The handmaids—if they had been allowed to write in Margaret Atwood’s dystopia—would not have much to write home about. As the book and popular Hulu show portray, the lives of fertile, low-status women in The Handmaid’s Tale consist of little more than sitting around in their “Commanders’” houses, waiting around to be inseminated.

But that’s still better than what happens to those who can’t bear children: They’re sent to some grim-sounding “Colonies” to clean up toxic waste. It’s this pollution that supposedly contributed to the epidemic of infertility that, according to the book, triggered the military rule, subjugation of women, and obsession with childbearing that forms the basis of the Gilead government.

Many writers have explored the parallels between the brutal patriarchy Atwood constructed and America’s new government. But a less-examined, medical theme in the book is actually kind of true: There is a link between pollution and infertility. Probably not enough of one to morph all of America into a demented version of Amish country, but a link nonetheless.

It’s hard to know what causes any given case of infertility—anything from age to smoking can affect a woman’s chances of getting pregnant—but several studies and reviews suggest exposure to various kinds of pollutants can play a role.

The book—spoiler!—explains that stillbirths, miscarriages, and birth defects all rose thanks to sexually transmitted diseases, as well as pesticides and leaks from nuclear power plants and stockpiles of chemical and biological weapons.

The nuclear-plant accidents in question would have to be pretty awful for them to cause widespread, permanent infertility. As in, worse than Chernobyl. International reports on the aftermath of Chernobyl found “no effects on fertility, numbers of stillbirths, adverse pregnancy outcomes or delivery complications.”

Eli Glatstein, a professor of radiation oncology at the University of Pennsylvania, said the extent to which radiation could affect fertility would depend on the age of the women nearby. “If a woman is close to menopause, it doesn’t take much to knock the rest of her fertility out,” he said. For women in their 20s, it would take a lot.

It would also depend on what kinds of isotopes are released in the nuclear accident, and where the fallout lands. If it gets into the groundwater, people could potentially ingest it, and it could damage most of their organs. But, Glatstein says, most nuclear isotopes don’t “home in” on the reproductive organs. The thyroid, for example, collects radioactive iodine, which is why one of the health concerns experts worry about most after accidents like Chernobyl is thyroid cancer.

And, for what it’s worth, Glatstein said, “testes are generally more sensitive than ovaries to radiation.” So perhaps we should have hand-men instead.

But there’s also evidence that more mundane types of pollution, such as vehicle exhaust and toxic substances in our homes, can affect fertility. A study last year by Shruthi Mahalingaiah, a researcher at Boston University School of Medicine, found that women who live within a tenth of a mile of a major roadway are 11 percent more likely to have problems conceiving than those who live further away. A review paper published last year found a small but significant association between exposure to traffic-related pollution and miscarriages and problems conceiving.

The culprits are the particulate matter, volatile compounds, and other chemicals found in exhaust, which experts say can disrupt the endocrine system—and thus, the delicate hormonal balancing act that must play out near-perfectly for a successful pregnancy. Air pollution might also reduce sperm quality and hurt the embryo at critical periods in its development, and it can increase the odds of preterm birth, which, in turn, carries the risk of birth defects.

And it isn’t just air pollution. Earlier research found that couples took about 20 percent longer to conceive if they were exposed to high levels of flame retardants or polychlorinated biphenyls, or PCBs, an old class of chemicals that can still be found in some types of paints and finishes.

What’s more, part of being unable to ovulate is how stressed and unsafe a woman feels, Mahalingaiah says. An environment so toxic that it became stressful and terrifying could impact peoples' hypothalamuses, a region of the brain that controls the pituitary gland, which regulates reproductive and other hormones.

One way to reduce exposures to endocrine-disrupting chemicals, of course, is to have better studies and stricter government regulations—but, you know, of chemicals, not of skirt lengths and head coverings.

Could it ever get so bad that fertile women are reduced to little more than sex slaves, serving at the whim of a small group of elite oligarchs, in order to bear them children that will swiftly be transferred into the possession of a small group of frosty, turquoise-clad “Wives”?

Probably not. There are lots of things we could do before the situation got that bad. For one, using CRISPR and other technologies, we could edit human genes in ways that would equip people for survival in a more polluted environment.

And, “If the earth became too toxic, one solace is that there are thousands of human seeds—embryos, eggs, and sperm frozen in liquid nitrogen tanks,” said Mahalingaiah. We could use them to re-populate a fresh planet ... “But that would mean a search for a new earth, space travel, gestational carriers, or synthetically grown uteri to grow the babies.”

Under his eye, of course.