The influences of weather on patients with different ovarian responses in the treatment of assisted reproductive technology

Independent and joint effects of air quality index and the average ambient temperature on in vitro fertilization pregnancy outcomes in Zhengzhou, China

OBJECTIVES

This study aimed to estimate the independent and joint effects of the air quality index (AQI) and the average temperature on IVF pregnancy outcomes.

METHODS

We retrospectively analyzed 15,326 first fresh cycles garnered from January 2015 to December 2021 at the First Affiliated Hospital of Zhengzhou University. Daily average levels of AQI and air temperature were obtained from fixed monitoring stations near patients' residences. They were divided into six different exposure periods according to the clinical timeline of IVF treatment. Logistic regression analysis and the interaction calculation table were used to assess independent and joint effects.

RESULTS

The effects of AQI and the average temperature on clinical pregnancy were not statistically significant across age groups and window periods. However, AQI and the average temperature significantly impacted live births. We only found a significant interaction effect of AQI and the average temperature on live births, more vital in periods after embryo transfer (ET) compared to the various pre-ET windows. The independent and joint associations were more pronounced in those < 35 years of age.

CONCLUSIONS

AQI and the average temperature did not affect clinical pregnancy but were negatively correlated with the probability of live birth. There was an interaction effect between the AQI and average temperature on live birth, significantly reducing the odds of live birth, especially after ET. These correlations were more pronounced in the < 35-year-old population than ≥ 35-year-old.

Association between ambient temperature exposure and pregnancy outcomes in patients undergoing in vitro fertilization in Shanghai, China: a retrospective cohort study

STUDY QUESTION

Does ambient temperature exposure affect outcomes including clinical pregnancy and live birth in women undergoing IVF?

SUMMARY ANSWER

Both extreme cold and hot ambient temperatures were significantly associated with adverse pregnancy outcomes of IVF cycles.

WHAT IS KNOWN ALREADY

Heat exposure has been linked to adverse pregnancy outcomes worldwide. However, the effect of ambient temperature on infertile women undergoing IVF treatment is unclear.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study was conducted from a database of 3452 infertile women who underwent their first fresh or frozen embryo transfer in the Shanghai First Maternity and Infant Hospital from April 2016 to December 2020.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Daily mean ambient temperature exposure for each patient was obtained based on their residential address. Temperature-stratified multiple logistic regression analysis was performed to investigate associations between temperature exposure and pregnancy outcomes after controlling for confounders. Vulnerable sub-groups were identified using forest plots.

MAIN RESULTS AND THE ROLE OF CHANCE

The clinical pregnancy rate and live birth rate were 45.7% and 37.1%, respectively. Regarding clinical pregnancy, a higher temperature during cold weather was significantly associated with a higher pregnancy rate in the period about 11 weeks before ovarian stimulation (adjusted odds ratio (aOR) = 1.102, 95% CI: 1.012-1.201). Regarding live birth, an increased temperature during cold weather was significantly related to a higher live birth rate in the period after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs of 6.299 (95% CI: 3.949-10.047) or 10.486 (95% CI: 5.609-19.620), respectively. However, a higher temperature during hot weather was negatively associated with the live birth rate in the periods after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs at 0.186 (95% CI: 0.121-0.285) or 0.302 (95% CI: 0.224-0.406), respectively. Moreover, the decline in live birth rates during cold and hot weather was accompanied by increased rates of early miscarriage (P < 0.05). Stratified analyses identified susceptibility characteristics among the participants.

LIMITATIONS, REASONS FOR CAUTION

Climate monitoring data were used to represent individual temperature exposure levels according to the patient's residential address in the study. We were not able to obtain information of personal outdoor activity and use of indoor air conditioners in this retrospective study, which may affect actual temperature exposure.

WIDER IMPLICATIONS OF THE FINDINGS

This study highlights that the ambient temperature exposure should be taken into account during IVF treatment and afterwards. There is a need to be alert to extremes in cold and hot ambient temperatures, especially during the period of follicle development and pregnancy. With this knowledge, clinicians can scientifically determine the timing of IVF treatment and reinforce patients' awareness of self-protection to minimize adverse pregnancy outcomes associated with extreme temperatures.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a grant from the Clinical Research Plan of Shanghai Hospital Development Center [SHDC2020CR4080], a grant from the Science and Technology Commission of Shanghai Municipality [19411960500], and two grants from the National Natural Science Foundation of China [81871213, 81671468]. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva, and research grants from Merck KGaA, Ferring and Guerbet. The other authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Influence of climatic conditions in the mesothermal climate area on pregnancies following elective fresh single blastocyst transfer

PURPOSE

To investigate the effect of climatic parameters in the mesothermal climate area on clinical pregnancy and live birth following fresh single blastocyst transfer.

METHODS

This study investigated clinical pregnancies and live births that resulted from 555 ovarian stimulation cycles followed by fresh single blastocyst transfer. The samples were stratified according to climatic conditions (low T, temperature < 12.9 °C; middle T, 12.9 °C ≤ temperature < 22.6 °C; high T, temperature ≥ 22.6 °C; low H, relative humidity < 62.1%; middle H, 62.1% ≤ relative humidity < 66.5%; high H, relative humidity ≥ 66.5%; short S, sunlight duration < 5.2 h; middle S, 5.2 h ≤ sunlight duration < 6.7 h; long S, sunlight duration ≥ 6.7 h). Clinical pregnancy and live birth rates among three groups from each climatic parameter were compared. Multivariable analyses were performed to investigate the effects of climatic conditions on blastocyst development, endometrial thickness, clinical pregnancy, and live birth.

RESULTS

A statistically significant difference was found in pregnancy rates among low T (48.8%), middle T (37.3%), and high T (36.6%) groups. Multivariable analyses revealed that temperature was associated with clinical pregnancy and live birth rates with adjustment for patient age, BMI, type of ovarian stimulation, endometrial thickness, and expansion grade of the transferred blastocyst. The association between climatic parameters and blastocyst development and endometrial thickness was not confirmed.

CONCLUSIONS

This study suggests that lower temperatures in the mesothermal climate area could favorably affect the rates of clinical pregnancy and live birth achieved by fresh single blastocyst transfer.

The effects of daily meteorological perturbation on pregnancy outcome: follow-up of a cohort of young women undergoing IVF treatment

BACKGROUND

Human reproduction follows a seasonal pattern with respect to spontaneous conception, a phenomenon wherein the effect of meteorological fluctuations might not be unique. However, the effect of seasonal variations on patients who underwent in vitro fertilization (IVF) treatment is unclear. We aimed to evaluate the effects of meteorological variation on the pregnancy rate in a cohort undergoing IVF treatment by performing multivariable analyses.

METHODS

We conducted a cohort study in a sub-tropical region with prominent seasonal variations (2005-2016). Women aged < 35 years who were treated with a long ovarian stimulation protocol and underwent fresh embryo transfer (ER) were included. Data on gonadotropin administration (CYCL), oocyte retrieval (OR), ER, and pregnancy outcomes were prospectively recorded. For each patient, the daily average of meteorological data (temperature, humidity, sunlight duration, solar radiation) was recorded from the date of CYCL to ER. Multiple logistic regression analysis adjusted for age, fertilization method, year of the cycle, gonadotropin dose, and transferred embryo grade was performed to determine the relationship between the meteorological parameters and clinical pregnancy. Patients with one successful cycle and one failed cycle were subtracted for a case-control subgroup analysis through mixed effect logistics regressions. Time-series analysis of data in the epidemic level was conducted using the distributed lag linear and non-linear models (DLNMs).

RESULTS

There were 1029 fresh cycles in 860 women (mean age 31.9 ± 2.0 years). Higher mean temperature from CYCL to OR (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.01-1.07, P = 0.01) increased the odds of pregnancy, while OR to ER did not show any statistical significance. Compared to that in winter, the odds of becoming pregnant were higher during higher temperature seasons, summer and autumn (aOR 1.47, 95%CI 0.97-2.23, P = 0.07 (marginally significant) and aOR 1.73, 95%CI 1.12-2.68, P = 0.02, respectively). Humidity, sunlight duration, and solar radiation had no effect on the outcome. The subgroup analysis confirmed this finding. The time-series analysis revealed a positive association between temperature and relative risk for pregnancy.

CONCLUSIONS

In IVF treatment, the ambient temperature variation alters the pregnancy rates; this aspect must be considered when obtaining patient consent for assisted conception.

Culture systems: physiological and environmental factors that can affect the outcome of human ART

Many aspects of the embryo culture environment have been shown to affect embryo development and the subsequent outcomes of human ART. It is now becoming increasingly evident that embryo and later development can be affected by events and conditions that occur before, perhaps long before, the oocytes and sperm are collected and brought together in the ART laboratory. These include diet and metabolic disorders, general health and disease, physical and psychological stress, exposure to environmental estrogens and other toxins, pharmaceuticals, alcohol, smoking, and drug abuse. This paper discusses the known and potential effects of season of the year (or temperature) and environmental air pollution on the outcomes of human ART. It may be useful to advise ART patients to avoid high environmental temperature and air pollution. In addition, it is important for clinical embryologists to recognize that adverse outcomes may result from such exposures, and to incorporate this into the analysis of clinic data for the purposes of quality management.

Expression of inhibin-activin subunits, follistatin and smads in granulosa-luteal cells collected at oocyte retrieval

PURPOSE

To examine the expression of inhibin-activin subunits, follistatin, and Smads 2, 3 and 4 in granulosa-luteal cells at the time of oocyte retrieval.

METHODS

Quantitative reverse transcriptase-polymerase chain reaction was performed to quantify the mRNA expression of the investigated genes: inhibin alpha-subunit, inhibin-activin betaA- and betaB-subunits, follistatin, and Smads 2, 3 and 4.

RESULTS

alpha-, betaA- and betaB-subunits of inhibin-activin, and follistatin were all well expressed in granulosa-luteal cells obtained from either dominant or cohort follicles. alpha-subunits strongly correlated with Smad2 (p < 0.001). betaA-subunit significantly correlated with Smad4, p < 0.001. betaB-subunit significantly correlated with Smad2, p = 0.002, and follistatin expression strongly correlated with the expression of Smads 2 and 4 (p < 0.001 and = 0.007 respectively).

CONCLUSIONS

We found, for the first time that inhibin-activin betaB-subunit mRNA was well expressed in human granulosa-luteal cells obtained from either dominant or cohort follicles. alpha-, betaA- and betaB-subunits and follistatin correlated with Smads to varied degrees, suggesting the active roles of the above genes at the time of oocyte retrieval.