Single- and combined-heavy metals/metalloids exposures are associated with infertility in US women aged 20-44: NHANES 2013-2020 analysis.

Infertility is a major medical and social issue, with environmental factors, including metal exposure, playing a crucial role. This study analyzes how individual metals and their mixtures, which include a selection of heavy metals and metalloids totaling sixteen metals, contribute to infertility risk, using data from the National Health and Nutrition Examination Surveys. The study included 1326 women aged 20-44 years, comprising 1145 classified as fertile and 181 as infertile, with data on reproductive questionnaires and covariates. Infertility was defined through self-reported data. To assess the associations between exposure to these elements and infertility risk, we employed logistic regression, principal component analysis (PCA), restricted cubic splines (RCS), quantile regression with group-specific combination (qgcomp), and bayesian kernel machine regression (BKMR). After adjusting for potential confounders, logistic regression revealed positive associations of blood manganese (BMn) and urinary tin (USn) with infertility, whereas serum selenium (SSe) was negatively associated. RCS analysis demonstrated nonlinear relationships between urinary barium (UBa), urinary molybdenum (UMo), and urinary antimony (USb) and infertility. Potential interactions were identified between the following metal pairs: UMo and urinary cadmium, USb and UBa, and USb and UMo. PCA identified a positive association between PC3 and infertility (OR = 1.17, 95 % CI: 1.00, 1.36). The qgcomp model also indicated a positive association between metal mixtures and female infertility (OR = 1.25, 95 % CI: 1.03, 1.52). In conclusion, this study highlights significant associations between exposure to specific metals and infertility risk among women of reproductive age.