Climate change is here, raising the risks for reproductive health

Published 30 August 2022

A series of editorials and studies in the August issue of Fertility & Sterility describe climate change as a major risk factor for reproductive health. Erratic weather and its consequences - air pollution, wildfires, heat stress, floods, and vector-borne diseases – will have an impact on male and female fertility.

Record temperatures, wildfires, droughts and floods. Who doubts climate change? The extreme conditions felt by millions throughout Europe and the US this summer are surely yet more evidence of climate change’s growing threat to the planet - and to health.

The latter includes a risk to fertility, with most experts agreeing that exposure to increasing pollution and shifts in weather and temperatures have contributed to reduced fecundity, decreasing sperm counts and increased rates of miscarriage and preterm birth over the past 50 years.

Such is the concern that Fertility and Sterility has now dedicated the editorial theme of its August issue to the subject. The consensus from its research and reviews is that events related to climate change are increasing and pose a major risk to reproductive health both in the short and long-term. They serve as a rallying cry to healthcare professionals to take responsibility to educate themselves and others about the impacts, to collaborate and protect patients. Preparedness in the form of disaster emergency planning for the next crisis also needs to improve, urges F&S.

Results from a systematic review suggest that those at greatest risk from melting ice-caps, forest infernos and diesel exhaust are disadvantaged and marginalised people, including those in both low-income and urban areas.(1) The conclusion is backed by evidence from a literature search on the adverse effects of greenhouse gas emissions on fertility and pregnancy. The topics covered include air pollution, fine particles in wildfire smoke, heat stress, floods which cause displacement and maternal stress, endocrine-disrupting toxic chemicals and heavy metals, vector-borne diseases caused by stagnant water, and their effects on vulnerable populations.

Data show the pervasive effects of rising temperatures, pollution and floods on populations. Pregnant women in lower and middle-income countries are more exposed to heat stress because they work in the fields until childbirth; preterm births in the US have been specifically attributed to wildfire smoke in California during 2007 to 2012; and there is substantial evidence for the adverse effects of vector-borne illnesses such as malaria and the Zika virus on pregnancy and neonatal outcomes. Moreover, certain components of air pollution may increase the effects of the other vector-borne illnesses: one hypothesis, for example, is that air pollution and Covid-19 may act together to reduce sperm counts via angiotensin-converting enzyme 2 (the entry receptor for SARS-CoV-2).

The authors say reproductive health professionals have an ‘unprecedented opportunity’ to educate patients, government officials and other stakeholders to implement climate-friendly mitigation strategies to and reach net zero CO2 within the next 20 years. In a call to action, they write: ‘We urge healthcare providers to recognize the many facets of climate change and its impact on fertility, fetal development, and obstetric outcomes, which will impact future generations.’

However, the threat to reproductive health lies not just in the short-term but in the long-term too. As weather patterns and pollution continue to deteriorate, fewer healthy parents will give birth to less healthy offspring, who themselves will face an increased risk of adverse outcomes. Outlined in a discussion paper, this scenario is described by the authors as a cycle of repeating vulnerability to poorer reproductive health, which is replicated across the lifespan and down the generations.(2)

Cardiovascular and respiratory conditions are among the chronic diseases likely to contribute to these worse reproductive outcomes. The authors cite a pooled analysis of 5.4 million women indicating a twofold risk of future cardiovascular events within the first decade after birth for women with gestational diabetes. Unborn children too are vulnerable: a meta-analysis of nine observational studies has found fetal exposure to gestational diabetes associated with a 164% increased chance of ADHD.

To mitigate such risks, the authors urge specialists to look beyond ‘the immediate goal of a healthy infant in our arms’ to the long-term implications of climate change on reproductive health. In addition, they call for better support in the form of continuing education to help reduce the impact of climate change.

Turning back the clock on climate change is unlikely – disasters such as fires and floods seem now unavoidable. However, being well prepared for these events is crucial to protect fertility patients. In the event of an emergency, the ASRM has urged clinics to have in place an individual plan in place to cover four key priorities: safety of patients and personnel, continuation/cessation of treatment, cryopreserved gametes, and records.(3)

To illustrate how this works in practice, a team of researchers have used the case study of Hurricane Sandy, which hit New York in October 2012 - including the NYU Fertility Center.(4) Although the superstorm caused the clinic to lose power, staff managed to save every gamete and embryo thanks to preparations made well in advance of the event. Measures included buying power supply units in the years before to ensure cryopreservation continued safely; and maintaining all embryology records in duplicate (electronic and paper), which proved vital when loss of power rendered computers inaccessible. Other disaster plans included telephone calls patients scheduled for IUI to discontinue medications and attempt timed intercourse where possible.

Despite the success of the Hurricane Sandy response, a systematic review of crisis standard-of-care documents suggests that systems overall are wholly unprepared; the healthcare profession has a duty ‘to our patients and our profession’, say the authors, to ensure it is ready for the next inevitable crisis.

One commentary also notes that healthcare contributes nearly 4.4% of all carbon dioxide emissions globally yet has done little to reduce its footprint despite position statements from the ASRM and others. This apparent failure is criticised in a strongly-worded article in which the authors present their own preventive framework for clinicians to implement.(5) Their approach involves preventing human exposure to climate-related events (for example, shelters for patients), and screening and treatment for climate-related diseases, especially among the most vulnerable.

Of course, whether these and other suggestions are realistic remains to be seen given that climate change is still such a divisive subject. However, adapting clinical practice will – or already has – become inevitable for fertility clinics to meet what is regarded as the biggest global health threat of the 21st century.

1. Segal TR, Giudice LC. Systematic review of climate change effects on reproductive health. Fertil Steril 2022; 118: 215–223.
2. Mendola P, Ha S. Beyond the infant in your arms: effects of climate change last for generations. Fertil Steril 2022; 118: 224–229.
3. Practice Committees of the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, and the Society of Reproductive Biologists and Technologists. Development of an emergency plan for in vitro fertilization programs: a committee opinion. Fertil Steril 2021; 115: 870-873.
4. Goldman KN, McCaffrey, Riley J, et al. Disaster preparedness in assisted reproductive technology. Fertil Steril 2022; 118; 230-238.
5. Martin L, Zhang Y, Mustieles V, et al. Reproductive medicine in the face of climate change: a call for prevention through leadership. Fertil Steril 2022; 118:

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