Environmental determinants of IVF treatment

Lay summary

Air pollution and other environmental characteristics are negatively linked with reproductive outcomes. The period around the time of conception is critical for successful and healthy pregnancy but very few studies have examined how environmental exposures affect conception. This project is a pilot study that aims to 1) establish connections and linkages between existing assisted reproduction data and environmental exposure data and 2) to use this linked data to examine whether exposure to ambient outdoor air pollution and UV radiation is linked to the outcomes of fertility treatment in the UK. The project uses data about fertility treatment of Scottish fertility patients between 1991 and 2018 from the UK Human Fertilisation and Embryology Authority (HFEA) register and has linked these data records to NHS data about pregnancy and pregnancy outcomes as well as local neighbourhood environmental measures. These environmental measures include air quality data (from a combination of meteorological models and air quality monitors across Scotland) as well as UV sun radiation data (obtained from satellites). It examines firstly whether exposure to ambient outdoor air pollution, including particulate matter and nitrogen dioxide, is linked with an increased risk of unsuccessful fertility treatment and secondly whether exposure to greater levels of UV might offer protective effects against unsuccessful fertility treatment outcomes. The project will contribute to an improved understanding of the potential wider environmental determinants of fertility treatment success. It will provide important evidence for policymakers linking these exposures to fertility treatment and will provide support for policy changes that tackle, for example, poor urban air quality. Identifying and improving these wider environmental determinants of fertility success may help to reduce rates of unsuccessful treatment. Even small improvements across the population is likely to result in considerable cost savings for the NHS as well as reducing the burden, stress and anxiety of repeated fertility treatment cycles for many individuals.

Public benefit statement

The main aim of this project is to examine whether exposure to environmental characteristics is associated with outcomes of IVF fertility treatment. At the completion, the project will have produced the following outcomes. (1) Establishment of feasibility and approach for linking environmental exposures to the HFEA register as well as wider linkage to NHS data in Scotland and (2) preparation of 3 academic publications and a conference presentation. Furthermore, the study envisages that the implications of the research findings will translate into public and patient benefit. Both the condition and treatment of infertility can be traumatic with links to negative health outcomes including psychological distress, depression and anxiety as well as relationship breakdown and financial difficulties associated with paying for IVF treatment. Improving treatment success rates (and therefore reducing the number of cycles) through greater understanding of potentially modifiable environmental risk factors may help to reduce these burdens.

Data linkages

• Scottish Community Health Index, National Records of Scotland Birth registrations, NHS Outpatient attendance, General/acute inpatient and day case, NHS maternity inpatient and day case, mental health inpatient and day case
• Scottish Index of Multiple Deprivation
• Air pollution data (Department for Environment Food and Rural Affairs)
• Meteorological data (Met Office Integrated Data Archive System)
• Ultraviolet radiation data (Japan Aerospace Exploration Agency)