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Air pollution is no longer just a respiratory or cardiovascular concern. Fertility specialists and obstetricians say mounting scientific evidence now links long-term exposure to polluted air with declining fertility in men and women, poorer IVF outcomes, and higher risks during pregnancy — even among otherwise healthy individuals.
As India continues to battle hazardous air quality levels across major cities, doctors are urging patients and clinicians to recognise pollution as a serious, yet often overlooked, reproductive health risk.
How strong is the evidence linking pollution to infertility?
According to Dr Sandeep Talwar, Fertility Specialist at Nova IVF Fertility, Delhi-NCR, the link between air pollution and reduced fertility is now supported by multiple large-scale global studies.
“Chronic exposure to fine particulate matter, particularly PM2.5, has been consistently associated with reduced sperm concentration, poor sperm motility, increased DNA fragmentation and hormonal disturbances in men,” Dr Talwar said.
In women, similar exposure has been linked to diminished ovarian reserve, irregular ovulation and poorer outcomes during assisted reproductive treatments such as IVF.
What strengthens the argument today, he explained, is the growing understanding of the biological mechanism. Pollutants trigger oxidative stress and chronic inflammation in the body, damaging sperm DNA and accelerating the depletion of ovarian follicles.
“Recent IVF studies, after adjusting for age and lifestyle factors, show lower implantation and live-birth rates among women living in heavily polluted regions. This moves the discussion beyond coincidence to a credible cause-and-effect relationship,” he said.
Is pollution being overstated compared to lifestyle factors?
Doctors caution against framing pollution as a replacement for known fertility risk factors such as smoking, obesity, alcohol consumption, poor diet and chronic stress. However, they emphasise that pollution acts as a powerful background exposure that can worsen reproductive health even in people who follow healthy lifestyles.
“Unlike smoking or diet, pollution is not a personal choice,” Dr Talwar said. “New evidence shows it interacts with traditional risk factors, amplifying their harmful effects.”
For instance, sperm damage is significantly higher in men who smoke or are overweight and also live in areas with poor air quality, compared to those exposed to only one risk factor. “Pollution acts as a silent multiplier rather than a standalone cause,” he added.
Should pollution be treated as a clinical risk factor?
While pollution exposure is not yet formally included in standard fertility assessment scores, doctors say it is increasingly being considered in clinical practice — especially in unexplained infertility, recurrent IVF failure, poor sperm DNA quality and repeated pregnancy loss.
The case is even stronger during pregnancy. “Polluted air has been linked to miscarriage, placental dysfunction, preterm birth and low birth weight,” Dr Talwar noted.
Recognising pollution as a risk factor, he stressed, is not about creating fear but about prevention — including minimising exposure, improving indoor air quality, ensuring adequate antioxidant intake and monitoring high-risk pregnancies more closely.
How does air pollution affect pregnancy and the unborn child?
Dr Priyanka Dass, Consultant Obstetrician and Infertility Specialist at Motherhood Hospitals, Bengaluru, said chronic exposure to PM2.5, nitrogen dioxide and traffic-related pollutants has been consistently associated with adverse pregnancy outcomes.
“These pollutants induce systemic inflammation and oxidative stress in the mother, impair placental function, and reduce oxygen and nutrient delivery to the foetus,” she explained.
Clinically, this translates into higher risks of miscarriage, preterm labour, restricted foetal growth and low birth weight. Prolonged exposure, rather than short-term pollution spikes alone, appears to have a cumulative impact on pregnancy health.
Is there any ‘safe’ level of pollution during pregnancy?
From a medical standpoint, doctors say there is no clearly defined safe threshold.
“Even pollution levels considered acceptable for the general population may pose risks to a developing foetus,” Dr Dass said. Pregnancy is a uniquely vulnerable period, and even low-to-moderate exposure can have subtle but meaningful effects.
As a result, antenatal care increasingly focuses on risk reduction rather than assuming safety at certain pollution levels.
Impact on the baby’s brain and lungs
High pollution exposure during pregnancy can interfere with critical stages of foetal organ development.
“In the lungs, it can affect airway formation and immune responses, increasing the child’s risk of wheezing, asthma and reduced lung function later in life,” Dr Dass said.
Pollutants can also cross the placental barrier and influence brain development by altering inflammation pathways and blood flow, potentially affecting how neural connections form during gestation.
Does pollution exposure affect a child’s cognition later in life?
According to Dr Dass, there is growing and credible evidence linking prenatal pollution exposure to long-term neurodevelopmental effects.
“Several studies associate in-utero exposure to air pollutants with lower cognitive scores, attention difficulties and learning challenges in childhood,” she said.
While genetics and postnatal environment remain important, pollution exposure during pregnancy is increasingly recognised as a modifiable risk factor that can influence a child’s cognitive potential.
The bottom line
Doctors agree that air pollution should now be viewed as a reproductive health issue — not just an environmental one. While individuals cannot fully control the air they breathe, awareness, exposure reduction and medical vigilance may help mitigate some of the long-term risks to fertility, pregnancy and child health.
English (US) ·