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Infertility: How Air Pollution Can Affect Your Reproductive and Sexual Health

16 · Aug · 2021
Photograph by: Belgutei on

Mонгол хэлээр уншиx | Read in Mongolian

By Jenny Han Simon and Munkhbayar Bayartsengel Elkins

When it comes to air pollution, the initial health concern for most people is the respiratory system. However, short- and long-term exposure to air pollution has adverse effects on all parts of the body, including your reproductive system. Breathe Mongolia recently released a summary of a report that establishes a correlation between exposure to industrial pollutants and cryptorchidism—when one or both testicles fail to descend from the abdomen into the scrotum. Unknowingly, air pollution can affect your body in some unexpected ways!

Beyond industrial pollutants, fertility rates in Ulaanbaatar show a direct link to air pollution levels. Between 1990 to 2017, Mongolia’s fertility rate decreased by 25%, with the average number of children born to a single woman going from four to three. Medical records between 2014-15 show a cyclical relationship between Ulaanbaatar’s air pollution and fertility: there was a 3.2-fold decrease in successful conception in January (the month with the highest levels of the air pollutant PM2.5) compared to October. 

With the continuous increase of air pollution levels in Mongolia and the proliferation of studies linking pollution with infertility, more action is needed to protect citizens and future generations. Breathing polluted air infringes on the fundamental human right to good health. 

Монгол улсын агаарын бохирдлын түвшин тасралтгүй нэмэгдэж, бохирдлыг үргүйдэлтэй холбож судалдаг болсонтой холбогдуулан иргэд, хойч үеээ хамгаалахын тулд илүү их арга хэмжээ авах шаардлагатай байна. Бохирдсон агаараар амьсгалах нь хүний эрүүл байх үндсэн эрхийг зөрчиж байна.

Men’s reproductive health

Recent studies have concluded that air pollutants have significant negative effects on the male reproductive system. While air pollutants can vary across communities, industries, and countries, the main culprits are sulfur dioxide (SO2), nitrogen dioxide (NO2), PM2.5, and PM10. An alarming trend is the decline of male sperm quality in countries with high levels of these pollutants. Sperm quality refers to the number of sperm in semen upon ejaculation. A normal sperm count consists of at least 15 million sperm per milliliter of semen. 

Many studies suggest a causal relationship between air pollutants and male infertility. One study established a link between jobs with high exposure to exhausts and complications with sperm quality. For example, toll collectors on motorways showed high sperm abnormalities ranging from low sperm counts, mobility, and defective shapes compared to participants not exposed to these pollutants. The study emphasized that constant exposure to diesel vehicle emissions is correlated with a significant decrease in male fertility. Other studies have shown a similar decline in the quality of male sperm as a result of PM2.5 exposure. The findings pinpointed issues in sperm motility and shape, specifically of the head, as potential causes of infertility. 

In Mongolia, the rate of male infertility has increased steeply. A recent study of 2,000 families found that 7.5% of males are infertile, an underestimated value given the taboo surrounding the topic. An interview with Clinical Professor P. Khadbaatar showed that 50% of recorded infertile couples are due to the male partner, an increase from 10-15%. A common diagnosis of male infertility is chromosomal abnormalities. Worryingly, the causes of 30% of male infertility are unknown, making it extremely difficult for doctors to treat, leaving them to rely on experimental treatments. Therefore, there is a pressing need for studies on the relationship between air pollution and male infertility. With the continuous rise in Mongolian air pollution, male infertility may become an epidemic that will have drastic consequences on the population and society.

Women’s reproductive health

Just as suggested with men’s reproductive health, air pollution has negative effects on a woman’s reproductive health and fertility issues. A study analyzing 18,000 couples found a significant relationship between their exposure to moderate to high levels of air pollution and infertility. The study examined small particle pollution of 10 micrograms per cubic meter, showing that any increase above 10 micrograms per cubic meter per year increased the risk of infertility—defined as lack of conception within a year of trying to conceive—by 20%. For reference, China is recorded to be exposed to 53 micrograms per cubic meter while Ulaanbaatar recorded an average of 66.5, 58.5, 62, and 52.9 micrograms per cubic meter in 2017, 2018, 2019, and 2020, respectively. Another study carried out in a US infertility clinic established a correlation between air pollution and the decline in the number of eggs maturing in the ovaries. The study concluded that a small increase in PM2.5 particles decreases the reserve eggs in your ovaries, fundamentally altering your reproductive age and increasing the rate of infertility. 

Another study on infertility in Mongolia found 9.8% of infertility cases were unexplained, while the female infertility rate was 45.8%, compared to the male infertility rate of 25.6%. Additionally, only 29.7% of infertile women received any form of treatment. While women in Mongolia seem to seek medical help for infertility (77.5% of the women in the study sought medical assistance), only 44% received fertility testing, and 29.7% of the tested women were given actual treatment. With studies highlighting the dangerous link between infertility and air pollution, there is a vital need to expand infertility testing capacity and the necessary treatment in Mongolia, for the benefit of the current population and future generations.

Air pollution has also been linked to other reproductive health issues such as miscarriages and menstrual irregularities. The effects of Mongolia’s seasonal air pollution are made clear in the data from studies that display a cyclical effect between air pollution levels and health effects. The rate of spontaneous abortion (or miscarriage) has a strong correlation with Ulaanbaatar’s pollution season (Figure 1; see Figure 1 in full). The level of all air pollutants included in the 2014 study, as well as the rate of miscarriage, was highest in January, February, and December. 

Figure 1. Calendar monthly averages of ambient air pollutant levels (PM2.5) correlated with hours of darkness. Source: Enkhmaa, et al. (2014) Seasonal ambient air pollution correlates strongly with spontaneous abortion in Mongolia.

A 2020 government document by the Mongolian National Statistics Office and the Health Development Center revealed a starking impact of air pollution on reproductive health. In 2018, 81 per 1000 births were premature—the highest in the last five years. In 2019, it decreased to 72 per 1000 births but increased to 76 per 1000 births in 2020. Children born with congenital malformations increased over the last three years with six cases recorded in 2018; eight cases in 2019; and nine per 1000 births in 2020. When analyzed monthly, the highest incidence of congenital malformations and stillbirths occurred during the peak air pollution levels. The document highlights a small correlation between high levels of air pollution and reproductive health risks. Further research is necessary to understand the link to create target-specific policies. 

There are also emerging studies on the effects of air pollution and other aspects of reproductive health, such as on the menstrual cycle and libido. For example, exposure to PM2.5 and NO2 led to a longer follicular phase- the time between the start of a female’s period and ovulation. Other studies have suggested a link between air pollution and a decline in mental health. Poor mental health may include symptoms such as depression, a decreased sex drive, and a loss of interest in previously pleasurable activities. Both unexpected changes in the menstrual cycle and low libido can contribute to a decline in fertility rates. 


Increased exposure to air pollution has been documented to have a negative effect on male sperm quality, penis size, and females’ reproductive health. Not only does air pollution negatively affect our health here and now, but it can also affect future generations and even our ability to create a future generation!

To help fight air pollution in Mongolia, visit our website to share resources, learn more, and take action in your everyday life to protect yourself and your loved ones. You can take action immediately by:

  • Wearing a mask outdoors when the AQI is above 50
  • Using an air purification device indoors and in your vehicle 
  • Seeing your doctor for annual check-ups and as needed to monitor your health 

To eradicate air pollution in Mongolia, please share these resources to educate and protect those in your community. Also, urge the government and policymakers to take a more aggressive stance against air pollution! 

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