Air pollution is among the causes of increased infertility and sterility rates in women and men across the Western Balkans. It particularly affects women living in polluted areas, as pollution may lead to a lower healthy egg cell count, and thus to a decline in fertility. It also renders in vitro fertilization less successful. Particulate matter PM 2.5 causes a decline of fertility in women by 2% per 10 µg/m3 in the air. These levels in polluted cities across Western Balkans reach values above 50 µg/m3 (PM 2.5), which is double the permitted annual value and may reduce fertility by up to 10% in women. Daily PM 2.5 levels in certain cities often exceed even 200 µg/m3 which may increase infertility in women by more than 10%. In men, particulate matter pollution reaches the testicles and causes lower sperm production levels, less sperm motility and more miscarriages due to programmed cell death.
Infertility and low birth rates are important factors behind the population decline in Western Balkan countries, both on a constant rise. Scientific research has confirmed that the incidence of miscarriages and stillbirths increases significantly during periods of air pollution exposure. A 2010 study focusing on the town of Labin, Croatia, shows that the incidence of miscarriages and stillbirths in the town was significantly higher during periods of exposure to air pollution from the nearby coal-fired power plant, compared with periods without such exposure. Sulfate compounds which are created in the coal combustion process, increase the risk of miscarriage by up to 13%, whereas the exposure to PM2.5 and PM 10 reduces conception rates.
Air contaminated by particulates, heavy metals, micro- and nano plastics, and other pollutants, leads to higher miscarriage rates, regardless of the in vitro fertilization process, given that polluted air in IVF laboratories reduces success rates.
The "Balkans United for Clean Air" campaign calls upon citizens of Western Balkan countries to join our struggle, and to improve air quality together, while also tackling infertility and improving children’s health.
“It will be very difficult to preserve public health and wage the battle against infertility if the everyday level of exposure to harmful matter does not decrease. This campaign is the best possible way of promoting a healthy life and it aims to inform a broader public, but also sends a warning to lawmakers and the authorities, namely that without their actions there can be no successful prevention of diseases caused by polluted air – including sterility and the resulting demographic decline”, says Miodrag Stojković, our eminent human genetics professor and founder of the Special hospital for the treatment of infertility in Leskovac.
We demand an urgent solution for the chronic air pollution problem that is killing Western Balkan countries. Phasing out coal in the production of electricity is the most pressing measure for improving air quality. The replacement of household heating and cooking appliances with environmentally cleaner solutions, solar panels on house and building rooftops, and projects aimed at improving energy efficiency can have an important role, too. Relevant institutions should develop policies promoting healthy pregnancy, so as to increase the knowledge of women and men during pregnancy and equip future mothers to protect themselves and the fetus. In vitro fertilization needs to be available to everyone who wants to have children. In addition, highly efficient indoor air filtering needs to be provided, and citizens need to be timely informed about the air pollution in order to avoid outdoor activities during periods of poor air quality.
To preserve and prolong human life together, join us in the solidary struggle of Western Balkans citizens and become a part of the “Balkans United for Clean Air” campaign.
Bosnia and Herzegovina: http://bit.ly/UjedinjenBalkan
North Macedonia: http://bit.ly/ObedinetBalkan
MORE AIR POLLUTION, FEWER CHILDREN IN THE WESTERN BALKANS
Poor air quality is among the causes of increased infertility and growing sterility rates in women and men across the Western Balkans. It particularly affects women living in polluted areas, since air pollution may cause a reduced number of healthy egg cells and thus decrease fertility rates, also lowering in vitro fertilization success rates. Particulate matter PM 2.5 reduces fertility by 2% per 10 µg/m3 in the air. Polluted cities across the Western Balkans reach levels of more than 50 µg/m3 (PM 2.5), which is double the permitted annual value and can reduce fertility by up to 10% in women. In men, particulate matter pollution reaches the testicles where it decreases sperm production and motility, also causing more frequent miscarriages due to programmed cell death.
The human body is an adaptable, yet very delicate organism. Adaptability to different environmental conditions, including pollution, is paid by shorter life expectancy, diseases, as well as reproductive problems. Air pollution causes additional contamination of fertile land, plants, animals and the entire food chain, and by doing so, it increases the effect of harmful matter on human health. Also, it is a known fact that obsolete technology, lack of filtering and environmental pollution by waste can lead to infertility and sterility.
Several international studies have linked air pollution with infertility, childbirth complications, a higher rate of congenital abnormalities in offspring, and stillbirths. The fertility rate is statistically decreasing with the increase of air pollution. Certain air pollutants, such as lead and copper, disrupt the function of glands in the human organism, which has a negative impact on reproduction.
Another cause is plastic pollution, particularly by micro- and nanoplastics which is steadily growing, mirroring the increase in plastic manufacturing – surpassed only by the production of steel and cement. Just one cycle of a washing machine with synthetic laundry releases more than 700,000 plastic fibers.
Plastic pollution is a global problem, given that plastic particles are spread by rain and wind, after plastic waste decomposition and combustion, which is a particularly burdensome issue in countries of the Western Balkans. Recent research results have clearly shown that polystyrene, a type of plastic, found in food, water and air in its micro and nano form, affects early embryo development, which, at a later stage, could cause abnormal development and preterm birth.
Air pollution as a cause of female infertility
Poor air quality causes both female and male infertility. However, the consequences of inhaling polluted air vary slightly, in accordance with physiological differences.
Several studies have proven that women who inhabit polluted areas have fewer vital egg cells, lower fertility rates and a higher rate of unsuccessful embryo implantation during in vitro fertilization, compared with women who are not exposed to the impact of air pollution. Fine particulate matter PM 2.5 decreases egg cell quality, reducing fertility by 2% per 10 µg/m3 in the air. Western Balkan cities most affected by pollution record an annual average of over 50 µg/m3, which is double the maximum permitted annual values, whereas the daily levels often exceed 200 µg/m3. Long-term exposure to polluted air in the Western Balkans can reduce female fertility by more than 10%; high daily pollution levels reduce the chances of conception, and increase the likelihood of miscarriage.
A study from Brazil has shown that women exposed to high PM 10 levels (>56.72 µg/m3), which is the case in several cities across Western Balkans, have higher miscarriage rates, despite the fact that they have undergone the process of in vitro fertilization.
At the same time, a 2010 study focusing on the town of Labin, Croatia, shows that the incidence of miscarriages and stillbirths was significantly higher during the period of exposure to air pollution produced by the nearby coal-fired power plant, compared to the period without such exposure. Sulfate compounds created by the process of coal combustion increase the risk of miscarriage by up to 13%, while exposure to PM2.5 and PM 10 reduces conception rates.
This data prompts the obvious conclusion that air pollution has a negative influence on female fertility and that a radical improvement of air quality is necessary so as to revert fertility rates to normal, and render in vitro fertilization more efficient.
Air pollution as a cause of male infertility
During pregnancy, women are more vulnerable to air pollution; however, poor air quality causes infertility and sterility in men, too.
Several studies have indicated that PM10 and PM2.5 particulate matter, apart from being able to penetrate lung alveoli, can also reach the testicles and reduce fertility, cause fetal anomalies and increase the likelihood of miscarriage.
Also, several experiments performed on animals have shown that prenatal exposure to exhaust fumes can lead to a significant decrease in daily sperm production.
A Czech study has shown that air pollution is also linked with a decline in sperm motility – a parameter of major importance for natural fertilization.
Air quality’s impact on in vitro fertilization
In 2019, one in six couples in Serbia experienced problems conceiving, and the situation was similar in other Western Balkan countries, too. This also causes a growth in the number of patients requiring medical assistance and who are increasingly undergoing in vitro fertilization.
Laboratory air pollution is an additional problem when tackling the issue of sterility, since it decreases the vitality of egg cells, sperm and embryo, thus also reducing in vitro fertilization success rates. For instance, in case of an internal filtering system malfunction, the pregnancy rates following in vitro fertilization drop significantly. After new filters are installed, the success rates return to normal values. However, if patients are constantly exposed to contaminated air, the problem of sterility and loss of pregnancy may persist regardless of modern laboratory technology.
In the USA, 7 out of 10 leading laboratories operate in clean rooms, where every possible form of contamination is eliminated. This example, along with a comprehensive reduction of ambient air pollution, should be followed by Western Balkan countries. Such conditions not only increase success rates, they also prevent harmful matter’s impact on laboratory air. These include volatile organic compounds which can hamper early embryo development.
How can infertility rates in the Western Balkans be reverted?
Reverting infertility rates in the Western Balkans requires, apart from various health measures, urgent action to improve air quality. Pollution caused by particulate matter, sulfur oxides and heavy metals must be reduced as soon as possible, so that fertility rates can gradually return to normal values. Phasing out coal in the production of electricity is the most important measure for air quality improvement. The replacement of household heating and cooking appliances with environmentally cleaner solutions, solar panels on house and building rooftops and projects aimed at improving energy efficiency can have an important role, too. Action must be taken sooner rather than later – namely, if we observe infertility through a time prism, it is constantly growing and thus represents one of the major factors in the population decline of the Western Balkan countries.
Another measure to lessen air pollution’s harmful impact is by reducing single-use plastic, especially non-recyclable packaging, as well as replacing synthetic fiber with natural fiber.
Countries in the region should support reproductive endocrinologists and gynecologists in promoting healthy pregnancy, by educating women to adopt a safe lifestyle during the pre-conception period. In order to reduce infertility rates, it is necessary to ensure highly efficient indoor air filtering systems, along with providing timely information for citizens on air pollution so as to avoid open-air activities during periods of poor air quality. This measure is particularly significant for special institutions for the treatment of sterility. This way, they would create optimal conditions for patients during the in vitro fertilization process and reduce the negative effects of laboratory air pollution on the highly sensitive egg cells and embryos. Infertility treatment and in vitro fertilization must become much more available to all persons who want to have children. This type of treatment has become a privilege today, couples who want to have children must bear significant costs, and the process often involves travelling abroad for certain procedures.
Apart from instant short-term improvements, it is also necessary to advance the capacities of diagnostic centers; support the realization of joint studies which will use monitoring and measuring data from Western Balkan countries. The joint creation of interactive maps and mathematical models would summarize the short- and long-term exposure to harmful airborne pollutants, with a special emphasis on their effects on infertility, preterm births, onset of disease and stillbirth rates.
Finally, Western Balkan countries, instead of focusing only on birth rates, must get to work and provide people who wish to have children with support and conditions in which the children will be able to grow and breathe clean air.
One of the measures of alleviating the harmful effects of air pollution is to decrease the use of disposable plastic, especially non-recyclable packaging, as well as to replace synthetic fiber with natural fiber. This would be aimed at preventing the emission and ingestion of micro- and nanoplastics – namely, just one cycle of a washing machine with synthetic laundry releases more than 700,000 fibers, and the pollution by plastic also causes infertility. Diagnostic centers’ capacities must be raised, and joint studies need to be conducted, using the monitoring and measuring data on the consequences of air pollution in the form of infertility, preterm births, onset of diseases and neonatal deaths in the countries of the Western Balkans.
To support life together, join us in the solidary struggle of Western Balkans’ citizens and become a part of the “Balkans United for Clean Air” campaign.
 Bojic et al., 2020
 Conforti et al., 2018; Xue & Zhang, 2018
 Perin et al., 2010
 Mohorovic et al., 2010
 Lafuente et al., 2016; Carre et al., 2017; Zhou et al., 2019
 Jurewicz et al., 2018
 Report by the European Society of Human Reproduction and Embryology, https://www.eshre.eu/Press-Room/Press-releases-2020/ART-in-Europe