Fig. 1.

Potential mechanisms by which fatigue influences female infertility. The relationship between fatigue and female infertility is under-recognized, and it has complex crosstalk with co-factors (for example, pain and depression) through the activation of in vivo stress-responsive systems (HPA-axis, neurotransmitter system) and inflammation stimulated by different stress signals, and then contributing to hormonal dysregulation, oxidative stress, and mitochondrial metabolic dysfunction, which may be an underlying mechanism that affects female infertility. The solid lines represent reported studies, and the dotted lines represent studies that need to be developed. Double arrows represent interconnections. HPA, hypothalamic-pituitary-adrenal; 5-HT, 5-hydroxytryptamine; ROS, reactive oxygen species