Poverty and social disadvantage linked to lower fecundability and greater risk of subfertility

A recent cohort study published in JAMA Network Open evaluated the relationship between poverty, social disadvantage, and fertility outcomes among couples actively pursuing pregnancy. Investigators reported that socioeconomic disadvantage, reflected in household income and educational attainment, was associated with lower fecundability and increased risk of subfertility but not with miscarriage.¹

According to the study, fecundability was defined as the per-month probability of conceiving, while subfertility was defined as a time to pregnancy longer than 12 months or the use of assisted reproductive technology (ART). Miscarriage risk was also evaluated as an outcome measure.¹

Study design and population

The prospective cohort included men and women attempting conception without the use of fertility treatment at enrollment. Participants provided baseline demographic information, including household income, highest level of education, and additional health and lifestyle factors. Couples were then followed for up to 12 months or until pregnancy was achieved.¹

Investigators measured monthly fecundability using self-reported time to pregnancy and categorized outcomes as conception within 12 months, subfertility, or pregnancy loss. The study design allowed for assessment of both female and male partner characteristics.¹

Key findings

The results demonstrated consistent associations between markers of socioeconomic disadvantage and fertility outcomes. Couples in lower income brackets and those with lower levels of education had reduced fecundability and higher likelihood of experiencing subfertility. These associations were observed for both female and male partners, suggesting the impact of disadvantage extended beyond maternal characteristics.¹

However, the analysis did not identify an association between disadvantage and miscarriage risk. Rates of pregnancy loss were similar across socioeconomic strata once conception occurred.¹

Press release statement

In the press release accompanying the publication, investigators emphasized the potential implications for public health strategies.² “The findings of this cohort study suggest that poverty and social disadvantage, characterized by low educational level and household income among both women and men, were associated with lower fecundability (defined as the per-month probability of conceiving) and increased risks of subfertility (defined as a time to pregnancy or the duration of actively pursuing pregnancy of more than 12 months or use of assisted reproductive technology) but not with miscarriage risk,” authors wrote.

The authors added, “Further studies are needed to identify the underlying and explanatory mechanisms associated with fertility outcomes and the potential for novel public health strategies for couples desiring pregnancy.”²

Implications for clinical practice

These findings highlight the influence of social determinants of health on fertility outcomes, independent of clinical or biological factors.¹ For physicians, the results suggest that lower fecundability and subfertility may be partially explained by broader socioeconomic conditions.

The absence of an association between social disadvantage and miscarriage risk indicates that once pregnancy is achieved, adverse outcomes may be less influenced by socioeconomic status than by other clinical or biological factors.¹

Future directions

The investigators emphasized the need for further research to clarify mechanisms linking disadvantage and reduced fertility, including environmental exposures, access to health care, and chronic stress. Additional studies could also inform targeted interventions for couples at increased risk of subfertility.²

While the findings do not directly alter clinical management, they underscore the importance of considering social and economic context when counseling couples on fertility expectations and potential challenges in conception.¹

References

1. Boxem AJ, Mulders AGMGJ, van Rossum I, Bekkers EL, Gaillard R, Jaddoe VWV. Poverty and social disadvantage in women and men and fertility outcomes. JAMA Netw Open. 2025;8(9):e2532741. doi:10.1001/jamanetworkopen.2025.32741
2. Poverty and social disadvantage in women and men and fertility outcomes. JAMA Network. September 19, 2025. Accessed September 23, 2025. https://www.eurekalert.org/news-releases/1098703.