldin (Goldin, 2006) highlighted that engagement of women in the workplace exposed many to a dual burden.  On one side, they had tasks for work for which they were paid, and on the other side they were left with domestic duties for which they were not compensated.  

Goldin emphasised that fertility rates had more profoundly dropped in southern European countries where men’s involvement at home was limited.  Conversely, total fertility rates remained higher in Nordic countries where men were typically more involved in domestic tasks.  

In her book Father Time, American anthropologist and primatologist, Sarah Blaffer Hrdy, highlights the benefits that men encounter when being involved in infant care.  These include hormonal elevations that control well-being and pleasure.

Enacting paid parental leave for fathers and mothers encourages the involvement of men in infant care.  

In all, we believe the current fertility decline is not necessarily bound to be definitive.  Indeed, there is hope that the The Time of Men will bring a resurgence in natality (de Ziegler et al, 2026).

References

de Ziegler D, Sean S, Toner JP. ‘The Time of Men: Can their involvement in the domestic sphere revive birth rates?’ Fertil Steril. 2026.

Eisenberg ML, Thoma ME, Li S, McLain AC. ‘Trends in time-to-pregnancy in the USA: 2002 to 2017’. Human Reproduction. 2021;36(8):2331–8.

Goldin C. ‘The quiet revolution that transformed women's employment, education, and family’. American Economic Review. 2006;96(2):1–21.

I am delighted to share the latest developments in reproductive medicine in Hong Kong, a period marked by significant strides in public policy and clinical accessibility. 

The most transformative update in our field is the Government’s proactive measures supporting family planning to address the city's demographic challenges. 

The successful implementation of the Assisted Reproductive Services tax deduction, which allows couples to claim up to HK$100,000 (about US$12,800) annually for IVF and related treatments, has substantially alleviated the financial burden on our patients. 

This landmark policy has driven a notable increase in clinical consultations and fostered a more open, supportive societal dialogue surrounding infertility.

Dr David Y. L. Chan
ASPIRE Country Representative for Hong Kong

Despite our relatively small population, New Zealand continues to punch well above its weight in reproductive medicine by making significant contributions across clinical research, digital health, imaging and artificial intelligence. 

Strong collaborations between fertility specialists, embryologists, scientists, engineers and industry partners are driving innovation that is influencing both local practice and the wider fertility community.

A recent highlight has been the work of researchers from the University of Auckland investigating embryo-derived extracellular vesicles (EVs) as potential non-invasive biomarkers for embryo assessment. 

Supervised by Dr Lynsey Cree, the systematic review evaluated 32 studies and concluded that while EVs remain a promising area of research, there is currently insufficient high-quality evidence to support their routine clinical use in predicting embryo competence or IVF outcomes. 

The review, recently published in Human Reproduction Update, provides an important evidence-based framework for future research in this rapidly evolving field.

Artificial intelligence is another area where New Zealand researchers are having a growing impact. The Auckland team recently presented work at the 2026 ESHRE meeting in London demonstrating how AI-powered quantitative image analysis can provide new insights into blastocyst expansion dynamics and embryo development. 

This work has been enabled through WyldBloom, a New Zealand-developed AI platform created through collaboration between clinicians, embryologists, researchers, engineers and Fertility Associates. 

Beyond supporting automated embryo assessment and laboratory quality monitoring, AI is helping generate new scientific knowledge by transforming embryo evaluation into objective, quantitative measurements that can be studied at scale.

Our clinical research community also remains highly active. Dr Lucy Prentice continues to lead important work examining treatment options for unexplained infertility, including randomised controlled trials, treatment tolerability research and systematic reviews comparing IUI and IVF outcomes. 

Her work includes cost-effectiveness analyses of fertility treatments and involvement in a pilot randomised trial evaluating surgical management of minimal and mild endometriosis with fertility outcomes as a key endpoint. 

National collaborative efforts are also underway to develop evidence-based approaches to BMI thresholds for access to fertility treatment.

Professor Cindy Farquhar (CNZM) continues to champion evidence-based practice across Australasia. Her current work includes leading guideline development for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) helping ensure clinical care remains grounded in the best available evidence.

At a policy level, the Advisory Committee on Assisted Reproductive Technology (ACART) is currently reviewing guidelines surrounding preimplantation genetic testing (PGT), particularly PGT-M. 

As seen in many jurisdictions, scientific advances continue to move at extraordinary pace often challenging existing regulatory frameworks. ACART’s work will help ensure New Zealand maintains a balanced approach that supports innovation while upholding ethical standards and patient-centred care.

Dr Andrew Murray
ASPIRE Country Representative for New Zealand