Patients often feel a loss of control over their lives when they enter into fertility treatment. Capable, professional men and women who are used to exercising personal power and making their own decisions are suddenly thrust into a world of medical tests, procedures and treatments that are largely dictated by someone else. In order to ease the anxiety associated with infertility treatment, it is important to find ways to empower patients.
Many factors associated with infertility are beyond our control. Biological and genetic factors that lead to infertility may not be modifiable. But emerging research is pointing toward environmental contaminants as a factor contributing to infertility. The reproductive effects of chemicals and other toxic substances include decreased sperm counts, malformations in male genitalia, and in women endometriosis, changes in ovulation and miscarriage. Reducing exposure to environmental contaminants is a factor that is, to some extent, within the control of the individual.
Research over the last few decades has found a connection between substances commonly encountered in everyday life and compromised fertility. Studies in humans and in animals point toward a variety of hormonally active agents or “endocrine disruptors” found in consumer products. Examples of endocrine disruptors include chemicals found in plastics, like Bisphenol A (BPA) and phthalates, flame retardants, non-stick chemicals and pesticides. While it is not possible to eliminate all chemical exposures, it makes sense for an individual or a couple experiencing infertility to limit the amount of toxic substances with which they come in contact. Strategies for limiting exposures may be viewed as a continuum, from actions patients can take at an individual level, exerting influence through consumer pressure, and helping to protect a wider range of people by supporting chemical regulations at the state and federal level.
Careful selection of products we bring into our homes can limit exposure to endocrine disrupting compounds. For example, a recent study published in Environmental Health Perspectives found that families were able to decrease the amount of BPA in their systems by 60% through eating a fresh healthy diet and avoiding processed foods. Many public interest groups provide guidance on how to make safer choices in purchasing personal care products, cleaners, and alternatives for using pesticides in the home. Good websites to find information on limiting exposure to chemicals that cause reproductive harm include the University of California’s Program on Reproductive Health and the Environment Toxic Matters and the Environmental Working Group’s Skin Deep Database of personal care products.
As the public makes safer choices in purchasing, manufacturers begin to notice. Pressure from consumers to provide safer alternatives to toxic products has successfully influenced what ends up on the shelves. The issue of BPA in baby bottles is a story that will be familiar to many. Consumer advocacy groups began calling for the elimination of BPA in baby bottles and sippy cups, after the chemical was found to be associated with reproductive harm and cancer in laboratory animals. Responding to consumer pressure, Wal-Mart banned products such as baby bottles containing BPA, and later a controversial flame retardant known as PBDE. This corporate response to consumer pressure for safer products is known as retail regulation, and couples concerned with reproductive toxicants can exert their power to move the market toward healthier options.
Another successful way that patients can take action to lessen their exposure to toxic chemicals is to encourage their elected state representatives to create laws to ban substances that may harm health. Several states have enacted legislation to ban BPA in various children’s products. Patients can look up their state representative through the Project Vote Smart, then express their concern over toxic chemicals through an email, letter, or personal visit. State regulation is a good way to begin to control toxic exposures, but is of limited value because of the wide range of chemicals in use today. Tens of thousands of chemicals have been introduced into consumer products over the last few decades, most with limited safety testing. In order to minimize hazardous chemicals to which couples of reproductive age are exposed, a comprehensive national chemical policy is needed.
Many people believe that chemicals used in the products we encounter in everyday life, such as water bottles, cooking pans, and flame resistance furniture are tested for safety by the federal government. However, this is not the case. The Environmental Protection Agency is charged with regulating chemicals in consumer products, but is constrained by a set of criteria so inflexible that only 5 chemicals have been banned over the last 35 years. For example, the current federal law governing chemicals, the Toxic Substance Control Act of 1976, limits but does not prohibit the use of asbestos, despite volumes of evidence connecting it to the cancer mesothelioma. A new law, the Safe Chemicals Act of 2011, seeks to increase manufacturer testing of chemicals that go into consumer products,
allows the EPA to take swift action to regulate chemicals found to be dangerous, and promotes innovation in ‘green chemistry’ alternatives to toxic substances. Patients who want to protect not only their own, but also other’s fertility can contact the Safer Chemicals, Health Families organization for ways to become involved.
There are many ways for patients to take control of their health and limit their exposure to chemicals that may impair fertility. Whether they choose to act on the personal, consumer, state or federal level, taking steps to reduce chemical exposures will empower them to optimize their chances of becoming parents. When successful, they can feel reassured that the choices they made to enhance their fertility will also be valuable in protecting the health of their future children.
Karin Gunther Russ MS, RN is the National Coordinator, Fertility and Reproductive Health Working Group for CHE –Collaborative on Health and the Environment and is also Nursing Outreach Coordinator for Maryland Hospitals for a Healthy Environment.