Environmental Factors Affecting Female Infertility

Fujimoto, Victor Y.; Giudice, Linda C.

doi:10.1007/978-1-60327-392-3_1

Cited by 1 publication

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“…While delayed childbearing, genetics, obesity, sexually transmitted infections and lifestyle factors play important roles in infertility ( Homan et al , 2007 ), widespread and ongoing exposures to environmental contaminants, including toxic metals and metalloids, may also be important ( Kumar, 2004 ; Al-Gubory, 2014). Women are exposed to arsenic (As), a metalloid, and the toxic heavy metals mercury (Hg), cadmium (Cd) and lead (Pb) through diet ( Fujimoto et al , 2009 ; Kim et al , 2013 ; Nachman et al , 2013 ; Butts et al , 2020 ) and tobacco smoke ( Satarug et al , 2003 ). Although the results have been inconsistent, exposure to As, Hg, Cd and Pb has been associated with diminished fecundity in couples conceiving with ( Choy et al , 2002 ; Chang et al , 2006 ; Silberstein et al , 2006 ; Al-Saleh et al , 2008 ; Bloom et al , 2010 , 2011 , 2012a,b; Dickerson et al , 2011 ; El Mohr et al , 2020 ; Wu et al , 2020 ) and without ( Cole et al , 2006 ; Louis et al , 2012 ) assistance.…”

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confidence: 99%

Toxic elements in follicular fluid adversely influence the likelihood of pregnancy and live birth in women undergoing IVF

Butts

Bloom

McGough

et al. 2021

Human Reproduction Open

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STUDY QUESTION Are follicular fluid (FF), arsenic (As), mercury (Hg), cadmium (Cd) and lead (Pb) concentrations associated with IVF outcomes among women undergoing IVF? SUMMARY ANSWER There was a non-linear association between higher FF Hg concentration and a lower likelihood of biochemical pregnancy and live birth. Higher FF Pb concentration was also associated with a lower probability of live birth. WHAT IS KNOWN ALREADY Previous research suggests that toxic elements may affect fertility among couples conceiving with and without assistance. However, the results have been inconsistent, possibly related in part to exposure misclassification. Very few studies have used ovarian FF to measure toxic elements, as it requires an invasive collection procedure, yet it may offer a more accurate estimate of a biologically effective dose than blood or urine. STUDY DESIGN, SIZE, DURATION This is a prospective study of 56 women undergoing IVF, from October 2015 to June 2017. FF was collected for analysis on the day of oocyte retrieval. PARTICIPANTS/MATERIALS, SETTING, METHODS As, Cd, Hg and Pb were determined in 197 FF specimens, using inductively coupled plasma tandem mass spectrometry. FF glutathione peroxidase, glutathione reductase, total glutathione-S-transferase, superoxide dismutase, arylesterase and paraoxonase (PON1p) activities were measured using kinetic enzyme assays. MAIN RESULTS AND THE ROLE OF CHANCE Non-linear associations were detected, in which the probabilities of biochemical pregnancy (P = 0.05) and live birth (P = 0.05) were lower in association with FF Hg greater than ∼0.51 µg/l Hg, adjusted for age, race, cigarette smoking and recent seafood consumption. Higher FF Pb was also associated with a lower likelihood of live birth (relative risk (RR) = 0.68, 95% CI: 0.46, 1.00; P = 0.05). We also found a suggestive, although imprecise, antagonizing mediating effect of PON1p activity on the association between FF Pb and live birth (−28.3%; 95% CI: −358%, 270%). LIMITATIONS, REASONS FOR CAUTION The results should be interpreted judiciously given the limited sample size and difficulty accounting for correlated data in generalized additive models and mediation analyses. Additionally, women undergoing IVF are highly selected with respect to age and socioeconomic status, and so the generalizability of the results may be limited. WIDER IMPLICATIONS OF THE FINDINGS Overall, the results suggest that FF Hg was associated with a lower likelihood of biochemical pregnancy and live birth, with a potential threshold effect, and that higher FF Pb was associated with a lower probability of live birth. These results may help to guide clinical recommendations for limiting the exposure of patients to Hg and Pb and ultimately improve IVF success rates. STUDY FUNDING/COMPETING INTEREST(S) This work was funded in part by the National Institute of Environmental Health Sciences (NIEHS), grant number 1R56ES023886-01, to the University at Albany (M.S.B.), and in part by the National Institute of Environmental Health Sciences (NIEHS), grant number 1U2CES026542-01, to the Wadsworth Center (P.J.P.). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A

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