Five changes to improve our reproductive health

As an environmental and reproductive epidemiologist, I have spent several decades studying the hidden threats to human beings’ reproductive health and development. My goal has always been and continues to be to help people protect themselves from harmful chemicals and detrimental lifestyle practices so that they can enjoy good health and preserve their ability to have children. 

We have made considerable progress on this front, but there’s still a long way to go. One thing that’s been particularly frustrating is that much of what we have learned about environmental risks for reproductive health hasn’t been incorporated into education and medical practice the way it should be.

Here are five changes I’d like to see for how society deals with reproductive health:

1) The government should fund research into reproductive health issues.

The National Institutes of Health (NIH), which is under the auspices of the U.S. Department of Health and Human Services, has 27 institutes and centers. Some of these have highly specialized foci (such as the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Deafness and Other Communication Disorders), but reproductive health is not on the radar at NIH, which claims to be “the steward of medical and behavioral research for the Nation.” When my colleagues and I applied for NIH funding for research into declining sperm counts in the western world, we received a negative response with a convoluted explanation about why it wasn’t appropriate for NIH to fund it.

Reproductive health is an important aspect of human health, and research into markers of reproductive health and factors that are affecting it is important. If NIH doesn’t want to create a dedicated institute or center on reproductive health, the agency could place it under the umbrella of one of the existing centers, just as research on sexually transmitted diseases is under the auspices of the National Institute of Allergy and Infectious Diseases (NIAID). However it happens, the government should be invested in research that aims to protect human reproductive health. The survival of our species really does depend on it

2) There should be a greater educational focus on the male role in fertility issues.

In society, infertility continues to be largely thought of as a woman’s issue, even though it has become increasingly recognized in scientific circles that men contribute to a greater proportion of infertility cases than previously believed. Male reproductive issues are now thought to cause approximately one-quarter to one-third of infertility cases — the same proportion as female reproductive challenges do. The remaining cases are believed to stem from a combination of male and female factors. Most people don’t realize this. Recent research also suggests that sperm defects (including DNA damage) contribute to a significant proportion of recurrent miscarriages. Most people don’t know this, either. These realities should become common knowledge and perhaps taught as part of sex education (a.k.a., family life) in school.

3) Speaking of men, they should have reproductive wellness check-ups, just as women do.

At regular intervals throughout their lives, women have gynecological examinations and screenings for the human papillomavirus (HPV) and cervical cancer. Meanwhile, men’s reproductive health remains a largely private matter, addressed only when it becomes clear that there’s a problem with, say, fertility or erectile function. Men’s reproductive and sexual health should have a place in regular physical exams with internists or general practitioners. During these visits, men should be asked and counseled about lifestyle factors and chemical exposures that could harm their sperm count and motility, and men should have their testosterone levels measured as part of routine care. These steps would help men safeguard their reproductive health and prevent them from feeling blindsided if they discover their fertility or sexual function isn’t as robust as they assumed it was.

4) I’d like to see affordable screening for body burdens of hormone-disrupting chemicals become part of routine health care.

These scans would include testing urine and blood samples for endocrine-disrupting chemicals (EDC), such as phthalates, bisphenol A and pesticides at an annual checkup. Right now, these tests are very expensive and mostly used for research, but lower-cost tests could be developed. The average person doesn’t need to know her or his exact levels of these chemicals, but it would be good to know whether any exceed a level of concern (as is done now for lead screening). These tests could encompass a panel of six to ten chemicals of concern, just as a complete blood count measures several parameters in the blood. It’s important to have these EDC screenings available because if people know that they have high levels of certain chemicals in their bodies, they will be motivated to change their behavior to decrease their exposure and their physicians should provide information on how to reduce those exposures. This would be an important step in safeguarding an individual’s reproductive health, as well as the reproductive and brain development of their children.

5) Medical school curriculums should include courses or lectures about the effects of environmental factors on reproductive health.

Medical students learn about the dangers of lead poisoning in children and the damaging effects of secondhand smoke on the lungs of children and adults alike. But the teaching of environmental health concepts in medical school is sporadic at best, when it should be comprehensive. At a minimum it should include education about the effects of endocrine-disrupting chemicals on an individual’s reproductive health and the impact of environmental chemicals on the health and well-being of their offspring. Not only is this important for future doctors’ knowledge and ability to practice medicine effectively; it’s a public health issue. 

And it’s something that some medical students are even asking for. As a fourth-year medical student wrote in a 2019 letter to the editor at the journal Academic Medicine, “As a student, I understand firsthand that medical school curricula are bursting at the seams. Nevertheless, environmental health should not be sidelined. Medical school teaches future doctors how to think. I urge medical educators to train students to think about the human body in the context of its environments.” In my opinion, we should all be doing that.

Shanna H. Swan, Ph.D., is a leading environmental and reproductive epidemiologist and a professor of environmental medicine and public health at the Icahn School of Medicine at Mount Sinai in New York City. She is coauthor of the new book “Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race.” Her work examines the impact of environmental exposures, including chemicals such as phthalates and Bisphenol A, on men’s and women’s reproductive health and the neurodevelopment of children.