Australia is an international leader in human reproduction research and innovation, with many firsts in understanding fundamental processes of reproduction, and treatment options for infertility and subfertility. Infertility and subfertility affect a significant and increasing proportion of humanity and this is a ‘canary in the gold mine’ alerting us to environmental impacts on human health. WHO estimate 1 in 4 of women desiring pregnancy experience infertility / subfertility, and in men, sperm counts have dropped around 50% in major Western countries over the last four decades. IVF is an enormously successful technology, and 6 million IVF babies have now been born. However IVF remains expensive, invasive, and variably successful, and does not solve the underlying causes. There is a long way to go to deliver better options for couples and individuals who are unable to achieve and maintain pregnancy, especially in low resource settings. Current research priorities are to understand how environmental factors and genes interact to affect human fertility and reproductive senescence, and to define the significance of gamete health, peri-conception events and epigenetic processes in programming life course health and breaking the cycle of intergenerational transmission of disease. Investing in human reproductive health will inform a better start to life for all children, build healthier communities and help governments tackle rising health care costs.