Fertility is often treated as its own category of health.

But in practice, it is rarely just about the reproductive system.

When someone comes in with changes in fertility, I am usually thinking beyond that. I am looking at hormone patterns, yes, but also metabolic health, inflammation, sleep, and environmental exposures. Those tend to be part of the picture more than people expect.

This is part of why the broader trend matters. The World Health Organization estimates that infertility now affects about 1 in 6 people globally. That number has been rising over time.

In my clinic, I do not think of fertility as something separate. It is a reflection of what is going on overall. Not in a dramatic way, but in smaller patterns that add up.

So instead of asking only what is wrong, I usually start with a different question. What else could be contributing here? And this is not limited to people actively trying to conceive. In many cases, it shows up first in someone close to you. A daughter, a sibling, a friend. 

Looking More Closely at the Trend

There is no single reason fertility is declining. But there are patterns.

Age is one factor. People are trying to conceive later, and biology has not fully adapted to that shift. What feels different now is everything surrounding it.

For example, I might see someone in their early thirties with cycles that look normal on paper. Regular timing. No obvious issues. But when we look a little closer, there are small things underneath. Blood sugar is not as stable. Sleep is inconsistent. There are signs of inflammation.

Nothing severe on its own, but enough to matter long term. 

Over time, that can affect ovulation or progesterone support in ways that are easy to miss at first. Metabolic health plays into this more than most people realize. Energy dips in the afternoon. Cravings. Subtle shifts that do not always show up clearly on the standard labs.

Stress is another piece. Not acute stress, but the kind that stays in the background. 

The body adapts to that. Hormones shift gradually. Cycles can become a little less predictable. Reproduction just becomes less of a priority.

Then there is exposure, such as plastics, pesticides, additives, and personal care products.

It is rarely one thing. It is the combination. And over time, that adds up. Many of these compounds can interfere with hormone signaling in ways that are subtle, but persistent.

What I see most is not one clear cause. It is a layering of factors that have been building. 

Fertility Reflects the System

I usually explain this pretty simply. Fertility is a process. Multiple systems working together.

Ovulation has to happen at the right time. Hormones rise and fall in sequence. The uterine lining develops appropriately. The immune system stays balanced enough for implantation. 

For men, sperm production follows its own version of that same coordination. If one part is slightly off, it can change the outcome. And that does not always show up in a clear way.

Cycles can look “normal,” but not quite optimal. On occasion, the luteal phase is shorter or longer than expected. Sometimes it just takes longer to conceive. 

So I do not focus only on the reproductive system. I look at the system as a whole.

Female Fertility: Looking Beneath the Surface

A lot of the time, the focus is on estrogen and progesterone. They matter. But they are not the full picture.  What I pay attention to is how those hormones behave over time.

Thyroid function comes up often. Even small changes can affect ovulation.

Inflammation is another piece. It is not always obvious. Sometimes it shows up as painful periods with cramps, or bloating, or fatigue that has just been accepted as normal.

Gut health ties into this more than people expect. Even mild digestive symptoms can affect hormone metabolism and immune signaling. The same goes for detoxification. The liver processes hormones. If that system is under strain, things can shift, even if labs look normal. 

This is why focusing on one hormone rarely tells the full story.

Male Fertility: The Missing Half of the Conversation

Male fertility is still not talked about as much. But it should be.

A large meta-analysis published in Human Reproduction Update found that sperm counts declined by more than 50 percent between 1973 and 2018.

In practice, I see this come up frequently.

Sperm quality is tied to overall health. Diet. Sleep. Environmental exposures. All of it plays a role. I also see situations where one partner has done extensive testing, and the other has not been evaluated yet. When we do look, there are often things we can address.

Oxidative stress is one example. So is heat exposure. Hot tubs. Saunas. Even laptops used directly on the lap. And timing matters. Sperm development takes about 70 to 90 days. 

When both partners are part of the process, things tend to move more smoothly.

Environmental Exposure Is Part of the Background

This is one of the quieter contributors, but it comes up consistently.

Endocrine-disrupting chemicals are present in plastics, food packaging, personal care products, and indoor environments. Most people are not exposed to just one source.

Over time, that can influence ovulation, sperm quality, and hormone regulation.

What matters clinically is not just exposure, but how well the body processes and clears those compounds. That is where liver function, gut health, and overall resilience come in.

What I Focus on When Someone Is Trying to Conceive

When someone is preparing for pregnancy, the focus becomes more specific.

I usually come back to a few core areas, along with the lab tests I use to evaluate them:

  • Blood sugar stability (labs: fasting insulin and fasting glucose)
  • Nutrient status, including iron, vitamin D, folate, iodine, and omega-3s (labs: iron, Vit D, iodine, Omega levels) 
  • Heavy metal toxins (labs: lead, mercury)
  • Hormonal patterns across the cycle (labs: E2, progesterone, Testosterone, SBHG)
  • Gut health (stool microbiome test )
  • Inflammatory markers (labs: HS-CRP and ESR)
  • Detoxification capacity (labs: Liver enzymes AST/ALT, kidney function GFR) 
  • Sleep and stress (Cortisol, DHEA)

How I Approach This in Practice

Testing can be helpful, but only when it adds context.

I usually start with the clinical picture and go from there. Hormones, metabolic markers, inflammation, nutrients. Then we go deeper if needed.

The goal is to understand what the body may need. Fertility is often framed in very binary terms. It comes back to how the body’s systems are working together.

When something shifts, it is usually pointing to patterns that have been building over time.

And when we address those, we are supporting overall health.