title: Secondhand tobacco smoke exposure is associated with increased risk of failed implantation and reduced IVF success.
abstract: BACKGROUND
  Infertility and early pregnancy loss are prevalent as is exposure to secondhand tobacco smoke (STS). Previous research has suggested a relationship between STS exposure and early pregnancy loss, but studies have been limited by small study sizes and/or imprecise methods for exposure estimation. IVF allows for the collection of follicular fluid (FF), the fluid surrounding the pre-ovulatory oocyte, which may be a more biologically relevant sample media than urine or serum in studies of early reproduction.
  
  
  METHODS
  In a retrospective analysis of a prospective cohort study, we measured cotinine in FF collected during 3270 IVF treatment cycles from 1909 non-smoking women between 1994 and 2003 to examine the relationship between STS exposure and implantation failure.
  
  
  RESULTS
  In adjusted models, we found a significant increase in the risk of implantation failure among women exposed to STS compared with those unexposed [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 1.20-1.92; risk ratio (RR) = 1.17; 95% CI = 1.10-1.25]. We also found a significant decrease in the odds for a live birth among STS-exposed women (OR = 0.75; 95% CI = 0.57-0.99; RR = 0.81; 95% CI = 0.66-0.99).
  
  
  CONCLUSIONS
  Female STS exposure, estimated through the measurement of cotinine in FF, is associated with an increased risk of implantation failure and reduced odds of a live birth.
authors.affiliation: Department of Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Merle D
authors.initials: MD
authors.lastname: Benedict
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.forename: Anjel
authors.initials: A
authors.lastname: Vahratian
authors.forename: Katharine F
authors.initials: KF
authors.lastname: Berry
authors.forename: Allison F
authors.initials: AF
authors.lastname: Vitonis
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Cramer
authors.forename: John D
authors.initials: JD
authors.lastname: Meeker
mesh_terms: D000328:Adult; D001723:Birth Rate; D003367:Cotinine / Q000032:analysis; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D015571:Follicular Fluid / Q000737:chemistry; D006801:Humans; D007246:Infertility / Q000628:therapy; D018811:Maternal Exposure; D009865:Oocytes / Q000187:drug effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014028:Tobacco Smoke Pollution; D016896:Treatment Outcome
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine