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<p>Environmental metal exposure is one of the factors that impair fertility. This study investigates the relationship between metal accumulation and infertility, as well as the association between mixed metal exposures and infertility, and conducts subgroup analysis for childbearing-age women with different ages and weights. Based on data from three time periods in the National Health and Nutrition Examination Survey (2013–2014, 2015–2016, and 2017–March 2020 pre-pandemic), we investigated the relationship between five mixed exposures (lead, cadmium, manganese, mercury, methylmercury) and infertility in 18–44&#xa0;years old women using multivariate logistic regression models, quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR). Subgroup analyses were performed according to BMI (&lt; 25&#xa0;kg/m<sup>2</sup> or ≥ 25&#xa0;kg/m<sup>2</sup>) and age (&lt; 35&#xa0;years or ≥ 35&#xa0;years). A total of 2647 women were included in this study. The multivariate logistic regression model showed a significant association between cadmium and infertility at quantile 4 in the non-overweight group (adjusted: OR 2.15, 95% CI 1.01–4.59, <i>P</i> = 0.048), as well as mercury in the overweight group (adjusted: OR 1.85, 95% CI 1.04–3.28, <i>P</i> = 0.035). The QCG and BKMR models both found that mixed metal exposures significantly increased the risk of infertility among non-overweight women, highlighting that cadmium was responsible for the outcomes. In addition, the QGC model showed that&#xa0;metal exposure mixtures were significantly related to female infertility in the advanced age group (OR 1.24, 95% CI 1.06–1.44, <i>P</i> = 0.006). From the&#xa0;BKMR analysis, when mixed metal exposures exceeded the 50th percentile, the risk of infertility considerably increased in women with non-overweight. No interactions among the&#xa0;five exposures were found. Exposure to mixed metals may increase the risk of infertility in women, especially those who are older or not overweight. Specific metals, such as methylmercury and cadmium, may be associated with infertility in certain populations.</p>

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Association Between Mixed Metal Exposures and Female Infertility: A Large Cross-sectional Study

  • 期刊论文

  • 发表日期：

    2025年3月24日

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  • Yunan He,
  • Xiaoxiao Su,
  • Zhiping Niu,
  • Bolun Zhang,
  • Hui Mu,
  • Lu Wang,
  • Yuanqing Yao,
  • Xiaohong Wang

摘要

Environmental metal exposure is one of the factors that impair fertility. This study investigates the relationship between metal accumulation and infertility, as well as the association between mixed metal exposures and infertility, and conducts subgroup analysis for childbearing-age women with different ages and weights. Based on data from three time periods in the National Health and Nutrition Examination Survey (2013–2014, 2015–2016, and 2017–March 2020 pre-pandemic), we investigated the relationship between five mixed exposures (lead, cadmium, manganese, mercury, methylmercury) and infertility in 18–44 years old women using multivariate logistic regression models, quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR). Subgroup analyses were performed according to BMI (< 25 kg/m2 or ≥ 25 kg/m2) and age (< 35 years or ≥ 35 years). A total of 2647 women were included in this study. The multivariate logistic regression model showed a significant association between cadmium and infertility at quantile 4 in the non-overweight group (adjusted: OR 2.15, 95% CI 1.01–4.59, P = 0.048), as well as mercury in the overweight group (adjusted: OR 1.85, 95% CI 1.04–3.28, P = 0.035). The QCG and BKMR models both found that mixed metal exposures significantly increased the risk of infertility among non-overweight women, highlighting that cadmium was responsible for the outcomes. In addition, the QGC model showed that metal exposure mixtures were significantly related to female infertility in the advanced age group (OR 1.24, 95% CI 1.06–1.44, P = 0.006). From the BKMR analysis, when mixed metal exposures exceeded the 50th percentile, the risk of infertility considerably increased in women with non-overweight. No interactions among the five exposures were found. Exposure to mixed metals may increase the risk of infertility in women, especially those who are older or not overweight. Specific metals, such as methylmercury and cadmium, may be associated with infertility in certain populations.