The silent crisis: investigating the impact of environmental pollutants on embryo-fetal development: a narrative review of the Group of Special Interest for Environment of the Italian Society of Fertility and Sterility and Reproductive Medicine.

Purpose: Environmental pollution is a growing global concern, yet its effects on reproductive health remain poorly understood. While numerous epidemiological studies have identified strong associations between exposure to pollutants and adverse reproductive outcomes, the precise biological mechanisms underlying these effects remain elusive.

Methods: A comprehensive literature search was performed by two reviewers using the US National Library of Medicine (NCBI Pubmed) up to August 15, 2025.

Results: Chemical and physical contaminants, including endocrine-disrupting chemicals (EDCs), particulate matter (PM), heavy metals, and heat stress (HS), have been implicated in disrupting of essential reproductive processes, such as gametogenesis, fertilization, implantation, and embryogenesis. Despite accumulating evidence, the complexity of these interactions has hindered the development of targeted interventions and effective regulatory policies.

Conclusions: This review argues that investment in reproductive environmental research is not only necessary but urgent. The pervasive nature of pollution and its potential long-term consequences on fertility and pregnancy outcomes warrant an intensified focus on mechanistic studies, improved environmental monitoring, and the integration of toxicological data into reproductive medicine. It is imperative to prioritize research that can provide the necessary insights to mitigate these threats. This paper highlights the knowledge gaps, emphasizing the need for a multidisciplinary approach that combines epidemiology, toxicology, and molecular biology to inform policies and safeguard reproductive health.