Association of air pollution and green space with endometriosis among women undergoing assisted reproductive technology: a cross-sectional study in Anhui, China

Yongzhen Peng, Chunyan Wang, Lanlan Fang, Guosheng Wang, Cong Ma, Xu Zhang, Xuyang Chen, Jianpin Ni, Yubo Ma, Guoqi Cai, Huifen Xiang, Faming Pan
International journal of environmental health research · 2025 · vol. 35(12) , pp. 3937–3949 · doi:10.1080/09603123.2025.2504611 · PMID:40355808
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This study found that increased exposure to air pollutants (PM2.5, PM10, SO2, NO2, CO) was associated with higher odds of endometriosis, while green space was protective, and an interaction between green space and CO suggested a mitigating effect.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This cross-sectional study evaluated whether ambient air pollution and residential green space were associated with endometriosis-related infertility among 20,981 women undergoing assisted reproductive technology at a large center in Anhui, China, with 1,201 diagnosed. Using satellite-based spatiotemporal models, the authors quantified exposures to PM2.5, PM10, NO2, CO, and SO2 and green space via NDVI, then estimated adjusted odds ratios with multivariable logistic regression. They found that each interquartile-range increase in several pollutants was associated with higher odds of endometriosis prevalence (e.g., PM2.5 aOR 1.20; NO2 aOR 1.18), while higher NDVI500 m was associated with lower odds (aOR 0.72), and an additive antagonistic interaction was observed between NDVI500 m and CO. This paper is centrally about endometriosis — it analyzes how air pollution and green space relate to endometriosis-related infertility in women undergoing ART.

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Abstract

Air pollution has reproductive toxicity, while green space could lessen such harmful consequences. However, the current research on the link between air pollution/green space, and endometriosis remains scarce. Therefore, we investigated the separate and interactive relationships between air pollution, green space and endometriosis-related infertility. We collected data on 20,981 women from a large assisted reproductive center in Anhui, China, of whom 1,201 were diagnosed with endometriosis-related infertility. air pollution (PM2.5, PM10, NO2, CO, and SO2) and Green space (quantified using the normalized difference vegetation index [NDVI]) were evaluated using spatiotemporal models developed from satellite data. We employed multivariable logistic regression to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Per interquartile range (IQR) increase in exposure was associated with elevated odds of endometriosis prevalence for PM2.5 (aOR = 1.20, 95%CI:1.11-1.30), PM10 (1.17, 1.08-1.27), SO2 (1.12, 1.02-1.24), NO2 (1.18, 1.08-1.38), and CO (1.12, 1.05-1.19). Conversely, each IQR increase in NDVI500 m showed protective effects (0.72, 0.63-0.83). Notably, an additive antagonistic effect was observed between NDVI500 m and CO. Our findings indicated that air pollution could potentially increase the risk of endometriosis, while green space is its protective factor. Besides, green space might attenuate the negative impact of air pollution on endometriosis.
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Abstract

Air pollution has reproductive toxicity, while green space could lessen such harmful consequences. However, the current research on the link between air pollution/green space, and endometriosis remains scarce. Therefore, we investigated the separate and interactive relationships between air pollution, green space and endometriosis-related infertility. We collected data on 20,981 women from a large assisted reproductive center in Anhui, China, of whom 1,201 were diagnosed with endometriosis-related infertility. air pollution (PM2.5, PM10, NO2, CO, and SO2) and Green space (quantified using the normalized difference vegetation index [NDVI]) were evaluated using spatiotemporal models developed from satellite data. We employed multivariable logistic regression to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Per interquartile range (IQR) increase in exposure was associated with elevated odds of endometriosis prevalence for PM2.5 (aOR = 1.20, 95%CI:1.11–1.30), PM10 (1.17, 1.08–1.27), SO2 (1.12, 1.02–1.24), NO2 (1.18, 1.08–1.38), and CO (1.12, 1.05–1.19). Conversely, each IQR increase in NDVI500 m showed protective effects (0.72, 0.63–0.83). Notably, an additive antagonistic effect was observed between NDVI500 m and CO. Our findings indicated that air pollution could potentially increase the risk of endometriosis, while green space is its protective factor. Besides, green space might attenuate the negative impact of air pollution on endometriosis.

Acknowledgements

The authors thank the participants who made this study possible and gratefully acknowledge the role of the staff and volunteers in collecting the data. Acknowledgment for the data support from National Earth System Science Data Center, National Science & Technology Infrastructure of China. (http://www.geodata.cn). Disclosure statement No potential conflict of interest was reported by the author(s). Data availability statement The authors do not have permission to share data. Code was available from the corresponding author on reasonable request. CRediT authorship contribution statement Yongzhen Peng: Writing – review & editing, Writing – original draft, Visualization, Validation, Software, Resources, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Lanlan Fang and Chunyan Wang: Software, Methodology, Data curation, Conceptualization. Guosheng Wang: Writing – review & editing, Resources, Data curation. Cong Ma: Visualization, Investigation, Formal analysis, Data curation. Xu Zhang and Jianpin Ni: Methodology, Investigation, Formal analysis, Data curation. Yubo Ma, Xuyang Chen, and Guoqi Cai: Validation, Software, Data curation. Faming Pan and Huifen Xiang: Writing – review & editing, Supervision, Methodology, Funding acquisition. Supplementary material Supplemental data for this article can be accessed online at https://doi.org/10.1080/09603123.2025.2504611

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Condition tags

endometriosisinfertility

MeSH descriptors

Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants Air Pollutants

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