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• W4382118471 abstract "Global warming has led to increased frequency, duration and intensity of heat waves and heat related impact on human health. According to the Lancet countdown report, the year 2022 saw extreme heat conditions in North America, Europe and Asia simultaneously. It states that heat wave mortality for people over 65 has increased by approximately 68% between 2000-2004 and 2017-2021.[1] There is also negative impact on health of other vulnerable segments of population. During the peak of summer, in urban areas, the “heat island” effect multiplies the effect of ambient temperature. As urban population is set to increase enormously over the next 2 - 3 decades, more people are likely to fall victims to impacts of intense heat. High ambient temperatures affect vulnerable population like agricultural and construction workers, people living in overcrowded, poorly ventilated houses, those at extremes of age and, pregnant women. According to demographics of the year 2022, India is a “young” country, with more than 50%of Indians being under 25 years of age. This means that a large percentage of our population is either currently in the reproductive age group or will be embarking on their reproductive journeys in the upcoming decade. Protecting their reproductive health is important for overall population health. Currently, about 10- 15% of married couples in urban India are grappling with infertility (inability to conceive naturally after one year or more, of unprotected intercourse). Heat, along with other climate change effects, is a major contributor to this problem. Dividing germ cells like spermatozoa in males, due to their higher mitotic activity, are especially susceptible to it; the mechanisms being autophagy, apoptosis, and DNA breakage.[2] It has been reported in European studies, that semen analyses done in summer showed 70% lower sperm counts as compared to winter.[3] Though the effects of hot weather on sperm are generally reversible, it can cause a postponement of conception, which pushes the latter part of pregnancy and delivery into the hot months, exposing pregnant mothers and neonates to the dangers of high ambient temperatures. We need to have similar Indian studies to know the effect of temperature rise on semen parameters and its subsequent impact on pregnancies. There is no clear evidence of heat affecting female reproductive cycles in humans, but this aspect has been studied in other mammals like cows in an experimental setting (dairy industry) and a clear effect of ambient heat on reproductive cycles of female dairy animals has been found.[4] However, poor tolerance of the human oocyte to temperature fluctuation has been clearly documented, in the laboratory during the process of in-vitro fertilization (IVF). There is a clear documentation of febrile illness during IVF stimulation negatively affecting number of oocytes and estradiol levels, and resulting in longer duration of ovarian stimulation.[5] It can therefore be assumed that there may be a link between heat exposure and female gametogenesis, although not yet clearly defined. The deleterious effect of extreme hot weather on pregnant women and the in- utero fetus, on the other hand, is well known. There is evidence of embryotoxic effects of heat waves, heat exposure being directly responsible for very early pregnancy losses (through unknown mechanisms).[6] The effect of higher core temperature during febrile illnesses on pregnancy can be catastrophic, including the possibility of miscarriage, pre-term labour, and still birth.[5] Such febrile illnesses are already on the rise due to increase in vector borne illnesses like malaria and dengue due to climate change affecting various biomes. Unabated global warming will increase the incidence of such illnesses in the future. Exposure to extreme external heat during pregnancy increases the incidence of pre-eclampsia, low birth weight babies, as well as the incidence of gestational diabetes.[7] Neonates are especially susceptible to hot weather. During the heat wave of Ahmedabad in 2010, a study reported a significantly higher incidence of Neonatal intensive care unit (NICU) admissions as well as higher neonatal deaths.[8] Apart from all the above, the negative health effects continue during early childhood development, as per a recent United Nations Children’s Fund (UNICEF) report.[9] From all the available evidence and reports of heat wave calamities, we must realize that tackling temperature rise is the need of the hour. We, as doctors, need to document and report the effects of temperature rise on human health. This is needed to bring about policy changes which specifically address this problem. Pregnant women would be better served if carers and family members are sensitized to dangers of exposing them to very hot and humid weather. All health workers, henceforth, need to educate patients about the dangers of heat exposure and advise them to protect themselves from extreme hot weather. This would be the way ahead to ensure better overall health as well as optimum reproductive outcomes, and mitigate the negative impact of global warming on future human potential. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest." @default.
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• W4382118471 date "2023-01-01" @default.
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• W4382118471 title "Global warming: impact on human fertility" @default.
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• W4382118471 doi "https://doi.org/10.4103/amjm.amjm_24_23" @default.
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