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Table 2 Overall meta-analytical summary estimates of associations between exposure to ambient air pollution and pregnancy outcome in women treated with assisted reproductive technologies

From: Association between ambient air pollution exposure and pregnancy outcomes in women treated with assisted reproductive technology: an updated systematic review and meta-analysis

Air pollutant

Exposure period

No. of studies included

RR (95% CI)

I2 (%)

Tau2

P-value for Cochran鈥檚 Q test

P-value for egger鈥檚 test

Clinical pregnancy

CO

Any period of assisted reproductive process

16

0.956 (0.921, 0.993)

73

0.0045

0

0.0537

Ovarian stimulation to oocyte retrieval

5

0.949 (0.900, 0.999)

73

0.0024

0.005

0.1795

Oocyte retrieval to embryo transfer

6

0.981 (0.937, 1.026)

39

0.0022

0.143

0.6776

Embryo transfer to hCG test

5

0.932 (0.847, 1.025)

86

0.0099

0

0.3386

NO2

Any period of assisted reproductive process

17

0.983 (0.971, 0.995)

60

0.0004

0.001

0.9549

Ovarian stimulation to oocyte retrieval

5

0.976 (0.961, 0.992)

10

0.0002

0.347

0.803

Oocyte retrieval to embryo transfer

7

0.992 (0.976, 1.008)

47

0.0003

0.077

0.5619

Embryo transfer to hCG test

5

0.976 (0.948, 1.005)

76

0.0009

0.002

0.9728

O3

Any period of assisted reproductive process

20

1.002 (0.995, 1.008)

78

0.0002

0

0.9692

Ovarian stimulation to oocyte retrieval

6

1.001 (0.988, 1.014)

80

0.0002

0

0.9954

Oocyte retrieval to embryo transfer

8

1.000 (0.991, 1.009)

78

0.0001

0

0.8468

Embryo transfer to hCG test

6

1.004 (0.990, 1.019)

81

0.0003

0

0.8122

PM10

Any period of assisted reproductive process

17

0.997 (0.993, 1.002)

60

0.0001

0.001

0.0643

Ovarian stimulation to oocyte retrieval

5

0.997 (0.992, 1.001)

40

0.0000

0.158

0.3606

Oocyte retrieval to embryo transfer

6

1.000 (0.994, 1.005)

34

0.0000

0.185

0.3812

Embryo transfer to hCG test

6

0.996 (0.985, 1.007)

77

0.0002

0.001

0.3272

PM2.5

Any period of assisted reproductive process

20

0.996 (0.990, 1.001)

59

0.0001

0

0.1167

Ovarian stimulation to oocyte retrieval

6

0.994 (0.984, 1.004)

65

0.0000

0.014

0.2295

Oocyte retrieval to embryo transfer

8

0.997 (0.990, 1.005)

5

0.0001

0.391

0.5427

Embryo transfer to hCG test

6

0.996 (0.983, 1.008)

80

0.0001

0.01

0.5350

SO2

Any period of assisted reproductive process

17

0.982 (0.966, 0.999)

74

0.0009

0

0.0095

Ovarian stimulation to oocyte retrieval

5

0.986 (0.967, 1.006)

66

0.0003

0.018

0.1794

Oocyte retrieval to embryo transfer

6

0.982 (0.958, 1.006)

77

0.0006

0.001

0.1557

Embryo transfer to hCG test

6

0.978 (0.938, 1.020)

82

0.0023

0

0.2698

Biochemical pregnancy

CO

Any period of assisted reproductive process

9

0.990 (0.965, 1.015)

0

0.0010

0.499

0.4997

Ovarian stimulation to oocyte retrieval

3

0.985 (0.975, 0.996)

0

0.0000

0.922

0.1275

Oocyte retrieval to embryo transfer

3

1.005 (0.941, 1.073)

47

0.0026

0.152

0.6783

Embryo transfer to hCG test

3

0.990 (0.939, 1.044)

0

0.0015

0.453

0.148

NO2

Any period of assisted reproductive process

9

0.993 (0.973, 1.013)

62

0.0008

0.006

0.3015

Ovarian stimulation to oocyte retrieval

3

0.978 (0.961, 0.996)

27

0.0001

0.254

0.9368

Oocyte retrieval to embryo transfer

3

0.996 (0.962, 1.031)

73

0.0008

0.025

0.7242

Embryo transfer to hCG test

3

1.007 (0.955, 1.062)

77

0.0019

0.013

0.5097

O3

Any period of assisted reproductive process

9

0.999 (0.993, 1.005)

52

0.0001

0.035

0.0575

Ovarian stimulation to oocyte retrieval

3

0.998 (0.989, 1.007)

74

0.0000

0.022

0.7135

Oocyte retrieval to embryo transfer

3

1.002 (0.986, 1.018)

69

0.0001

0.04

0.3658

Embryo transfer to hCG test

3

0.998 (0.989, 1.008)

16

0.0000

0.303

0.3204

PM10

Any period of assisted reproductive process

10

1.003 (0.993, 1.014)

64

0.0002

0.003

0.5741

Ovarian stimulation to oocyte retrieval

4

1.000 (0.995, 1.006)

68

0.0000

0.026

0.9922

Oocyte retrieval to embryo transfer

3

1.003 (0.990, 1.017)

63

0.0001

0.065

0.8619

Embryo transfer to hCG test

3

1.013 (0.976, 1.052)

80

0.0010

0.008

0.6579

PM2.5

Any period of assisted reproductive process

9

1.022 (0.985, 1.061)

62

0.0027

0.01

0.1386

Ovarian stimulation to oocyte retrieval

3

1.018 (0.951, 1.090)

67

0.0029

0.05

0.7804

Oocyte retrieval to embryo transfer

3

1.017 (0.964, 1.073)

56

0.0018

0.10

0.4880

Embryo transfer to hCG test

3

1.038 (0.945, 1.141)

79

0.0061

0.01

0.6289

SO2

Any period of assisted reproductive process

9

0.994 (0.970, 1.019)

73

0.0010

0

0.5796

Ovarian stimulation to oocyte retrieval

3

0.990 (0.972, 1.008)

78

0.0001

0.01

0.6974

Oocyte retrieval to embryo transfer

3

1.011 (0.933, 1.096)

84

0.0039

0.002

0.9537

Embryo transfer to hCG test

3

0.995 (0.962, 1.030)

72

0.0006

0.027

0.9106

Live birth

CO

Any period of assisted reproductive process

4

0.975 (0.963, 0.988)

36

0.0001

0.195

0.4044

Ovarian stimulation to oocyte retrieval

2

0.981 (0.955, 1.008)

0

0.0002

0.380

NA

Oocyte retrieval to embryo transfer

1

0.975 (0.961, 0.989)

NA

NA

NA

NA

Embryo transfer to hCG test

1

0.966 (0.950, 0.981)

NA

NA

NA

NA

NO2

Any period of assisted reproductive process

7

0.954 (0.916, 0.995)

80

0.0027

0

0.0016

Ovarian stimulation to oocyte retrieval

2

0.940 (0.854, 1.035)

88

0.2243

0.001

NA

Oocyte retrieval to embryo transfer

3

0.977 (0.939, 1.017)

68

0.0010

0.045

0.3445

Embryo transfer to hCG test

2

0.928 (0.818, 1.053)

92

0.0077

0.001

NA

O3

Any period of assisted reproductive process

10

1.008 (0.995, 1.021)

77

0.0004

0

0.5813

Ovarian stimulation to oocyte retrieval

3

1.015 (0.978, 1.054)

89

0.0010

0

0.7811

Oocyte retrieval to embryo transfer

4

1.000 (0.993, 1.007)

54

0.0000

0.09

0.6478

Embryo transfer to hCG test

3

1.015 (0.984, 1.047)

84

0.0007

0.002

0.6927

PM10

Any period of assisted reproductive process

9

1.002 (0.989, 1.014)

33

0.0003

0.151

0.1169

听

Ovarian stimulation to oocyte retrieval

3

1.011 (0.973, 1.050)

68

0.0009

0.044

0.0654

听

Oocyte retrieval to embryo transfer

3

0.998 (0.990, 1.006)

21

0.0000

0.282

0.5657

听

Embryo transfer to hCG test

3

1.003 (0.985, 1.020)

0

0.0002

0.443

0.451

PM2.5

Any period of assisted reproductive process

14

0.997 (0.989, 1.005)

0

0.0001

0.780

0.3199

Ovarian stimulation to oocyte retrieval

5

0.999 (0.990, 1.009)

0

0.0000

0.880

0.8255

Oocyte retrieval to embryo transfer

5

0.994 (0.980, 1.008)

0

0.0001

0.563

0.0575

Embryo transfer to hCG test

4

0.998 (0.981, 1.014)

0

0.0001

0.500

0.1875

SO2

Any period of assisted reproductive process

7

0.998 (0.989, 1.006)

28

0.0001

0.216

0.0193

Ovarian stimulation to oocyte retrieval

2

1.001 (0.994, 1.007)

0

0.0001

0.910

NA

Oocyte retrieval to embryo transfer

3

0.992 (0.971, 1.014)

68

0.0003

0.044

0.2962

Embryo transfer to hCG test

2

0.998 (0.988, 1.008)

48

0.0001

0.170

NA

  1. Summary effect estimates are in bold when the 95% CI do not include 1. For the meta-analysis on any period of assisted reproductive process, we did not extract the data corresponding to the specific period from ovarian stimulation to hCG test to avoid the repeated effect estimates entrance
  2. Abbreviations: CO Carbon monoxide, NO2 Nitrogen dioxide, O3 Ozone, PM2.5 Fine particulate matter, PM10 Inhalable particulate matter, SO2 Sulfur dioxide, NA Not applicable, hCG Human chorionic gonadotropin, RR Relative risk
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