{
    "abstract": "A severe decline in child births has occurred over the past half century, which will lead to considerable population declines, particularly in industrialized regions. A crucial question is whether this decline can be explained by economic and behavioural factors alone, as suggested by demographic reports, or to what degree biological factors are also involved. Here, we discuss data suggesting that human reproductive health is deteriorating in industrialized regions. Widespread infertility and the need for assisted reproduction due to poor semen quality and/or oocyte failure are now major health issues. Other indicators of declining reproductive health include a worldwide increasing incidence in testicular cancer among young men and alterations in twinning frequency. There is also evidence of a parallel decline in rates of legal abortions, revealing a deterioration in total conception rates. Subtle alterations in fertility rates were already visible around 1900, and most industrialized regions now have rates below levels required to sustain their populations. We hypothesize that these reproductive health problems are partially linked to increasing human exposures to chemicals originating directly or indirectly from fossil fuels. If the current infertility epidemic is indeed linked to such exposures, decisive regulatory action underpinned by unconventional, interdisciplinary research collaborations will be needed to reverse the trends.",
    "authors": [
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. Niels.Erik.Skakkebaek@regionh.dk.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Niels.Erik.Skakkebaek@regionh.dk.\nDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Niels.Erik.Skakkebaek@regionh.dk.",
            "firstname": "Niels E",
            "initials": "NE",
            "lastname": "Skakkeb\u00e6k"
        },
        {
            "affiliation": "Department of Public Health, University of Southern Denmark, Odense, Denmark.",
            "firstname": "Rune",
            "initials": "R",
            "lastname": "Lindahl-Jacobsen"
        },
        {
            "affiliation": "School of Public Health, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.",
            "firstname": "Hagai",
            "initials": "H",
            "lastname": "Levine"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Anna-Maria",
            "initials": "AM",
            "lastname": "Andersson"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Niels",
            "initials": "N",
            "lastname": "J\u00f8rgensen"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.\nDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Katharina M",
            "initials": "KM",
            "lastname": "Main"
        },
        {
            "affiliation": "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.\nDepartment of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "\u00d8jvind",
            "initials": "\u00d8",
            "lastname": "Lidegaard"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "L\u00e6rke",
            "initials": "L",
            "lastname": "Priskorn"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Stine A",
            "initials": "SA",
            "lastname": "Holmboe"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Elvira V",
            "initials": "EV",
            "lastname": "Br\u00e4uner"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Kristian",
            "initials": "K",
            "lastname": "Almstrup"
        },
        {
            "affiliation": "Department of Morphology, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.",
            "firstname": "Luiz R",
            "initials": "LR",
            "lastname": "Franca"
        },
        {
            "affiliation": "Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.",
            "firstname": "Ariana",
            "initials": "A",
            "lastname": "Znaor"
        },
        {
            "affiliation": "Division of Environmental Sciences, Brunel University London, Uxbridge, UK.",
            "firstname": "Andreas",
            "initials": "A",
            "lastname": "Kortenkamp"
        },
        {
            "affiliation": "Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia.\nFertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia, Australia.",
            "firstname": "Roger J",
            "initials": "RJ",
            "lastname": "Hart"
        },
        {
            "affiliation": "Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.\nInternational Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.\nDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.",
            "firstname": "Anders",
            "initials": "A",
            "lastname": "Juul"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2021. Springer Nature Limited.",
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    "journal": "Nature reviews. Endocrinology",
    "keywords": [],
    "methods": null,
    "publication_date": "2021-12-17",
    "pubmed_id": "34912078\n32679112\n34265193\n12663901\n29117321\n31530417\n12855067\n27343747\n30983583\n12004104\n15189134\n4943183\n30852201\n20806995\n23548368\n18194282\n23384741\n14471934\n26962904\n27490044\n27179755\n31774741\n17976178\n22736324\n28921518\n32255196\n29053188\n9512236\n17135304\n434009\n7193908\n6686890\n32123753\n24472708\n30248536\n26185187\n12801554\n25822490\n6809780\n25391845\n31604276\n22841925\n29398739\n26854709\n32978068\n15673607\n27061873\n27541842\n28557831\n25395025\n27286252\n25108464\n9112368\n9607780\n10455051\n11478683\n11331655\n6772801\n9298784\n9828180\n15626401\n1393072\n28981654\n27793371\n29493550\n31013428\n29659832\n22761286\n9777833\n11794171\n11821304\n20111088\n11331648\n31773729\n8386660\n8637026\n13561247\n13396200\n33538338\n24268506\n21397064\n17847006\n29527098\n29622783\n34347949\n31955275\n27798627\n19448619\n28436984\n30649302\n22267201\n22771120\n31341302\n27349168\n32190749\n31600381\n29505975\n32755991\n25424739\n25552657\n29492305\n29024969\n32444626\n29147574\n32415866\n30780129\n26721685\n26658372\n32066367\n22914163\n28088314\n556420\n6721590\n6465547\n26582516\n23949223\n14203187\n11099647\n12832361\n18174960\n18340380\n28352662\n31525431\n27923611\n12573895\n19850123\n32638039\n21262597\n16371110\n22519522\n17938745\n12460788\n20171682\n18159067\n15846514\n15256440\n26935559\n18308057\n23589523\n2875208\n8621244\n23670171\n12151459\n6293886\n10458231\n17895324\n17062768\n27113031\n14693659\n17369608\n9829871\n24746741\n27190399\n30576495\n32558890\n26283092\n30726923\n9712595\n28029592\n31375368\n32083688\n29733398\n32268461\n29384791\n29486787\n29452915\n23242914\n30407511\n22234399\n23380634\n28868837\n31858122\n28092795\n19528062\n21233055\n3080910\n24080458\n32051500\n32036120\n17951105\n33577774\n31093631\n28918439\n8709758\n14998749\n11713004\n25742517\n26651223\n15951667\n15972942\n32624213\n14698935\n16615653\n16755258\n26484423\n16319285\n32666138\n24673563\n30772659\n19779279\n25568307\n17442852",
    "results": null,
    "title": "Environmental factors in declining human fertility.",
    "xml": "<Element 'PubmedArticle' at 0x788504721580>"
}