In 2019, an article from the American Society of Reproductive Medicine (ASRM) and its publication Fertility and Sterility examined the impact of environmental toxins on fertility and reproductive outcomes, and its staggering potential for multigenerational effects. By shining a light on the known effects of these chemical compounds, the organization hopes to educate more healthcare professionals to proactively assess their patient’s risk factors, improve lifestyle health, and appropriately guide them during the preconception phase.
According to the journal, more than 80,000 chemicals are registered in the United States and known chemical toxins, phthalates and pesticides have been detected in 99-100% of women. Chemicals and heavy metals are also shown to be present in 90% of the population. The list of endocrine-disrupting chemicals (EDCs) includes plasticizers like phthalates, bisphenol A (BPA), and polybrominated diphenyl ethers (PBDEs), as well as pesticides, heavy metals, and air pollutants.
In 2015, the American College of Obstetricians and Gynecologists (ACOG) and ASRM published a committee opinion on these environmental toxins to minimize patient exposures and recommend screening and preventative measures. Known chemicals such as mercury and lead have been shown to cause sensory disturbances, cerebral palsy, and permanently impaired intellectual development in children. Cadmium, which accumulates in the testes, ovaries and placenta, affects in vitro fertilization (IVF) outcomes, and is associated with decreased birth weight and premature birth. In men, it is linked to lower semen quality and decreased motility, and lower testosterone levels.
The three most well-known EDCs are BPAs, phthalates, and PBDEs. BPAs are the more ubiquitous of the EDCs, found in many types of plastics, canned food liners, and cash receipts, and are detected in up to 93% of the population. BPA is associated with miscarriages, fewer oocytes (immature ovum or egg cell) retrieval in IVF treatment, as well as lower birth weight and head circumferences in infants, and can cross the placental barrier.
Phthalates are most commonly found in consumer care products such as lotions and cosmetics and, similar to BPAs, are linked to lower pregnancy rates and miscarriages. In men, phthalates lead to sperm DNA damage, and abnormal semen parameters and decreased motility. PBDEs have the longest life of the three EDCs and can linger in adipose tissue from months up to 12 years. PBDEs are found in furniture, carpeting and electronics, and are known to cause thyroid abnormalities, low birth weight, premature birth, and miscarriage, as well as impaired neurological development in children.
The article concludes with the imperative role of healthcare clinicians to assess and educate patients on the hazards of environmental toxins and its risks to fertility conception, and recommends ways to mitigate exposure and improve chances for healthy birth outcomes. Because chemicals are now pervasive in our environment, more healthcare providers who become educated can improve the health prospects of both patient health and the health of their potential offspring. Two available resources to get started include a hand-out for reducing toxin exposure at work, home, and in food choices; and an overview from the CDC on reproductive health in the workplace.
Thalia R. Segal, M.D., Linda C. Giudice, M.D., Ph.D.
Fertility and Sterility, October 2019