Date of Award

Fall 2022

Document Type

Open Access Dissertation


Environmental Health Sciences

First Advisor

Dwayne Porter

Second Advisor

Geoffrey Scott


Environmental and chemical exposures are continually introduced into our bodies. The female reproductive cycle is complex and particularly sensitive to toxic substances. A recent rise in infertility and reproductive diseases and cancers make reproductive toxicity a public health concern. The overall purpose of this dissertation is to explore how environmental and chemical exposures impact women’s reproductive health and overall wellbeing. To do this, a variety of topics related to women’s reproductive health are explored, including how environmental exposures can impact reproduction, methods for studying reproductive dysfunctions, fertility preservation among cancer patients, and the overall wellbeing of female cancer patients.

The first objective, using cross-sectional data from the National Health and Nutrition Examination Survey, is to determine the association between three heavy metals (lead, cadmium, and mercury) and their mixture and infertility and long-term amenorrhea. The second objective is to review the literature of bioengineering models used by researchers in labs to better understand a variety of female reproductive diseases. The third objective is to review the literature on current oocyte preservation options in oncofertility and discuss current guidelines and practices of female fertility preservation. The fourth objective is to focus specifically on assessing knowledge, attitude, and behavior towards oncofertility among female breast cancer patients in China.

For the first objective, findings showed that higher lead blood concentrations increased the odds of infertility. Additionally, blood concentrations of lead and heavy metal mixtures were significantly higher in infertile women than pregnant women, but the concentrations of cadmium and mercury were comparable. In summary, heavy metals have endocrine disrupting effects and may increase women’ risks of infertility and long-term amenorrhea. For the second objective, peer-reviewed literature demonstrated that applying bioengineering to female reproductive biology and medicine provides great potential to advance the knowledge of female fertility, genetic vulnerability, medications, environmental exposures and toxicities, aging, nutrition, and diseases. For the third objective, the literature reviewed explained that current fertility preservation options such as oocyte and embryo cryopreservation are well established for reproductive aged female cancer and infertility patients. Moreover, recent advancements in reproductive science and medicine have allowed for investigational fertility preservation options for both childhood and reproductive-age patients, including ovarian tissue cryopreservation, in vitro oocyte maturation, ovarian transposition, ovarian suppression, and adjuvant therapy. Finally, results of the fourth objective suggest that breast cancer patients in China view oncofertility as important, but inadequate oncofertility knowledge remains. Additionally, providers need to communicate more information to patients about how their cancer treatment will impact their fertility and what options they have for fertility preservation.

Undoubtedly, the many evident complexities of the interactions between xenobiotic exposures and women’s reproductive health outcomes emphasize the need for more research. Efforts are needed to reduce endocrine disrupting exposures among women and to further develop fertility preservation approaches for cancer or infertility patients. Public health research and science-informed policies are critical to reducing adverse health outcomes, especially in the modern world where not only are environmental, occupational, and medical substances progressively introduced into the human body, but also reproductive disease and infertility rates are on the rise.


© 2022, Maria Zubizarreta McClam