The effect of short term exposure to outdoor air pollution on fertility

Reprod Biol Endocrinol. 2021 Oct 6;19(1):151. doi: 10.1186/s12958-021-00838-6.


Background: There is evidence to suggest that long term exposure to air pollution could be associated with decreased levels of fertility, although there is controversy as to how short term exposure may compromise fertility in IVF patients and what windows of exposure during the IVF process patients could be most vulnerable.

Methods: This prospective cohort study aimed to evaluate the impact of acute exposure that air pollution have on reproductive outcomes in different moments of the IVF process. Women undergoing IVF living in Barcelona were recruited. Individual air pollution exposures were modelled at their home address 15 and 3 days before embryo transfer (15D and 3D, respectively), the same day of transfer (D0), and 7 days after (D7). The pollutants modelled were: PM2.5 [particulate matter (PM) ≤2.5 μm], PMcoarse (PM between 2.5 and 10μm), PM10 (PM≤10 μm), PM2.5 abs, and NO2 and NOx. Outcomes were analyzed using multi-level regression models, with adjustment for co-pollutants and confouding factors. Two sensitivity analyses were performed. First, the model was adjusted for subacute exposure (received 15 days before ET). The second analysis was based on the first transfer performed on each patient aiming to exclude patients who failed previous transfers.

Results: One hundred ninety-four women were recruited, contributing with data for 486 embryo transfers. Acute and subacute exposure to PMs showed a tendency in increasing miscarriage rate and reducing clinical pregnancy rate, although results were not statistically significant. The first sensitivity analysis, showed a significant risk of miscarriage for PM2.5 exposure on 3D after adjusting for subacute exposure, and an increased risk of achieving no pregnancy for PM2.5, PMcoarse and PM10 on 3D. The second sensitivity analysis showed a significant risk of miscarriage for PM2.5 exposure on 3D, and a significant risk of achieving no pregnancy for PM2.5, PMcoarse and PM10 particularly on 3D. No association was observed for nitrogen dioxides on reproductive outcomes.

Conclusions: Exposure to particulate matter has a negative impact on reproductive outcomes in IVF patients. Subacute exposure seems to increase the harmful effect of the acute exposure on miscarriage and pregnancy rates. Nitrogen dioxides do not modify significantly the reproductive success.

Keywords: Acute exposure; Fertility; Miscarriage; NO2; Nitrogen dioxide; PM10; PM2.5; Particulate matter; Pregnancy.

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Abortion, Spontaneous / etiology
  • Adult
  • Air Pollutants / adverse effects
  • Air Pollution / adverse effects*
  • Cohort Studies
  • Environmental Exposure / adverse effects
  • Female
  • Fertility / drug effects*
  • Fertilization in Vitro / statistics & numerical data
  • Humans
  • Infant, Newborn
  • Infertility, Female / epidemiology
  • Infertility, Female / etiology
  • Infertility, Female / therapy
  • Male
  • Particulate Matter / adverse effects
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Risk Factors
  • Spain / epidemiology
  • Time Factors
  • Treatment Outcome


  • Air Pollutants
  • Particulate Matter