Hormonal health
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.
Fertility
Weight loss jab shows early promise in improving PMOS fertility

A weight loss jab may improve fertility outcomes in women with PMOS, early findings from an ongoing clinical trial suggest.
The proof-of-concept analysis found that injectable semaglutide may offer reproductive benefits while also addressing obesity and metabolic dysfunction.
It is the first report to examine how injectable semaglutide may improve reproductive outcomes in women with PMOS while also addressing obesity and metabolic dysfunction.
The work forms part of the ongoing RESTORE clinical trial.
Melanie Cree, professor at CU Anschutz and first author of the report, said: “Women with PMOS frequently face a frustrating choice between treatments that target reproductive symptoms and those that address metabolic health.
“Our early findings suggest injectable semaglutide may have the potential to improve both, offering a more comprehensive approach to care.
“This medication is incredibly promising when someone responds with 10 per cent weight loss.”
The trial is examining whether semaglutide can restore ovulation and improve reproductive health in adolescents and adults with polyendocrine metabolic ovarian syndrome, known as PMOS.
PMOS, formerly known as polycystic ovary syndrome or PCOS, is a hormone and metabolic condition linked to irregular periods, raised testosterone levels, infertility risk, obesity and increased cardiometabolic disease.
Cardiometabolic disease refers to conditions linked to the heart and metabolism, such as heart disease, high blood pressure and type 2 diabetes.
Existing treatments, including metformin and hormonal contraceptives, often do not fully address reproductive and metabolic complications at the same time.
The analysis focused on participants aged 12 to 35 who lost at least 10 per cent of their body weight during treatment.
Researchers said reproductive improvements appeared earlier than expected, prompting them to report preliminary findings while the wider study continues.
Cree is also a paediatric endocrinologist at Children’s Hospital Colorado.
Endocrinologists are doctors who specialise in hormones and hormone-related conditions.
Cree said: “What makes this work particularly important is that it focuses specifically on women with PMOS receiving injectable semaglutide.
“Although GLP-1 medications have transformed obesity treatment, there remains a significant need for rigorous data examining how these therapies affect fertility and reproductive function in this population.”
The RESTORE study is evaluating semaglutide treatment in girls and women with PMOS and obesity.
Its broader aim is to determine whether weight loss and metabolic improvements can restore ovulation and improve reproductive outcomes.
Ovulation is the release of an egg from the ovary, a key part of the menstrual cycle and fertility.
The authors said the findings are from an early proof-of-concept analysis and that larger, longer-term studies will be needed to confirm whether the reproductive benefits last.
The findings suggest injectable semaglutide may become a treatment option for women with PMOS seeking improvements in both metabolic and reproductive health, if future studies confirm the results.
Menopause
Apple Health adds menopause and perimenopause tracking

Apple announced menopause and perimenopause tracking for its Health app at WWDC 2026, with symptom logging and cycle alerts for some users.
The update expands the app’s cycle tracking beyond fertility and menstrual periods.
If logged cycle patterns suggest a user may be experiencing perimenopause, the app will send a notification prompting a conversation with a doctor.
However, this perimenopause-specific cycle deviation notification is only for users aged 40 and over and is not intended to replace a doctor’s diagnosis or treatment.
Stacey Ford, Apple’s vice-president of OS management, said users will also be able to log menopause and perimenopause symptoms in the Health app.
Educational content will also be available to help users learn more about these life stages and understand changes in their bodies.
Every year, about 2 million women enter perimenopause, the stage before menopause when levels of the hormone oestrogen decline.
According to a February 2025 survey involving 4,432 participants aged over 30, more than half of women aged 30 to 35 experienced moderate or severe perimenopause symptoms.
The findings suggest perimenopause does not affect only older adults.
About 6,000 women in the US enter menopause every day, according to the Society for Women’s Health Research.
Given the number of women affected by perimenopause and menopause, the update broadens the Health app’s scope.
The app launched in 2019, meaning it has gone seven years without these women’s health tracking features, which could help users better understand their bodies and prepare for informed conversations with doctors.
Hormonal health
Iron deficiency in women: The tiredness everyone normalises

Article produced in association with Spital Clinic
Feeling permanently tired has become so normal for so many women that most of us have stopped questioning it. But one of the most common reasons behind it is also one of the easiest to miss – and one of the most satisfying to fix.
The tiredness that gets explained away
There’s a particular kind of tired that a lot of women simply live with. The mid-afternoon slump that no amount of coffee touches. Needing an early night and still waking up flat. Putting it all down to work, kids, stress, age or hormones – anything except a cause you could actually do something about.
Often, though, that’s exactly what it is: a cause you could do something about. Low iron is one of the most common reasons women feel wiped out, and because it builds so gradually, it rarely announces itself. You don’t wake up one morning feeling different. You just slowly get used to running on less, until “exhausted” starts to feel like your baseline.
Why women are far more likely to run low
Iron is what your body uses to carry oxygen around in your blood. When levels fall, everything has to work a little harder to do the same job – which is why feeling tired is usually the very first thing you notice.
The reason this affects women so disproportionately is simple: periods. Every cycle carries a small iron cost, and over months and years that quietly adds up. Pregnancy adds to the demand too, when the body’s iron needs rise sharply.
But heavy periods are the big one – left unchecked, they can steadily drain your iron, which is why the NHS treats them as something worth looking into rather than just putting up with.
So if your periods sit on the heavier side, you’re not just dealing with the inconvenience in the moment – you may be slowly draining your iron stores at the same time, month after month.
The reassuring part is that heavy periods can be treated, so it’s worth having them looked at rather than soldiering on.
What low iron actually feels like
Tiredness is the headline, but it’s rarely the only clue. Low iron can show up as feeling breathless going up stairs you used to manage without thinking, a foggy, can’t-quite-focus feeling, looking paler than usual, or noticing your heart racing or thumping for no obvious reason.
Then there are the stranger signs people almost never connect to iron: brittle nails, more hair than usual collecting in the brush, restless legs at night, and – oddly – craving and crunching ice. On their own, each of these is easy to shrug off. Lined up together, they’re very often the same story.
Why it so often slips under the radar
Part of the problem is that none of these symptoms screams “iron.” They’re vague, they overlap with ordinary life, and they arrive slowly enough that you adjust without realising. Most of us are also remarkably good at minimising our own tiredness – we assume everyone feels like this, so there’s nothing to mention.
The result is that low iron can go unaddressed for years, not because it’s hard to find, but because nobody thinks to look. It’s a genuinely common, genuinely treatable issue that quietly chips away at how good you’re allowed to feel.
When “heavy” periods are actually heavy
Here’s the tricky bit: most women have no real benchmark for what counts as heavy, because the only period we ever experience is our own. A useful rule of thumb is needing to change a pad or tampon every hour or two, bleeding that lasts longer than seven days, or passing clots bigger than a 10p coin.
NICE frames it even more usefully: periods count as heavy if they’re getting in the way of your life – physically, emotionally or socially. You don’t have to measure anything. If you’re planning your week around your period, doubling up on protection, or it’s leaving you drained, that’s reason enough to take it seriously.
And the good part is they don’t have to be permanent. If yours have crept up over time, getting them under control is worth it in its own right – and it often tackles the iron problem at its source, rather than topping you up only to lose it again next month.
How you actually find out
You can’t tell your iron levels from how you feel. Plenty of women feel rough with results that look “borderline fine,” and some feel reasonably okay while their reserves are already running low.
The only way to know is a straightforward blood test that checks both your blood count and your ferritin – the marker that reflects how much iron you’ve actually got stored away.
Ferritin is the one that matters here, because it tends to drop first, before a standard anaemia test would flag anything as wrong. That’s exactly why a woman can be told her bloods are “normal” and still feel exhausted: the headline number looks acceptable, but the reserves sitting behind it have been running down for a while.
The good news: it’s very fixable
This is the part worth holding onto. Iron deficiency is one of the more rewarding things to put right. The NHS approach is usually a course of iron tablets over several months to rebuild your stores, paired with a source of vitamin C – even just a glass of orange juice – to help your body absorb them properly.
Alongside that, dealing with whatever’s causing the loss in the first place is what stops you ending up back at square one.
Most women start to notice the difference within a few weeks, often well before their levels are fully restored. The fog lifts, the stairs get easier, and the version of “normal” you’d quietly resigned yourself to turns out not to have been normal at all.
The takeaway
The exhaustion so many women treat as a fixed fact of life frequently isn’t one. Low iron is common, it’s quick to check, and it’s straightforward to put right – but only if someone actually looks for it.
If you’ve been tired for longer than you can remember, especially if your periods are heavy, it’s worth getting your iron checked rather than explaining it away for another year. Speaking to a GP is usually all it takes to get that started – and more often than not, the fix turns out to be far simpler than the months of tiredness would suggest.
Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published NHS and NICE information as at May 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 Spital Clinic, 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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