Phthalate exposure and human reproductive health: an epidemiological review

Plastics are ubiquitous in the environment and are widely used in food packaging, medicine, agriculture, construction and other sectors. However, the plasticizers they contain pose a substantial threat to environmental safety and human health. Phthalates represent the most important class of plasticizers and are classified as endocrine-disrupting chemicals (EDCs), capable of causing adverse effects even at very low exposure levels. Extensive in vitro and in vivo studies have demonstrated that phthalates and their metabolites exhibit reproductive toxicity, leading to reduced sperm motility and count, hormonal dysregulation, ovarian failure, preterm birth and other detrimental outcomes. This review synthesizes current evidence on the association between phthalate exposure and various reproductive system disorders. Epidemiological studies show that phthalate exposure is linked to impaired sperm quality, prostate disease and erectile dysfunction in males, suggesting a contributing role in the pathogenesis of infertility. However, the association with shortened anogenital distance remains unclear. In females, phthalate exposure has been associated with endometriosis, polycystic ovary syndrome, premature ovarian failure, infertility and miscarriage, although the epidemiological evidence is inconsistent. In conclusion, paying attention to the reproductive health risks posed by phthalate exposure is of critical importance, particularly for vulnerable groups including women of childbearing age, pregnant women, and children.