What are the Five Main Factors that Affect Fertility in Women?-image

What are the Five Main Factors that Affect Fertility in Women?

Medically Reviewed by Hertility on March 28, 2024

In this article, we’ll delve into the five main lifestyle factors that play a pivotal role in female fertility, and how you can shape and optimise your lifestyle to support your reproductive health.

Quick facts:

  • A mixture of biological, genetic and environmental factors all impact fertility.
  • These include your hormones, age, underlying conditions and lifestyle choices. 
  • There are several things you can do to support your reproductive health, it isn’t all down to chance. 
  • Optimising your diet, reducing alcohol, stress and smoking can all help to support your hormones and fertility. 
  • Getting your tested for underlying conditions if you have any hormonal symptoms is also key.

Understanding female fertility

When embarking on your fertility journey, whether it’s trying to conceive for your first or your fifth—planning is everything. 

Understanding the various lifestyle factors that can affect your fertility is crucial for both individuals and couples looking to begin their conception journey.  

Lots of couples conceive without any issues, but 1 in 6 heterosexual couples face fertility struggles, so if it’s taking longer than you’d hoped, know that you’re not alone. 

The earlier you know what’s going on inside your body, the earlier you can take action to support your future fertility goals. 

There are lots of different factors that can impact female fertility—including age, lifestyle factors, hormones, reproductive health conditions and environment. 

To get pregnant and have a baby, lots of these biological and environmental factors come into play. When one or more of these factors fall out of sync, that’s when you might face difficulties with fertility.

Let’s take a look at some of these factors and how you can prepare for your fertility journey.

Age and fertility

First, let’s explore what fertility is from a biological perspective. Ovulation plays a critical role, marking the release of an egg from the ovary. For a pregnancy to occur, a healthy egg must meet healthy sperm (usually in the fallopian tube) where the egg gets fertilised.

Plus, the uterus (womb) must be in optimal condition so the fertilised egg can implant and grow into a healthy baby.

But unfortunately, biology often has other plans for us. We hear a lot about the ‘biological clock’ when it comes to women and those assigned female-at-birth (AFAB). This references the deterioration of both the quality and quantity of your eggs over time—known as your ovarian reserve. 

Women and those AFAB are born with all the eggs they’ll ever have. Each menstrual cycle, you lose eggs. Once you hit your mid-thirties, this decline increases even more rapidly. Add in hormonal changes as a result and collectively, it reduces your ability to become, and often stay, pregnant.

For a pregnancy to occur, you need healthy eggs. So from a biological standpoint, the younger you are, the healthier your eggs will be. 

While an Anti-Müllerian Hormone (AMH) test can help you to understand how many eggs you have left, it can’t tell us the quality of the eggs we have.

Additionally, after the age of 35, there’s a higher risk of pregnancy-related complications and negative health outcomes for the baby. There’s also a higher risk of miscarriage, high blood pressure, and gestational diabetes. Plus, chromosomal conditions like Down’s syndrome are more common.

Despite misconceptions, ageing affects male fertility too. From age 40 onwards, sperm quality and sperm function decrease with significant implications to pregnancies and births including increased time to conception and increased risk of miscarriage.

Lifestyle choices and fertility

The idea that our fertility is out of our control is somewhat of a myth. Whilst biological and genetic factors play a big role—there’s a lot we can do to support our reproductive health. 

Through lifestyle choices, we can impact the quality of our eggs and contribute to a healthier reproductive environment.

Eating a well-balanced, nutritionally rich diet, getting regular physical exercise, managing stress, getting enough sleep and stopping or reducing smoking and excess alcohol can contribute to improving your fertility.

This is because your lifestyle choices directly impact your hormones, and hormonal balance (involved in regulating your menstrual cycle) is crucial to a successful conception, pregnancy and healthy baby.

Let’s take a look at some lifestyle tips that can help take care of your fertility

Eat a fertility-friendly diet

One of the best things you can do to support your fertility is to focus on your nutrition. Eating a Mediterranean diet—one that’s based on plant foods like fruit, vegetables, nuts, beans and whole grains with a moderate amount of dairy, fish, meat and eggs—can be really beneficial. 

Check out our fertility-friendly meal plan, and fertility nutrition shopping list to support your healthy diet.
If you’re trying for a baby and in the first 12 weeks of pregnancy, taking prenatal supplements like folic acid is important as it can help prevent major birth defects by supporting neural tube development.

Get regular physical exercise

Getting regular physical exercise is healthy no matter where you are in your fertility journey, but be wary of overexercise. Too much vigorous physical activity can stop ovulation, cause irregular periods or stop them altogether, known as hypothalamic amenorrhea. 
An absent period is often a sign that something’s not quite right, so it’s worth speaking with a healthcare professional if you’re worried.

Limit smoking and alcohol

Smoking, alcohol and recreational drug use are associated with an increased risk of miscarriage and complications during conception and pregnancy.

Cigarette smoke contains chemicals that can disrupt your hormones and impact your fertility. It’s also been linked with early onset menopause.

There’s limited evidence to know how vaping affects fertility (although early studies suggest it could affect the ability to implant and result in lower birth weights) but if you’re trying to get pregnant, not vaping is safer than vaping. 

The lack of information doesn’t mean it’s safe, but by stopping, you’re being exposed to fewer chemicals. Get help to quit smoking in the UK with the NHS.

Excess alcohol consumption is not only associated with hormone imbalances, there is no safe level of alcohol that can be consumed during pregnancy as it can lead to adverse health effects for the baby. 

In women and those assigned-female-at-birth, disrupting your hormones can affect your menstrual cycle causing irregular periods which can affect ovulation, reducing your chances of conceiving.

As well as its impact on our hormones, drinking and smoking negatively impact our general health which can lead to knock-on impacts on our fertility making it harder to become and stay pregnant, as well as increasing the risk of foetal conditions and birth complications.

Try to combat stress

While there aren’t many studies that suggest that stress itself affects fertility, reducing stress supports healthy hormones, and disruption to your hormonal balance might affect your reproductive health.

It’s likely down to the indirect effects. Chronic stress can cause a loss of sex drive or impact our menstrual cycle causing irregular periods and anovulation (when ovulation doesn’t occur). If you’re having sex less and you’re not ovulating, you’re much less likely to become pregnant.

It’s worth taking note of the choices you make when you’re stressed, anxious, or depressed too. Things like overeating, undereating, drinking alcohol, smoking, not exercising, overexercising, and trouble sleeping can negatively impact your health, well-being and fertility.

Manage your stress and emotional well-being with coping strategies to support your mental health. These could include boosting your relaxation with breathing techniques, yoga, massages, walks, exercise, cooking, reading, mindfulness, journalling, dancing, painting or meditation—anything that makes you feel calmer.

Sometimes distraction is a great way to destress too. Cleaning, decluttering or watching your favourite TV show can help to take your mind off things.

Talking with a friend, family or fertility counsellor about your worries could help too. A problem shared is often a problem halved. Even managing your boundaries can help you to feel less stressed—whether that’s taking more time for yourself or saying no more often.

Reproductive health conditions and fertility

Reproductive health conditions are common and can affect fertility. Unfortunately, some are difficult to detect. 

Signs and symptoms to look out for are irregular or absent periods, severe period pain, vaginal dryness and hot flushes, skin and hair conditions like acne, excess hair growth, fatigue and feeling cold and pain during intercourse.

If you’re concerned about symptoms, our hormone and fertility test can screen you for up to 18 health conditions. 

Ovulation disorders, which affect the release of eggs from the ovaries, can affect your fertility. Without an egg, pregnancy can’t occur. Let’s take a look at some of the most common ovulation disorders.

PCOS (Polycystic ovary syndrome)

Affecting 1 in 10 in the UK, PCOS is a common hormone and metabolic disorder that leads to a hormonal imbalance which can make periods and ovulation irregular or even stop affecting fertility and also cause symptoms like acne and excessive hair growth.


Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus. 

Estimates suggest that around 10% of women of reproductive age may have endometriosis. It is a leading cause of pelvic pain and can have a significant impact on fertility. Women with endometriosis are at an increased risk of miscarriage, ectopic pregnancy and other complications compared to those without.


Uterine fibroids are benign growths of fibrous and muscle tissue in or around the uterus (womb). Around 2 in 3 will develop one at some point in their life, and most often occurs when you’re aged 30 to 50.

Primary ovarian insufficiency 

Primary ovarian insufficiency (known as premature menopause or POI) is when the ovaries stop working before the age of 40, marking the end of your reproductive years.

Fallopian tube damage

Fallopian tube damage or blockage is often caused by pelvic inflammatory disease (PID) which can be caused due to untreated sexually transmitted infections or a past ectopic pregnancy. If PID affects the fallopian tubes, it can scar the lining making it more difficult for eggs to pass through to be fertilised.

Protect against STIs

Left untreated sexually transmitted infections can lead to fertility issues because they can lead to scarred or blocked Fallopian tubes, which can increase your risk of an ectopic pregnancy.

Protect yourself from STIs by using barrier protection like condoms (external and internal ) as well as attending routine STI testing and cervical screening appointments. Most STIs can be treated or managed with timely intervention.

Hormones and fertility 

Reproductive hormones, including oestrogen, progesterone, testosterone, follicle-stimulating hormone, luteinising hormone, as well as thyroid and other hormones all contribute to regulating your menstrual cycle. 

A healthy functioning menstrual cycle and ovulation is crucial for female fertility. If any of these hormones become imbalanced it can negatively affect your ability to conceive as well as cause a range of hormonal symptoms. For more info about all of these hormones take a look at our post about why you should test your hormones.

Thyroid problems (hyperthyroidism and hypothyroidism)

Your thyroid regulates lots of bodily processes, including regulating metabolism, heart rate, temperature and muscle contraction. 

Thyroid disorders, like hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can cause a whole host of problems and knock-on effects on your fertility. 

It may result in symptoms such as anxiety, heart palpitations and unintended weight loss and hypothyroidism may result in symptoms such as depressive or low mood, fatigue and weight gain. If untreated, hyperthyroidism and hypothyroidism can affect your long term health and fertility.  


Hyperprolactinemia is marked by abnormally high levels of the hormone prolactin (which stimulates breast milk production during and after pregnancy). 

In women, elevated prolactin levels can disrupt the normal menstrual cycle and ovulation, potentially leading to irregular periods and difficulties with conception.

Environment and fertility 

To support your fertility, you should avoid exposure to environmental pollutants, toxins and chemicals since these have been proven to negatively impact fertility. Pollutants can disrupt your hormones, affect your reproductive health and harm a baby’s chance for survival.

Unfortunately, chemicals exist in our air, food, water, cleaning products, and health and beauty products. Some practical steps to reduce your exposure to pollutants, chemicals and toxins include to:

  • Eat organic food to reduce exposure to pesticides and synthetic hormones.
  • Use natural cleaning products to avoid harsh substances at home.
  • Filter your water to reduce any contaminants in drinking water.
  • Choose beauty products free from harmful chemicals that could disrupt your hormones. 
  • Avoid using plastic containers and opt for stainless steel or glass instead. If you must use plastic, look for BPA-free.

Limit exposure to industrial chemicals in your workplace by wearing protective gear and taking precautions.


How does age affect a woman’s fertility?

As we age, the quality and quantity of our eggs (ovarian reserve) decline. To become pregnant and stay pregnant, you need healthy eggs and a reproductive environment that supports pregnancy. Age also increases the risk of pregnancy-related complications such as hypertension and gestational diabetes. The risk of chromosomal issues like Down’s syndrome increases with age, and the rate of miscarriage and stillbirths is higher.

What lifestyle choices can improve or impair fertility?

Eating a nutritionally rich, well-balanced diet, getting regular physical exercise, managing stress, and stopping or reducing smoking, alcohol and the use of recreational drugs can all positively impact fertility.

Being a healthy weight is important to support fertility, and a balanced diet with regular, but not vigorous exercise, is important to help maintain it.

What are common reproductive health issues that impact fertility?

Common reproductive health issues that impact fertility are PCOS (polycystic ovary syndrome), endometriosis, premature ovarian insufficiency (early menopause), fibroids and thyroid problems.

If you’re concerned that you have a reproductive health condition, track your symptoms, consider taking a hormone and fertility test, and speak with a fertility advisor.

Can environmental factors affect fertility?

Unfortunately, research suggests that environmental factors like pollutants, chemicals and toxins in our air, food, water, cleaning products and health and beauty products can negatively impact fertility.

Studies suggest that they can reduce sperm count, cause anovulation (the loss of ovulation), impair implantation (where the fertilised egg attaches to the uterine wall to develop a foetus), and harm a baby’s chances for survival.

How does stress influence fertility?

While day-to-day stress is likely to have little impact on pregnancy, chronic stress can lead to a loss of sex drive and increase the chance of irregular periods and anovulation (the loss of ovulation). If you’re not having sex due to the loss of libido, and you’re not ovulating, you’re less likely to become pregnant.


  1. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/female-fertility/art-20045887
  2. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/lifestyle
  3. https://crystaivf.com/blogs/link-between-environmental-factors-and-fertility/ 
  4. https://www.clearblue.com/how-to-get-pregnant/how-long-does-it-take/stress-affect-chances-getting-pregnant
  5. https://www.verywellhealth.com/lupus-and-infertility-5114589#:~:text=In%20lupus%2C%20the%20immune%20system,can%20develop%20into%20an%20egg
Zoya Ali BSc, MSc

Zoya Ali BSc, MSc

Zoya is a scientific researcher with a Bachelor's degree in Biotechnology and a Masters in Prenatal Genetics & Foetal Medicine from University College London. Her research interests are reproductive genetics, fertility preservation, gynaecological health conditions and sexual health.

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