Healthcare providers are exposed to a variety of health and safety hazards every day, but no one ever imagined that loss of fertility is one of them. This risk results from the high content of phthalates found in medical devices and pharmaceuticals, resulting in the exposure of healthcare providers, among others, to this substance. Phthalates, salts of phthalic acid, have been utilized as plasticizers, materials supplemented to plastics, in order to elevate their flexibility, stability, and longevity in industrial products since the 1930s. They are generally considered to be widespread environmental contaminants, reproductive and developmental toxicants, and mutagens.
Medical treatment might introduce high levels of phthalates via use of medical devices or medicaments containing the substance in their coating. Phthalates are abundantly found in blood bags, tubing, lubricating substances, plastic packaging, disposable gloves, pharmaceuticals, and personal care products, such as lotions, and soaps. In the 2001-02 National Health and Nutrition Examination Survey, four phthalate metabolites were present in most participants, thus confirming widespread general population exposure to phthalates. The main routes of exposure are through ingestion, inhalation, and dermal contact. Phthalate exposure is known to cause multiple disruptions in cellular networking, as well as possibly initiating consecutive genetic mutations that would eventually alter the normal pathway of cellular proliferations, and result in mutation or cancer. Furthermore, these substances might negatively influence the development of estrogen sensitive target tissues and the level of circulating hormone levels.
In animal models, phthalates had been shown to act as endocrine disruptors and mutagens with documented testicular toxicity. Male rats who ingested phthalates for 2 weeks demonstrated disrupted sperm production, reduced sperm motility, DNA damage, and a lower count of spermatocytes and spermatids.
Two recent human studies have shown lower sperm concentration and motility in individuals who had shown high concentrations of phthalate metabolite in their urine. Interestingly, exposure may also be significantly elevated in patients using medications with slow release phthalates-contained-capsules. An epidemiological study that examined a potential association between phthalate exposure and female fertility demonstrated that longer time was required to get pregnant in females with higher levels of phthalates in their blood. According to a new study presented recently at the annual meeting of the European Society of Human Reproduction and Embryology, during IVF procedure, females who had the most phthalates in their systems were twice as likely to suffer from embryo implantation failure, as the ones with the lowest levels.
In the past few years, scientists have shown a clear link between phthalates exposure and attention-deficit hyperactivity disorder, breast cancer, obesity and type II diabetes, premature birth, early manifestation of puberty in girls, neurodevelopmental issues, behavioral issues, autism spectrum disorders, altered reproductive development and male fertility issues.
The pervasive nature of plastics has raised concerns about the impact of continuous exposure to plastic additives on human health. Intense industrialization and urbanization release several chemicals such as phthalates into the environment. This pollution has shown to cause adverse DNA damage and negative impact on the reproductive system, mainly sperm damage, testicular injury and decline in semen quality in humans in general and in health care providers in specific. These findings highlight the urgent need to eliminate the plasticizers from products, take immediate steps to regulate the use of phthalates and identify safer alternatives. These steps aim to reduce both environmental and iatrogenic exposure of phthalates to create a toxic-free future.