BACKGROUND: Exposures to air pollution has been associated with lower conception and fertility rates. However, the impact of pollution on infertility is unknown. OBJECTIVES: To examine the associations of roadway proximity (a measure of traffic exposure) and particulate matter (PM) air pollution and incidence of infertility. METHODS: Proximity to major roadways and ambient exposures to particulate matter less than 10 microns (PM10), between 2.5 and 10 microns (PM2.5-10), and less than 2.5 microns (PM2.5) were determined for all residential addresses for 36,294 members of the prospective Nurses' Health Study II cohort from 1993 to 2003. Infertility was defined by report of attempted conception for ≥12 months without success. Participants were able to report if evaluation was sought and if so, offer multiple clinical indications for infertility. Multivariable adjusted Cox proportional hazard models were used to estimate the relation between each exposure and infertility risk. RESULTS: Over 213,416 person-years, there were 2,508 incident reports of infertility. Results for overall infertility were inconsistent across exposure types. We observed a small increased risk in those living closer to compared to farther from a major road, multivariable adjusted hazard ratio (HR)=1.11(95% confidence interval (CI) = 1.02-1.20). Among those reporting primary infertility, risk was greater with closer distance to road and for all PM size fractions and exposure time windows. The multivariable adjusted HR (95%CI) for women living closer to compared to farther from a major road for primary infertility was 1.37 (1.22-1.52), while for secondary infertility HR=1.07 (0.95-1.21). In addition, the HR for every 10 mcg increase in cumulative PM2.5 among women with primary infertility was 1.61 (1.35-1.92), while it was 1.1 (0.91-1.33) for those with secondary infertility. CONCLUSIONS: This study suggests exposures to traffic and PM may be associated with a small increased risk of infertility, especially primary infertility.

Thesis advisor: Barbara E. Wolfe / Studies suggest that eating disorder (ED) pathology may be linked to ovulatory and unexplained infertility in women who present to reproductive treatment centers. Specifically, studies have linked hypothalamic amenorrhea, oligomenorrhea, and anovulatory cycles to disordered eating. Advances in Assisted Reproductive Technology can lead to successful conception for women with ED; however, they have a higher risk for poor maternal and fetal outcomes. This descriptive, comparative, quantitative study examined disordered eating and psychological symptoms in women with ovulatory and unexplained infertility compared with women receiving routine health care from their primary care providers. Women ages 20 to 44 were recruited. After providing verbal consent, a study packet was mailed to the study participant's home. The Eating Disorder Inventory-3-Referral Form and Herman and Polivy Restraint Scale measured disordered eating symptoms. The Speilberger Anxiety Inventory and Beck Depression Inventory-II examined psychological symptoms. Provisional DSM IV TR diagnoses were ascertained using the Eating Disorder Inventory-3-Symptom Checklist, along with other scale items. Multivariate analysis of covariance (MANCOVA) confirmed that women with ovulatory and unexplained infertility had significantly higher Desire for Thinness (p = .001) and Bulimia (p = .007) subscale scores putting them at risk for Anorexia Nervosa or Bulimia. Women receiving routine care had significantly higher Body Dissatisfaction (p = .000) subscale scores consistent with their higher weight and tendency toward overeating. Women receiving routine care also had significantly higher Restraint (p = .000) scale scores, leaving them at risk for dietary disinhibition. The groups did not differ on psychological symptoms. Women with infertility had lifetime ED diagnoses many times the national ED prevalence rate, similar to the research findings of Freizinger et al. (2010). The study results support that women with ovulatory and unexplained infertility are at risk for having an occult ED. The critical import of integrating ED assessment into infertility evaluation, reproductive and primary care was implicated. Further study to isolate biobehavioral markers to better identify women at risk for ED and improve their maternal and fetal outcomes was recommended. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.