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The Observer
Interview

Shanna Swan: 'Most couples may have to use

assisted reproduction by 2045'
Zoë Corbyn

The professor of environmental medicine explains how chemicals

in plastics are causing our fertility to decline – and what we can do
about it

Sun 28 Mar 2021 10.00 BST

Shanna Swan is a professor of environmental medicine and public health at Mount

Sinai school of medicine in New York City, studying fertility trends. In 2017 she
documented how average sperm counts among western men have more than halved
in the past 40 years. Count Down is her new book.

You’ve spent more than 20 years examining the effects of hormone disrupting
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chemicals on reproductive health. Are you now sounding the alarm?

I am directly speaking to this hidden problem people don’t like to talk about, which
is their sub-fertility or reproductive problems, and how that is tied to the
environment. People are recognising we have a reproductive health crisis, but they
say it’s because of delayed childbearing, choice or lifestyle – it can’t be chemical. I
want people to recognise it can. I am not saying other factors aren’t involved. But I
am saying chemicals play a major causal role. It is difficult to use that word, “cause”,
but it’s a body of evidence. We have mechanisms, animal studies, and multiple
human studies.

Female fertility declines rapidly after about 35. Isn’t that why so many people are
turning to IVF?
It’s not that simple. When a colleague and I looked at the change in impaired
fecundity [the ability to have children] we were surprised to see younger women
had experienced a bigger increase than older age groups. This suggests that
something besides ageing and delayed childbearing is affecting fertility.

Moreover, there’s compelling evidence that the risk of miscarriage has been rising
among women of all ages.

Which chemicals are the most worrying for reproductive health and how do they
work?
Those that can interfere with or mimic the body’s sex hormones – such as
testosterone and oestrogen – because these make reproduction possible. They can
make the body think it has enough of a particular hormone and it doesn’t need to
make any more, so production goes down.

Phthalates, used to make plastic soft and flexible, are of

paramount concern. They are in everybody and we are probably primarily exposed
through food as we use soft plastic in food manufacture, processing and packaging.

They lower testosterone and so have the strongest influences on the male side, for
example diminishing sperm count, though they are bad for women, too, shown to
decrease libido and increase risk of early puberty, premature ovarian failure,
miscarriage and premature birth.

Bisphenol A (BPA), used to harden plastic and found in cash-register receipts and
the lining of some canned-food containers, is another. It is oestrogen mimicking and
so is a particularly bad actor on the female side, increasing risks of fertility
challenges, but likewise it can affect men. Men occupationally exposed to BPA have
shown decreased sperm quality, reduced libido and higher rates of erectile
dysfunction. Other chemicals of concern include flame retardants and certain
pesticides such as atrazine.
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When is the most damage done?

A lot of the exposure that causes these changes occurs in utero when the foetus is
first forming. These rapidly dividing cells are the most sensitive. The hits then
continue through childhood, adolescence and adulthood. There is a cumulative
nature to this. And we can pass these effects on. The simplest way is by direct
exposure. A female foetus, in utero, is growing the eggs that she will use to have her
own children. These chemicals can make their way to those germ cells, too.

What is the anogenital distance (AGD) and why does it matter?

It is the distance from the anus to the genitals and it is usually far longer in males
than females. It is a indicator of how much androgen [male sex hormones including
testosterone] an infant was exposed to during early pregnancy. AGD is such an
important marker of reproductive health and endocrine disruption – if we measured
it for every infant, we would know something about their future fertility. Shorter
AGDs in males and longer AGDs in females indicate less reproductive success.

To the extent You’ve used AGD to show phthalates cause low sperm
possible, eat count in men. How?
unprocessed foods, When I started looking at phthalates, around 2000,
as this should phthalate syndrome had been shown experimentally in
reduce exposure rodents but not in humans. Mother rats given phthalates
through plastic had male babies with a smaller penis and scrotum, their
sperm counts were lower and their AGD was shorter. I
ran a study where we measured the stored urine of
pregnant women for phthalates and we measured their male babies’ and toddlers’
AGDs – a first – along with some other genital measurements. We found exactly
what had been found in rodents: phthalate syndrome. I then did a study of college-
age men, where we got them to give a semen sample and measured their AGD, and
we showed that the shorter the AGD, the lower the sperm count. This is why I am

confident: we have a direct link from phthalates to short AGD and then from short
AGD to low sperm count, and those results have been confirmed by subsequent
studies.

How dire is the reproductive crisis? You’ve said we are on course for an infertile
world by 2045…
It is serious. If you follow the curve from the 2017 sperm-decline meta-analysis, it
predicts that by 2045 we will have a median sperm count of zero. It is speculative to
extrapolate, but there is also no evidence that it is tapering off. This means that
most couples may have to use assisted reproduction.

Drugs are monitored for safety. What is the regulatory situation for these
chemicals?
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chemicals?
In the US, most chemicals have not been tested and are assumed to be safe. There
has been better progress in Europe. Though imperfect, the EU’s Reach (Registration,
Evaluation, Authorisation and Restriction of Chemicals) regulation was a big step
forward. There are huge economic interests preventing tougher regulation.

What needs to happen?

The chemical industry must start producing chemicals that can be used in everyday
products that are non-hormonally active. Regrettable substitution – where one
harmful chemical is replaced by another untested one, which then turns out to have
the same risks – must also stop. It has happened with different phthalates, BPA and
flame retardants and it is unacceptable. And we need to test the chemicals we are
currently using – and not just at high doses and not just one at a time, because we
are being exposed to a large number.

Should we believe packaging that says BPA or phthalate free?

If it says “BPA free” it probably doesn’t have BPA. But notice that it doesn’t say
bisphenol free so you could still be getting bisphenol S or F, which are regrettable
substitutes. “Phthalate free” I would also be suspicious of. While it might be free of
the old, well-known actors, it may not be free of newer ones. People should feel
angry about potentially being tricked this way and press for change.

What should we be doing to cut down our exposure?

People of reproductive age, particularly those planning pregnancy or pregnant,
should be aware that everything they bring into their home has the potential to
contain these chemicals. To the extent possible, eat unprocessed foods – a bunch of
carrots, potatoes that you cook yourself – as this should reduce exposure through
plastic. Also, when cooking, don’t use Teflon or anything coated and don’t
microwave in plastic. For personal care and household products use a minimum of
simple products and try to avoid those that are scented; phthalates are added to

hold scent. The non-profit Environmental Working Group has free consumer guides
that give information about specific products.

Can we can turn things around?

I think we can. We have the ingenuity and the resources to do it. But we need a
recognition of the problem and the will to change.

Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and
Female Reproductive Development, and Imperiling the Future of the Human Race by
Shanna H Swan with Stacey Colino is published by Simon & Schuster (£20). To order
a copy go to guardianbookshop.com. Delivery charges may apply

“It’s now or never” for tackling the climate crisis. That was the blunt warning that
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It s now or never for tackling the climate crisis. That was the blunt warning that
stood out from the UN’s most recent comprehensive review of climate science,
drawing on the work of thousands of scientists over many years.
As environment correspondent, I’ve spent 18 years grappling with this data and
reporting on the science – and this is without a doubt the starkest language yet,
the strongest words I've ever heard from a body that is sometimes criticised for
pulling its punches, and whose conclusions are often vetted and watered down by
world leaders keen to diminish their impact.

The truth is that this latest report is the last one to be published while we still
have a realistic chance of limiting global heating to 1.5C above pre-industrial
levels.
At the Guardian, we feel that up-to-date, fact-checked, independent journalism is
key to taking meaningful action. That’s why we have been reporting on global
heating for decades, and giving scientific findings more publicity and prominence
than any other news organisation. We have put the climate crisis at the heart of
our work, knowing that accurate information is essential for the future of
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Fiona Harvey
Environment correspondent

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