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| Effects of antibiotic exposure on human fertility: a systematic review |
| GAO Yaya1,2, XIA Luobin1,2, PAN Guixia1, TAO Fangbiao1,2, SHAO Shanshan1,2
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1. School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China;
2. Key Laboratory of Population Health Across Life Cycle, Ministry of Education, Hefei, Anhui 230032, China |
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Abstract Objective To explore the impact of antibiotic exposure on human fertility, so as to provide the reference for related research on risk factors and prevention of infertility. Methods Publications pertaining to antibiotic exposure and human fertility were retrived in CNKI, Wanfang Data, VIP, PubMed, Embase and Web of Science from inception to March 2024. Two reviewers independently conducted literature screening, data extraction, and quality assessment. A qualitative analysis was performed to investigate the effect of antibiotic exposure on human fertility. Results A total of 11 623 articles were retrieved, and 31 of them were finally included. Among them, 19 were quasi-experimental studies (4 high-quality and 15 medium-quality), 6 were observational studies (5 high-quality and 1 medium-quality), and 6 were randomized controlled trials (RCTs) with high risks of implementation bias and measurement bias. Sixteen quasi-experimental studies and five RCTs found that the use of sensitive antibiotics such as doxycycline for the treatment of reproductive system infections improved female pregnancy rates or male semen quality. Two quasi-experimental studies and one RCT suggested that antibiotics (such as sirolimus or sulfasalazine) used to treat other systemic diseases might cause adverse effects on the reproductive system. Four observational studies indicated that exposure to antibiotics such as sulfonamides, macrolides, and tetracyclines increased the risk of infertility or prostate cancer. Two observational studies found a dual effect of antibiotics on infertility. Conclusions Antibiotic exposure appears to have either beneficial or harmful effects on fertility, depending on the antibiotic types, doses, and indication. However, these studies have limitations such as small sample size, selection bias, and the inability to achieve randomization and blind methods. Further research with optimized designs is necessary to explore the relationship between antibiotic exposure and fertility.
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Received: 18 March 2024
Revised: 16 May 2024
Published: 22 August 2024
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