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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.
Ovarian cancer cells quickly activate survival responses after PARP inhibitor treatment, and a lung cancer drug could help block this, research suggests.
PARP inhibitors are a common treatment for ovarian cancer, particularly in tumours with faulty DNA repair. They stop cancer cells fixing DNA damage, which leads to cell death, but many tumours later stop responding.
Researchers identified a way cancer cells may survive PARP inhibitor treatment from the outset, pointing to a potential way to block that response. A Mayo Clinic team found ovarian cancer cells rapidly switch on a pro-survival programme after exposure to PARP inhibitors. A key driver is FRA1, a transcription factor (a protein that turns genes on and off) that helps cancer cells adapt and avoid death.
The team then tested whether brigatinib, a drug approved for certain lung cancers, could block this response and boost the effect of PARP inhibitors. Brigatinib was chosen because it inhibits multiple signalling pathways involved in cancer cell survival.
In laboratory studies, combining brigatinib with a PARP inhibitor was more effective than either treatment alone. Notably, the effect was seen in cancer cells but not normal cells, suggesting a more targeted approach.
Brigatinib also appeared to act in an unexpected way. Rather than working through the usual DNA repair routes, it shut down two signalling molecules, FAK and EPHA2, that aggressive ovarian cancer cells rely on. FAK and EPHA2 are proteins that relay survival signals inside cells. Blocking both at once weakened the cells’ ability to adapt and resist treatment, making them more vulnerable to PARP inhibitors.
Tumours with higher levels of FAK and EPHA2 responded better to the drug combination. Other data link high levels of these molecules to more aggressive disease, pointing to potential benefit in harder-to-treat cases.
Arun Kanakkanthara, an oncology investigator at Mayo Clinic and a senior author of the study, said: “This work shows that drug resistance does not always emerge slowly over time; cancer cells can activate survival programmes very early after treatment begins.”
John Weroha, a medical oncologist at Mayo Clinic and a senior author of the study, said: “From a clinical perspective, resistance remains one of the biggest challenges in treating ovarian cancer. By combining mechanistic insights from Dr Kanakkanthara’s laboratory with my clinical experience, this preclinical work supports the strategy of targeting resistance early, before it has a chance to take hold. This strategy could improve patient outcomes.”
Nighttime temperatures during pregnancy may be linked to a higher chance of an autism diagnosis in children, a recent study suggests.
The research tracked nearly 295,000 mother-child pairs in Southern California from 2001 to 2014 and linked warmer overnight temperatures with higher risk in early and late pregnancy.
Children of mothers exposed to higher than typical nighttime temperatures during weeks one to 10 of pregnancy had a 15 per cent higher risk of an autism diagnosis.
Exposure during weeks 30 to 37 was linked to a 13 per cent higher risk.
Lead author David Luglio, a post-doctoral fellow at Tulane University, said: “A key takeaway is that we identified specific windows when a mother and her developing child can be most affected by exposures to higher nighttime temperatures.
“This is critical and hopefully can help mothers prepare accordingly.”
The study is described as the first to examine how temperature may affect fetal neurodevelopment, the process by which a baby’s brain and nervous system form during pregnancy.
Extreme temperatures linked to increased risk were classified as above the 90th percentile, meaning 3.6°F hotter than average, and the 99th percentile, 5.6°F above average.
The association held even after researchers accounted for factors such as neighbourhood conditions, vegetation and fine-particle air pollution.
The study could not account for other factors such as access to air conditioning. Researchers did not find the same association with daytime temperatures, potentially because people spend more time away from home during the day.
“Heat waves are becoming more frequent, and people may only think of the dangers of daytime heat exposure,” said Mostafijur Rahman, assistant professor of environmental health sciences at Tulane University.
“These results indicate a strong association between high nighttime temperatures during pregnancy and autism risk in children and show that we need to think about exposure to heat around the clock.”
The study did not examine how higher temperatures at night might affect prenatal development, though Luglio said it is possible that warmer nights disrupt sleep for pregnant mothers.
Previous research has suggested insufficient sleep during pregnancy may be linked to a higher risk of neurocognitive delays in children.
“Extreme heat exposure during pregnancy has been linked to a range of adverse health outcomes, including prenatal neurodevelopment delays and complications with an embryo’s development of a central nervous system,” Luglio said.
“The goal of our study was to specifically explore the link between prenatal heat exposure and autism diagnoses for the first time.”
Kindbody has launched a fertility platform integrating AI with clinical care and patient support for employers and health plans.
The platform will enter a pilot with select Kindbody employer clients in 2026, covering over three million lives, ahead of wider availability in 2027.
Building on the company’s clinical model, the platform aims to improve outcomes and cost efficiency across family-building journeys. It connects Kindbody-owned clinics, partner clinics and an integrated clinical app.
The app offers virtual care across conception, pregnancy and reproductive health, extending through the menopause transition.
Launch features include updates in medication management, third-party reproduction, adoption, pregnancy, men’s health and global programme design.
David Stern, chief executive of Kindbody, said: “With our next-generation fertility platform, Kindbody is redefining what comprehensive, intelligent and affordable family-building care looks like for employers, health plans and patients.
“By unifying best-in-class clinical care, AI-driven intelligence and whole-person support, we are making it easier and more cost-effective for more people to build the families they envision.”
Kindbody has expanded access via its national network of IVF centres, including IVIRMA, Inception Fertility and Ivy Fertility.
A new Fertility Medication Portal is designed to streamline authorisations so medicines can be dispensed on time, giving patients visibility from prescription to coverage, pharmacy fulfilment and delivery tracking.
Through KindMan, men’s health education, digital resources and integrated clinical care are expanding, including hormone management programmes.
Services cover andropause (age-related testosterone decline), erectile dysfunction, low testosterone and other male reproductive conditions.
Specialist fertility care includes semen analysis, diagnostic testing, male hormone panels, genetic testing, surgical sperm extraction and sperm cryopreservation.
Launching in the second quarter, a pregnancy support app will act as a digital companion for expecting and new parents, with resources, interactive tools and clinical assessments to identify social drivers of health and mental health needs during pregnancy and beyond.
Kindbody’s physician-led menopause programme provides consultations with board-certified obstetricians and gynaecologists to diagnose, treat and manage menopausal symptoms, including hormone replacement therapy where appropriate, with support from nutritionists, mental health therapists and pelvic floor specialists.
AI and analytics will be embedded across the care journey. An AI care navigator will guide employees from benefit activation through intake, triage and scheduling.
Tools will track benefits and treatment plans, showing coverage and expected out-of-pocket costs at each step.
AI-supported scribing will assist clinicians with documentation, and a predictor tool will estimate a patient’s likelihood of having a baby across different treatment paths.
In 2027, Kindbody plans a savings model for eligible large employers that it says will guarantee lower total fertility spend while improving clinical efficiency and patient experience.
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