Can Heavy Metal Exposure Harm Reproductive Health?

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1. You are a member of the health care team caring for a 27-year-old woman with infertility. On the basis of the study by McClam and colleagues of women of reproductive age who completed National Health and Nutrition Examination Survey (NHANES) 2013 to 2018 and who had blood heavy metals data, which one of the following statements about associations of blood concentrations of lead, cadmium, and mercury, alone and in a mixture, with infertility and long-term amenorrhea is correct?
   Percentages of women who exceeded typical or normal levels of blood heavy metals was less than 5% for lead, cadmium, and mercury
   After full adjustment, there was a significant, dose-dependent positive association between blood lead levels and historical infertility
   Cadmium blood levels were positively associated with long-term amenorrhea
   Blood concentrations of cadmium and mercury were significantly higher in ever-infertile women than in pregnant women
2. According to the study by McClam and colleagues of women of reproductive age who completed NHANES 2013 to 2018 and who had blood heavy metals data, which one of the following statements about clinical implications of associations of blood concentrations of lead, cadmium, and mercury, alone and in a mixture, with infertility and long-term amenorrhea is correct?
   Reducing risk to female reproductive health/fertility mandates prevention and reduction of heavy metal exposure, which is an urgent, unmet need
   Reproductive toxicant exposure, but not genetic factors, contribute to female infertility and amenorrhea
   The study proves that heavy metal exposure causes infertility
   The study proves that amenorrhea is the leading cause of female infertility