Tamara Nadirashvili – Reproductologist, Obstetrician-Gynecologist
A large-scale global study (based on the GBD framework) published in the prestigious medical journal The Lancet Obstetrics, Gynaecology, & Women’s Health (July 2026) raises serious concerns. This latest paper addresses the growing trends of infertility among women of advanced reproductive age, social imbalances, and alarming projections.
According to these data, the world is on the verge of a demographic and social crisis, driven significantly by reproductive health challenges. The study indicates that infertility rates among women of advanced maternal age will rise sharply over the next decade, potentially affecting over 80 million women by 2036.
As a physician whose daily work is tied to the birth of new life and the struggles along that path, I fully share the conclusions of the study’s authors. The analysis, which spans from 1990 to 2023, predicts the hardest hit will be in developed and high-income countries. It is precisely where social activity is high that the highest rates of delayed motherhood are observed, directly increasing biological risks.
Why Can’t Medicine Alone Solve the Problem?
In my office, I often hear the phrase: “Isn’t medicine omnipotent today?” Yes, reproductive medicine and assisted reproductive technology (ART/IVF) are advancing daily. However, together with my colleagues around the world, I agree on one fundamental truth: we cannot solve this issue through a purely clinical approach. It has long transcended medical boundaries and become a deep social phenomenon.
I recently attended the ESHRE conference, where this issue was highlighted alongside other scientific topics. As leading specialists in the field noted, simply expanding access to assisted reproductive technologies is not enough. It is essential to eliminate the social and economic factors that force women to delay motherhood, including:
- Lack of balance between career and personal life;
- Unstable economic environments for young people;
- A deficit of state and institutional support for early family planning.
The Paradox: High Development and Low Birth Rates
The numbers are uncompromising—one in six people globally faces infertility at some point in their lives, and infertility affects women and men equally (8–12% of couples).
However, the primary scientific focus remains on women of advanced reproductive age. Why? Because societal narratives often create false expectations. Many believe that medicine can work miracles at any age. Yet the reality I witness every day in my practice shows that even technology cannot keep up with the biological clock unless social policies at workplaces and national levels change in a timely manner.
What is Happening in the Georgian Reality?
This global demographic trend does not bypass Georgia. Recent data from Geostat clearly show that the average age of having a first child in the country is increasing year by year, shifting from 26 to 28–29 years old, while the rate of first pregnancies in the 35+ age group has risen significantly.
In my practice, the postponement of having a first child is becoming increasingly evident. Women often delay family planning due to career development, the pursuit of economic stability, or a lack of adequate social guarantees. This is a completely understandable social choice; however, as a doctor, I am obligated to remind every patient of biological realities.
Although the latest reproductive technologies are available in Georgia today, egg quality and ovarian reserve inevitably decline with age—technology cannot stop the biological clock. Therefore, I advise women to consider their reproductive plans at an earlier age. For those who intend to postpone motherhood until ages 35–40 due to social or career reasons, I recommend egg freezing (fertility preservation). This serves as a form of “biological insurance” that preserves their reproductive freedom for the future.
What is the Solution?
Based on The Lancet publication, scientists are calling on governments and employers to create supportive ecosystems for motherhood and fatherhood. To ensure future generations do not have to choose between a career and a child, flexible work schedules, financial incentives, and access to quality early childhood education are essential.
As a practicing physician, I am convinced that only through the synthesis of reproductive health and social security will it be possible to prevent the demographic crisis that realistically threatens us by 2036.
Source: Y. Du et al., Epidemiological trends, disparities, and developmental correlates of infertility in women of advanced maternal age, 1990–2023: a comprehensive analysis within the GBD framework, The Lancet Obstetrics, Gynaecology, & Women’s Health, July 2026.