Air pollution and fecundability: Results from a Danish preconception cohort study

Paediatr Perinat Epidemiol. 2022 Jan;36(1):57-67. doi: 10.1111/ppe.12832. Epub 2021 Dec 10.


Background: Animal and epidemiologic studies indicate that air pollution may adversely affect fertility. Epidemiologic studies have been restricted largely to couples undergoing fertility treatment or have retrospectively ascertained time-to-pregnancy among pregnant women.

Objectives: We examined the association between residential ambient air pollution and fecundability, the per-cycle probability of conception, in a large preconception cohort of Danish pregnancy planners.

Methods: During 2007-2018, we used the Internet to recruit and follow women who were trying to conceive without the use of fertility treatment. Participants completed an online baseline questionnaire eliciting socio-demographic characteristics, lifestyle factors, and medical and reproductive histories and follow-up questionnaires every 8 weeks to ascertain pregnancy status. We determined concentrations of ambient nitrogen oxides (NOx ), nitrogen dioxide (NO2 ), carbon monoxide (CO), ozone (O3 ), particulate matter <2.5 µm (PM2.5 ) and <10 µm (PM10 ), and sulphur dioxide (SO2 ) at each participant's residential address. We calculated average exposure during the year before baseline, during each menstrual cycle over follow-up and during the entire pregnancy attempt time. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for potential confounders and co-pollutants. The analysis was restricted to the 10,183 participants who were trying to conceive for <12 cycles at study entry whose addresses could be geocoded.

Results: During 12 months of follow-up, 73% of participants conceived. Higher concentrations of PM2.5 and PM10 were associated with small reductions in fecundability. For example, the FRs for a one interquartile range (IQR) increase in PM2.5 (IQR = 3.2 µg/m3 ) and PM10 (IQR = 5.3 µg/m3 ) during each menstrual cycle were 0.93 (95% CI: 0.87, 0.99) and 0.91 (95% CI: 0.84, 0.99), respectively. Other air pollutants were not appreciably associated with fecundability.

Conclusions: In this preconception cohort study of Danish women, residential exposures to PM2.5 and PM10 were associated with reduced fecundability.

Keywords: air pollution; fecundability; particulate matter; preconception cohort; time-to-pregnancy; traffic.

MeSH terms

  • Air Pollutants* / toxicity
  • Air Pollution* / analysis
  • Air Pollution* / statistics & numerical data
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Humans
  • Particulate Matter / toxicity
  • Pregnancy
  • Prospective Studies
  • Retrospective Studies
  • Time-to-Pregnancy


  • Air Pollutants
  • Particulate Matter