Influence of air quality in IVF clinics on success rate of ART procedures

Our ever-changing  and rapidly evolving urban lifestyle is fueled by technology innovations in IT –  telecom, medicine and food. These innovations have significantly improved the quality of our life in terms of superior digital connectivity and access to information, easy access to quality healthcare services and food commodities. However, our modern lifestyle and occupational activities have also put us under increased exposure to various potentially harmful chemicals such as endocrine disrupting chemicals (EDC), volatile organic compounds (VOCs), heavy metals and pesticides. Studies have shown that long-term exposure to these chemicals, exhibit disruptions in male and female fertility, in both human and animals. [1, 2]

What are VOCs?

Where do they come from?

Why does it matter?

Concentrations of most volatile organic compounds are higher in indoor air than outdoor air

Health link BC

Consequently, exposure of gametes and embryos to such harmful chemicals can have detrimental effects on their growth and development. The environment requirements for gametes and embryos were initially adapted from tissue culture laboratory systems [3]. Better understanding and increased commercial interest for gametes and embryos has led to the recognition of the importance of laboratory air quality as an important factor for the safety of gamete and embryos in IVF clinics.

Several studies (primarily conducted between 1990 – 1998) have shown that poor laboratory conditions in fertility clinics, particularly the air quality can result in impairment of gametes and embryo development thereby reducing the success-rates of such fertility clinics. In fact, studies of air quality in the older ART/IVF laboratory/clinic designs (1990 – 1998) have indicated high concentrations of VOCs (like toluene and iso propyl alcohol) compared to outdoor environment, especially in the incubators. [3, 4]

Most of these IVF clinics/labs had high-efficiency particulate air (HEPA) filters which can remove particulate materials of size ~ 0.3 microns. However, HEPA filters offer limited protection from VOCs. VOC concentration greater than 1 ppm is considered high and can cause direct toxicity to embryos. Embryo development occurs reasonable well at VOC levels of ~ 0.5 ppm, however chances of miscarriage is also very high in such cases. The VOC levels should ideally be zero or at least less than 0.2 ppm. [5]

Carbon activated air filtration (CODA) systems were first implemented in 1997 and provided efficient filtration of VOCs. Clinics which installed CODA systems in addition to HEPA filters reported an increase in high quality embryos, reduction in miscarriages and higher clinical pregnancies. [5]

Regulatory bodies in the European Union and Brazil have specified the air quality requirements in ART laboratories in view of the damaging effects of VOCs and other air contaminants. [6]

Due to the growing amount of evidence suggesting that air contaminants can affect IVF outcome, cleanroom specifications for particulate and microorganism contamination in IVF laboratories have been enforced by European Union laws under Directive 2006/86/EC.

Esteves and Bento (2016), Asian Journal of Andrology

Heitmann et al (2015), reported a study wherein the mere improvement of air quality in their IVF facility by adopting CODA filters and strategic engineering designs of their lab, yielded nearly 10 % higher live births. No other changes were made to the laboratory equipment, protocols and lab personnel. [7]

Embryo implantation (32.4% versus 24.3%; P < 0.01) and live birth (39.3% versus 31.8%, P < 0.05) were significantly increased in the new facility compared with the old facility.

Heitmann et al. (2015), Reproductive Biomedicine Online

In another study, Khoudja et al. (2012) studied the influence of the use of a novel-air purification system on IVF outcomes. Their air purification system removes airborne molecular contaminants and chemical air contaminants in addition to VOCs. The results were compared to the outcomes prior to filter change. Few performance indicators are summarized below:

Improvements observed in IVF laboratory performance indicators after changes in air handling systems [5]

It can be clearly inferred from these studies that improvements in the air quality is fundamental for healthy embryo development and successful implantation rates, thereby coinciding with higher live births.

From this discussion, it is therefore imperative that fertility centers have better awareness about the importance of air quality and the factors which can contribute to air contamination inside clinics. The use of certain building materials such as vinyl, paints and fabrics can also contribute to increased VOC level in the clinic environment. New ventures in the IVF domain may unknowingly install vinyl flooring and other such materials for increased aesthetic appeal. This may inadvertently cause elevated levels of vinyl chloride (a known carcinogen) and other VOCs thereby posing a risk to all the stakeholders involved. Understanding and adherence to safety norms in IVF clinics will go a long way in ensuring high success rates of such clinics.


IVF – in-vitro fertilization

ART – Assisted Reproductive Technology

VOC – Volatile Organic Compound


[1] Rattan, S., Zhou, C., Chiang, C., Mahalingam, S., Brehm, E., & Flaws, J. A. (2017). Exposure to endocrine disruptors during adulthood: consequences for female fertility. Journal of Endocrinology, 233(3), R109-R129.

[2] Ten, J., Mendiola, J., Torres-Cantero, A. M., Moreno-Grau, J. M., Moreno-Grau, S., Roca, M., … & Bernabeu, R. (2008). Occupational and lifestyle exposures on male infertility: a mini review. The Open Reproductive Science Journal, 1(1), 16-21.

[3] Cohen, J., Gilligan, A., Esposito, W., Schimmel, T., & Dale, B. (1997). Ambient air and its potential effects on conception in vitro. Human reproduction (Oxford, England), 12(8), 1742-1749.

[4] Hall, J., Gilligan, A., Schimmel, T., Cecchi, M., & Cohen, J. (1998). The origin, effects and control of air pollution in laboratories used for human embryo culture. Human reproduction, 13(suppl_4), 146-155.

[5] Khoudja, R. Y., Xu, Y., Li, T., & Zhou, C. (2013). Better IVF outcomes following improvements in laboratory air quality. Journal of assisted reproduction and genetics, 30(1), 69-76.

[6] Esteves, S. C., & Bento, F. C. (2016). Air quality control in the ART laboratory is a major determinant of IVF success. Asian journal of andrology, 18(4), 596.

[7] Heitmann, R. J., Hill, M. J., James, A. N., Schimmel, T., Segars, J. H., Csokmay, J. M., … & Payson, M. D. (2015). Live births achieved via IVF are increased by improvements in air quality and laboratory environment. Reproductive biomedicine online, 31(3), 364-371.

Gamete Intrafallopian Transfer (GIFT)

Gamete Intrafallopian Transfer (GIFT) is an assisted reproductive technique were the eggs are retrieved from the ovaries just like an IVF procedure. Then the Gametes (Eggs and Sperms) are placed into Fallopian tube with a help of a catheter using a surgical procedure called laparoscopy(as shown in the figure below) where the egg gets fertilized.[1]

Gamete Intrafallopian Transfer(GIFT) procedure




Zygote Intrafallopian Transfer (ZIFT)

Zygote Intrafallopian Transfer (ZIFT) is an assisted reproductive technique were the eggs are retrieved from the ovaries just like an IVF procedure. These retrieved eggs are then mixed with sperms in the laboratory. Then the fertilized eggs (zygotes) are placed into fallopian tube with a help of a catheter using a surgical procedure called laparoscopy(as shown in the figure below). The zygote should eventually be implanted in the uterus and develop into a fetus. [1]

Zygote Intrafallopian Transfer (ZIFT)

References :



In vitro fertilization (IVF)

In vitro fertilization is an assisted reproductive technique were the male sperms and the female eggs are fertilized in a laboratory. The fertilized egg is developed into embryo stage which is then placed into the woman’s uterus with a help of a catheter.[1]

In vitro fertilization



IVF Process- A beginners guide

Introduction to RoboICSI®

RoboICSI® is an award-winning device to assist the embryologist during IVF towards improving the outcomes, thus helping infertile couples bear a child. Based on a novel design technique, RoboICSI® is a patent-pending device that will help bridge the gap between the demand and supply in the explosively growing infertility industry. It will be a Made-in-India device that will be a pioneer, offering several features for the First time in the World.

It is a smart device, which helps the embryologist to perform ICSI in an enhanced manner. RoboICSI® substitutes the holding pipette that is being used in the conventional ICSI.

Here is a quick overview about RoboICSI


What is ICSI

Intracytoplasmic sperm injection (ICSI) is an ART involving the injection of a single sperm into the cytoplasm of an oocyte to achieve fertilization. It is mainly performed for the treatment of couples with male factor infertility and those with poor fertilization with conventional IVF.

ICSI is the only treatment option for couples with severe male factor infertility. It can be performed with ejaculated or surgically retrieved sperm.

Intracytoplasmic Sperm Injection

Infertility Treatments

Assisted Reproductive Technology (ART), according to WHO, refers to infertility treatments where both eggs (oocytes) and sperm are handled ex-vivo to achieve pregnancy. In conventional ART procedures, the oocytes and sperms are combined in a laboratory ex vivo (i.e. outside the human body) and the resulting embryo (mature and fertilized oocyte) is implanted back into a woman.

ART’s includes techniques such as In-vitro fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Gamete Intra-Fallopian Transfer (GIFT) or Zygote Intra-Fallopian Transfer (ZIFT) .