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<p>Infertility affects approximately 17.5% of the adult population globally, according to the World Health Organization’s 2023 report, with environmental pollutants increasingly identified as modifiable risk factors. This systematic review and meta-analysis investigates the effects of particulate matter (PM₂.₅), nitrogen dioxide (NO₂), bisphenol A (BPA), and phthalates on semen quality, ovarian reserve, oocyte yield, clinical pregnancy rates (CPR), and time to pregnancy (TTP) in the context of assisted reproductive technology (ART). This study adhered to PRISMA 2020 guidelines (PROSPERO: CRD420251066799). We searched PubMed, Scopus, Web of Science, and Embase from January 2008 to December 2024. Studies assessing pollutant exposure through ambient monitoring or biomarkers and reporting human reproductive outcomes were included. Two reviewers independently screened 2,478 records, extracted data, and evaluated quality using the Newcastle-Ottawa Scale (NOS ≥7) and ROBINS-I V2, 2024 tool. Random-effects meta-analyses were performed using R (metafor package), with heterogeneity (I²), subgroup analyses, and publication bias (funnel plots, Egger’s test) assessed. From 2,478 records, 38 high-quality studies (n=55,620) were included. PM₂.₅ exposure (per 10 µg/m³) reduced sperm concentration by 5.5 million/mL (95% CI: -6.05 to -5.11 , P&lt;0.001, I²=72%) , and NO₂ (per 10 ppb) decreased motility by 4.3 percentage points (95% CI: -4.52 to -4.11 , P&lt;0.001, I²=65%). BPA lowered anti-Müllerian hormone (AMH) by 0.42 standardized mean difference (SMD) (95% CI: -0.46 to -0.37 , P&lt;0.001, I²=69%), and phthalates reduced antral follicle count (AFC) by 0.38 SMD (95% CI: -0.42 to -0.33 , P&lt;0.001, I²=67%). Oocyte yield decreased with PM₂.₅ (SMD: -0.33 , 95% CI: -0.38 to -0.28 , P&lt;0.001, I²=62%), and CPR declined with BPA (odds ratio [OR]: 0.83, 95% CI: 0.81- 0.85, P=0.001, I²=58%). No significant TTP effect was observed (SMD: 0.10, 95% CI: -0.09 to 0.29, P=0.30, I²=85%). Although high heterogeneity was explored through subgroup and sensitivity analyses, revealing variability by region and exposure duration, there was no change in the overall non-significance. PM<sub>2.5</sub>, NO<sub>2</sub>, BPA, and phthalates demonstrate significant, dose-dependent adverse impacts on male and female fertility parameters, including semen quality, ovarian reserve, oocyte yield, and CPR. These results underscore the pressing need for regulatory measures and further research to alleviate reproductive health threats from rising environmental pollution.</p>

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Association between Particulate Matter (PM₂.₅), Nitrogen Dioxide (NO₂), Bisphenol A (BPA), and Phthalates and Infertility Outcomes: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年2月6日

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  • Leila Majdi,
  • Gholamreza Tizro,
  • Saghar Salehpour,
  • Sedighe Hosseini,
  • Parisa Taherzadeh Boroujeni

摘要

Infertility affects approximately 17.5% of the adult population globally, according to the World Health Organization’s 2023 report, with environmental pollutants increasingly identified as modifiable risk factors. This systematic review and meta-analysis investigates the effects of particulate matter (PM₂.₅), nitrogen dioxide (NO₂), bisphenol A (BPA), and phthalates on semen quality, ovarian reserve, oocyte yield, clinical pregnancy rates (CPR), and time to pregnancy (TTP) in the context of assisted reproductive technology (ART). This study adhered to PRISMA 2020 guidelines (PROSPERO: CRD420251066799). We searched PubMed, Scopus, Web of Science, and Embase from January 2008 to December 2024. Studies assessing pollutant exposure through ambient monitoring or biomarkers and reporting human reproductive outcomes were included. Two reviewers independently screened 2,478 records, extracted data, and evaluated quality using the Newcastle-Ottawa Scale (NOS ≥7) and ROBINS-I V2, 2024 tool. Random-effects meta-analyses were performed using R (metafor package), with heterogeneity (I²), subgroup analyses, and publication bias (funnel plots, Egger’s test) assessed. From 2,478 records, 38 high-quality studies (n=55,620) were included. PM₂.₅ exposure (per 10 µg/m³) reduced sperm concentration by 5.5 million/mL (95% CI: -6.05 to -5.11 , P<0.001, I²=72%) , and NO₂ (per 10 ppb) decreased motility by 4.3 percentage points (95% CI: -4.52 to -4.11 , P<0.001, I²=65%). BPA lowered anti-Müllerian hormone (AMH) by 0.42 standardized mean difference (SMD) (95% CI: -0.46 to -0.37 , P<0.001, I²=69%), and phthalates reduced antral follicle count (AFC) by 0.38 SMD (95% CI: -0.42 to -0.33 , P<0.001, I²=67%). Oocyte yield decreased with PM₂.₅ (SMD: -0.33 , 95% CI: -0.38 to -0.28 , P<0.001, I²=62%), and CPR declined with BPA (odds ratio [OR]: 0.83, 95% CI: 0.81- 0.85, P=0.001, I²=58%). No significant TTP effect was observed (SMD: 0.10, 95% CI: -0.09 to 0.29, P=0.30, I²=85%). Although high heterogeneity was explored through subgroup and sensitivity analyses, revealing variability by region and exposure duration, there was no change in the overall non-significance. PM2.5, NO2, BPA, and phthalates demonstrate significant, dose-dependent adverse impacts on male and female fertility parameters, including semen quality, ovarian reserve, oocyte yield, and CPR. These results underscore the pressing need for regulatory measures and further research to alleviate reproductive health threats from rising environmental pollution.