Poverty, Social Disadvantage Linked to Lower Fecundability
WEDNESDAY, Sept. 24, 2025 -- Poverty, low educational level, and household income are associated with lower fecundability and subfertility, according to a study published online Sept. 19 in JAMA Network Open.
Aline J. Boxem, M.D., from Erasmus MC University Medical Centre in Rotterdam, Netherlands, and colleagues examined whether poverty and markers of social disadvantage are associated with 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) and miscarriage (defined as pregnancy loss before 22 weeks of gestation) risks in a population-based prospective cohort study involving women and their partners from the preconception period onward.
Among 3,604 women and 2,557 male partners, the time-to-pregnancy study population included 2,851 episodes among women and 2,830 episodes among men. The miscarriage study population included 2,515 episodes in women and 2,498 episodes in men. The researchers found that the median time to pregnancy was 3.5 months in women; overall, 34.6 and 11.8 percent of episodes were subfertile and led to a miscarriage, respectively. In subanalyses based on 2,103 to 2,805 episodes among women, poverty was associated with lower fecundability (confounder model fecundability ratio [FR], 0.61). Low educational level among women and men was associated with lower fecundability compared with high educational level (FRs, 0.61 and 0.72). A household income of less than €3,000 per month was associated with lower fecundability compared with a household income of €6,000 or more per month (FR, 0.59). The effect estimates of subfertility were similar to those for fecundability. Demographic and lifestyle factors only partly explained these associations. There was no association between miscarriage risk and poverty and markers of social disadvantage.
"Acknowledging the effects of social factors in addition to biological factors associated with fertility and early-pregnancy outcomes could contribute to targeted and effective preventive strategies for couples desiring pregnancy," the authors write.
Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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