Can Where You Live Affect Your Ability to Conceive?

It’s no secret that many different factors can affect fertility. In addition to age, diet and hormonal imbalances, where you live can also play a role. Research shows that people who live in socioeconomically disadvantaged neighborhoods are 20% less likely to get pregnant in a given menstrual cycle than people who live in areas with more resources.

The study measured “fertility”, i.e. the monthly probability of becoming pregnant, in couples who are trying to conceive without fertility treatment. The researchers compared neighborhoods based on their “Area Deprivation Index”, a measure of a neighborhood’s socioeconomic resources. They found that even in a relatively affluent, highly educated study population, people who lived in deprived neighborhoods had lower fertility rates than people who lived in neighborhoods with better opportunities.

Neighborhood and Likelihood of Pregnancy

Fertility research is beginning to look at factors related to the built environment. There are dozens of studies looking at how a neighborhood’s environment relates to unfavorable birth outcomes, but the pre-conception period is still much under-researched from a structural perspective, according to lead author of the study, Mary Willis, a postdoctoral fellow in OSU’s College of Public Health and Human Sciences. It turns out that there are things that affect your health before you’re even pregnant.

Public health research over the past decade has emphasized the importance of social determinants of health, showing that zip code is the biggest predictor of overall life expectancy, based on factors such as income, access to health care, employment rate, education level and access to clean water. But the concept that neighborhood affects fertility has not yet been studied in depth.

Low Fertility in Highly Deprived Neighborhoods

The study used data from an ongoing Boston University study, the Pregnancy Study Online (PRESTO). The researchers analyzed a cohort of 6,356 people between the ages of 21 and 45 who were trying to get pregnant without fertility treatment and whose data was collected from 2013 to 2019. Study participants completed online surveys every eight weeks for up to 12 months, answering questions about menstrual cycle characteristics and pregnancy status. During the study period, 3,725 pregnancies were documented.

The researchers compared the participants with various deprivation indices at both national and state level, taking into account socioeconomic indicators such as educational attainment, housing, employment and poverty. They found that based on the national rankings, participants in the most deprived neighborhoods had 19-21% lower fertility than those in the least deprived neighborhoods. Based on the within-state ranking, fertility in the most deprived neighborhoods was 23-25% lower than in the least deprived areas. The majority of respondents were white, had a four-year college degree and earned more than $50,000 a year.

Looking at fertility research from a structural standpoint, the findings could help reduce or prevent infertility overall, Willis said, especially because fertility therapies are costly and usually only accessible to families with significant means. The study concludes that investing in disadvantaged neighborhoods to address socioeconomic inequalities can have a positive impact on fertility.