Abstract
Human health is affected by various factors such as air pollutants. Exposure to toxic air pollutants is impaired fertility in men and women. The purpose of this review study was investigation of the effect of toxic air pollutants on fertility and birth rate. Databases used to for searched were the PubMed, Web of Science, Springer and Science Direct (Scopus) and Google Scholar. Identify all relevant studies published 1999–2022. In this study, according to databases five hundred articles were retrieved. 33 studies were screened after review and 19 full-text articles entered into the analysis process. Finally, 11 articles were selected in this study. The literature signs a notable health effects from toxic air pollutants and increase risk of infertility in men and women and having a variety of reproductive system cancers such as prostate, bladder, ovary, kidney and uterus. According to the finding toxic air pollutants can increase the risk infertility in men and women, incidence of cancers of reproductive system and decrease the birth rate. Activities that play an important role in reducing the health effects of toxic air pollutants such as infertility in men and women and reducing the population rate of communities are improving the quality of fuel used in the home, car, industries, changing production processes in large industries, installing catalysts to reduce emissions in cars, use more public transportation, plant trees and increase green space per capita, increase public awareness about various effects of toxic air pollutants and protective measures.
Introduction
The fertility rate and having a young generation are the most important components of the power of a society and a country [1]. In recent years, infertility among men and women is increasing for various reasons [2]. Infertility means that a couple tries to conceive continuously for a year without using contraception, but the woman does not become pregnant [3]. According to the result studies, the proportion of infertility cases in the community is about 40% in male, 40% in female and 20% are common or unknown causes [4]. One of the most important reasons for the increase in infertility and the decrease in population growth rate is the entry of various pollutants into the environment, especially the air [5]. According to the reports of various institutions, especially the World Health Organization (WHO), a large share of non-communicable diseases is due to the presence of dangerous pollutants in the respiratory air [6], [7], [8]. The reason for this is the constant and vital human need for oxygen and respiration that the presence of pollutants in the air causes the entry of these dangerous factors through the respiratory system and absorption in various organs and tissues [9], [10], [11].
Industrial processes, activities of power plants (man-made origin), combustion of full (petroleum, oil, gasoline, diesel, wood, coal), pollutants enter the oceans through evaporation, volcanic eruptions (natural) and forest fires are the main source sources of production and emission toxic air pollutants [12, 13]. The existence of heavy industries in the region such as oil, gas, steel and petrochemicals, the quality of production processes in industry, the existence of public transportation system such as metro, city population, the number of motor vehicles, fuel used in homes and power plants, the quality of gasoline consumed in gas stations, climate, topography, land use, how to locate the city limits and the direction of prevailing winds are the most important factors intensifying the level of dangerous air pollutants [14], [15], [16], [17].
According to reports from the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) the risk of a variety of diseases, especially cancers can increase due to exposure to these toxic air pollutants [18], [19], [20]. Nervous, circulatory, reproductive, respiratory and cardiovascular system is the different systems of the body that inhales toxic air pollutants that interfere with their function in the body and can cause dangerous diseases such as cancers of the brain, blood, lungs, heart, bladder, prostate and ovaries [21, 22].
A wide range of complications of air pollution affect the reproductive system, pregnancy, fetus and baby. Facing air pollution is directly related to a sharp decrease in the percentage of sperm stimulation, a sharp decrease in the percentage of normal sperm in terms of shape and the abnormal structure of sperm chromatin that can cause infertility in men. Women who inhale toxic air pollutants lose weight in their fetuses. Also, the high amount of air pollution has somehow increased the number of abortions.
The most important factors that can affect infertility and reduced birth rates due to dangerous air pollutants including clinical pregnancy, implantation, embryo quality, miscarriage and live birth [5]. Inhalation and exposure to toxic air pollutants in polluted areas could be related to a risk factor for low birth weight and preterm labor [23].
Few studies examined the association between air pollution and pregnancy, implantation, embryo quality, abortion, fertility and birth rate [23].
The aim of this narrative review report is to understand the effect of toxic air pollutants on fertility and birth rate. We have focused on the current state of knowledge of the association of toxic air pollutants and complications effects on the fertility and birth rate among humans.
Materials and methods
Eligibility criteria and search strategy
A review of the epidemiological literature was conducted according to different databases: PubMed, Web of Science, Springer and Science Direct (Scopus) and Google Scholar were retrieved (Table 1). Data gathering was done with the Medical Subject Heading (MeSH). Review time efficiency of studies was limited in the range of 1999–2022. English language was search of restrictions. Five hundred articles according to databases were retrieved.
Search terms and query results.
| Term | PubMed | Science Direct (Scopus) | Springer | Web of Science | Google Scholar | Unique results |
|---|---|---|---|---|---|---|
| Toxic air pollutants | 11 | 30 | 17 | 9 | 58 | 125 |
| Infertility | 7 | 22 | 12 | 5 | 26 | 72 |
| Birth rate | 8 | 19 | 11 | 4 | 15 | 57 |
| Risk factors | 18 | 21 | 10 | 12 | 33 | 94 |
| Cancer | 15 | 14 | 25 | 14 | 49 | 117 |
| Toxic air pollutants and infertility | 4 | 7 | 9 | 3 | 12 | 35 |
| Total | 60 | 103 | 84 | 58 | 195 | 500 |
Study selection and prepare studies
Study selection performed based on studies on the toxic air pollutants on fertility men and women, fetus and birth rate, including articles published in domestic and foreign journals. The literature search was performed in two steps. The first strategy was to use keywords search terms: ‘Toxic Air Pollutants’, ‘Infertility’, ‘Birth Rate’, ‘risk factors’, ‘cancer’, and ‘Toxic Air Pollutants and Infertility’. Prepare studies was based on Searches in science direct (Scopus) search 103 articles, web of sciences received 58 articles, springer database 84 articles, PubMed database 60 articles and 195 articles in the Google scholar. Review time efficiency of studies was limited in the range of 1999–2022.
87 and 15 articles were found and selected based on records identified through database searching and additional records identified through other sources. In the next stage, 33 studies were screened after review and 19 full-text articles entered into the analysis process. Finally, 11 articles were selected in this study. The how to prepare studies and the selection process articles based on PRISMA flow diagram showed in Figure 1.
Representation of the search strategy based on PRISMA flow diagram.
Ethical approval
Ethical issues (Including plagiarism, misconduct, data fabrication, falsification, submission, double publication, and redundancy) have been completely observed by the authors. According to the national guidelines, studies such as this do not require individual consent.
Results
Toxic air pollutants production resources
Increasing the use of fossil fuels, emissions of greenhouse gases, global warming, increasing industrialization, the destruction of trees, excessive consumerism of the world, growth population are the most important agents causes the release of toxic air pollutants and the entry of these toxic and dangerous factors into the food cycle (plants and animals) and consumption of people are the most important agents that cause various health consequences, especially cancers in humans [24, 25].
Man-made (petroleum, gasoline, oil, coal, motor vehicles, and industries) and natural (volcanic eruptions, bitumen) resources are the most important origins production toxic air pollutants [26].
Emission high amounts of toxic air pollutants are the extraction of fossil fuels, extensive use of biogas (dung or crop residues) in China and India, industrial processes, wood-burning, excessive and increasing consumption of oil, gas and gasoline [27, 28].
The most important sources of emission toxic air pollutants into the environment showed in Figure 2.
Sources of produce toxic air pollutants.
Route of destruction of fertility men and women and fetus due to exposures to toxic air pollutants
Toxic air pollutants get into the body mainly through breathing. They can also be ingested (for example, children eating soil contaminated with lead) or absorbed through the skin [29, 30]. Toxic air pollutants are one of the main agents that has attracted the attention of health organizations due to its many harmful effects [31]. Once a pollutant enters the body it can stay in the lungs (like asbestos), be exhaled, or move into the blood from the lungs or from the digestive system or skin [29, 30].
Gasoline, oil and coal, wood, tobacco, garbage, burning crop residues, dung, volcanic eruptions, high-temperature cooking in meat, are source generating toxic air pollutants [32]. A variety of foodstuffs, air, asphalt roads, smoke, water, and soil are among the environment media where humans are exposed to toxic air pollutants such as heavy metal and polycyclic aromatic hydrocarbons [32, 33].
Skin contact with toxic air pollutants such as heavy metal and polycyclic aromatic hydrocarbons (dermal), breathed of toxic air pollutants (inhalation), consume foods containing toxic air pollutants (ingestion or swallowed) are the main route of entire toxic air pollutants and destruction on human [32, 34]. Figure 3 presented the route of entire toxic air pollutants such as heavy metal and polycyclic aromatic hydrocarbons and destruction on human.
Route of entire the toxic air pollutants (A): route of entire the toxic air pollutants such as heavy metal and polycyclic aromatic hydrocarbons and destruction on human; (B): route of destruction health of pregnant women and fetus due to exposures to toxic air pollutants.
After enter toxic air pollutants such as heavy metal and polycyclic aromatic hydrocarbons the body, secondary compounds (metabolites) are formed in the body due to the decomposition and failure of the contaminant and finally these metabolites are excreted by the urine and feces [32, 35].
Based on Figure 3A explained the route of entire the toxic air pollutants such as heavy metal and polycyclic aromatic hydrocarbons and destruction on human and Figure 3B shows the route of destruction health of pregnant women and fetus due to exposures to toxic air pollutants.
Carcinogenicity of toxic air pollutants
Increased risk of various cancers, especially in children and pregnant women, is one of the most important risks of exposure to and inhalation of toxic air pollutants [36]. The main cancers that are caused by exposure to toxic air pollutants are ovarian, uterus, prostate, gastrointestinal, nervous, lung, and bladder [37, 38]. The origin and source of the diffuser toxic air pollutants, the topographic conditions of the area, the place of residence of the person and the direction of the prevailing winds are among the effective factors in level of toxic air pollutants and their health effects [39].
Among the types of cancer ovarian, lung, gastrointestinal and nervous cancers are more common due to long-term exposure to toxic air pollutants, especially heavy metal, particulate matter and polycyclic aromatic hydrocarbons [40, 41].
Environmental pollution increases male infertility. Male gametes are more vulnerable to environmental damage than women, which is why male infertility is on the rise in large, industrial cities with a variety of pollutants, especially air pollution [42]. The presence of lead and sulfur dioxide in the air in men’s breathing causes the natural shape of men’s sperm to change and has an adverse effect on sperm motility [43]. Air pollution in men reduces the rate of sperm mutation and thus reduces fertility [42, 44]. Air pollutants such as carbon monoxide (CO2), Sulfur dioxide (SO2), particulate matter (PM), Pb, O3 and other air pollutants affect sperm quality [44]. Sperm quality is one of the important factors in reducing the quality of fertility and health of infants [45].
Among the diseases that have the potential to transmit and grow in women in these conditions, we can mention the types of cancers, the most important and most common of which is lung cancer [46].
Carbon monoxide and fine particles in polluted air have very negative effects on the mother, which also affects her fetus [47]. It is possible that due to the breathing of polluted air by mothers, air pollution in the respiratory system may cause shortness of breath and malnutrition in the pregnant mother, because in polluted air they do not easily go to food, disrupting the fetus and ultimately leading to respiratory disorders such as asthma in infants [48].
Some chemicals cross the placental blood barrier and can be detected in the serum of the pregnant mother and fetus [49, 50]. The presence of some contaminants and chemicals in the amniotic fluid has also been reported [49]. These substances cause birth defects by affecting the dividing stages of mitosis, meiosis and DNA. The high rate of differentiation and cell growth in the embryonic period has caused humans to be more affected by pollutants in the embryonic period than in other periods of life [51]. Air pollutants have a direct impact on live birth, miscarriage, clinical pregnancy, implantation, and embryo quality.
Toxic air pollutants attributed to the carcinogenicity and on live birth, miscarriage, clinical pregnancy showed in Figure 4.
Toxic air pollutants attributed to the carcinogenicity and on live birth, miscarriage, clinical pregnancy.
Toxic air pollutants and increase the risk factors related to fertility men and women and fetus
Living near crowded areas and sources of emission of toxic air pollutants such as industries threaten the health of pregnant women and fetus [23]. Abortion, preterm delivery, increase in the incidence of congenital malformations, including cardiovascular and pulmonary abnormalities, as well as increasing the risk of small births for gestational age [23, 52].
Air pollutants, including suspended particles and toxic gases, enter the pregnant mother’s body through respiration and proximity to pollutants in conditions of alertness, urgency, crisis, and unhealthiness, and have devastating consequences for the fetus [53]. Research has shown that the effects of air pollution on women are greater than men due to longer exposure times [53]. Problems that are widespread in women include autoimmune problems as well as neurological problems. In times when the air is polluted, the immune systems of women who are at risk of air pollution are weaker than those of men. Therefore, they are naturally exposed to more diseases [54].
Another problem that women face during air pollution is reproductive dysfunction [55]. In 2018, more than 16,000 babies were born with air or respiratory problems or malformations, according to the US Environmental Protection Agency [56]. These studies show that in some cases, this has led to the death of infants and mothers. Mothers who are exposed to severe air pollution should be much more protective of themselves and their babies than other women [57]. One of the destructive effects of air pollution on pregnant women is inflammation of the lining of the uterus that can causes premature labor during pregnancy [58]. Premature birth can cause neurological disorders or physical defects in the baby in the future [59].
In the first eight weeks of pregnancy, air pollution due to suspended particles of sulfur dioxide and carbon monoxide affects the fetal heart and leads to fetal heart abnormalities, and also in the first eight to 12 weeks of pregnancy, because the fetal brain is forming [60]. Toxic air pollutants also have irreversible effects on the IQ of the fetus [61]. In general, toxic air pollutants during the whole pregnancy is dangerous for the mother and the fetus [62]. The first 12 weeks are a critical period for both mother and fetus [63]. Air pollution and living near industries areas threaten the health of the pregnant mother and fetus [64]. However, the first 12 weeks of pregnancy are a sensitive period for the mother and the fetus, and mothers should pay more attention to the health of the fetus [65]. Also, from eight to 12 weeks of pregnancy, the fetal brain begins to grow and form. Therefore, developmental disorders at this time can have a devastating effect on the IQ and brain abilities of the fetus, and it is more important to observe hygienic principles during this period [62]. Air pollution can be damaged birth defects when the cells of an unborn child are damaged, or cancer that develops when cells begin to grow at an uncontrolled rate [29, 30].
Figure 5 illustrated the risk factors related to fertility and fetus attributed to toxic air pollutants.
Risk factors related to fertility and fetus attributed to toxic air pollutants.
Table 2 shows respiratory diseases and the risk factors related to fertility men and women, fetus and birth rate resulting from the toxic air pollutants.
Summary of the association between toxic air pollutants on fertility men and women, fetus and birth rate.
| Pollutant | Major sources | Adverse health effects | References |
|---|---|---|---|
| Toxic air pollutants | Combustion of petroleum and oil, vehicle emission, fuel/tobacco combustion, dust storm, volcanic eruptions, coal, burning wood, gasoline and diesel, burning crop residues, tobacco, garbage, cigarette smoke, forest fire, grilling, wood-burning | DNA defects in infants, cancer (ovarian, uterus, prostate, gastrointestinal, nervous, lung, skin, bladder, liver, and stomach), abnormality of the wall between the ventricles of the heart, valvular defects of the heart, aortic artery abnormalities, pulmonary artery abnormalities, weight loss at birth, preeclampsia and gestational hypertension, intrauterine growth retardation, sperm quality, decreased sperm motility and ovarian laziness and increased infant mortality | [42, 49, 66], [67], [68], [69], [70] |
Discussion
Avoid tobacco, alcohol, cigarettes, chemicals in adhesives, radioactive materials, do not consume varnishes, do not use pesticides and insecticides, do not smoke indoors, reduce intra-city travel on polluted days, avoid traffic in open urban spaces, ventilation use clean energy such as solar energy, are effective activities to reduce the level of exposure and the entry of toxic air pollutants and reduce its adverse effects on fertility in women, men, fetuses and infants. Among the most important benefits of reducing the production and emission of toxic air pollutants are increasing the quality of clean air and increasing the level of health and hygiene of the community [21].
The main limitation of our findings resides in the fact that the design of studies included are review, observational and retrospective.
Conclusions
In this study, evaluation of the consequences of toxic air pollutants on fertility men and women, fetus and birth rate. The findings of this study showed that toxic air pollutants have a synergistic effect on related to fertility.
The result of study demonstrated that the air pollutants has caused great loss of life and infected millions of people because of synergism effects on pregnant mothers and fetus. There is a large and growing body of epidemiological evidence associating emissions toxic air pollutants and increased increase incidence of different cancer (bladder, liver, stomach, and lung), infertility problems in women, reduced sperm fertility in men and in general, reduced birth rates and reduced fertility rates in areas with high levels of pollution.
Improvement of industrial processes, replacing clean energy (more use of public transportation, solar with fossil fuels, replacement of smoky cars and regular control of toxic air pollutants) are the main activities that managers, politicians and governments can take to reduce the adverse effects of toxic air pollutants on the on public health.
Also, it is suggested to present necessary training about the threaten side effects of toxic air pollutants on pregnancy of women residing in crowded areas of city and also to adopt ways to reduce these pollutions.
Acknowledgments
The authors are grateful to Ahvaz Jundishapur University of Medical Sciences for providing necessary facilities to perform this research.
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Research funding: This work wasn’t financially supported.
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Author contributions: RM, HY, AA, AA, WK-A, SM, H-AE and M-JM were principal investigators of the study and drafted the manuscript. RM, HY, AA, AA, WK-A, SM, MK, H-AE and M-JM were advisors of the study. RM, HY, AA, AA, WK-A, MK, SM, H-AE and M-JM performed the statistical analysis. All authors contributed to the design and data analysis and assisted in the preparation of the final version of the manuscript. All authors read and approved the final version of the manuscript.
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Competing interests: The authors declare that they have no competing interests.
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Informed consent: Not applicable.
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Ethical approval: The conducted research is not related to either human or animal use.
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Disclosure statement: No potential conflict of interest was reported by the authors.
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Consent to participate: ’Not applicable’ for that specific section.
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