What causes infertility in The Handmaid's Tale?

Infertility in the novel is caused by a mix of environmental disaster, disease, reproductive technologies and choices, and even a weaponized sterility virus. All the while, Gilead publicly treats women as the source of the crisis.

Offred knows that healthy births have become rare: the chance of a healthy, living, normal-bodied baby is only one in four. The causes she names include radiation and pollution, atomic power plant accidents, pesticides, syphilis, birth control pills, and women being medically sterilized. Schools had already been closing before Gilead because there were too few children, showing that the fertility crisis existed before the theocracy fully took power.

The novel also makes clear that male sterility is widespread, even though Gilead refuses to admit it. During Offred’s medical exam, the doctor says many Commanders are sterile, a forbidden idea because Gilead’s law allows only women to be blamed for reproductive problems. Serena Joy also suspects the Commander may be unable to father a child, which is why she arranges for Offred to have sex with Nick. Later, the historical account confirms that both likely models for Offred’s Commander, Judd and Waterford, were sterile.

Gilead uses this fertility crisis as the excuse for the Handmaid system. Fertile women become state-controlled reproductive resources, while infertile Wives claim the babies Handmaids bear. The causes of infertility are broad and social, but Gilead turns the problem into a moral accusation against women, especially women associated with contraception, abortion, or sexual freedom. That contradiction sits at the center of The Handmaid’s Tale: a society terrified by biological collapse responds by tightening political and sexual control over the very bodies it depends on.