ENVIRONMENTAL EXPOSURES AND FEMALE REPRODUCTIVE HEALTH: EFFECTS OF SECONDHAND SMOKE AND AIR POLLUTION ON OVARIAN RESERVE

Abstract

Exposure to potentially toxic environmental agents has been investigated as a possible determinant of female reproductive health, particularly with regard to the preservation of ovarian reserve. The present study aimed to critically analyze the scientific literature on the relationship between passive exposure to tobacco smoke and air pollution and changes in ovarian reserve, focusing on the biological mechanisms involved and the main markers used to assess ovarian function. This is a narrative literature review of a descriptive, analytical, and interpretative nature, conducted through searches in the PubMed/MEDLINE, SciELO, and Google Scholar databases, encompassing publications from 2020 to 2026. Observational and experimental studies, as well as literature reviews related to environmental exposures, anti-Müllerian hormone, antral follicle count, and mechanisms of ovarian toxicity, were analyzed. The literature reviewed suggests an association between exposure to certain air pollutants, particularly PM₂.₅, PM₁₀, and NO₂, and changes in markers of ovarian reserve. Regarding passive smoking, clinical findings remain limited and heterogeneous, although experimental studies and evidence concerning the presence of tobacco components in the ovarian microenvironment provide biological plausibility for potential effects on follicular function. The proposed mechanisms include oxidative stress, inflammation, DNA damage, mitochondrial dysfunction, endocrine alterations, and apoptosis of follicular cells. It is concluded that environmental exposures constitute potential factors associated with ovarian function; however, the available literature does not allow consistent causal relationships to be established, particularly regarding passive smoking. Longitudinal studies with objective exposure assessment and monitoring of ovarian reserve markers are needed to clarify the clinical relevance of these associations.