title: Relationship between risk factors for infertility in women and lead, cadmium, and arsenic blood levels: a cross-sectional study from Taiwan.
abstract: BACKGROUND
  The World Health Organization reported that more than 10 % of women are severely affected by infertility, making the condition a major worldwide public health problem. Lead (Pb), cadmium (Cd), and arsenic (As) are environmental pollutants that may contribute to reproductive disorders. This cross-sectional study investigated the association between blood concentrations of Pb, Cd, and As and risk factors for infertility in women.
  
  
  METHODS
  Women who were infertile (N = 310) or pregnant (N = 57) were recruited from the gynecology and obstetrics department of a hospital. The participants were interviewed to obtain their sociodemographic, reproductive, and lifestyle information. The concentrations of Pb, Cd, and As in their blood samples were measured using inductively coupled plasma mass spectrometry.
  
  
  RESULTS
  Our findings suggested that the concentrations of Pb and As, but not Cd, were significantly higher in the blood of infertile women than in that of pregnant women. A higher percentage of the infertile women consumed more alcohol, used Chinese herbal medicine more frequently, and lacked physical activity compared with the pregnant women. After accounting for potentially relevant predictors, we observed that blood Pb levels might be elevated by using Chinese herbal medicine 1-6 times per week (aOR = 2.82, p = 0.05). In addition, engaging in physical activity 1-2 times per week (aOR = 0.37, p = 0.05) might assist in reducing Pb accumulation in infertile women, though the p value was borderline.
  
  
  CONCLUSIONS
  Lack of physical activity and frequent use of Chinese herbal medicine may be associated with elevated blood Pb levels in infertile women. Chinese herbal medicine use was observed to increase the Pb body burden of both infertile and pregnant women in this study. The risk-benefit for Chinese herbal medicine intake should be evaluated by women of childbearing age.
authors.affiliation: School of Public Health, Taipei Medical University, No. 250, Wuxing St., Taipei City, 110, Taiwan. d508099002@tmu.edu.tw.
authors.forename: Hsiao-Ling
authors.initials: HL
authors.lastname: Lei
authors.affiliation: Infertility Center, Taiwan Adventist Hospital, No. 424, Sec. 2, Bade Rd., Taipei City, 105, Taiwan. wei0937059468@yahoo.com.tw.|Xiamen EMBO Hospital, No. 117-119, Hubin South Road, Xiamen City, 361000, Fujian Province, China. wei0937059468@yahoo.com.tw.
authors.forename: Hsiao-Jui
authors.initials: HJ
authors.lastname: Wei
authors.affiliation: Infertility Center, Taiwan Adventist Hospital, No. 424, Sec. 2, Bade Rd., Taipei City, 105, Taiwan. drhsinyiho@gmail.com.|Xiamen EMBO Hospital, No. 117-119, Hubin South Road, Xiamen City, 361000, Fujian Province, China. drhsinyiho@gmail.com.
authors.forename: Hsin-Yi
authors.initials: HY
authors.lastname: Ho
authors.affiliation: School of Public Health, Taipei Medical University, No. 250, Wuxing St., Taipei City, 110, Taiwan. kaiwei0101@yahoo.com.tw.
authors.forename: Kai-Wei
authors.initials: KW
authors.lastname: Liao
authors.affiliation: School of Public Health, Taipei Medical University, No. 250, Wuxing St., Taipei City, 110, Taiwan. lcchien@tmu.edu.tw.
authors.forename: Ling-Chu
authors.initials: LC
authors.lastname: Chien
mesh_terms: D000328:Adult; D001151:Arsenic / Q000097:blood*; D002104:Cadmium / Q000097:blood*; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000209:etiology*; D007854:Lead / Q000097:blood*; D008019:Life Style; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan
chemical_list: D004785:Environmental Pollutants; D002104:Cadmium; D007854:Lead; D001151:Arsenic