Air quality in the assisted reproduction laboratory: a mini-review

Abstract

Quality of air in the clinical embryology laboratory is considered critical for high in vitro fertilization (IVF) success rates, yet evidence for best practices is lacking. Predominantly anecdotal reports on relationships between air quality and IVF success rates have resulted in minimal authentic clinical laboratory guidelines or in recommendations that are based on industrial cleanroom particulate standards with little attention to chemical air filtration. As a result, a nascent industry of costly, specialized air handling equipment for IVF laboratories has emerged to provide air quality solutions that have not been clearly assessed or verified. Clinics are embracing such technology because their embryology laboratories have become epicenters of assisted reproductive technology as the practice of IVF has moved to blastocyst transfers and utilization of trophectoderm biopsy for preimplantation genetic testing (PGT). Thus, a laboratory's ability to culture, biopsy, and freeze blastocysts is a rate-limiting step that depends on technical proficiency and a supportive and stable culture environment based on a foundation of high-quality ambient air. This review aims to describe how evidence for the importance of air quality, in particular the role of volatile organic compounds (VOC), has resulted in an evolution of clinical practice that has arguably contributed to improved outcomes.

‘There is only one thing that is truly important in an IVF laboratory: everything’ Cairo Consensus Guidelines on IVF Culture Conditions

“…Albumin is the most abundant protein in the oviduct (Leese, 1988) and thus the most common protein used in culture media. Albumin serves many functions, most notably as an antioxidant (Bavister, 1995;Morbeck, 2015). Lot-tolot variations exist with human serum albumin (HSA) (Swain, 2015), particularly with respect to the stabilizer octanoic acid (Fredrickson et al, 2015;Leonard et al, 2013).…”

An Internet of Things-Based Environmental Quality Management System to Supervise the Indoor Laboratory Conditions

“…On the other hand, IAQ should be monitored to minimise the impact the laboratory experiments' samples. For instance, IQ is extremely significant in the clinical embryology laboratory activities and is recognised as a significant parameter which influences in vitro fertilisation (IVF) success levels [57].…”

Effect of the Air Filtration System Replacement on Embryo Quality in the Assisted Reproduction Laboratory

“…25,26 Recently, attention has been focused on VOCs and their role on in vitro human embryo cultures. 27,28 As the practices of IVF evolve toward the transfer of embryos at the blastocyst stage and the use of trophectoderm biopsy for preimplantation genetic testing (PGT), the extended period of in vitro culture required depends on a favorable and stable environment based on high-quality ambient air. 28 A study conducted by Choe et al 29 investigated the association between air pollutant levels and intrauterine pregnancy per cycle in women undergoing one or more in vitro fertilization procedures.…”

“…27,28 As the practices of IVF evolve toward the transfer of embryos at the blastocyst stage and the use of trophectoderm biopsy for preimplantation genetic testing (PGT), the extended period of in vitro culture required depends on a favorable and stable environment based on high-quality ambient air. 28 A study conducted by Choe et al 29 investigated the association between air pollutant levels and intrauterine pregnancy per cycle in women undergoing one or more in vitro fertilization procedures. This study has shown that exposure to VOCs during ovarian stimulation and embryo transfer is associated with decreased intrauterine pregnancy in IVF cycles.…”

“…However, there is previous evidence that particle filtration alone improves embryo quality. 28 In vitro fertilization laboratories should be equipped with HEPAs and activated carbon filters with positive pressure control to control airborne particles. There were significant differences in fertilization rates (83.7% versus 70.1%), embryo cleavage rate (97.35% versus 90.8%), blastocyst formation rate at day 5 (51.1% versus 41.7%), and pregnancy/implantation rates (54.6%, 34.4% versus 40.6%, 26.4%) after replacing the air filtration system.…”