Medicosnext
Dr Shreyashi Aryal
She has an experience of more than 15 years working in the field of women’s health. She works currently as Associate Professor in the Department of Obstetrics and Gynaecology at Kathmandu Medical College, Nepal. She is also the managing editor of the medical journal of the same institute. She has a special interest in integration of mental and physical health of women. Dr Aryal is actively involved in voluntary activities serving Nepali women through Menopausal Society of Nepal, Nepal Society of Obstet and Gynaecology and General Member of Inner Wheel district 350. She has been awarded the Young Gynecologist award in 2017 and has a list of scientific publications in national and international peer reviewed journals to her credit. Dr Aryal is a mother of a 6 year old daughter and loves to travel with this little buddy.
“I do not want to overburden this planet.” “I do not want to bring a child to this detrimental environment”. This is what people have been reasoning to not have an offspring. The detrimental effects of climate change lead people to make decisions not to reproduce. This decision is for people who are able to conceive a baby spontaneously when they decide to, but there are couples who would give anything to have a child, but are unable to. In medical terms, these couples are known as subfertile couples.
Subfertility or infertiliy is defined as a condition where a couple is unable to conceive even after a year of regular intercourse without contraception. There are different factors affecting fertility in males and females and one such undermined cause is climate change.
Climate change is defined as a significant increase in temperature that lasts decades or longer. This causes an imminent environmental catastrophe defined as a climate crisis. Perceived effects of climate change include global warming causing extreme weather events, wildfires, increased air pollution, rising sea and waterway levels, floods, and disruption and migration of human populations.
The global rate of subfertility ranges from 6-9% which is increasing with more couples seeking treatments for assisted reproductive technologies. Climate change and its consequences directly or indirectly have a negative effect on the reproductive health of men and women. Data from19 industrialized countries in the 20th century suggest that human fertility is affected by global warming. Studies from different parts of Nepal suggest a subfertility rate of 6-8% with an increasing trend.
What are the effects of climate change on fertility?
There are behavioral and physiological effects of the environment on human fertility.
Behavioral effects
The first behavioral effect is the pattern of sexual activity. Heavy physical activity is limited in extreme heat. Infrequent sexual activity affects fertility rate.
The second impact is the hindrance of access to healthcare facilities during severe weather conditions. A glacier lake outburst in Thame village in Nepal in 2020, flooded the only health care center for a few villages in the area. Such events lead to delayed treatment and increase in incidences of sexually transmitted diseases or HIV. These if not treated in time cause infertility. Another service that is disrupted is the safe abortion services. Unsafe abortion is a major cause of maternal deaths in Nepal and is a leading cause for infertility. During extreme weather events women resort to unsafe abortion methods which may affect future fertility.
Physiological effects
The physiological effects include decreased sperm quality, decreased ovarian reserve, hormonal disruption causing conditions like polycystic ovarian syndrome, endometriosis and early menopause.
All of these conditions cause difficulty in conception. In case a couple manages to conceive after various treatments, the effects of climate change may cause adverse pregnancy outcomes. Miscarriages, preterm births and death of a baby in utero are some complications related to negative environmental influences.
What exactly is the cause?
The effects on fertility are manifested through three mechanisms. They are exposure to:
1. Endocrine Disrupting Chemicals (EDCs),
2. Heat stress, and
3. Environmental pollution.
Endocrine Disrupting Chemicals:
The measurable effects on reproductive health mostly have causal association with EDCs. These are exogenous chemicals that, when exposed, specifically in utero or puberty, can contribute to both female and male infertility. They also predispose to the development of other diseases like obesity, diabetes, and endocrine cancers that cause subfertility.
EDCs are derived from various sources like pharmaceutical products such as diethylstilbestrol [DES] and estradiol. Dichlorodiphenyltrichloroethane (DDT) and heavy metals like lead, mercury, cadmium, and arsenic have also been associated with male infertility.
These may be limited in use but there are products that we use on a daily basis which contain EDCs. Soy products, industrial chemicals such as pesticides and lubricants, household consumables like bisphenol present in plastics, phthalates and parabens present in makeup items, cleaning liquids, detergents, soaps, lavender and tea tree oils all affect fertility.
Heat stress
Semen quality is on the decline and one of the reasons for this is heat stress. Heat stress affects the process of sperm formation known as spermatogenesis and also affects the number and quality of sperms.
Nepal has one of highest numbers of male migrant workers and most of these men migrate to work in countries like UAE, Saudi Arabia, Qatar, where they work in extreme heat conditions. Elevated testicular temperature is associated with decreased sperm quality. This is one of the reasons for decreasing fertility in Nepali men.
Air pollution
Air pollution, another substantial contributor to climate change, encompasses various pollutants such as nitrogen oxides, sulphur oxides, ozone, ammonia, carbon monoxide, methane, volatile organic compounds (VOCs), fine particulate matter (PM2.5, PM10).
Activities such as burning fossil fuels, deforestation, vehicular emissions, aerosols, methane, and wildfires contribute to air pollution.
Particulate matters are solid or liquid particles suspended in the air. Fine particulate matters (PM 2.5) enter the air, soil, water, or food chain. Increased exposure to fine particulate matter reduces fertility. It reduces the chances of spontaneous conception and increases the need for assisted reproductive techniques.
Studies show that people living in the vicinity of major highways are exposed to vehicular traffic and diesel exhaust pollutants have abnormal sperm parameters,
Air Pollution is also associated with compromised in vitro fertilization (IVF) outcomes.
What can be done?
Policies and recommendation
Nepal, like many low-resource countries, contributes minimally to climate change but suffers disproportionately from its effects and is the least equipped to manage the consequences. While some policies have been implemented, much more needs to be done.
Here are some recommendations to mitigate the impact of climate change on reproductive health
Reductions in greenhouse gas
Long-term cuts in greenhouse gas emissions are a key step in slowing down global warming. A well-known but challenging step.
The Government of Nepal has adopted policies like phasing out coal-powered electricity, improving hydroelectricity capacity and private forest development.
Each individual can commit to reducing carbon footprints by small behavioral modifications like decrease electricity use, choose climate friendly options like driving less and carpooling or riding a bike. Recycling, reusing, conserving water and planting trees goes a long way too.
EDC exposure can be reduced through decreased consumption of processed, canned or plastic stored foods, avoid microwaving in plastic containers, limit use of personal care products like soaps, detergents and cosmetic products.
Food in cans and plastics can be replaced with healthier options like glass containers.
Eating healthy is a definitive prevention for most reproductive ailments.
Food Fortification: Addition of micronutrients to food during processing to increase its nutritional content is known as food fortification. This addresses micronutrients deficiency which may improve the chances of spontaneous conception.
Monitoring
There must be stringent laws governing toxicity testing. It is important to keep an eye out for dangerous substances like pesticides in fruits and vegetables. It is important to measure the level of toxicity in respect to reproductive health parameters.
Facilitate Research
The first step to any policy making is research. We need to know more about the direct and indirect effects of climate change on reproductive health. Such research needs to be encouraged.
Education, awareness and empowerment
People act on an issue only when they are aware of it. People need to know how climate change is detrimental to their reproductive health. Focus should be on informing people on how to avoid EDCs. Campaigns, workshops, training would empower couples to prevent fertility issues.
In the face of an escalating climate crisis, the profound impact on fertility serves as a stark reminder of the interconnectedness between human health and the environment. Addressing these challenges demands urgent collective action to safeguard reproductive health. Stakeholders need to consider fulfillment of sexual and reproductive rights to achieve a step towards reversing impacts of climate change. Let us remember, the decisions we make today echo in the lives of tomorrow.
