Particulate air pollution at the time of oocyte retrieval is independently associated with reduced odds of live birth in subsequent frozen embryo transfers.
Does exposure to particulate matter (PM) air pollution prior to oocyte retrieval or subsequent frozen embryo transfer (FET) affect the odds of live birth?
Live birth rates are lower when particulate matter (PM2.5 and PM10) levels are higher prior to oocyte retrieval, regardless of the conditions at the time of embryo transfer.
Exposure to air pollution is associated with adverse reproductive outcomes, including reduced fecundity and ovarian reserve, and an increased risk of infertility and pregnancy loss. It is uncertain whether the effect on ART outcomes is due to the effects of pollution on oogenesis or on early pregnancy.
This retrospective cohort study included 3659 FETs in 1835 patients between January 2013 and December 2021, accounting for all FETs performed at a single clinic over the study period. The primary outcome was the live birth rate per FET. Outcome data were missing for two embryo transfers which were excluded. Daily levels of PM2.5, PM10, nitric oxide, nitrogen dioxide, sulphur dioxide, ozone and carbon monoxide were collected during the study period and calculated for the day of oocyte retrieval and the day of embryo transfer, and during the preceding 2-week, 4-week, and 3-month periods.
Clinical and embryological outcomes were analysed for their association with pollution over 24 hours, 2 weeks, 4 weeks, and 3 months, with adjustment for repeated cycles per participant, age at the time of oocyte retrieval, a quadratic age term, meteorological season, year, and co-exposure to air pollutants. Multi-pollutant models were constructed to adjust for co-exposures to other pollutants. Median concentrations in pollutant quartiles were modelled as continuous variables to test for overall linear trends; a Bonferroni correction was applied to maintain an overall alpha of 0.05 across the four exposure periods tested.
Increased PM2.5 exposure in the 3 months prior to oocyte retrieval was associated with decreased odds of live birth (linear trend P = 0.011); the odds of live birth when PM2.5 concentrations were in the highest quartile were reduced by 34% (OR 0.66, 95% CI 0.47-0.92) when compared to the lowest quartile. A consistent direction of effect was seen across other exposure periods prior to oocyte retrieval, with an apparent dose-dependent relationship. Increased exposure to PM10 particulate matter in the 2 weeks prior to oocyte retrieval was associated with decreased odds of live birth (linear trend P = 0.009); the odds of live birth were decreased by 38% (OR 0.62, 95% CI 0.43-0.89, P = 0.010) when PM10 concentrations were in the highest quartile compared with the lowest quartile. Consistent trends were not seen across other exposure periods. None of the gaseous pollutants had consistent effects, prior to either oocyte retrieval or embryo transfer.
This was a retrospective cohort study, however, all FETs during the study period were included and data were missing for only two FETs. The results are based on city-level pollution exposures, and we were not able to adjust for all possible factors that may affect live birth rates. Results were not stratified based on specific patient populations, and it was not possible to calculate the cumulative live birth rate per commenced cycle.
This is the first study to specifically analyse FETs to separate the effects of environmental exposures prior to oocyte retrieval from those around the time of embryo transfer. Our findings suggest that increased PM exposure prior to oocyte retrieval is associated with reduced live birth rate following FET, independent of the conditions at the time of embryo transfer. Importantly, the air quality during the study period was excellent, suggesting that even 'acceptable' levels of air pollution have detrimental reproductive effects during gametogenesis. At the low pollution levels in our study, exposure to gaseous pollutants did not appear to affect live birth rates. This has important implications for our understanding of the effects of pollution on reproduction, and highlights the urgent need for effective policies limiting pollution exposure to protect human health and reproduction.
No funding was provided for this study. S.J.L. is supported by the Jean Murray Jones Scholarship from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, has received educational sponsorship from Besins, Ferring, Merck, and Organon, honoraria from Hologic and Organon, consulting fees from Merck unrelated to the current study, and is a member of the Reproductive Technology Council of Western Australia. S.J.L. and R.J.H. are board members of Menopause Alliance Australia. C.S.R., M.W., and E.N. have no conflicts of interest to declare. R.J.H. is the Medical Director of Fertility Specialists of Western Australia, the National Medical Director of City Fertility Australia, and a shareholder in CHA SMG. He chairs the Western Australian Minister's Expert Panel on ART and Surrogacy. R.J.H. has made presentations for and received honoraria from Merck, Merck-Serono, Origio, Igenomix, Gideon-Richter, and Ferring, and has received support for attending meetings from Merck, Organon, and Ferring.
N/A.
Leathersich SJ
，Roche CS
，Walls M
，Nathan E
，Hart RJ
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A case-crossover study of air pollution exposure during pregnancy and the risk of stillbirth in Tehran, Iran.
The growing fetus is very sensitive to environmental conditions. There is limited and conflicting evidence about the short-term effects of exposure to air pollutants on the pregnancy outcome. In this time-stratified case-crossover study, the effect of several air pollutants (i.e. O3, CO, NO2, SO2, and PM2.5) on the occurrence of stillbirth was evaluated in Tehran (the capital of Iran) between December 2018 and March 2023. Using a quasi-Poisson regression model and distributed lag nonlinear models (DLNM), we estimated the effect of exposure to air pollutants measured as lags (0 to 7 days) and cumulative average days (0-2, 0-6, and 0-14-day lag) before delivery on stillbirth. The association was adjusted for potential confounding factors including meteorological factors. During the study period in Tehran, 5311 stillbirths were reported. In single-pollutant models, during the entire year, SO2 (lag 1 day) and NO2 (lag 2 days) were found to have a direct and significant relationship with stillbirth. In the warm seasons, we found direct and inverse relationships between NO2 (lag 2 days) and PM2.5 (lag 4 days), respectively. In cold seasons, PM 2.5 (lag 1 day) and cumulative lag (0-2 days), SO2 (lag 1 day), and cumulative lag (0-2 and 0-6 days) were found to have direct and significant relationships with stillbirth. In two-pollutant models, SO2 & CO, and SO2 & O3, direct and significant associations were observed between SO2 exposures and stillbirth for the entire year. A similar pattern was observed for PM2.5 in combinations with NO2, and O3 and for NO2 in the two-pollutant model (O3 & NO2). However, in warm seasons, inverse associations were observed between PM2.5 and stillbirth in combinations with O3, NO2, and SO2, while NO2 showed a direct association in combinations with PM2.5, CO, and O3. In the cold seasons, direct and significant associations were observed between SO2 and stillbirth in model combinations with CO, O3, and NO2. This relationship was observed for PM2.5 in combination with CO, and NO2. Also, for CO in the two-pollutant model of CO & NO2. As a result, this study showed evidence of a relationship between short-term exposure to ambient air pollution before birth, especially SO2, NO2, PM2.5, and CO with increased risk of stillbirth.
Mohammadi Dashtaki N
，Fararouei M
，Mirahmadizadeh A
，Hoseini M
，Heidarzadeh M
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《Scientific Reports》
Lung-deposited dose of particulate matter from residential exposure to smoke from wood burning.
Residential settings are of utmost importance for human exposure, as it is where people spend most of their time. Residential wood combustion is a widespread practice known as a source of indoor particulate matter (PM). Nevertheless, research on the risks of exposure associated with this source is scarce, and a better understanding of respiratory deposition of smoke particles is needed. The dosimetry model ExDoM2 was applied to determine the deposited dose of inhalable particulate matter (PM10) from residential biomass combustion in the human respiratory tract (HRT) of adults and children. The dose was estimated using PM10 exposure concentrations obtained from a field campaign carried out in two households during the operation of an open fireplace and a woodstove. Simultaneously, PM10 levels were monitored outside to investigate the outdoor dose in a rural area strongly impacted by biomass burning emissions. Indoors, the 8-h average PM10 concentrations ranged from 88.3 to 489 μg m-3 and from 69.4 to 122 μg m-3 for the operation of the fireplace and the woodstove, respectively, while outdoor average PM10 concentrations ranged from 17.3 to 94.2 μg m-3. The highest amount of the deposited particles was recorded in the extrathoracic region (68-79%), whereas the deposition was much lower in the tracheobronchial tree (5-6%) and alveolar-interstitial region (16-21%). The total dose received while using the fireplace was more than twofold the one received in the room with a woodstove and more than 10 times higher than in the absence of the source. Overall, indoor doses were higher than the ones received by a subject exposed outdoors, especially at the alveolar-interstitial region. After 24 h of exposure, it was estimated that approximately 35 to 37% of the particles deposited in the HRT were transferred to the gastrointestinal tract, while approximately 2.0-2.5% were absorbed into the blood. The results from exposure and dose of indoor particles gathered in this work suggest that homeowners should be encouraged to upgrade the wood burning technology to reduce the PM levels inside their residences. This study also provides biologically relevant results on the lung deposition of particles from residential biomass burning that can be used as a reference for future research.
Vicente ED
，Alves CA
，Martins V
，Almeida SM
，Lazaridis M
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ResearchGate
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