Fertility
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.
Onto Health has acquired Levy Health, a fertility software company providing precision diagnostics and patient intake for reproductive medicine.
The acquisition, fuelled by Onto Health’s US$20m Series A fundraise in April, supports its plan to build scalable, tech-enabled infrastructure for reproductive medicine.
Onto founder Roohi Jeelani, MD, called it the first of several moves in the company’s expansion strategy in a LinkedIn post, adding that there was “more coming soon”.
She said: “This isn’t just an acquisition, it’s proof of how we’re building Onto: physician-led, tech-enabled, and built to scale without losing the personal touch fertility patients deserve.”
Headquartered in Chicago, Onto Health combines evidence-based fertility care with artificial intelligence-driven diagnostics, clinical automation and longevity science.
AI-driven diagnostics use software to analyse patient information and support clinical decision-making, rather than replace clinicians.
Levy Health, founded in Berlin with US offices in San Francisco, helps medical providers identify endocrine disorders more quickly and helps clinics streamline fertility workups.
Endocrine disorders affect the body’s hormone system, which can influence ovulation, menstrual cycles and fertility.
Co-founder Caroline Mitterdorfer said joining Onto would expand Levy Health’s fertility care tools to more clinics and patients, helping physicians focus on patient care.
Onto opened its first clinic in Chicago in February, with plans for three more in the greater Chicago area.
The company said in April that it would use its new funding, led by Artis and Humania, to support additional operations in the US and expand into the Gulf Cooperation Council.
The Gulf Cooperation Council includes six Arab states bordering the Persian Gulf.
Softening ageing ovaries could help women remain fertile for longer, early animal research suggests.
Fertility declines with age for several reasons, including poorer egg quality, fewer ovarian follicles and the gradual stiffening of ovarian tissue.
Existing fertility treatments, including hormone therapy and in vitro fertilisation, mainly address hormonal imbalances or help eggs mature or become fertilised.
Scientists are now examining whether changing the physical structure of the ovaries could provide another route for future fertility treatments.
Stuart A. Cook, of the Cardiovascular and Metabolic Disorders Programme at Duke-National University of Singapore Medical School, published an accompanying commentary on the research.
Researchers led by Shixuan Wang at Huazhong University of Science and Technology in Wuhan, China, collected healthy ovarian tissue from younger, middle-aged and older women.
They also examined samples from patients with polycystic ovary syndrome, known as PCOS, premature ovarian insufficiency, or POI, and endometriosis.
PCOS is a hormonal condition that can disrupt ovulation. POI occurs when the ovaries stop working normally before the age of 40, while endometriosis causes tissue similar to the womb lining to grow elsewhere in the body.
Tests of protein levels and gene activity found higher levels of the inflammatory protein interleukin-11, or IL-11, in ageing and diseased ovaries.
In laboratory experiments, the researchers exposed ovarian fibroblasts to IL-11. Fibroblasts are cells that produce connective tissue.
The protein caused the cells to produce excess collagen, a structural material that can build up during scarring and make tissue stiffer.
The researchers then genetically modified mice so they could not respond to IL-11. The animals developed less ovarian stiffening and maintained better ovarian function as they aged.
Similar results were seen in mouse models of PCOS and POI caused by chemotherapy.
In the final part of the experiment, older mice and rats were injected with a nanoparticle treatment containing small interfering RNA, or siRNA, designed to switch off IL-11.
The treatment made the animals’ ovaries less stiff and improved fertility.
Pregnancy rates among older mice rose from 25 per cent to 50 per cent, while average litter sizes also increased.
More rats treated with the therapy became pregnant and produced larger litters.
The approach remains highly speculative and will require considerably more research before its safety or effectiveness in women can be established.
However, the researchers said blocking the inflammatory pathway could eventually form the basis of new fertility treatments.
They said: “We propose that anti-IL-11 therapy represents a promising translational strategy for delaying ovarian ageing.”
W Group has opened applications for W Accelerate with Merck KGaA and M Ventures, inviting reproductive and maternal health startups, scaleups and spinouts to pitch for direct access to global pharma partnership and strategic investment.
Selected companies will pitch on 5th October, competing for the chance to accelerate their growth through commercial partnerships, investment, or both.
This is the third time Merck KGaA, a global leader in reproductive health, has partnered with W Group on the programme, which exists to close the innovation and investment gap in women’s health by connecting the sector’s most promising startups directly with the corporates and investors positioned to scale them.
What Merck KGaA and M Ventures are looking for
This year’s call is focused on breakthrough solutions in female infertility, fertility preservation, adenomyosis, endometriosis, polyendocrine metabolic ovarian syndrome (PMOS), ovarian insufficiency, preeclampsia and pregnancy comorbidities.
New for this round, applicants choose between three pathways depending on what they need from the programme:
- The Partnership Lane, for companies seeking commercial collaborations and strategic relationships
- The Investment Lane, for founders looking to connect with investors and secure funding to scale
- The Dual Lane, for innovators pursuing both partnership and investment opportunities
How the Accelerate event works
Selected companies get a 1:1 pitch practice session ahead of time, then a private 30-minute session with Merck KGaA and M Ventures leadership on the day itself, small-group sessions with regulatory and investment strategy experts, an “Ask Merck Anything” roundtable, and a VIP networking reception.
Key dates
- Open call launches: 8th July
- Open call closes: 2nd September
- Notification of successful companies: 11th September
- Pitch day: 5th October
Applications are open now at wplatform.typeform.com/to/KGzviBQM.
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