Environment and Infertility

Abstract

To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This activity expires on September 29, 2021. abundance of offspring is vital for propagation and economic growth of society. Declining fertility will have tremendous impact on population demographics and availability of a healthy labor force, which will in turn have impacts on the division of political power, culture, and gross domestic product.2 Conventional demographic and economic theories argue that declining fertility is due to social and economic development. The chain of causation reasons that development, including increases in industrialization, and education have led to an alteration in human capital formation primarily through a decrease in the benefits of child rearing, an increase in its cost, and a decrease in infant mortality.3 Simultaneously, there has been an increase in family planning programs and contraceptive use, and a delay in the timing of motherhood. However, there is increasing concern that chemical environmental contaminants as part of economic development may also be contributing to decreasing fertility. This is in part because rising industrialization has been accompanied by a waxing trend in environmental regulation, which has led to an increase in chemical environmental pollutants.4,5 Furthermore, industrialization has independently been associated with declining fertility.6 The impact and contribution of these environmental pollutants on female fertility are largely underexplored and unknown, and subsequently serve as impetus for this review. This is not intended to be an exhaustive review of all of the available information related to the environmental impacts on female fertility. Instead, our purpose is to evaluate some of the more representative (and frequently cited) examples in order to assess the strength of support. It is Globally, fertility has declined in virtually all regions of the world. In addition to changes in socioeconomic structures related to industrialization, chemical environmental contaminants, including air pollutants, are hypothesized to contribute to declining fertility rates worldwide. This article presents some of the representative (and frequently cited) literature on the effects of various endocrine disruptors, heavy metals, and air pollution on female fertility. There is substantial evidence to suggest that these classes of chemicals have a negative impact on fertility, although further research is needed to fully elucidate the impacts and mechanisms. Fertility worldwide is expected to decline from a rate of 2.5 births per woman in 2010–2015 to a rate of 2.2 per woman in 2045–2050. In the United States, recent data have shown that the general fertility rate has declined 1% in 2016 to 62.0 births per 1000 women age 15 to 44 years, a rate that has decreased 11% since the most recent high in 2007.1 These trends will have profound shortand long-term impacts not only on individuals attempting to conceive, but also on individual communities, governments, and the human population as a whole. The ability to produce an VOLUME 39 • NUMBER 14 September 30, 2019