The influence of environmental and chemical exposures on fertility in the Eastern Mediterranean region: A narrative review

Infertility has increasingly become a global medical challenge. Environmental exposures have been suggested to interfere with reproduction. This review focuses on the impacts of climate and chemical exposures on reproductive functions and assisted pregnancy outcomes in the Eastern Mediterranean region. The search strategy was applied to PubMed and Scopus databases including publications from January 2012-June 2024. 63 studies investigating climatic factors, chemical exposures, trace elements, and smoking among the Eastern Mediterranean region population were included. Around 59% (n = 37) and 36% (n = 23) of the analyzed publications evaluated male factors and female factors, respectively. A decrease in sperm parameters was correlated to high temperatures, bisphenol A, and air dust exposures. Men endocrine reproductive system is negatively affected by phthalates and pesticides containing products. Trace elements showed a double role regarding reproduction. Heavy smokers were found to have poorer semen quality compared to regular smokers. The available evidence summarizing environmental exposures and smoking habits, and infertility assistance outcomes is limited and inconsistently distributed across the studied region. Addressing the vast health disparities and cultural and social discrepancies within the region can enhance public awareness, education, policy, and regulation development.