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Eur J Public Health. 2016 Feb;26(1):76-83. doi: 10.1093/eurpub/ckv153. Epub 2015 Sep 1.

Toward a multi-country monitoring system of reproductive health in the context of endocrine disrupting chemical exposure.

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1 Environmental Health Department, French Institute for Public Health Surveillance (InVS), Saint Maurice, France
2 MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK.
3 Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
4 Braun School of Public Health and Community Medicine, Hebrew University-Hadassah and The Hebrew University Center of Excellence in Agriculture and Environmental Health, Jerusalem, Israel 5 Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
6 Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland.
7 Division of Preventive Medicine and Public Health, Department of Health and Social Sciences, University of Murcia School of Medicine, Murcia, Spain.
5 Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
8 Department of Physiology, University of Turku, Turku, Finland.
10 Endocrinology Department, CHU Paris Est - Saint-Antoine Hospital, Paris, France.
11 Inserm U.1085, Institut de Recherche en santé, environnement et travail (IRSET), University of Rennes, Rennes, France.
8 Department of Physiology, University of Turku, Turku, Finland 9 Department of Pediatrics, University of Turku, Turku, Finland.



Worrying trends regarding human reproductive endpoints (e.g. semen quality, reproductive cancers) have been reported and there is growing circumstantial evidence for a possible causal link between these trends and exposure to endocrine disrupting chemicals (EDCs). However, there is a striking lack of human data to fill the current knowledge gaps. To answer the crucial questions raised on human reproductive health, there is an urgent need for a reproductive surveillance system to be shared across countries.


A multidisciplinary network named HUman Reproductive health and Global ENvironment Network (HURGENT) was created aiming at designing a European monitoring system for reproductive health indicators. Collaborative work allowed setting up the available knowledge to design such a system. Furthermore we conducted an overview of 23 potential indicators, based upon a weight of evidence (WoE) approach according to their potential relation with EDC exposure.


The framework and purposes of the surveillance system are settled as well as the approach to select suitable reproductive indicators. The indicators found with the highest scores according to the WoE approach are prostate and breast cancer incidence, sex ratio, endometriosis and uterine fibroid incidence, indicators related to the testicular dysgenesis syndrome, precocious puberty incidence and reproductive hormone levels.


Not only sentinel health endpoints, but also diseases with high burdens in public health are highlighted as prior indicators in the context of EDC exposure. Our work can serve as a basis to construct, as soon as possible, the first multi-country reproductive monitoring system.

[Indexed for MEDLINE]

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