College of Environment and Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi, 030006, China; Department of Reproductive Medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, 030012, China.
Shanxi Academy for Environmental Planning, Taiyuan, Shanxi, 030002, China.
Environ Pollut. 2021 Jun 1;278:116868. doi: 10.1016/j.envpol.2021.116868. Epub 2021 Mar 3.
Air pollution has been an important risk factor for female reproductive health. However, epidemiological evidence of ambient air pollution on the predictor for ovarian reserve (antral follicle count, AFC) is deficient. We aim to comprehensively evaluate the association of long-term exposure to ambient air pollution with AFC among women of reproductive age in Shanxi of north China. 600 women with spontaneous menstrual cycle, not using controlled ovarian stimulation, were enrolled in the retrospective study. Two distinct periods of antral follicle development were designed as exposure windows. Generalized linear model was employed to estimate the change of AFC associated with exposure of atmospheric pollutants (SO, NO, PM, PM, CO and O). Stratification analysis based on age (<30, ≥30 years), university degree (yes, no), years of exposure (2013-2016, 2017-2019) and duration of infertility (<2, 2-5, >5 years) along with two pollutants model were employed to further illustrate the association. We found every 10 μg/m increase in SO concentration level during the entire development stage of antral follicle was associated with a -0.01 change in AFC (95% confidence interval: -0.016, -0.002) adjusting for the confounders including age, BMI, parity and infertility diagnosis factors. The significant association of increased SO level with decreased AFC was particularly observed during the early transition from primary follicle to preantral follicle stage by 10 μg/m increase in SO exposure level with a -0.01 change (95% CI: -0.015, -0.002) in AFC. The negative association was pronounced among women aged ≥30 years old, and also significant in two pollutants model after adjusting the confounders. No significant associations between other air pollutants and AFC were observed. Our finding suggests that long-term exposure to air pollutant SO is associated with lower AFC, raising our concern that atmospheric SO exposure may have potential adverse impact on women ovarian reserve.
空气污染一直是女性生殖健康的一个重要危险因素。然而，流行病学证据表明，环境空气污染对卵巢储备（窦卵泡计数，AFC）的预测因素不足。我们旨在全面评估中国北方山西省育龄妇女长期暴露于环境空气污染与 AFC 之间的关系。
这项回顾性研究纳入了 600 名月经周期自发、未使用控制性卵巢刺激的女性。设计了两个不同的窦卵泡发育阶段作为暴露窗口。采用广义线性模型估计与大气污染物（SO、NO、PM、PM、CO 和 O）暴露相关的 AFC 变化。根据年龄（<30、≥30 岁）、大学学历（是、否）、暴露年限（2013-2016 年、2017-2019 年）和不孕年限（<2、2-5、>5 年）以及两个污染物模型进行分层分析，进一步说明相关性。
我们发现，在窦卵泡整个发育阶段，SO 浓度每增加 10μg/m，AFC 就会发生-0.01 的变化（95%置信区间：-0.016，-0.002），调整了包括年龄、BMI、产次和不孕诊断因素在内的混杂因素。SO 水平升高与 AFC 降低之间的显著相关性，特别是在初级卵泡向窦前卵泡阶段的早期转变过程中，SO 暴露水平每增加 10μg/m，AFC 就会发生-0.01 的变化（95%置信区间：-0.015，-0.002）。在年龄≥30 岁的女性中，这种负相关更为明显，在调整混杂因素后的两个污染物模型中也具有统计学意义。
其他空气污染物与 AFC 之间没有显著相关性。我们的研究结果表明，长期暴露于空气污染物 SO 与 AFC 降低有关，这表明大气 SO 暴露可能对女性卵巢储备产生潜在的不利影响。
