News
Declining fertility rates: A fertility nurse’s perspective
By Heather Frame, BSN, RN
In my work with fertility patients, one question I hear again and again is: “Why does it seem harder to get pregnant now than it used to?”
It’s not just perception.
The numbers show a clear shift. In 2024, the United States (U.S.) lifetime fertility rate hit a historic low of less than 1.6 children per woman, well below the replacement rate of 2.1.
The total number of births, however, edged up slightly to 3.63 million—a sign that while more people are waiting to start families, many are still finding ways to succeed.
In the European Union (EU), the decline is even steeper. 2023 marked an all-time low, with fertility rates falling from 1.46 to 1.38 children per woman in just a year.
The causes are complex—social change, economic pressures, lifestyle shifts, environmental factors—but from where I sit as a fertility nurse, three themes stand out.
1. The Reality of Delayed Motherhood
In my practice, I meet incredible women in their late 30s and 40s who are just beginning their journey to conceive.
They’ve built careers, gained stability, traveled, and waited for the right moment.
But the biology of reproduction has its own timetable.
After age 35, egg quality begins to decline, miscarriage risk increases, and the “fertility window” narrows.
This doesn’t mean parenthood is impossible—far from it.
But it does mean understanding your body’s signals early, even years before you’re ready, can make a big difference.
That’s why I often encourage women to track ovulation and monitor hormonal health early.
The goal isn’t to rush you; it’s to give you the knowledge you’ll need when you decide the time is right.
2. The Hidden Role of Environmental Toxins
Fertility challenges don’t always start in the body. Sometimes they begin in our environment.
From pesticides in produce to chemicals in cosmetics, certain compounds can disrupt hormones, alter menstrual cycles, and even reduce sperm quality.
I’ve seen couples struggle for years before discovering that environmental toxins were an invisible obstacle.
Even small shifts like switching to fertility-friendly cleaning products, choosing organic when possible, and avoiding plastics can help reduce the toxic load on the body.
When we remove these hidden stressors, we often see improvements in cycle regularity, sperm health, and overall reproductive wellness.
3. Stress, Lifestyle, and the Modern Pace of Life
The connection between stress and fertility is real—and often underestimated.
Chronic stress can delay ovulation, affect hormone production, and lead to cycles that are harder to predict.
Layer on poor sleep, limited exercise, and less-than-optimal nutrition, and the odds of conceiving naturally can dip further.
I’ve worked with women who found that simply introducing light daily movement, better-quality sleep, and nutrient-dense meals improved their cycles within months.
These aren’t “quick fixes,” but rather the slow, sustainable habits that support reproductive health long-term.
The Cultural Shift We Can’t Ignore
Heather Frame
Statistics alone don’t tell the full story.
Across both the U.S. and the EU, more people are choosing to have fewer children or none at all.
Rising living costs, shifting career priorities, and changing expectations around parenting all play a role.
Some couples decide on one child for financial or lifestyle reasons.
Others postpone starting a family until they feel “ready”—a milestone that, for many, is harder to reach than expected.
This cultural shift doesn’t make fertility challenges any less personal.
For those who want children, it’s about aligning their own dreams with the realities of biology and life circumstances.
How Apps like Premom Ovulation Tracker Can Help
In today’s world of declining fertility rates, one of the most preventable barriers to conception is mistiming ovulation.
Cycles can vary more than many people realise, and without reliable tracking, the most fertile days are easy to miss.
The Premom app, when paired with ovulation tests and basal body temperature tracking, offers a clear, data-driven way to better understand and work with your cycle.
- Fertile Window Identification: Ovulation test results are analysed to show the days when conception is most likely, helping to reduce the number of cycles it takes to become pregnant.
- Early Awareness of Cycle Changes: By spotting potential issues like irregular cycles or hormonal imbalances, Premom gives you the opportunity to address concerns sooner and optimize your fertile window.
- Lifestyle Guidance: Personalised recommendations on nutrition, stress reduction, and sleep can help create a fertility-friendly lifestyle.
- Emotional Support: Premom connects you with a community of women who understand the emotional side of the journey, offering encouragement every step of the way.
When timing is right, conception often happens faster — and having the right tools can make that timing far easier to get right.
Final Thoughts: A Personal Perspective
I waited until my career was stable, my marriage was thriving, and I was financially secure before trying for a baby.
Even with all that preparation, I faced two years of infertility struggles.
Looking back, I wish I’d been more proactive by tracking my cycle earlier, getting baseline fertility tests, and making small lifestyle changes sooner.
If you’re reading this and wondering when to start thinking about your fertility, my advice is: start now.
Not because you should rush, but because being informed gives you choices.
Whether you’re ready this year, in five years, or not at all, understanding your body today will help you make the decisions that feel right for you tomorrow.
About the author
Heather Frame, BSN, RN, is a registered nurse and certified health and nutrition coach with a focus on women’s health and fertility. She serves as a Medical Advisor at Premom, providing evidence-based guidance on conception and reproductive wellness.
About Premom
Premom is a comprehensive period and fertility tracking app and resource hub designed to help women track ovulation, understand their cycles, and optimize their chances of conception. As the sister brand of Easy@Home, a leading ovulation test brand, Premom combines innovative technology with expert guidance to support women at every stage of their fertility journey.
A new Female Health Hub launched by the English FA will support women and girls in grassroots football in England with trusted advice on health issues affecting play.
The hub brings together expert-backed guidance, practical tools and player insights in one place, giving women and girls practical advice and reassurance on female health in football.
It has four core aims: to help women and girls better understand their bodies and how female health affects performance and participation, to educate players on key health topics and when to seek further advice or support, to provide practical strategies to help navigate common female health challenges, and to help break down taboos and normalise conversations around female health in football.
Users of the hub will also be able to hear directly from members of the England women’s national team, who share their own experiences of navigating female health matters while playing at the highest level of the game.
“Our ambition is to create a game where women and girls can thrive,” said Sue Day, the FA’s director of women’s football.
“To achieve that, it’s essential that players feel supported in environments that understand and respond to their female health needs.
“We’ve heard directly from grassroots players that they want better information and support around female health, but that they often don’t know where to find it.
“The launch of the Female Health Hub marks an important step in changing the landscape.
“We want every player to feel confident in her own skin and supported without judgment, so she can feel empowered by her body, rather than held back by it.”
The platform was launched following research conducted by the FA that highlighted the need for better education and support around female health in football.
According to the FA, 88 per cent of adult players surveyed said their menstrual cycle has an impact on their ability to train or play, but 86 per cent reported they had never received education about the menstrual cycle in relation to football performance and training.
The research also found 64 per cent of women experience issues related to sports bras or breast health while playing football, despite sports bras being considered one of the most important pieces of playing kit.
Players also expressed strong interest in learning more about injury prevention, at 87 per cent, nutrition, at 84 per cent, and mental health, at 77 per cent, in relation to female health.
The first phase of the Female Health Hub focuses on three of the most requested topics: menstrual health, breast health and injury resilience, with further content to follow, including nutrition and pelvic health guidance.
The Royal College of Midwives (RCM) has referred to the women’s health strategy as a ‘missed opportunity’ to address maternity services.
The renewed strategy was released by the government this week, with the aim of putting women’s experiences at the centre of care and ensuring they are “better heard and served”.
However, the government stated that because of ongoing investigations into maternity services across the country, the strategy “does not seek to address safety in maternity and neonatal services”.
The RCM described this as a “missed opportunity” and urged the government to ensure that, following the inquiries, maternity is placed “at the very heart” of the strategy.
Gill Walton, RCM chief executive, said the college was “deeply disappointed” that maternity services “do not feature as a headline priority” in the renewed strategy.
She said: “This is a significant missed opportunity and one that is very difficult to understand.
“Pregnancy, birth and the postnatal period are not a footnote in women’s health – they are one of the most significant and consequential phases of a woman’s life.
“A strategy that treats maternity as an afterthought is not truly a women’s health strategy at all. It is exactly the kind of thinking that has allowed maternity services to reach the point they are at today.”
Walton acknowledged that the strategy contained commitments on ensuring women’s voices shape their care, on supporting families through pregnancy loss and on the principle that services should be held accountable when they fail to listen to women.
She added: “But a strategy that addresses one part of women’s health while leaving maternity care behind is only doing half the job.”
Walton urged the government to ensure that this is addressed when the ongoing investigations into maternity care conclude, with any recommendations placed “at the very heart of this strategy with the seriousness and urgency that women, families and midwives deserve”.
In the foreword to the renewed plans, health and social care secretary Wes Streeting referred to the ongoing independent National Maternity and Neonatal Investigation as action being taken by the government to improve safety in maternity services.
The strategy also refers to the new National Maternity and Neonatal Taskforce, chaired by Streeting, which aims to help deliver “safer, more equitable care” for women, babies and families.
The foreword said that, because of ongoing initiatives, it was “important that this work continues without restriction and that the government can properly respond to the findings”.
It added: “This renewed women’s health strategy therefore does not seek to address safety in maternity and neonatal services other than that related to women’s health before and during pregnancy and the actions we are taking immediately to improve maternity and neonatal care.”
The strategy does, however, include plans to prioritise health education in schools, communities and healthcare settings to “empower women” with the “knowledge and tools they need to help control their fertility” and “prepare for the best pregnancy outcomes.
It also promises to provide women with access to “safe and high-quality contraception, abortion care, fertility services, preconception care and support after pregnancy loss in convenient settings.
Article produced in association with London Pregnancy Clinic and Jeen Health
For the majority of couples planning a pregnancy, genetic testing is not something they think about until a problem arises.
Pre-conception genetic carrier screening challenges this approach by identifying risk before pregnancy begins.
As panel sizes have grown and at-home testing options have become widely available, carrier screening is transitioning from a niche clinical referral into a mainstream component of reproductive planning.
What Carrier Screening Tests For
Being a carrier of a genetic condition means carrying one copy of a variant in a gene associated with that condition, without being affected by it.
In most cases, carriers are entirely unaware of their status.
The clinical significance of carrier status emerges when both members of a couple carry a variant in the same gene: in this scenario, each pregnancy carries a one in four chance of resulting in a child who inherits two copies of the variant and is affected by the condition.
The conditions most frequently included in expanded carrier screening panels include cystic fibrosis, spinal muscular atrophy (SMA), fragile X syndrome, sickle cell disease, and a range of metabolic and enzyme deficiency disorders.
The Beacon 787 carrier test, offered by Jeen Health, screens for 787 conditions from a single sample, making it one of the most comprehensive panels currently available to UK families.
Who Is Most Likely to Benefit
Any couple planning a pregnancy can consider carrier screening. It is particularly relevant for:
- Couples with a family history of a known inherited condition
- Those from populations with higher carrier frequencies for specific conditions, including Ashkenazi Jewish, South Asian and African communities
- Couples pursuing fertility treatment, where genetic information informs treatment planning
- Those who wish to have the most complete picture of their reproductive health before conception
Importantly, being a carrier of a condition does not mean a child will be affected. It means there is a defined statistical risk that can be quantified, discussed and planned for with appropriate clinical support.
How the Test Is Performed
Carrier screening is typically carried out on a blood or saliva sample.
For at-home options such as the testing offered by Jeen Health, a cheek swab collection kit is dispatched to the patient, the sample is returned by post, and results are delivered digitally within a defined turnaround period.
In-clinic carrier testing may use a blood draw and provides the advantage of immediate access to a clinical consultation at the point of result delivery.
London Pregnancy Clinic offers genetics counselling through its partnership with Jeen Health, allowing couples to receive and contextualise carrier test results with expert support.
Genetic counselling before and after testing is recommended by Genomics England as a standard component of any genomic testing pathway.
What Happens If Both Partners Are Carriers
If both partners are identified as carriers for the same autosomal recessive condition, they are typically offered further counselling to discuss their options.
These may include proceeding naturally with an awareness of the risk, using prenatal diagnosis (CVS or amniocentesis) during pregnancy to test the fetus, or pursuing preimplantation genetic testing (PGT) in the context of IVF, which allows unaffected embryos to be selected before transfer.
The purpose of identifying carrier status before pregnancy is to give couples time to consider these options without the added pressure of an ongoing pregnancy.
Knowledge of carrier status does not remove reproductive choices; it expands the information available when making them.
The Role of Pre-Conception Services
Carrier screening sits within a broader category of pre-conception care that includes fertility assessments, general health optimisation and, where relevant, management of existing conditions before pregnancy begins.
London Pregnancy Clinic offers pre-conception services encompassing fertility investigations, genetics counselling and carrier testing as part of an integrated 0th trimester approach, allowing couples to address genetic and clinical risk factors before their pregnancy starts rather than after.
Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment.
Clinical guidance referenced reflects published NHS, NICE and RCOG standards as at March 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.
This piece was produced in association with London Pregnancy Clinic and Jeen Health, which provided background clinical information for editorial purposes.
Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
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