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In the Emmy Award-winning new series The Handmaid’s Tale, a chilling new picture of a dystopian society emerges. Environmental contaminants are causing decreased sperm production among men, couples having difficulty conceiving and children being born with numerous health concerns. When I first read Margaret Atwood’s book The Handmaid’s Tale in the 80’s, I thought it was a science fiction novel. Never did I imagine that it was a plausible vision of the future.
The troubling reality is that we are seeing a huge increase in both chronic disease (over 50% of adults have at least one) and reproductive health issues. The primary force behind the increase in chronic diseases has been unmasked. The sheer amount of toxins overwhelming our body’s own detoxification systems, while simultaneously dysregulating the immune and endocrine system, is making us all sick. The CDC reports that over 100 toxic chemicals and metals out of the 212 that were measured (which is but a small fraction of the thousands of chemicals humans are exposed to daily) are present in the average U.S. resident.[i] This load is a prime causative factor for the majority of the epidemic of chronic diseases in the U.S. and must be addressed. Studies have shown that even our babies are being born pre-polluted. Heavy metals like lead and mercury, flame retardants, pesticides, herbicides, Bisphenol A and phthalates have been found in their cord blood, amniotic fluid, and breastmilk.[ii],[iii],[iv]
Major medical associations are becoming aware of this problem. FIGO, the international Federation of Gynecology and Obstetrics representing 125 different countries reports that:
"Exposure to toxic environmental chemicals during pregnancy and breastfeeding is ubiquitous and is a threat to healthy human reproduction." [v]
Infertility is on the Rise
In a world where couples spend more time and effort trying not to get pregnant than to conceive, it is often difficult to definitively measure fertility. The current belief is that infertility affects 10-15% of couples worldwide. But it is only when these couples try to get pregnant, and discover they can’t and have the financial means and access to healthcare, that we know they are suffering from infertility. Are we only seeing the tip of the iceberg?
While we cannot accurately quantify infertility prevalence, we do know it is rapidly becoming a bigger problem. Since 2003, there has been a 65% increase in the use of IVF for women who are unable to get pregnant.[vi]
One of the main arguments for increased infertility is that couples are delaying parenthood for career demands. According to the CDC, the mean age of first-time mothers increased 1.4 years over a 14 year period, from 24.9 in 2000 to 26.3 in 2014. This data illustrates the truth that Americans are delaying parenthood. But does that mean that age is the only infertility factor? The most recent CDC data from 2002 shows that 4.9% of women age 15-29 sought assisted reproduction assistance (ART), and that was 15 years ago. These women are in the peak fertility age range but could not get pregnant. In addition, this represents a small percentage of young infertile women, only those who had the financial means to seek ART.
These are inconvenient truths which raise inconvenient questions. As more and more children are born after their parents use fertility clinics, should we accept this as a reasonable solution or is it a short-term solution that does nothing for the fertility of future generations? Disturbingly, some environmental toxicants have been shown to have epigenetic ramifications on reproductive systems that transcend generations.[vii] This is an area that demands more research. The future of humanity hangs in the balance.
Testosterone Levels Have Plummeted
In the last decade, we have seen a sharp rise in marketing ads targeting men with ‘Low T’ featuring a slump-shouldered man on the screen with symptoms in bold font leaping across the screen: low libido, fatigue, infertility, erectile dysfunction, osteoporosis, reduced muscle mass and depressed mood. After 30 years of age, normal male aging has a gradual testosterone decline but recent trends show a much sharper decline compared with just a few decades ago. While there are a variety of known risk factors (obesity, medications, blood sugar dysregulation, smoking and a sedentary lifestyle[viii]), there are also a variety of environmental factors that contribute to low testosterone.
The shift in testosterone decline for an increasing number of men has been well documented. The Baltimore Longitudinal Aging Study examined over 40 years of data and found that sample taken from men in 1965-1971 had 40% higher testosterone levels than samples collected from men in 1985-1995.[ix] Another study found that testosterone levels were approximately 17% lower in American men from 1987 compared to 2004.[x] This data is concerning for a variety of reasons including the parallel drop in fertility rates that accompanies decreased testosterone levels. In another comprehensive meta-regression analysis, a significant decline in sperm counts between 1973 and 2011 was reported-- 50-60% in men from North America, Europe, Australia, and New Zealand.[xi]
A Decrease in Egg Quality
Along with the decrease in sperm counts and quality, egg quality and viability has decreased as well. Endocrine disruptors have also been implicated as a contributing factor. Studies have found that an overall higher Endocrine Disrupting Chemical (EDC) contamination in the delicate follicular micro-environment (the area around the egg) is associated with a decreased fertilization rate.[xii] Other studies have shown that pesticide exposure adversely affected the ability of the ovary to produce sex hormones, disrupted uterine structure and function, reduced fertility, and was correlated to earlier ages at menopause. Epidemiological studies on heavy metals and success with assisted reproduction have also indicated a decline in eggs retrieved and reproductive success in the women who had a significant elevation in the heavy metals in their follicular fluid.[xiii]
Many scientists are documenting the contributions of a phenomenon called endocrine disruption to fertility issues. According to the Endocrine Society, an organization that consists of 18,000 scientists, physicians, educators, nurses and students in over 100 countries, endocrine disrupting chemicals (EDCs) are exogenous agents that interfere with synthesis, transport, metabolism, binding action, or elimination of hormones, including those that are responsible for fertility.
Table 2 from: https://www.endocrine.org/-/media/endosociety/files/advocacy-and-outreach/important-documents/introduction-to-endocrine-disrupting-chemicals.pdf?la=en
Often, this happens at very low doses, which is why the existence of endocrine-disrupting chemicals (EDCs) in our environment pose such a threat to our health. It turns the old “dose makes the poison” argument on its head, as hormone activity itself occurs at extremely low levels of hormones.
While we have heard for decades about bisphenol A (BPA), women’s health, and increased risk of breast cancer, it is important to remember that men are also impacted by environmental exposures. BPA in plastic water bottles is not the only chemical that lowers testosterone in men. The number of testosterone lowering chemicals from commonplace environmental exposures is alarming. One study that followed mothers in their first trimester through pregnancy and their children until 14 years of age found that as urinary levels of phthalates and BPA increased, testosterone levels decreased.[xiv] The NHANES study found that higher phthalates levels were associated with a 24-34% drop in testosterone among boys 6-12 years old and that males between 40-60 years old also displayed the similar inverse relationship.[xv] Another study found that increased phthalate body burden was associated with a 20% reduction in male fertility.[xvi]
You can start by making small changes to reduce your exposures to these endocrine-disrupting toxins. Avoid high pesticide exposure by avoiding the ‘Dirty Dozen’ and stop putting RoundUp on your lawns. Reading labels and reducing your exposure to plastics and plasticizers is also a great way to reduce exposures. Remember that ‘fragrance’ or ‘parfum’ on an ingredient label likely contains phthalates. BPAs are found in nearly all beverage and food cans as epoxy lining, plastics with #7 recycling code, water bottles, composite fillings, various medical and dental devices, thermal receipts, and water supply pipes. Heating food in plastic containers also increases the leaching of these chemicals into your food, so forgo the plastic tupperware when heating or storing warm foods. Consider using an air filter in your homes to reduce particulate matter from air pollution. These are just a few of the ways in which you can decrease your exposures to the harmful toxicants.
While avoidance is the #1 rule of environmental medicine, what if you are already ill or trying to conceive? The emerging medical specialty of Environmental Medicine seeks to overcome chronic disease by discovering the root cause and then addressing it. Often this entails detailed Environmental Health Questionnaires and health and occupational histories that can be used to suggest lab tests for certain toxicants. Once a patient’s concentrations of toxins and heavy metals is mapped, an environmental doctor will tailor a personalized detoxification protocol for them, designed to lower the body burden of harmful toxicants that are contributing to the disease process. Seek out clinicians who are trained in this area and don’t rely on colon cleanses or 3 day juice cleanses that are popular in the market-place right now, as those “quick fixes” are ineffective and do not purge deep-seated toxins and heavy metals from your tissues.
By becoming aware of the environmental issues impacting fertility, we can avoid a precarious “Handmaid’s Tale”-like future where childbearing must be out-sourced, or become a high-tech invasive procedure, in order to continue the human race.
Unfortunately the underlying challenge of infertility, faced by the people in The Handmaid’s Tale, has become a reality for many people currently in the childbearing years. If you are planning to start a family, you may be feeling overwhelmed from reading this article. It is undoubtedly a frightening thought that more and more people will likely experience infertility if we continue to be exposed to chemicals that disrupt our reproductive systems.
The answer is not to stick our heads in the sand; the answer is to become informed and empowered. As individuals we have the power to use our financial leverage to buy less toxic foods, personal care products and other consumer goods. Not only will such choices reduce personal exposure to toxic chemicals, they will drive the market towards cleaner products. If you are ready to find out how to implement change to preserve your and your family’s fertility, know that you are not alone. There is a growing body of clean products, informational organizations teaching about exposure sources and medical providers skilled in the growing field of environmental medicine. It will take all of us, as a society, to turn the tide and preserve the future generations.
This article is a collaboration between Dr. Anne Marie Fine (www.grannemariefine.com), Dr. Bonnie Nedrow (www.bonniened.com), and Dr. Tina Beaudoin (www.healthstrongim.com) all practicing Naturopathic Doctors focused on Environmental Medicine and board members of the Naturopathic Academy of Environmental Medicine (NAEM). For a listing of environmental practitioners please visit www.naturopathicenvironment.com
[ii] Maekawa R. et al. Evidence of exposure to chemicals and heavy metals during pregnancy in Japanese women. Reprod Med Biol 2017;16:337-348.
[iii] President's Cancer Panel. Reducing environmental cancer risk: what we can do now. https://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf, Published April 2010 Accessed October 20, 2017
[iv] Watkins DJ et al. Impact of phthalate and BPA exposure during in utero windows of susceptibility on reproductive hormones and sexual maturation in peripubertal males. Environ Health. 2017 Jun 21;16(1):69.
[v]. Giudice, L, et al. International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals. International Journal of Gynecology and Obstetrics, September 2015 DOI: 10.1016/j.ijgo.2015.09.002
[vi] www.rmanj.com/infertility-in-america-2015-survey-report/ Accessed October 20, 2017
[vii] Manikkam M, et al. Transgenerational Actions of Environmental Compounds on Reproductive Disease and Identification of Epigenetic Biomarkers of Ancestral Exposures. Shioda T, ed. PLoS ONE. 2012;7(2):e31901. doi:10.1371/journal.pone.0031901.
[viii] Chiles, KA, Hypogonadism and erectile dysfunction as harbingers of system disease. Transl Androl Urol. 2016 Apr;5(2):195-200.
[ix] Meeker, JD & Ferguson, KK. Urinary phthalate metabolites are associated with decreased serum testosterone in men, women, and children from NHANES 2011-2012. J Clin Endocrinol Metab. 2014 Nov;99(11):4346-52.
[x] Buck, GM, et al. Urinary bisphenol A, phthalates, and couple fecundity: the LIFE Study. Fertil Steril. 2014 May;101(5):1359-66.
[xi] Levine, H et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update. 2017 Jul 25:1-14.
[xii] Petro EM et al. Endocrine-disrupting chemicals in human follicular fluid impair in vitro oocyte developmental competence. Hum Reprod. 2012 Apr;27(4):1025-33.)
[xiii] Rattan S. et al. Exposure to endocrine disruptors during adulthood: consequences for female fertility. J Endocrinol June 1, 2017 233 R109-R127
[xiv] Ferguson, KK et al. Prenatal and peripubertal phthalates and bisphenol A in relation to sex hormones and puberty in boys. Reprod Toxicol. 2014 Aug;47:70-6.
[xv] Meeker, JD & Ferguson, KK. Urinary phthalate metabolites are associated with decreased serum testosterone in men, women, and children from NHANES 2011-2012. J Clin Endocrinol Metab. 2014 Nov;99(11):4346-52.
[xvi] Buck, GM, et al. Urinary bisphenol A, phthalates, and couple fecundity: the LIFE Study. Fertil Steril. 2014 May;101(5):1359-66.