Photo: James Wesson

Over the last decade, the media has reported on a number of alarming links between environmental contaminants and human reproductive health. Sperm counts in some populations, for instance, have been shown to be decreasing. The incidence or prevalence rates of some hormone-related cancers are rising. And endocrine disruptors have been linked to a possible trend toward early puberty around the world.

But just how much human reproduction is being compromised -- and by which environmental contaminants -- remains undefined. This is partly because research on the environmental side hasn't interfaced with research on the health side. But it's also because the synergistic effects of environmental contaminants and reproductive health are so complex that the task of identifying them is nearly Herculean.

"More than 85,000 chemicals have been registered for commercial use in the U.S. over the last 80 years," says Dr. Linda Giudice, chair of the Obstetrics, Gynecology and Reproductive Sciences Department at UCSF. "Few of them were tested for their health effects, and it's hard to know just which chemicals, in which mixtures, and for what duration patients may have been exposed to. It's an area that is very difficult to study."

Linda Giudice, MD, PhD

Relationships of Contaminants and Reproductive Health

Still that daunting -- and delicate -- task is exactly what Giudice has made her goal. Since coming to UCSF in October, 2005, Giudice has established the innovative Program on Reproductive Health and the Environment (PRHE), housed in the UCSF National Center of Excellence in Women's Health. PRHE focuses on the relationships of contaminants ( in low "background" or concentrated exposures) and reproductive health. This includes pregnant women, fetuses, the prenatal origins of adult diseases, and reproductive tract disorders. (This latter category includes hormone-dependent cancers.)

The Program on Reproductive Health and the Environment is the only one of its kind in the country. Its members are particularly interested in translating the current academic research into information that community health centers and patient advocacy organizations can use to prevent, diagnose, and treat reproductive disorders.

"Most medical schools are not teaching their students about environmental health," Giudice says. "Yet it's crucial that we train health care professionals to advise their patients to minimize exposure to environmental contaminants."

Dr. Giudice became interested in environmental effects on reproduction when she started seeing patients with infertility problems at Stanford University, where she worked as both a clinician and the Division Chief of Reproductive Endocrinology and Infertility. "I was seeing a number of young patients who were infertile, some of whom seemed to be infertile for no reason. At the same time, I had a very young patient who we presumed had endometriosis, but we discovered had very high levels of mercury. I began to feel increasingly concerned about environmental contaminants and reproductive health."

Giudice's burgeoning interest in environmental health led her to join the Fertility/Early Pregnancy Compromise Working Group of the Commonweal Institute's Collaborative on Health and the Environment (CHE) (see link below to interview with Dr. Giudice). It also led her to found the Women's Health @ Stanford Program, a multi-disciplinary program that both provides clinical care to women and organizes research on women's health care issues.

The Vallombrosa Consensus Statement

In February, 2005, Giudice and Alison Carlson of CHE Fertility co-organized a landmark workshop held at the Vallombrosa Retreat Center in Menlo Park. Entitled "Understanding Environmental Contaminants and Human Fertility Compromise: Science and Strategy," the meeting was the first in the U.S. to join researchers in reproductive epidemiology, biology and toxicology; with clinicians; infertility patients; women's health and reproductive health advocacy organizations; and major funders; to review the current state of knowledge in the field of environmental reproductive health.

The workshop had several significant results, including the publication of the The Vallombrosa Consensus Statement on Environmental Contaminants and Human Fertility Compromise , which summarized the state of environmental reproductive health research and prioritized future investigations.

Other publications resulting from the Vallombrosa Workshop include a lay monograph, Challenged Conceptions: Environmental Chemicals and Fertility, and a June 2006 special issue of the journal Seminars in Reproductive Medicine.

Equally important, especially to the community health goals of the workshop, a series of briefings by Dr Giudice and Vallombrosa colleagues were held last February on Capitol Hill, sponsored by Senator Barbara Boxer.

"We are still nurturing those relationships, and we hope that having senators aware of the issues will help disseminate information to the public," Giudice says. "We don't expect people to exclude everything from their life that might possibly contain contaminants. But we do want to provide information to men and women about how to take care of their reproductive health by reducing their exposures to certain chemicals."

Source: Susan Davis

Links for more information:

Interview with Dr. Giudice (The Collaborative on Health and the Environment)

The Vallombrosa Consensus Statement

Challenged Conceptions: Environmental Chemicals and Fertility

Upcoming Summit on Environmental Challenges to Reproductive Health and Fertility