The WHO Special Planning for Human Reproduction Office estimated a global infertility rate of at least 15 % which means nearly 60–80 million couples are infertile worldwide. Male reproductive health is receiving increasing attention and studies have shown that men contribute to 40–70% of the couple’s infertility.

In recent years, extensive evidence has suggested a global downward trend in semen quality, and multiple studies have reported significant declines in sperm concentration, count, and motility in recent decades, almost 50% in 50 years.

We spoke to Dr. Sanjay Prakash J, Consultant Microsurgical Andrologist & Urologist, Asian Institute of Nephrology and Urology, Chennai to understand how air pollution impacts male fertility.

He explained that the usual explanations are varicocele, seminal infections, hormonal imbalances, cryptorchidism (undescended testis), lifestyle factors such as diet, stress, smoking, obesity, drug and steroid abuse and BMI. In recent years, studies have documented the significant implications that environmental factors impose on male fertility potential.

Studies have reported that, today, almost 2.4 billion people are exposed to hazardous levels of indoor pollution, while 99% of the global population breathes air pollutants that exceed the World Health Organization guideline limits. This trend is particularly concerning in highly polluted areas across South Asia, the Middle East, and parts of Africa, where infertility rates are notably high.

Exposure to air pollutants occurs continuously, either from indoor (household) or outdoor (ambient) sources, resulting in exposure to transient mixtures of pollutants. The air pollutants identified to cause public health concerns include the following: CO, nitrogen dioxide (NO2), SO2, O3, and particulate matter (2.5 µm; 10 µm).

Upon entry, air pollutants cause an increase in reactive oxygen species (ROS) induce lipid peroxidation of membranes leading to structural deformity of sperms leading to sperm death (apoptosis) and poor counts, impaired motility, abnormal morphology, DNA strand breaks , sperm aneuploidy, and other genetic abnormalities, apoptosis of testicular germ cells and more. It also creates a disruption of the Hypothalamo-Pitutary-Gonadal (HPG) axis, resulting in an imbalance of the testosterone hormone milieu, all resulting in male infertility.

Nevertheless, studies revealed that exposure to air pollutants can affect male sexual health, either via the initiation of depression and anxiety or via disruption of chemical pathways.

The continuous and prolonged exposure to air pollutants is associated with the development or exacerbation of acute or chronic health conditions which further impacts the reproductive health.

Therefore, it is imperative to emphasize the necessity of increasing awareness among the public and the authorities. Air pollution’s effect on male fertility is largely preventable and the policymakers need to recognize the risk and act to improve air quality as a public health priority. Tackling air pollution by reducing emissions, promoting clean energy, and encouraging urban green spaces could help mitigate this hidden risk to male fertility. As the world grapples with environmental health crises, acknowledging air pollution’s impact on reproductive health is a critical step toward safeguarding future generations.

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