Poor Ovarian Response (POR) significantly impairs the success of Assisted Reproductive Technologies (ART). The specific roles of oxidants and fine particulate matter (PM 2.5 ) on female fertility, especially those with POR, remains poorly understood. In this cohort study of 4920 women undergoing ART cycles, we investigated the associations between long-term pre-treatment exposure to oxidants, PM 2.5 , their constituents, and six key reproductive outcomes. Results revealed that elevated oxidants exposure increased risks of pregnancy failure (for each 10 μg/m³ increase in oxidants, odds ratios OR=1.238, 95%CI: 1.158, 1.325) and live birth failure (OR=1.330, 95%CI: 1.245, 1.420), with ozone identified as the primary contributor. Exposure to PM 2.5 was significantly linked to an increased risk of POR (for each 10 μg/m³ increase in PM 2.5 exposure, OR=1.249, 95%CI: 1.205, 1.299), with organic matter (OM) being the key constituent. Crucially, residential greenness exerted significant protective effect, associated with reduced risks, accounting for 7.44%-17.72% of the observed associations between pollutants and adverse reproductive outcomes through the pathway of reducing oxidants and PM 2.5 . These findings highlight oxidants and PM 2.5 as modifiable risk factors in the fertility equation, and emphasize residential greenness as a potential strategic nature-based intervention to mitigate pollution-related fertility impairment.
Chen et al. (2026) studied this question.