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Peer-reviewedCC BY 4.0Frontiers in Public Health

Association between infertility prevalence and exposure to heat stress: an ecological study based on the Universal Thermal Climate Index

  • Dian Wang1
  • Jiahua Qian1
  • Xiaoming Zhang1
  • Chunbao Mo2,3
  • Yihao Chen4
  • Yuhe Si1
  • Yicheng Wang4
  • Jianan He1
  • Jianxiong Ma1
4 affiliations
  1. 1Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)
  2. 2Department of Public Health, The Reproduction Hospital of Guangxi Zhuang Autonomous Region
  3. 3Guangxi Key Laboratory of Artificial Intelligence for Genetic Diseases of Long-dwelling Nationalities
  4. 4The Second Clinical Medical College, Zhejiang Chinese Medical University
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Abstract

Background: Repeated exposure to heat stress may adversely affect reproductive health, yet the population-level relationship between heat stress and infertility has not been well characterized.

Methods: We conducted a global ecological analysis across 174 countries and regions from 1990 to 2021. Heat exposure was quantified as the annual number of days falling into four Universal Thermal Climate Index categories: moderate, strong, very strong, and extreme heat stress. We additionally constructed a weighted score combining very strong and extreme heat stress. Associations with male and female infertility prevalence were estimated using linear mixed-effects models.

Results: Each additional day of very strong and extreme heat stress was associated with increases in male infertility ASPR of 1.292 (95% confidence interval [CI]: 0.675–1.908) and 1.654 (95% CI: 0.214–3.096) per 100,000 population, respectively. The corresponding increases in female infertility ASPR were 2.126 (95% CI: 0.785–3.467) and 7.133 (95% CI: 3.940–10.323) per 100,000 population, respectively. Higher weighted heat-stress scores were also consistently associated with greater infertility prevalence.

Conclusions: These findings suggest that recurrent heat-stress exposure may be associated with a higher population burden of infertility and support consideration of reproductive health in climate-change adaptation and heat-protection strategies.

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Cite

BibTeXRIS
BibTeX
@article{wang2026association,
  title = {{Association between infertility prevalence and exposure to heat stress: an ecological study based on the Universal Thermal Climate Index}},
  author = {Dian Wang and Jiahua Qian and Xiaoming Zhang and Chunbao Mo and Yihao Chen and Yuhe Si and Yicheng Wang and Jianan He and Jianxiong Ma},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1948152},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1948152/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association between infertility prevalence and exposure to heat stress: an ecological study based on the Universal Thermal Climate Index
AU  - Dian Wang
AU  - Jiahua Qian
AU  - Xiaoming Zhang
AU  - Chunbao Mo
AU  - Yihao Chen
AU  - Yuhe Si
AU  - Yicheng Wang
AU  - Jianan He
AU  - Jianxiong Ma
PY  - 2026
DA  - 2026/10/16
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1948152
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1948152/full
AB  - Background: Repeated exposure to heat stress may adversely affect reproductive health, yet the population-level relationship between heat stress and infertility has not been well characterized.  Methods: We conducted a global ecological analysis across 174 countries and regions from 1990 to 2021. Heat exposure was quantified as the annual number of days falling into four Universal Thermal Climate Index categories: moderate, strong, very strong, and extreme heat stress. We additionally constructed a weighted score combining very strong and extreme heat stress. Associations with male and female infertility prevalence were estimated using linear mixed-effects models.  Results: Each additional day of very strong and extreme heat stress was associated with increases in male infertility ASPR of 1.292 (95% confidence interval [CI]: 0.675–1.908) and 1.654 (95% CI: 0.214–3.096) per 100,000 population, respectively. The corresponding increases in female infertility ASPR were 2.126 (95% CI: 0.785–3.467) and 7.133 (95% CI: 3.940–10.323) per 100,000 population, respectively. Higher weighted heat-stress scores were also consistently associated with greater infertility prevalence.  Conclusions: These findings suggest that recurrent heat-stress exposure may be associated with a higher population burden of infertility and support consideration of reproductive health in climate-change adaptation and heat-protection strategies.
SN  - 2296-2565
ER  -