Dimitris Michalakis
MD, MSc, Gynecologist in Assisted
Reproduction, Fertility Specialist
In recent years, our understanding of fertility has expanded beyond the limits of physiology alone. The environment in which we live – the air we breathe, the water we drink, and the materials we come into contact with each day – can leave subtle but measurable marks on reproductive health. For many women, these invisible influences may affect ovarian reserve (Gaskins et al., 2019) and, consequently, the outcome of assisted reproductive treatments.
Air pollution remains one of the most extensively studied environmental factors. Exposure to fine particulate matter (PM2.5 and PM10) and gases such as nitrogen dioxide (NO₂), especially in urban areas, has been associated with a reduced ovarian response and lower live birth rates following IVF. A recent systematic review and meta-analysis (Liu et al., 2023) found that women exposed to higher air pollution levels during ovarian stimulation or embryo transfer were less likely to achieve a clinical pregnancy or live birth — emphasizing the importance of minimizing exposure during these critical treatment phases.
Microplastics have now become ubiquitous, reaching from the highest mountain peaks to the deepest ocean waters Phthalates and bisphenols (BPA), known endocrine disruptors, interfere with hormonal balance and can induce oxidative stress in ovarian tissue and developing follicles. Studies suggest that increased exposure to BPA may disrupt folliculogenesis and oocyte maturation, leading to a lower ovarian reserve and poorer IVF outcomes (Ehrlich et al., 2012; Pandey et al., 2025). Although complete avoidance is impossible, practical changes – such as reducing plastic use, avoiding food storage in plastic containers, and choosing fragrance-free products – can meaningfully reduce exposure.
More recently, attention has turned to the so-called “forever chemicals”, or PFAS, found in non-stick cookware and water-resistant fabrics. These substances are extremely persistent and can remain in the human body for years. Evidence suggests that high PFAS exposure is associated with lower fertilization rates and reduced embryo quality among women undergoing IVF (Shen et al., 2024). Using water filters and limiting contact with non-stick materials represent simple butvaluable preventive measures. Heavy metals, including cadmium, lead, and mercury, are also recognized as potential reproductive toxins. Chronic exposure has been linked to lower anti-Müllerian hormone (AMH) levels and, in some cases, earlier menopause (Ding et al., 2024). Everyday actions such as avoiding fish with high mercury content, quitting smoking, and using reliable water filtration systems can reduce exposure -particularly important for women preparing for fertility treatment.
None of these environmental influences acts in isolation, and none solely determines fertility potential. Yet, collectively, they contribute to a broader picture of reproductive health – one where lifestyle, environment, and medical careare deeply interconnected. For women preparing for assisted reproduction, small environmental adjustments combined with evidence-based medical guidance maysupport ovarian function and improve treatment success.
At Embryolab, environmental awareness is a fundamental part of our Next-Gen IVF philosophy. By guiding our patients toward healthier choices – cleaner air, safer materials, and a more conscious daily lifestyle – we honor both science andthe delicate balance that sustains human life.
Bibliography
- Gaskins AJ, Mínguez-Alarcón L, Fong KC, et al. Exposure to Fine Particulate Matter and Ovarian Reserve Among Women from a Fertility Clinic. Epidemiology. 2019;30(4):486-491. doi:10.1097/ EDE.0000000000001029
- Ehrlich S, Williams PL, Missmer SA, et al. Urinary bisphenol A concentrations and early reproductive health outcomes among women undergoing IVF. Hum Reprod. 2012;27(12):3583-3592. doi:10.1093/humrep/des328
- Pandey AN, Yadav PK, Premkumar KV, et al. Damage mechanisms of bisphenols on the quality of mammalian oocytes. Hum Reprod. 2025;40(2):186-198. doi:10.1093/humrep/deae284
- Shen J, Mao Y, Zhang H, et al. Exposure of women undergoing in-vitro fertilization to per-and polyfluoroalkyl substances: Evidence on negative effects on fertilization and high-quality embryos. Environ Pollut. 2024;359:124474. doi:10.1016/j. envpol.2024.124474
- Ding N, Wang X, Harlow SD, Randolph JF Jr, Gold EB, Park SK. Heavy Metals and Trajectories of Anti-Müllerian Hormone During the Menopausal Transition. J Clin Endocrinol Metab. 2024;109(11):e2057-e2064. doi:10.1210/clinem/ dgad756
