Abstract Background Growing evidence points to an association between ambient air pollution and decreased human reproductive potential. The aim of this study was to systematically review the association between air pollutants and female ovarian reserve. Methods The literature was searched in six electronic databases through August 2023. Screening of the 75 articles retrieved for inclusion criteria resulted in the selection of 12 human observational studies that evaluated the effect of environmental pollutants on markers of female ovarian reserve. The study protocol was registered on PROSPERO (registration code CRD42023474218). Results The study design of selected studies was found to be cross-sectional (2 of 10), retrospective cohort (7 of 10), prospective cohort (2 of 10), and case-control (1 of 10). The study population was equally distributed between Asians (60%) and Americans (50%) with an Italian minority (10%). The main findings showed a higher body of evidence for the environmental pollutants PM2.5, PM10, and NO2, while a low body of evidence for PM1, O3, SO2, and a very low body of evidence for benzene, formaldehyde, and benzo(a)pyrene, yet consistently showing significant inverse association data. The overall methodological quality of the selected studies was rated moderated across the 14 domains of the NIH toolkit. Conclusions Increased exposure to air pollutants seems to be associated with reduced female ovarian reserve with evidence being strongest for pollutants such as PM2.5, PM10, and NO2. More evidence is needed to draw conclusions about causality. Key messages • Increased exposure to air pollutants seems to be associated with reduced female ovarian reserve with evidence being strongest for pollutants such as PM2.5, PM10, and NO2. • Global environmental policy programs are urgently needed to reduce the risks associated with reduced fertility such as reduced birth rates or the use of assisted reproductive technologies.