Abstract
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 (NO(x) ), nitrogen dioxide (NO(2) ), carbon monoxide (CO), ozone (O(3) ), particulate matter <2.5 µm (PM(2.5) ) and <10 µm (PM(10) ), and sulphur dioxide (SO(2) ) 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 PM(2.5) and PM(10) were associated with small reductions in fecundability. For example, the FRs for a one interquartile range (IQR) increase in PM(2.5) (IQR = 3.2 µg/m(3) ) and PM(10) (IQR = 5.3 µg/m(3) ) 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 PM(2.5) and PM(10) were associated with reduced fecundability.