Association between heavy metals exposure and infertility among American women aged 20–44 years: A cross-sectional analysis from 2013 to 2018 NHANES data

Abstract

BackgroundInfertility has been confirmed as a significant medical and social problem. Heavy metal exposure refers to a risk factor for infertility, which is capable of damaging the reproductive system of males and females. However, heavy metal exposure and female infertility have rarely been investigated. The aim of this study was to analyze the association between heavy metal exposure and female infertility.MethodsA cross-sectional study using data from three cycles of the National Health and Nutrition Examination Survey (NHANES, 2013–2018) was performed. Female infertility was evaluated by positive responses to question rhq074 in the questionnaire. Cadmium (Cd), lead (Pb), mercury (Hg), and arsenic (As) levels in blood or urine were examined by inductively coupled plasma mass spectrometry. The correlation between heavy metal and female infertility was analyzed through weighted logistic regression.ResultsA total of 838 American women aged 20–44 years were covered in the study. Among all participants, 112 (13.37%) women were subjected to infertility. Urinary Cd and urinary As levels were significantly higher in infertile women than in control women (P < 0.05, P < 0.05). Urinary As showed a positive correlation with the prevalence of female infertility, and the risk of infertility rose with the increase of urinary As levels (P for trend = 0.045). Urinary Cd was associated with female infertility in some weighted logistic regression (Crude, Q2: OR = 3.99, 95% CI 1.82, 8.74, Q3: OR = 2.90, 95% CI 1.42, 5.92. Model 1, Q2: OR = 3.68, 95% CI 1.64, 8.27, Q3: OR = 2.33, 95% CI 1.13, 4.48. Model 2, Q2: OR = 4.11, 95% CI 1.63, 10.07, Q3: OR = 2.44, 95% CI 1.07, 5.53. Model 3, Q2: OR = 3.77, 95% CI 1.52, 9.35). Moreover, blood Pb (OR = 1.52, 95% CI 1.07, 2.16), urinary Pb (OR = 1.68, 95% CI 1.11, 2.55), and urinary As (OR = 1.02, 95% CI 1.00, 1.03) were positively correlated with the risk of infertility in women aged 35–44 years. The blood Pb (OR = 1.67, 95% CI 1.16, 2.40, 2.49) and urinary Pb (OR = 1.54, 95% CI 1.00, 2.38) in women with BMI ≥25 were positively correlated with the risk of infertility.ConclusionsUrinary As was significantly associated with female infertility, and the risk of infertility increased with higher urinary As levels. To some extent, urinary Cd was correlated with infertility. Blood/urine Pb was related to infertility in advanced age and overweight/obese women. The results of this study need to be further validated in future prospective studies.

Maternal exposure to metals and time‐to‐pregnancy: The MIREC cohort study

“…23 Lead concentrations were associated with infertility in some categories but with no overall doseresponse pattern. 23 Compared with MIREC, mean concentrations of cadmium and mercury in NHANES were higher (0.45 μg/L for cadmium, 1.15 μg/L for mercury); however, concentrations of lead were the same (0.70 μg/dL). We found a decreased odds of infertility in the second tertile (0.50-0.77 μg/dL) of exposure for lead (OR 0.52, 95% CI 0.33-0.84), but not in those in the highest tertile (>0.77 μg/ dL) or when the exposure was modelled as a continuous variable.…”

“…Another study including a larger sample of 838 participants from the 2013–2018 NHANES reported no association between blood concentrations of cadmium or mercury and self‐reported infertility 23 . Lead concentrations were associated with infertility in some categories but with no overall dose–response pattern 23 . Compared with MIREC, mean concentrations of cadmium and mercury in NHANES were higher (0.45 μg/L for cadmium, 1.15 μg/L for mercury); however, concentrations of lead were the same (0.70 μg/dL).…”

“…The geometric mean of blood lead was lower in this study (0.50 μg/dL) compared with MIREC; however, the geometric mean of blood cadmium (0.26 μg/L) was similar. Another study including a larger sample of 838 participants from the 2013–2018 NHANES reported no association between blood concentrations of cadmium or mercury and self‐reported infertility 23 . Lead concentrations were associated with infertility in some categories but with no overall dose–response pattern 23 .…”

“…inability to conceive after 12 months of unprotected intercourse) have reported associations with infertility at increased levels of cadmium or lead. [22][23][24] This study aims to evaluate the association between selected metals (arsenic, cadmium, lead, manganese and mercury), TTP and infertility in participants from the Maternal-Infant Research on Environmental Chemicals (MIREC) study, a Canadian pregnancy and birth cohort.…”

The association between weight‐adjusted‐waist index and self‐reported infertility among women of reproductive age in the United States

“…As cadmium (Cd), lead (Pb), mercury (Hg), arsenic (As), di-2-ethylhexyl phthalate (DEHP), and bisphenol A (BPA), may alter several reproductive functions in women and have the toxicological aspect of fertility. [7][8][9][10][11] Observational studies have shown that lifestyle factors such as smoking, excessive consumption of alcohol and caffeine, and unbalanced nutritional habits exert a profound impacts on female reproductive health. [12][13][14] Some anthropometric indices have been proven to have side effects on female fertility.…”