Mechanisms and research progress of single and combined antibiotic‑induced female reproductive toxicity

With the production and discharge of antibiotics continuing to grow annually, antibiotic pollution has become a global environmental and health concern. Antibiotics are mostly used in livestock, and continuously enter the environment through various routes, eventually accumulating in the human body. This review summarizes the main exposure pathways of antibiotics, their toxic effects on the female reproductive system, and the associated toxicity mechanisms. Evidence shows that antibiotics influence the female reproductive system through mechanisms including oxidative stress, endocrine disruption, microbiota dysbiosis, and epigenetics, leading to offspring reduction, multi-generational toxicity, and decline in ovarian reserve. We assess reproductive toxicity both during pregnancy and in the preconception period. Subsequently, we briefly discuss the combined effects of antibiotic mixtures, and identify key gaps for future research. This review aims to improve public understanding of the adverse effects of antibiotics on the female reproductive capacity and their underlying mechanisms.