title: Heavy metal and trace element concentrations in blood and follicular fluid affect ART outcome.
abstract: OBJECTIVE
  To assess the effects of heavy metal and trace element concentrations in blood and follicular fluid on assisted reproductive technology cycle outcome.
  
  
  METHODS
  A prospective study was conducted between January 2012 and July 2012 in a university hospital infertility clinic. One hundred and one patients with unexplained infertility who underwent intracytoplasmic sperm injection using GnRH-antagonist protocol were recruited. Concentrations of four toxic metals (Cd, Pb, Hg, As) and three trace elements (Cu, Zn, Fe) were measured both in blood and follicular fluid specimens. Patients were evaluated in two groups; the study group consisted of patients with ongoing pregnancy (n=20) and the reference group consisted of patients experienced assisted reproductive technology failure, miscarriage or biochemical pregnancy (n=81).
  
  
  RESULTS
  Demographics and cycle parameters were comparable between the groups except for median number of day 3 Grade A embryos. Statistically significant negative correlations were found between blood Pb levels and number of MII oocytes, implantation, clinical pregnancy and ongoing pregnancy rates. Results of the log binomial regression revealed 2.2% lower risk for ongoing pregnancy for each 1μg/dL higher blood Pb concentration while holding the other variables in the model constant (RR 0.978; 95% CI 0.956-0.998; P=.041). Also, the results revealed 71.9% lower risk for ongoing pregnancy for each 1μg/dL higher follicular fluid Cu concentration while holding the other variables in the model constant (RR 0.288; 95% CI 0.085-0.92; P=.039).
  
  
  CONCLUSIONS
  Blood concentrations of Pb and follicular fluid concentrations of Cu seem to have significant impacts on assisted reproductive technology cycle outcome.
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Harun Egemen
authors.initials: HE
authors.lastname: Tolunay
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Yavuz Emre
authors.initials: YE
authors.lastname: Şükür
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Ozkavukcu
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Mehmet Murat
authors.initials: MM
authors.lastname: Seval
authors.affiliation: Ankara University School of Medicine, Department of Biostatistics, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Ateş
authors.affiliation: Ankara University School of Medicine, Department of Forensic Sciences, Turkey.
authors.forename: Vugar Ali
authors.initials: VA
authors.lastname: Türksoy
authors.affiliation: Ankara Liv Hospital, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Ecemiş
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Cem Somer
authors.initials: CS
authors.lastname: Atabekoğlu
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Batuhan
authors.initials: B
authors.lastname: Özmen
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Berker
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey. Electronic address: msonmezer@gmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Sönmezer
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood*; D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D015571:Follicular Fluid / Q000737:chemistry*; D006801:Humans; D019216:Metals, Heavy / Q000032:analysis* / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted; D020554:Sperm Injections, Intracytoplasmic; D014131:Trace Elements / Q000032:analysis* / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019216:Metals, Heavy; D014131:Trace Elements
keywords: Heavy metal; Intracytoplasmic sperm injection; Ongoing pregnancy; Trace element