How infertility uncertainty reshapes fertility desires and visions of parenthood

Infertility Reshapes the Plan for Parenthood—But Not the Longing, Landmark Australian Study Finds

Infertility is often described as a double burden: a medical condition that closes off the most common route to parenthood, and a psychological ordeal that unsettles a person’s sense of who they are and who they might become. A new study published in the journal Genus adds a striking nuance to that picture. Analysing four years of data from thousands of Australian men and women, demographer Ester Lazzari of the Wittgenstein Centre for Demography and Global Human Capital in Vienna shows that experiencing infertility drives people to scale back their expectations of having a child—while their underlying desire for children remains largely untouched, at least in the short term. The head and the heart, the findings suggest, respond to reproductive misfortune on different timetables, with far-reaching implications for how scientists measure human fertility plans.

The backdrop to the research is one of the defining demographic shifts of our era: the systematic postponement of parenthood. Infertility is medically defined as the failure to conceive or maintain a pregnancy after twelve months or more of regular unprotected intercourse, and its global lifetime prevalence is estimated at 17.5 percent, according to a 2022 systematic review and meta-analysis. Because the biological capacity to reproduce declines with age—steeply for women and, to a lesser extent, for men—every year of delay raises the share of couples who eventually confront fertility problems. In Australia, where the study was set, an estimated 16 percent of heterosexual couples report difficulties conceiving. The timing of first births has transformed accordingly: in 1991, roughly a quarter of Australian women had their first child at age 30 or older; by 2020, more than half did. Meanwhile the two-child ideal has barely budged over two decades, even as completed family size has slid steadily downward—a widening gap between intended and achieved fertility that postponed and thwarted conception helps to explain.

Demographers have long known that fertility preferences are not fixed traits. Economic insecurity, career changes, new partnerships, separations and health shocks have all been shown to nudge childbearing desires and expectations up or down. Yet the uncertainty generated by infertility itself—a condition that is at once chronic, often persisting for months or years, and unplanned, arriving without warning—has remained largely uncharted territory. Earlier cross-sectional studies offered tantalising clues: among American women, those who identified as infertile reported lower fertility intentions but higher desires and a larger ideal family size, and infertile women attending gynaecology clinics in China expressed bigger ideal families alongside shakier confidence in achieving them. Because such single-moment snapshots cannot establish which came first, the altered preferences or the infertility, the causal story stayed murky. The new study is among the first to follow men as well as women through the transition into infertility and watch, statistically, what happens to their plans.

To do so, Lazzari turned to the Household, Income and Labour Dynamics in Australia (HILDA) Survey, a nationally representative panel launched in 2001 with more than 13,000 participants and wave-on-wave response rates above 90 percent. The analysis hinges on two waves separated by four years: 2015, designated Time 1, and 2019, designated Time 2. Respondents aged 18 to 45 for women and 18 to 50 for men answered two questions on 11-point scales: “How do you feel about having a child (more children) in the future?”, capturing desire, and “How likely are you to have a child (more children) in the future?”, capturing expectation, with the expectation scale running from very likely at zero to very unlikely at ten. Crucially, HILDA poses these questions to everyone of reproductive age, not merely to those who conceive easily—an inclusive design that sidesteps the routine exclusion of infertile respondents from fertility research, under the mistaken assumption that they lack fertility preferences. Infertility status was derived from a single question: “Based on medical advice, do you know of any physical or health reason that would make it difficult for you (and/or your partner) to have children?”

The methodological architecture is deliberately conservative. The cross-sectional sample numbered 6,520 respondents after the exclusion of cases with missing values, while the longitudinal core comprised 3,702 people who were fertile at baseline and traced to follow-up four years later; those already reporting infertility in 2015 were removed so that the analysis isolates the transition into the condition. Between the waves, 11.3 percent of women and 5.5 percent of men made that transition. Because infertility is not randomly assigned—people with strong fertility desires are more likely to forgo contraception and attempt conception, and therefore more likely to encounter infertility—Lazzari employed the regressor variable method, an ordinary least squares technique that predicts preferences at Time 2 while statistically holding constant each person’s baseline preference at Time 1. The models further adjusted for events unfolding between waves, including the birth of a child, changes in relationship status and shifts in financial satisfaction, together with age, education, parity, migration and Indigenous status, and area of residence. A supplementary analysis of 777 heterosexual co-resident couples incorporated partners’ own preferences, ages and education, since childbearing decisions are typically negotiated between two people rather than made by one.

The snapshot results echoed earlier work with new precision. Among infertile men, 42 percent registered a desire score of zero and 45 percent an expectation score of zero, compared with 27 and 25 percent of their fertile counterparts; just under 40 percent of infertile women expressed the lowest possible expectation of having a child, against 23 percent of fertile women. Yet once age, parity, partnership status, education and finances were taken into account, a paradox surfaced: infertility was actually associated with higher fertility desires among women, and with lower expectations among both sexes. The expectation gap was no artefact of infertile respondents simply being older or more often parents—it persisted, statistically significant, after all observable differences were accounted for, in line with the study’s cross-sectional hypotheses.

The longitudinal analysis delivered the headline finding. Net of all controls, transitioning into infertility between 2015 and 2019 predicted a significant downward revision of fertility expectations for both men and women, confirming the hypothesis that expectations bend under the weight of the condition. Desires, by contrast, did not move significantly in either direction. Simple descriptive comparisons told the same story: by 2019, both groups had tempered their outlooks, but the downward adjustment in expectations was markedly larger among those who had experienced infertility, and for women the difference between infertile and never-infertile respondents was statistically significant in formal tests. A companion model restricted to co-resident couples, which additionally modelled each partner’s own wishes and relationship satisfaction, reproduced the pattern almost exactly: infertility reshaped expectations within couples, but left desires standing.

Two of the study’s predictions failed in illuminating ways. Lazzari had hypothesised that people of lower socioeconomic status, facing greater barriers to assisted reproductive technology, would revise their expectations downward more sharply, and that women, who the literature says bear the greater emotional toll, would show stronger effects than men. Neither held: education and financial satisfaction left the infertility–expectation link essentially unchanged, and interaction models revealed no gender-specific effects. The author points to Australia’s policy environment as a partial explanation: the national insurer Medicare subsidises assisted reproduction without restrictions on age, parity or the number of subsidised treatments, and general practitioners serve as gatekeepers to fertility clinics—circumstances that may blunt socioeconomic gradients, even though disparities in access persist and women remain about three times more likely than men to consult a doctor about fertility concerns. An alternative reading is that men who are aware of their infertility already constitute a self-selected, highly engaged group, compressing observable gender differences.

The dissociation between expectations and desires slots neatly into modern theories of fertility decision-making. In the traits–desires–intentions framework, desires represent an idealised vision of childbearing, relatively insulated from situational constraints, whereas intentions and expectations rationally incorporate perceived barriers and perceived behavioural control, as the Theory of Planned Behaviour also maintains. Cognitive models and the Theory of Conjunctural Action add that decisions are shaped as much by emotional associations and mental schemas as by explicit calculation. The Narrative Framework goes furthest: heightened uncertainty may darken expectations without extinguishing the imagined future self as a parent. Infertility is uniquely ambiguous on this score, since a medical diagnosis implies reduced odds of conception rather than impossibility—natural conceptions after unsuccessful assisted reproduction are far from rare—and because it destabilises identity, leaving people suspended between a parenthood they cannot assume and a childlessness they will not embrace, a state sociologists have described as a “spoiled identity.” Desires, in this reading, encode a deep psychological commitment to parenthood that survives even biological setbacks.

The implications cut two ways. For survey researchers the message is unambiguous: failing to measure infertility risks misreading the declining expectations of affected respondents as irrationality or unstable reproductive planning rather than a rational response to uncertainty. People may continue actively pursuing a child even as their stated expectations fall, deviating from what expectation-based forecasts alone would predict—an insight with consequences for projections of population fertility as parenthood is delayed further. The study also carries caveats: infertility was self-assessed and conditional on having received medical advice, likely undercounting disadvantaged and remote populations who consult doctors less often; two measurement points cannot capture self-perceptions that fluctuate over time; and HILDA records no information on assisted reproduction treatment, whose failures can darken expectations independently of the underlying condition. Still, the central lesson stands. Fertility expectations, the paper concludes, are more likely to be adjusted downward in the face of infertility, while desires tend to remain mostly unaffected—a quiet testament to how tenaciously the imagined future survives an uncertain present.